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103
*Correspondence to serene.health.reflexology@gmail.com
The authors are from Womack Army Medical Center, Fort Bragg, NC.
ABSTRACT
Background: Chronic pain is a major cause of disability across
the military, especially for the combat Soldier. More than two-
thirds of Americans with chronic pain are now using comple-
mentary medicine. Methods: Patients with chronic pain opting
for reflexology as part of their treatment plan received bilateral
therapy. Alternating pressure was applied to the individual pa-
tient’s reflex points corresponding to their pain sites. Follow-
ing a single treatment session, patients were asked to complete
a short survey. Discussion: There is evidence that reflexology is
therapeutic for many conditions, to include sleep and anxiety,
both of which can be comorbidity in the patient with chronic
pain. There is a lack of evidence on the use of reflexology with
chronic pain patients receiving multidisciplinary pain care.
Results: A total of 311 participants completed the survey.
Posttreatment pain scored decreased by a median of 2 points
(interquartile range [IQR] 1–3) on a 10-point pain scale. This
represents a median 43% (IQR 25%–60%) reduction in pain
for males and a 41% (IQR 30%–60%) reduction in pain for
females. Conclusion: Currently research is limited on effects of
reflexology in treating chronic pain, yet, like acupuncture, this
is an inexpensive, reliable, teachable, and simple noninvasive
treatment. Further studies are warranted.
Keywords: reflexology; pain; chronic pain; complementary
treatments; alternative treatments
Introduction
Chronic pain is a major cause of disability across the military
but is most common in the Soldier deployed for combat.1 The
Final Report from the Army Surgeon General’s Pain Manage-
ment Task Force recommended the use of complementary al-
ternative medicine (CAM) but specifically stated the lack of
evidence supporting its use.2 More than two-thirds of Ameri-
cans with chronic pain are now using complementary and al-
ternative therapies.
The origins of reflexology reach back to ancient Egypt, with
hieroglyphic evidence as early as 2330 BC in the tombs of
Ankhamor. This evidence demonstrated sophisticated systems
of treatment that are comparable to the “foot maps” available
today. From Egypt, this modality spread throughout the Ro-
man Empire, helping to popularize it long before allopathic
medicine was developed.3
In practice of reflexology, it is believed that there are reflex
points that correspond to every gland, organ, muscle, tissue,
and body system. In addition, through mastery and applica-
tion of reflexology techniques, it is thought that the blood and
lymph circulation to these can be influenced toward homeo-
stasis (Figure 1).4 According to the Reflexology Association
of America, “Reflexology is a non-invasive complementary
practice involving the use of alternating pressure applied to
reflexes within reflex maps of the body, located on the feet,
hands and outer ears.”5
Recently, some therapists practicing reflexology have inte -
grated related forms of therapy such as yoga/stretching,
breath ing exercises, and mindfulness with guided imagery.
One application of this type of integrative therapy is Integra-
tive Method Reflex Therapy (IMRT), in which reflexology is
used in conjunction with a comprehensive medical program in
a clinical setting as a therapeutic tool. When practicing IMRT,
the reflexologist has the advantage of access to clinical data
that is not available in a nonclinical setting.6
Reflexology may improve chronic pain by helping to improve
sleep.7,8 A study analyzing the effects of reflexology on alpha
brain waves in sleep found that the application of reflexology
induced change in the activity of brain waves in correspon-
dence with the appearance of a high degree of sleepiness.8 In
addition, there is evidence that reflexology may impact the
The Benefits of Reflexology
for the Chronic Pain Patient in a Military Pain Clinic
Connie Kern, NBCR, IMRT; Amy McCoart, RN, BSN*;
Thomas Beltranm, MA; Michael Bartoszek, MD
FIGURE 1 Foot massage chart.
Source: https://upload.wikimedia.org/wikipedia/commons/b/bf/Foot
-massage-chart.jpg
104 | JSOM Volume 18, Edition 4 / Winter 2018
the efficacy of the treatment (P = .78). Posttreatment, both
males and females reported a decrease on the pain scale. For
males, the self-reported median posttreatment pain score was
3 (IQR 1.5–4.5) and the median posttreatment pain score for
females was 3 (IQR 2–4). This represents a 43% (IQR 25%–
60%) reduction in pain for males and a 41% (IQR 30%–60%)
reduction in pain for females (Figure 2).
No differences were observed in self-reported pain type (mus-
culoskeletal, nerve, or both) based on sex (P = .55). Overall,
53 patients (19.9%) reported musculoskeletal pain, 26 (9.7%)
reported nerve pain, and 188 (70.4%) reported experiencing
both musculoskeletal and nerve pain. Posttreatment change in
pain was not related to age (P = .45) or type of pain (P = .30).
When asked about perceived benefit, 96.4% (n = 296) of pa-
tients reported that the treatment helped with their pain; 0.3%
(n = 1) reported that the treatment did not help; and 2.9% (n =
9) of patients reported “Not sure.” Similar responses were ob-
served when asked about repeating the treatment. Ninety-nine
percent (n = 302) of patients reported that they would be in-
terested in further treatment, while 1% (n = 4) responded that
they were not sure.
Discussion
This prospective, nonrandomized, observational study demon-
strated pain reduction with a high degree of tolerability when
reflexology was added to treatments offered in a military mul-
tidisciplinary pain management clinic. These data support ex-
pansion of reflexology services in a military multidisciplinary
pain management clinic and support further academic expan-
sion on the role of reflexology in the management of chronic
pain. Previous studies have shown reflexology to be beneficial
in treating sleep disturbances and stress. Future studies should
seek to integrate outcomes measures considering stress, sleep
quality, and chronic pain using multiple treatments over time.
In addition, future studies on training healthcare providers
and the benefits that may provide could prove beneficial.
Conclusion
Reflexology, when used as part of a multidisciplinary treat-
ment plan, has been shown to have high patient tolerability
with pain reduction. Further studies are warranted.
Disclosure
There was no funding source for this project, and there were
no conflicts of interest. The views expressed herein are those
of the author(s) and do not reflect the official policy of the
stress response.9 A study of cancer patients with anxiety found
that “patients experienced a significant decrease in pain inten-
sity and anxiety” compared with the control group.10,11 Studies
like these have helped to build objective evidence supporting
the use of reflexology in chronic pain patients. There is a lack
of evidence on the use of reflexology with chronic pain pa-
tients receiving multidisciplinary pain care. We sought to de-
termine the feasibility of incorporating the use reflexology for
US Army Soldiers with chronic pain within in an interdisci-
plinary pain clinic.
Methods
The Interdisciplinary Pain Management Center (IPMC) at
Womack Army Medical Center, Fort Bragg, NC, is a fully in-
tegrated clinic offering comprehensive pain management. Pa-
tients with chronic pain receiving treatment at IPMC opting
for reflexology received 25 minutes of therapy using both feet
(unless contraindicated) in addition to their standard of care
pain management therapies, which could include acupuncture,
chiropractic care, massage, exercise therapy, physical therapy,
interventional pain procedures, and prescription medications.
Adhering to the guidelines of the American Reflexology
Certification Board, alternating pressure was applied by a
board-certified reflexologist correlating to the individual pa-
tient’s pain sites and other points based on the reflexologist’s
assessment of the patient’s pain complaint and comorbidities.
Following a single treatment session, patients were then asked
to complete a voluntary survey reporting their sex, age, and
pretreatment pain score using the Defense and Veterans Pain
Rating Scale (DVPRS).12 The survey also included the classi-
fication of pain (musculoskeletal, nerve, or both), immediate
posttreatment pain scores, satisfaction, and self- assessment of
treatment benefit.
Summary statistics are reported as median and IQR for contin-
uous variables. Categorical variables are reported as percent-
ages. Patients’ change in pain was computed using self-reported
assessments of pretreatment and posttreatment pain. Kruskal–
Wallis tests were used to assess the relationship between cat-
egorical variables and age, pretreatment pain, posttreatment
pain, as well as change in pain. Linear regression analysis was
used to examine the relationship between posttreatment pain
reduction, age, and pain type. All statistical tests were per-
formed by using a P < .05 level of significance. Data analyses
were conducted using SPSS v23 (IBM, Armonk, NY).
Results
A total of 311 participants completed the survey. Among the
295 who indicated their sex, 67.5% (n = 199) reported being
male and 32.5% (n = 96) reported being female. The median
age of the participants was 36 years (IQR 28–44). Females
were significantly older than males, with a median age of 42
years (IQR 30–46) compared with a median age of 35 years
(IRQ 38–43) for males (P < .01).
Sex differences were observed in self-reported pain before
treatment. For pretreatment pain, females reported less pain
than males (P = .02). Posttreatment pain did not differ by sex
(P > .05). Females reported a median pretreatment pain of 5
(IQR 3.5–6.5), while males reported a median pretreatment
pain of 6 (IQR 3.5–7.5). There were no differences by sex in
FIGURE 2 Pain reduction of 43% (IQR 25%–60%) for males and
of 41% (IQR 30%–60%) for females.
Reflexology for Chronic Pain in Military Patients
| 105
Department of the Army, Department of Defense, or the US
government.All authors approved the final version.
Author Contributions
CK is a board-certified reflexologist who had an interest in
conducting a research study on the effectiveness of reflexology.
She provided the therapy and contributed in writing the manu-
script; AM with CK developed the questionnaire and plan for
the project and initiated the manuscript, TB analyzed the data
and wrote the Results section; and MB reviewed and edited
the final version of the manuscript.
References
1. Cohen SP, Nguyen C, Kapoor SG, et al. Back pain during war an
analysis of factors affecting outcome. Arch Intern Med. 2009;169
(20):1916–1923. doi:10.1001/archinternmed.2009.380
2. https://apps.dtic.mil/dtic/tr/fulltext/u2/a523510.pdf. Accessed 21
Sept 2017.
3. Dale C. The subtle body: an encyclopedia of your energetic anat-
omy. Sounds True. 2014.
4. Foot massage chart. https://upload.wikimedia.org/wikipedia
/commons/b/bf/Foot-massage-chart.jpg. Accessed 20 Apr 2013.
5. Reflexology Association of America. http://reflexology-usa.org.
Accessed November 2015.
6. Hillinger MG, Wolever RQ, McKernan LC, et al. Integrative
medicine for the treatment of persistent pain. Primary Care Clin
Office Pract. 2017;44(2):247–264.
7. Finan PH, Goodin BR, Smith MT. The association of sleep and
pain: an update and a path forward. J Pain. 2013;14(12), 1539–
1552. http://doi.org/10.1016/j.jpain.2013.08.007
8. Esmel-Esmel N, Tomás-Esmel E, Tous-Andreu M, et al. Reflex-
ology and polysomnography: Changes in cerebral wave activity
induced by reflexology promote N1 and N2 sleep stages. Com-
plement Therap Clin Pract. 2017.
9. Hebden Bridge Times. Your health with Lucy Wilson of Physio
& Therapies: How reflexology can relieve stress. http://www
.hebdenbridgetimes.co.uk/news/your-health-with-lucy-wilson-of
-physio-therapies-how-reflexology-can-relieve-stress-1-7579462.
Accessed 29 Sep 2017.
10. Stephenson NL, Swanson M, Dalton J, et al. Partner-delivered
reflexology: effects on cancer pain and anxiety. Oncol Nursing
Forum. 2007;34(1).
11. Frambes D, Sikorskii A, Tesnjak I, et al. (2017, September). Care-
giver-reported health out comes: effects of providing reflexology
for symptom manage ment to women with advanced breast can-
cer. Oncol Nursing Forum. 2017;44(5):596–605.
12. Buckenmaier CC III, Galloway KT, Polomano RC, et al. Prelim-
inary validation of the Defense and Veterans Pain Rating Scale
(DVPRS) in a military population. Pain Med. 2013;14(1):110–123.
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