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ORIGINAL PAPER • Mater Sociomed. 2016 Jun; 28(3): 220-223
Eect of Therapeutic Touch on Pain Related Parameters in Patients with Cancer
220
DOI: 10.5455/msm.2016.28.220-223
Received: 23 January 2016; Accepted: 15 March 2016
ORIGINAL PAPER Mater Sociomed. 2016 Jun; 28(3): 220-223
© 2016 Amir Tabatabaee, Mansoureh Zagheri Tafreshi, Maryam Rassouli, Seyed Amir Aledavood, Hamid AlaviMajd, and Seyed Kazem
Farahmand
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-
nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
EFFECT OF THERAPEUTIC TOUCH ON PAIN
RELATED PARAMETERS IN PATIENTS WITH
CANCER: A RANDOMIZED CLINICAL TRIAL
Amir Tabatabaee1, Mansoureh Zagheri Tafreshi2, Maryam Rassouli3, Seyed Amir Aledavood4,
Hamid AlaviMajd5, and Seyed Kazem Farahmand6
1Department of Nursing, International Branch, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2Department of Management, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences,
Tehran, Iran
3Department of Pediatric Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical
Sciences, Tehran, Iran
4Cancer Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
5Department of Biostatistics, School of Paramedical, Shahid Beheshti University of Medical Sciences, Tehran, Iran
6Department of Traditional Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
Corresponding author: Mansoureh Zagheri Tafreshi. Vali-Asr Avenue, Cross of Vali-Asr and Neiaiesh Highway, Opposite
to Rajaee Heart Hospital, Tehran, Iran, Postal Code: 1996835119 l. E-mail: contactroute@yahoo.com
ABSTRACT
Introduction: In patients with cancer, pain may influence their life style, and feeling of satisfaction and comfort, leading to
fatigue, and cause impairment of their quality of life, personal relationships, sleep and daily activities. The aim of this study was
to evaluate the eect of therapeutic touch (TT) on pain related parameters of in patients with cancer. Methods: In a random-
ized clinical trial a total of 90 male patients referring to Specialized Oncology Hospital in Mashhad, were conveniently selected
and randomly divided into three intervention, placebo, and control groups. The intervention consisted of TT in 7 sessions for
a 4-week period. The data were collected using a demographic questionnaire along with the Brief Pain Inventory, which were
then analyzed and compared using Kruskal-Wallis and Mann-Whitney tests.vResults: By comparing scores parameters of pain
scales (general activity, mood, walking ability, relations with other people and sleep) in the three groups, there was no signifi-
cant dierence at the beginning of the first session. However, a significant dierence was observed at the end of TT sessions
between the three groups (p= 0.001). Furthermore, the groups were compared two-by-two by using Mann-Whitney test and
Bonferroni correction, and the result indicated significant dierences between the two intervention and placebo groups as well
as between the two intervention and control groups.Conclusion: The results of the study showed that TT had a positive impact
on the positive management of pain related parameters in cancer patients. Therefore, TT is suggested to be used by healthcare
providers as a complementary method for managing pain and its parameters.
Key words: Pain parameters, Therapeutic touch, Cancer, General activity, Sleep.
1. INTRODUCTION
According to the World Health Organization report in
2012, cancer accounted for 8.2 million deaths across the
globe, with an estimated 14 million new cases for the same
year (1). Over the past 3 decades, the 5-year relative survival
rate for all cancers combined has increased 20 percentage
points among patients with cancer (2). This disease is also
known as a growing problem in the Middle Eastern coun-
tries (3). Cancer is often associated with pain which is seen
in approximately 50 -70% of patients (4). Ca ncer patient s deal
with dierent problems in various individual, family and
social areas and experience reduced life quality (5). Pain
is a stressful event in patients with cancer that can aect a
patient’s way of life as well as his feeling of satisfaction and
comfor t, cause suering, di scomfort and fatigue and lead to
impaired quality of life, personal relationships, sleep and
daily activities (6). Pain exerts a negative impact primarily
on mood, normal work, and sleep among cancer patients.
Additionally, it has been shown that pain signicantly
correlates to poor quality of life and sleep quality and in
patients with cancer (7).
Numerous studies have investigated pain and its high
221
Mater Sociomed. 2016 Jun; 28(3): 220-223 • ORIGINAL PAPER
Eect of Therapeutic Touch on Pain Related Parameters in Patients with Cancer
prevalence in patients with cancer as a top priority and
have supported palliative and treatment methods of pain
and patients’ aitudes towards it (8, 9). Given the high
prevalence of pain in cancer and failure of most interven-
tions in relieving pain, more eective methods must still be
researched (6). Interventions used to relieve pain include
three major categories of invasive interventions, noninva-
sive interventions and drug therapy. On average, cancer
pain in 70% of cases is not suciently relieved by medical
interventions and most patients, despite tolerating the side
eects of sedatives, still suer from pain (10, 11). One of
the most common non-invasive methods in relieving pain
is to use complementary and alternative medicine (CAM)
(12). Despite the focus of modern medicine on treating
problems, the philosophy underlying complementary and
alternat ive medicine treatme nts foc uses on harmony withi n
an individual and his health. In one study, 82 percent of
patients claimed the side eects of drugs and the lack of
resolution of problems to be among the factors that caused
them to use CAM (13). According to the American Cancer
Society, CAM for cancer includes methods that lead to the
prevention, diagnosis and treatment of cancer. Some types
of complementary therapies can help to relieve from some
certain symptoms of cancer and side eects caused by the
treatment, such as fatigue, and pain, or lead to an increased
sense of well-being in a person (14). New studies indicate
the increasing referral of patients, especially patients with
cancer, to dierent branches of complementary medicine,
which is bet ween 22 to 73 perc ent. Moreover, 62% of women
with breast cancer have also used CAM (15).
The Nat ional Center for Complementary and Alternative
Medicine places therapeutic touch (TT) into the category
of bio-eld energy (16). In the TT method, the therapist’s
hand is used to increase comfort and reduce pain using
the body’s energy eld correction mechanism (17). TT is
used for patient bio-eld coordination and the therapist
aempts to balance patients’ energy eld in order to create
and maintain health in them and to reduce the symptoms
of pain and anxiety (18). Jackson et al. in a systematic study
concluded that TT could be an acceptable method for reduc-
ing physical and psychological symptoms in cancer patients
(19). Although, some studies have noted the eects of TT in
lowering pain in cancer patients, clinical trial data on the
eect of TT through using an evidence-based and system-
atic approach have not yet been evaluated in patients with
ca ncer (20). The results obtained from RCT st udies regardi ng
the eects of TT on cancer patients have been reported to be
both signicant and non-signicant. Even in the absence of
signicant result s, recipient s of TT often reported to exper i-
ence mental benets, including improved mood, feeling of
well-being, and positive interpersonal relations and also
expressed reduced pain and fatigue as well as satisfaction
with treatment (21).
This study was designed with the aim of determining
the eect of TT on parameters of pain in cancer patients.
It is hoped that by increasing knowledge about TT, this
study could draw the aention of patients, nurses and other
treatment team personnel towards the use of non-pharma-
cological therapies such as TT for pain relief at lower cost
and less complications.
2. MATERIALS AND METHODS
After approval by the ethics commiee, International
Branch of Shahid Beheshti University of Medical Sciences,
and patients’ informed consent, this randomized clinical
trial which was designed in three groups (intervention,
control, and placebo) using a non-probability convenience
sampling method has been conducted. The participants in
the study included male patients referring to Omid Oncol-
ogy Specialized Hospital in Mashhad in 2016 among whom,
90 patients were conveniently selected based on the criteria
for participation and randomly divided into three groups,
each containing 30 individuals. Inclusion criteria included,
informed consent of participants; male patients aged 20 to 65
years; being con sc ious; having ca ncer related pai n conr med
by physician; being diagnosed and treated at least for one
year; being in remission stage; no plan for surgery as treat-
ment during the intervention; and no history of using TT.
Due to the nature of cancer and review of related articles
(22, 23) as well as consultation with TT experts, seven ses-
sions with an interval of 3 days between each two, were
selected for the patients. The TT program was performed
as follows:
In the experiment group, the patients were taken to a
quiet room and those accompanying them could also join
them. The patients were asked to close their eyes and start
breathing slowly and deeply and not to think about any-
thing. Then, the therapist focused and kept his hands at a
distance of 5 to 10 cm from the patient’s body and began to
explore the energy eld and aura around the patient’s body
so that he could search for energy decit or energy increase
in the patient’s energy eld. In the second stage, the therapist
would move his hand from the head to the feet and perform
cleansing in order to compensate for the energy decit, to
burn o the accumulated negative energy and to develop an
alternative positive energy. In the third stage, the therapist
focuses his hands on specic areas of the body and transfers
positive energy to the patient through his hands (16). The
placebo group was also used to determine and compare
the possible impact of the relaxation caused by the pres-
ence of the researcher. In the placebo group, for the same
amount of time, the hands were placed around the body as
a gesture, with distance from the body, and were moved
without a certain order. For the participation in the control
group, the practitioner did not do any intervention except
routine interventions in the ward. All groups (TT, placebo,
and control) received the same standard medical care. TT
was carried out in the intervention group by a skilled and
qualied researcher in TT, who had undertaken a specic
7 month TT course, and had 15 years of experience in this
area. Both the therapeutic and simulated touches took be-
tween 10 to 15 minutes.
Data were collected with the help of patients complet-
ing a demographic questionnaire along with the Brief Pain
Inventory (BPI), which were then analyzed and compared
using SPSS software, Kruskal-Wallis and Mann-Whitney
tests and Bonferroni correction. A p value of 0.05 or less
was considered statistically signicant.
The BPI has been used extensively in pain research and
has been found to reliably assess levels of pain and pain re-
lief from various interve ntions and has established face and
ORIGINAL PAPER • Mater Sociomed. 2016 Jun; 28(3): 220-223
Eect of Therapeutic Touch on Pain Related Parameters in Patients with Cancer
222
content validity. Pain function was the average of 5 items
assessing how much pain interfered with General Activity,
Mood, and Walking abi l ity, Relations with other people and
Sleep (24). Test-retest reliability has been assessed for cancer
pain and shows good reliability for pain intensity (r = 0.8)
and pain interference (r = 0.8). Internal consistency of the
BPI is high for the severity scale (0.81<a<0.89) and interfer-
ence scale (0.88 < a < 0.95) (25). It should be noted that reli-
ability and validity of the Persian version of the Brief Pain
Inventory have been investigated by Vakilzadeh (26). This
study registered in the Iranian Registry of Clinical Trials
Database (201412094115N3).
3. RESULTS
Comparison between three groups with regard to par-
ticipants’ baseline characteristics was shown no signicant
dierences (Table 1).
However, at posest, there was signicant dierence be-
tween the three groups in patients’ activity general, Mood,
Walking ability, Relations with other people, and Sleep
scores (Table 2). Pair-wise comparison of the groups (post
hoc) showed that there were sig n i cant di erences betwe en
the experiment and control groups, and experiment and pla-
cebo groups (p<0.001). Furthermore, there were statistically
not signicant dierences among the placebo and control
groups. The posest revealed signicant dierences in
patients’ sleep scores between the three groups. Moreover,
pair-wise comparison of the groups (post hoc) showed that
there were signicant dierences between the experiment
and control groups, and the experiment and placebo groups.
However, no statistically signicant dierences were ob-
served between the placebo and control groups.
In addition, regarding the impact of pain on the ability
to walk, positive and negative signicant dierences were
observed at the beginning and end of the study in the in-
tervention group and in the placebo and control groups,
respectively (p=0.001). Due to the increase in the average
impact of pain on walking ability in two placebo and con-
trol groups, TT intervention may not only have prevented
any increase in the impact of pain on the ability to walk,
but also caused the impact of pain on walking ability be
eectively reduced.
According to the results, there was found a signicant
di erence (p= 0.001) betwe en the impact of pain on the value
of sleep score at the beginning and end of the study in the
intervention group. However, no signicant dierence was
observed in the control group (p= 0.298). According to the
results, it can be said that the TT interve ntion ha s posit ively
inuenced the reduction in the impact of pain on general
ac tiv it y, Mood Walking ability, Relations with other people,
and Sleep scores.
4. DISCUSSION
The results demonstrated that TT is signicantly more
eective on the Pain parameters in the experimental group
than on the placebo and control groups. The ndings by
Abbot et al. showed that spiritual healing, as a therapy for
chronic pain, signicantly decreased pain intensity during
the sessions of therapies (27). Moreover, Denison found
that TT decreased the intensity of pain in the patients with
Fibromyalgia Syndrome during the six sessions of TT (28).
Wardell and et al., conducted a study to evaluate the use
of TT in soldiers with neuropathic chronic pain and second-
ary psychological stress to spinal cord injury. The study ben-
eted from a mixed methods and intervention was carried
out by a trained person in the houses of 12 samples within
six sessions. The results showed the pain reduction to be
statistically signicant. Other ndings included improved
mood and greater satisfaction with life after the TT sessions
(21). Wez and et al., found that TT decreased pain in the cli-
ents with cancer within the six sessions of treatment (29). In
this regard, Post-white and et al., in thei r st udy invest igated
the eects of massage therapy (MT) and TT compared to the
Variable Experim-
ental (n=)
Placebo
(n=)
Control
(n=) P-value
Age
Mean (SD) (.) .
(.)
.
(.)
F= .
P=.
Primary
Education
%. % %.
χ= .
P=.
High
school %. %. %.
Diploma
& High % %. %
Yes Chronic
Diseases
%. %. % χ= .
P=.
No %. %. %
II, III Stage of
cancer
(TNM cri-
teria)
%. %. %. Kruskal-Wallis
χ= .
P=.
IV %. %. %.
Table 1. Comparison between three groups with regard to
participants’ baseline characteristics
Variable
Experimental Placebo Control Kruskal-Wallis & P-value
Session Session Session Session Session Session Session Session
Activity General
Mean (SD) . (.) . (.) . (.) . (.) . (.) . (.) X= .
P=.
X=.
P=.
Mood
Mean (SD) . (.) . ( .) . (.) . (.) . (.) . (.) X= .
P=.
X=
.
P=.
Walking ability
Mean (SD) . (.) . (.) . (.) . (.) . (.) . (.) X= .
P=.
X=
.
P =.
Relation other people
Mean (SD) . (.) . (.) . (.) . (.) . (.) . (.) X= .
P=.
X=
.
P =.
Sleep
Mean (SD) . (.) . (.) . (.) . (.) . (.) . (.) X= .
P=.
X=
.
P =.
Table 2. Comparison pain related parameters in the three groups-experimental, placebo and control
223
Mater Sociomed. 2016 Jun; 28(3): 220-223 • ORIGINAL PAPER
Eect of Therapeutic Touch on Pain Related Parameters in Patients with Cancer
standard care on inducing relaxation and reducing symp-
toms in 203 patients with cancer. The results demonstrated
TT to cause a greater relaxed feeling and short term pain
reduction, along with less disturbed mood in the patients
in the intervention group as compared to the patients in
the control group. Participants found TT gave them more
energy and a peaceful feeling, and they were beer able to
sleep with fewer symptoms (30). The results obtained from
the aforementioned studies were consistent with the nd-
ings of this study with regard to the positive impact of TT
on patients’ parameters of pain.
Although, energy healing methods have still remained
as one of the controversial issues in CAM (31), th i s study in-
dicated the positive result s of the TT met hod on parameters
associated with pain in patients with cancer.
It also seems that this method can be used as a safe
method in t he management of physical function, pain, an xi-
ety, and nausea in cancer patients. Due to the limitations
of this study (including its small sample size, conducting
this study in just one hospital, and only man samples), it
is recommended that further investigations with a larger
sample be performed at other hospitals and both genders.
5. CONCLUSION
The goal of complementary alternative therapies such as
these is to relieve symptoms, modify or remove contribut-
ing factors, and restore balance to the body. Based on these
ndings the authors make a number of recommendations
in relation to the use of TT by cancer patients.
• Acknowledgments: The paperis derived from thePhD thesis
ofthe first author in nursing International Branch of Shahid Be-
heshti University of Medical Sciences, Tehran, Iran.
• Conflict of interest: None declared.
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