Effects of Reflexology on Pain in Patients With Fibromyalgia

Abstract

The aim of this study was to investigate the effect of reflexology on pain intensity in patients with fibromyalgia, using an experimental repeated-measures design, and a convenience sample of 30 fibromyalgia inpatients. Thirty patients aged 18 to 70 years with fibromyalgia and hospitalized in the algology clinic were taken as a convenience sample. Patients received a total of 12 60-minute sessions of reflexology over a period of 6 consecutive weeks. Reflexology was carried out bilaterally on the hands and feet of patients at the reflex points relating to their pain at a suitable intensity and angle. Subjects had pain scores taken immediately before the intervention (0 minute), and at the 60th minute of the intervention. Data were collected over a 10-month period in 2012. The patients' mean pain intensity scores were reduced by reflexology, and this decrease improved progressively in the first and sixth weeks of the intervention, indicating a cumulative dose effect. The results of this study implied that the inclusion of reflexology in the routine care of patients with fibromyalgia could provide nurses with an effective practice for reducing pain intensity in these patients.

Full text

FEATURES
Effects of Reflexology on Pain in Patients
With Fibromyalgia
■Esra Akin Korhan, PhD ■Meltem Uyar, MD ■Can Eyig¨
or, MD
■G¨
ulendam Hakverdio˘
glu Y¨
ont, PhD, RN ■Leyla Khorshid, PhD, RN
The aim of this study was to investigate the effect of reflexology on pain intensity in patients with fibromyalgia, using
an experimental repeated-measures design, and a convenience sample of 30 fibromyalgia inpatients. Thirty
patients aged 18 to 70 years with fibromyalgia and hospitalized in the algology clinic were taken as a convenience
sample. Patients received a total of 12 60-minute sessions of reflexology over a period of 6 consecutive weeks.
Reflexology was carried out bilaterally on the hands and feet of patients at the reflex points relating to their pain at a
suitable intensity and angle. Subjects had pain scores taken immediately before the intervention (0 minute), and at
the 60th minute of the intervention. Data were collected over a 10-month period in 2012. The patients’ mean pain
intensity scores were reduced by reflexology, and this decrease improved progressively in the first and sixth weeks
of the intervention, indicating a cumulative dose effect. The results of this study implied that the inclusion of
reflexology in the routine care of patients with fibromyalgia could provide nurses with an effective practice for
reducing pain intensity in these patients. KEY WORDS:
pain
,
pain score
,
patients
,
patients with fibromyalgia
,
reflexology
Holist Nurs Pract 2016;30(6):351–359
INTRODUCTION
Fibromyalgia syndrome is a clinical syndrome
characterized primarily by chronic widespread
pain and diffuse musculoskeletal aching and soreness,
accompanied by poor sleep, fatigue, cognitive dys-
function, irritable bowel and bladder, headache, and a
variety of somatic complaints and morning stiffness.1-5
The American College of Rheumatology criteria for
the diagnosis of fibromyalgia include widespread mus-
culoskeletal pain of more than 3 months’ duration and
pain on palpation of more than 11 of the 18 standard
Author Affiliations: Faculty of Health Science, Department of Nursing,
˙
Izmir Katip C¸ elebi University, C¸i˘
gli, ˙
Izmir, Turkey (Dr Korhan); Faculty of
Medicine, Algology Department, Ege University, Bornova, ˙
Izmir, Turkey
(Drs Uyar and Eyig¨
or); Faculty of Health Science, Department of Nursing,
S¸ ifa University, Bornova, ˙
Izmir, Turkey (Dr Y¨
ont); and School of Nursing,
Ege University, Bornova, ˙
Izmir Turkey (Dr Khorshid).
We thank all the people who so willingly participated in this study.
The Institution at which the work was performed: ˙
Izmir Ege University
Education and Research Hospital, Algology Clinic, ˙
Izmir, Turkey.
The authors have disclosed that they have no significant relationships with,
or financial interest in, any commercial companies pertaining to this article.
Correspondence: Esra Akin Korhan, PhD, Faculty of Health Science,
Department of Nursing, ˙
Izmir Katip C¸ elebi University, C¸i˘
gli, ˙
Izmir, Turkey
(akinesra80@hotmail.com).
DOI: 10.1097/HNP.0000000000000178
tender points.6The etiology of fibromyalgia is still
unknown.7Muscle abnormalities, sleep disturbances,
and a biochemically unbalanced metabolism have
all been considered as playing a part in fibromyalgia.3
Fibromyalgia tends to be more common among
women than among men, with female prevalence
ranging from 73% to 88%.8,9 Women are 10 times
more likely to develop fibromyalgia than men, and the
occurrence of the condition increases with age.3,10,11
In fibromyalgia, frequently observed symptoms are
widespread chronic pain of the musculoskeletal
system, tiredness and fatigue, waking up in the
morning with a feeling of tiredness, restlessness,
stiffness in the morning, a subjective feeling of
bloating in the soft tissues, paresthesia, tremor,
excessive perspiration, cold extremities, globus
sensation, chronic headache (migraine),
temporomandibular joint pain, dysmenorrhea,
premenstrual syndrome, irritable colon syndrome,
dysuria, functional respiratory system symptoms,
functional cardiac symptoms, symptoms that change
with the weather, symptoms that increase with stress
and anxiety, Raynaud’s phenomenon, and anxiety
symptoms.10, 12 One of the symptoms most frequently
experienced by patients with fibromyalgia is pain.
Fibromyalgia is regarded as a chronic musculoskeletal
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351

352 HOLISTIC NURSING PRACTICE •NOVEMBER/DECEMBER 2016
pain disorder: burning, searing, tingling, shooting,
stabbing, or sharp pain, or deep aching, typifies
fibromyalgia; the pain is widespread, emanates from
periarticular structures, and is characterized by distinct
tenderness to palpation at a number of widely
distributed “tender point” sites.13 For this reason, the
standard of medical care has been focused chiefly on
pain management and modulation of fatigue.7
Although the exact etiology of fibromyalgia
is unknown, the existing recommendation
for fibromyalgia is to use a multidisciplinary
individualized approach that combines medications,
relaxation techniques, biofeedback, activity
pacing, sleep hygiene, cognitive behavioral therapy,
graded exercise, physical and occupational therapy,
and appropriate complementary modalities.14 The
lack of any known cure for fibromyalgia along with a
poor prognosis and ongoing chronic symptoms has led
many patients to turn to complementary and alternative
medicine (CAM) therapies in search of possible pain
relief. Eisenberg et al performed a national survey
of CAM use in the United States and found that a little
over a third of Americans reported the use of at least
one CAM therapy in the previous year. Many studies
have documented even higher rates of CAM usage by
patients with fibromyalgia, including a study showing
that 50% of patients attending the Mayo Clinic’s
fibromyalgia treatment program reported using some
type of CAM therapy.15-17 An assessment of the use
and satisfaction with alternative medicine practices
by patients with fibromyalgia and a comparison
of patients with fibromyalgia with other patients
with rheumatology were made in a study in Canada.
The findings indicated that 73 (91%) of patients
with fibromyalgia identified alternative medicine
use, compared with 140 (63%) of control patients.
In reviews by Schneider et al4and Kalichman,18 it was
found that complementary and alternative techniques
such as massage, reflexology, and acupuncture
were the most frequently used in the management
of symptoms in patients with fibromyalgia.
Few rigorous studies have demonstrated the effects
of reflexology as an effective treatment for chronic
symptoms. One study was encountered in the
literature, which found that reflexology was effective
for the symptoms experienced by patients with
fibromyalgia,3and this only dealt with its effect on
pain levels.
The aim of this study was to investigate the effect
of reflexology applied by the nurse on self-reported
pain intensity in patients with fibromyalgia.
LITERATURE REVIEW
The PubMed/MEDLINE, Cochrane Library, and
Science direct electronic databases were screened
using the key words “fibromyalgia syndrome,”
“chronic pain,” “alternative methods,” and
“reflexology.”
REFLEXOLOGY AND PAIN
Reflexology is a reliable, noninvasive, integrated
recovery and specific pressure technique that does not
have side effects and requires the application of direct
local pressure on reflex points on the hands, feet, and
ears.19-22 Reflexology, which is an ancient healing art,6
a holistic noninvasive pressure19 and a touch therapy,23
is a system of massage based on the principles that
there are reflex points on the feet, hands, and ears,
which correspond to every part, organ, and gland of
the body.6,19,22 ,24-26 All approaches to reflexology
develop very specific maps of the feet, hands, or ears
showing these connections.22 When a gentle pressure
is applied to a particular zone of the feet, hands, or
ears, it influences the corresponding zone in the
body.26,27 Pressure applied to these specific areas
assists in potentiating the normal functioning of the
corresponding body part25 and activates the body’s
inherent healing power.6Releasing and activating the
healing powers of the body and balancing the
biological systems,6,25 reflexology causes extreme
relaxation23, 27 and produces a wonderful sense of
well-being.19, 23, 27 It is also suggested that reflexology
stimulates the release of endorphins, the body’s
painkilling chemical.27 Reflexology facilitates
homeostasis24 and relaxes the body, mind, and spirit19;
it is effective in helping to diminish a variety of
adverse symptoms such as stress, fatigue, pain, and
tension23 and helps with anxiety and depression.6
REFLEXOLOGY
In reflexology, a variety of foot massage techniques
are employed using the thumb and forefinger.28 One of
them is palpation of the feet, which is used to gather
information on the patient’s overall health. Areas of
the feet that are sensitive, painful, or “gritty” are
noted.22 The principle is that a reflexologist will break
down the uric acid crystals to help the patient toward
better health. Reflexology is different from foot
massage in that it involves more superficial contact
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Effects of Reflexology on Pain in Patients With Fibromyalgia 353
and deeper pressure on certain parts of the foot, and
resembles a caterpillar-like movement.28 Any
congestion or problems in the body show up as
sensitivities when pressure is applied. Changes in the
skin are taken to indicate areas of energy stagnation in
the corresponding zone. Denser areas suggest the need
for deeper massage of those regions to decongest the
energy.19, 22 It has been claimed that by pressing the
“reflex zones,” energy blocks or disturbances such as
calcium, lactate, or uric acid crystals are reabsorbed
and later eliminated—a process referred to as
“detoxification.”28, 29 Reflexology works via the
nervous system with pressure applied to reflexes in the
feet, which sends a signal to the peripheral nervous
system and then enters the central nervous system
where the brain can process the information. The brain
relays messages to internal organs and glands to make
adjustments such as getting more nutrients and oxygen
into the cells.6Several reflexology sessions will
normally be suggested for maximum benefit.22
EFFECTS OF REFLEXOLOGY ON
DIFFERENT DISORDERS
Researchers have examined the effectiveness of
reflexology in improving the perceived health and
well-being of patients with irritable bowel syndrome,7
in relieving migraine and tension headache,21 in
improvement of sleep quality in patients with
insomnia,30 in treating encopresis and constipation in
children,24 in reducing anxiety in hospitalized patients
with cancer in chemotherapy treatment,31 in
decreasing anxiety in patients undergoing coronary
artery bypass graft surgery,20 in evaluating the effect
of reflexology on mood and symptom rating of
patients with advanced cancer,32 in reduction in
observed pain in nursing home residents,33 in
decreasing pain intensity and anxiety in patients with
metastatic cancer,33 in investigating the effect of foot
reflexology on general fatigue, foot fatigue, mood, and
blood glucose levels in non-insulin-dependent
patients,34 and in a symptomatic treatment for breast
cancer.34,35 In recent studies, reflexology has been
described as an important treatment method in
reducing anxiety, agitation, and pain, providing
relaxation and comfort, and increasing sleep
quality.7,36,37 In the only study examining the effects
of reflexology on the symptoms of patients with
fibromyalgia, it was found that reflexology helped to
reduce these symptoms, that it reduced the intensity of
pain experienced, and helped patients to relax.3
ALLAYING THE PAIN IN FIBROMYALGIA
In a systematic review and meta-analysis by Lauche
et al,38 low-quality evidence was found for a short-term
improvement of pain after Qigoing for fibromyalgia. In
another review study by Terhorst et al,39 balneotherapy,
mind-body, and acupuncture trials showed evidence of
effectiveness interventions for fibromyalgia. In a third
review study by Schneider et al4aimed to perform
a comprehensive review of the literature for the most
commonly used treatment procedures in chiropractic
for fibromyalgia syndrome, strong evidence
was found to support aerobic exercise and cognitive
behavioral therapy, and moderate evidence was
found to support massage, muscle strength training,
acupuncture, and spa therapy (balneotherapy).
METHODS
Ethical considerations
This study was approved by the Ethics Committee of
the University, Izmir, Turkey. Permission to conduct
the study was obtained from the Director of Doctors
and Clinical Services. All the patients were informed
regarding the procedures of the study, and informed
consent was obtained from each of the participants.
Study design
An experimental repeated-measures design was used
in this study to test the effects in question. The
algology clinic of a university hospital in Izmir was
utilized for the study. The algology clinic is
interventional pain treatment modulation. The
patients, who had been diagnosed with fibromyalgia,
were all receiving the standard treatment for
fibromyalgia, and moderate pain relief had been
provided. On the day when the reflexology was given,
no kind of analgesic was given before, during, or
immediately after the reflexology.
The research hypotheses for the study were:
1. Reflexology sessions administered to patients with
fibromyalgia reduce pain intensity scores between
specified time points.
2. There are significant differences between 0 and the
60th minute in terms of mean visual analog scale
(VAS) pain intensity scores reported by patients with
fibromyalgia.
3. There are significant differences between mean VAS
week 1 and Mean VAS week 6 in terms of mean
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354 HOLISTIC NURSING PRACTICE •NOVEMBER/DECEMBER 2016
VAS pain intensity scores reported by patients with
fibromyalgia.
Patient selection criteria
Sample size was determined on the basis of
repeated-measures analysis of variance (R_ANOVA)
power analysis. Power analysis revealed that a sample
size of 30 would achieve a power of 99% using an
effect size 0.85 and an αcoefficient of 0.05. The target
population for the research was those patients who
were hospitalized in the algology unit of the hospital.
An MD who specializes in treating patients with
fibromyalgia recruited eligible participants, men or
women, who were diagnosed with fibromyalgia
according to the American College of Rheumatology
criteria. A convenience sample (n =30) was taken
from patients who met the study criteria and were
hospitalized in the algology unit between January 1,
2012, and November 1, 2012. The sample consisted of
30 women who were all of Turkish nationality, were
aged 18 to 70 years (mean =43.30, standard deviation
=9.70) and had been diagnosed with fibromyalgia,
and who had no psychiatric illnesses, no neurological
illnesses, and no laterality problem; they had both feet
and all toes intact and free from wounds; and they had
not taken any sleep aid or sedative drug, had not been
receiving any treatment by complementary or
alternative methods.
The patients selected for the sample had not been
given any nonpharmacological treatment or any
integrative therapy before the reflexology was
administered. Only pharmacological treatment was
specified in the patients’ treatment protocols. The
selection of patients was based on their declarations
during interviews that they had not received any
integrative therapy by their own choice.
Demographic data collected from the patients’
medical records comprised years since diagnosis of
neuropathic pain, age, gender, education level,
duration of pain, frequency of pain, and the intensity
of pain generally experienced by patients.
Intervention
Each reflexology treatment was carried out in a private
room at the algology clinic, affording privacy and a
quiet space to work in. Before the initial treatment, an
education of what reflexology was and what might be
expected during the treatment was provided, and the
subject also completed both outcome measures. The
subject was supported in a comfortable supine
position for each treatment. Patients received a total of
12 60-minute sessions of reflexology over a period of
6 consecutive weeks.
Participants received precision reflexology
involving a sequence of pressure massage, which
allowed stimulation of the numerous specific reflex
points on the feet associated with organs throughout
the body. This method was based on that developed by
Eunice Ingham,40, 41 which is supported by the
International Institute of Reflexology. Reflexology
was applied to the hands and feet of patients
bilaterally at a suitable angle and intensity in relevant
areas relating to pain in the brain, cortex,
hypothalamus, pituitary gland, subcortex and adrenal
glands. The researcher, who had a certificate in
reflexology, stimulated all reflex zones in both feet and
hands using the thumb and finger technique
resembling a “caterpillar”-like action.42 Patients’ pain
scores were recorded separately using the VAS before
the start of the reflexology treatment (0 minute) and
immediately after the treatment was completed (60th
minute) each week for a total of 6 weeks.
Instruments
Data collection included demographic data: age,
gender, education level, duration of pain, the
frequency of pain, and years of neuropathic pain
diagnosis. The measures used in this study consisted
of one standardized instrument, the VAS. The VAS is
a simple and often-used method for evaluating
variations in pain intensity43 and other subjective
clinical phenomena. Subjects are instructed to indicate
the intensity of the pain by marking a l00-mm line
anchored with terms describing the extremes of pain
intensity. Its usefulness has been validated by several
investigators in the setting of chronic pain.44,45
Gonzalez et al46 reported that the reliability of the
Spanish version of the VAS was 0.64 in Hispanic
persons with chronic arthritis and that there was a
strong correlation (0.72) with the visual numeric pain
scale, supporting its construct validity. Daily pain was
measured using the VAS at bedtime. Pain intensity
was measured by using a vertical VAS from 0 to 10,
with high numbers meaning greater pain intensity.
Data analysis
Power analysis was used to determine sample size.
Using the VAS to distinguish results between the
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Effects of Reflexology on Pain in Patients With Fibromyalgia 355
applications with a power of 100%, and to achieve the
difference between the periods evaluated with a power
of 100%, it was determined that a sample size of 30
was sufficient for this study. Data were analyzed using
the Statistical Package for the Social Sciences (SPSS)
for Windows (version 17.0). A 95% confidence
interval (α=.05) was considered in all tests.
An R_ANOVA was used to examine mean VAS
scores across the intervention period and comparisons
between the 0 and the 60th minute within groups. The
R_ANOVA was also used to examine mean VAS
scores across the intervention period, measured at
6 weekly intervals within groups. For this reason, the
Bonferroni test was used to examine the difference
between the intervals within groups, and to examine
the interaction between groups and times. The
Bonferroni contrasts were carried out to compare the
mean VAS scores measured at 3 time points, such as
comparisons between mean VAS first week and mean
VAS second week, mean VAS first week and mean
VAS third week, mean VAS first week and mean VAS
fourth week, mean VAS first week and mean VAS fifth
week, and mean VAS first week and mean VAS sixth
week, after obtaining a significant within-subject
effect. The R_ANOVA was used to examine the effects
of sociodemographic characteristics and the frequency
and intensity of the pain generally experienced by the
patients on the difference in the VAS score of pain
occurring during the reflexology in the group.
RESULTS
Demographic characteristics
The study participants ranged in age from 18 to
70 years (mean, 43.30 years; standard deviation,
10.21 years). The sample consisted of 30 Turkish
subjects, 30 female. Most were educated to primary
school level (n =10), 6 to secondary school level,
and 14 to high school or university level. The number
of years since patients had been diagnosed with
fibromyalgia ranged from more than 1 year to more
than 20 years. Mean time since diagnosis was 5.80
years (standard deviation, 7.64). All of the patients
had experienced pain throughout the period since their
diagnosis. It was determined that 70.0% of patients
suffered from pain “always,” and 30.0% of them
experienced pain “frequently.” Age and educational
level had no effect on pain scores (P>.05). There
were statistically significant differences in the baseline
data of the frequency and intensity of pain generally
felt by the patients, and the patients’ pain scores
(P<.05).
Effects of reflexology
The mean VAS scores of patients immediately before
the reflexology session (0 minute) and immediately
after it (60th minute) were found to be as follows: in the
first week, 8.13 and 6.20; in the second week, 7.77 and
5.87; in the third week, 6.193 and 4.93; in the fourth
week, 5.77 and 3.90; in the fifth week, 4.50 and 2.87;
and in the sixth week, 3.30 and 3.30 respectively. When
the mean VAS scores for 0 minute and the 60th minute
are compared internally, it can be seen that the differ-
ences are statistically significant (P<.05) (Figure 1).
The mean weekly VAS scores of patients were found
to be 7.17 ±1.75 for the first week (Figure 2), 6.82 ±
1.86 for the second week (Figure 3), 5.93 ±1.72 for the
third week (Figure 4), 4.83 ±1.73 for the fourth week
(Figure 5), 3.68 ±1.42 for the fifth week (Figure 6),
and 2.30 ±1.22 for the sixth week (Figure 7). There
was found to be a statistically significant difference
between weeks in the mean VAS scores (P<.05).
An examination of the difference of the mean VAS
score for each week from the other weeks shows that
there was no statistically significant difference
between the mean VAS scores of the first and second
weeks (P>.05), but that there was a statistically
significant difference between the values for weeks 3,
4, 5, and 6 (Table). Mean VAS scores for patients in
the second week were not significantly different from
FIGURE 1. Mean VAS score of patients at the six weeks.
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356 HOLISTIC NURSING PRACTICE •NOVEMBER/DECEMBER 2016
FIGURE 2. Mean VAS score of patients at the first week.
those in the first week (P>.05), but the difference
from the values for weeks 3, 4, 5, and 6 was
significant (P<.05) (Table). The difference between
patients’ mean VAS scores for the third week and the
values for weeks 1, 2, 4, 5, and 6 was found to be
statistically significant (P<.05) (Table). The
difference between patients’ mean VAS scores for the
fourth week and the values for weeks 1, 2, 3, 5, and 6
was found to be statistically significant (P<.05)
(Table). The difference between patients’ mean VAS
scores for the fifth week and the values for weeks 1, 2,
3, 4, and 6 was found to be statistically significant
(P<.05) (Table). The difference between patients’
mean VAS scores for the sixth week and the values for
FIGURE 3. Mean VAS score of patients at the second week.
FIGURE 4. Mean VAS score of patients at the third week.
weeks 1, 2, 3, 4, and 5 was found to be statistically
significant (P<.05) (Table).
DISCUSSION
Fibromyalgia is difficult to treat by clinical methods,
and nonpharmacological treatment options can help in
this regard. Reflexology has been recognized and
specifically used as a therapeutic intervention since
the mid-20th century, but it has existed in various
forms in most cultures for many centuries. In recent
years, the use of reflexology as an intervention has
increased and this, to some extent, may reflect the
growing interest in complementary therapies.
FIGURE 5. Mean VAS score of patients at the fourth week.
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Effects of Reflexology on Pain in Patients With Fibromyalgia 357
FIGURE 6. Mean VAS score of patients at the fifth week.
Reflexology was used in this study as a
nonpharmacological nursing intervention to facilitate
the relief of pain. It reduced pain among patients with
fibromyalgia, and pain scores decreased over time for
the subjects in the reflexology group. These findings
were supportive of the hypothesis that reflexology has
a significant effect in reducing VAS pain scores in
patients with fibromyalgia. Findings from this study
on pain scores were congruent with other studies of
decreased pain scores in patients with different pain in
response to reflexology intervention.21,47 , 48 In a study
by Launs¨
oetal,
21 patients described less pain after
reflexology treatment for headache. Stephenson et al47
also provided evidence that foot reflexology was
effective in reducing pain and anxiety, and it could be
integrated into standard care. In a study of patients
with metastatic cancer by Stephenson et al,49 it was
shown that pain scores decreased during the
reflexology intervention. In a study by Wallace (2003,
cited in Stephenson et al49), foot reflexology was
FIGURE 7. Mean VAS score of patients at the sixth week.
found to have an immediate positive effect for patients
with metastatic cancer who reported pain. In a study
by Park et al,50 a significant decrease in pain scores
was found during reflexology sessions in patients with
breast cancer. In a study by Khan et al,51 reflexology
was associated with a reduction in foot pain as
described by patients with rheumatoid arthritis. In a
study by Quinn et al,52 patients described less pain
after reflexology treatment for low back pain. Brown
and Lido53 provided evidence that reflexology was
effective in reducing pain and that there was an
improvement in the perception of the presence and the
intensity of phantom limb pain, with a corresponding
improvement in the duration of the pain and the
person’s lifestyle. In a study by Samuel and
Ebenezer,48 a significant decrease in pain scores and
the amount of analgesia were found during
reflexology sessions in acute pain.
Systematic reviews on reflexology indicate that it is
effective in reducing pain scores. Despite the results of
various studies examining the effect of reflexology on
TABLE. Significance of the Difference Between Mean VAS Scores of Patients Measured at Different Times
Measured at
Different Times
First
Week
Second
Week
Third
Week
Fourth
Week
Fifth
Week
Sixth
Week
First week aaaa
Second week aaaa
Third week aaaaaa
Fourth week aaaaaa
Fifth week aaaaaa
Sixth week aaaaaa
aStatistically significant (
P
=.05).
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358 HOLISTIC NURSING PRACTICE •NOVEMBER/DECEMBER 2016
pain with different sample groups, there has been only
one study examining the effect of reflexology on
fibromyalgia. In a study to examine the effect of
reflexology on the symptoms of patients with
fibromyalgia, Gunnarsdottir and Peden-McAlpine3
gave patients a total of 10 sessions of reflexology of
45 minutes each. Their results showed that reflexology
had a reducing effect on symptoms of fibromyalgia,
that it reduced pain experienced for example in the
head, chest, and arms, and that it generally isolated
pain and reduced its intensity.
Our results indicated that reflexology had decreased
pain scores. The decreasing trend continued in the first
and sixth weeks of the intervention, implying a
cumulative dose effect. This suggests that reflexology
should be used over periods of at least 6 weeks. Age,
gender, and educational level had no effect on pain
scores.3Also, the frequency and intensity of pain
generally experienced by the patient had an effect on
pain scores. This result indicates that reflexology,
which has a significant reducing effect on pain, can be
more effective as the frequency and intensity of pain
in the patient are reduced, and considerably reduces
the pain perceived. Nurses are in a primary position to
conduct research on reflexology, in that their holistic
background is in tune with the philosophies behind
reflexology. Before reflexology is used within hospital
settings to benefit patients, more empirical research
evidence is needed to support its use.
CONCLUSION
Pain scores were reduced significantly after
reflexology was completed, and findings supported the
benefits of reflexology for patients with fibromyalgia.
Reflexology has an influence that can be used as a
therapeutic tool for lowering pain scores in patients
with fibromyalgia. It is a safe intervention that is not
detrimental to patients, and has the advantage of
managing pain in patients with fibromyalgia without
risking unwanted side effects.
Reflexology is a noninvasive, inexpensive, and
non-time-consuming nursing intervention. It is
recommended that studies be conducted to explore the
optimal time, duration, or number of reflexology
sessions to be used when implementing reflexology.
Nurses who work in algology clinics may apply
therapy as a nonpharmacological intervention to
decrease pain scores in patients with fibromyalgia.
Relevance to clinical practice
rReflexology should be considered as a first-line
therapy to allay pain in patients with fibromyalgia
pain.
rNurses should include reflexology in the routine
care of patients with fibromyalgia pain.
rFurther research is needed to investigate the effects
of the duration of the application and the areas to
which reflexology is applied (ear or hand or foot)
on patients with fibromyalgia pain.
Limitations
This study reflects an encouraging insight into the
future of reflexology, but further studies should be
made with larger samples to verify the results of our
study. The fact that the research nurse was not blinded
as to the allocation of each group is another limitation
of the study. Under limitations consider addressing
that the effects of the intervention were not measured
over time; as in 6 months postintervention.
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