Full title: Using a mixed methods research design to investigate complementary alternative medicine (CAM) use among women with breast cancer in Ireland.

Eur J Oncol Nurs. 2012 Nov 20. pii: S1462-3889(12)00102-0. doi: 10.1016/j.ejon.2012.10.008. Fox P, Butler M, Coughlan B, Murray M, Boland N, Hanan T, Murphy H, Forrester P, O' Brien M, O' Sullivan N. UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Belfield, Dublin, Ireland. Electronic address: patricia.fox@ucd.ie.

AIM: To investigate complementary and alternative medicine (CAM) use among women with breast cancer in Ireland using a mixed methods modified sequential explanatory design.

METHODS: Semi-structured interviews were conducted with oncology professionals (n = 20) and CAM practitioners (n = 20) and this was followed by a survey of 406 women with breast cancer using the 'Use of Complementary and Alternative Therapies Survey' questionnaire (UCATS) (Lengacher et al., 2003). Follow up interviews were subsequently undertaken with a subset of this survey sample (n = 31).

RESULTS: Over half of those surveyed (55.7%, n = 226) used some form of CAM since diagnosis. The most frequently used therapies were massage, herbal supplements (including herbs with oestrogenic properties), antioxidants, relaxation, counselling, health supplements, reflexology, reiki and support groups. Dietary interventions were used primarily to reduce symptoms and/or side effects while reduction of psychological stress was the primary reason for use of stress-reducing therapies. Most respondents reported that the CAM therapies they had used were helpful. The qualitative data elaborated on and provided clarification of the survey results.

CONCLUSIONS: Similar to international studies, CAM is popular among women with breast cancer in Ireland. As such, the challenge for Irish oncology professionals is to identify low risk CAM therapies that are likely to benefit patients while educating patients and themselves on therapies which may be of concern. This study clearly illustrates the benefits of using a mixed methods approach to enhance our understanding of a complex clinical issue and thus we recommend that this method should be the method of choice when planning health services research.

Am J Hosp Palliat Care. 2012 Dec 5. Marcus DA, Blazek-O'Neill B, Kopar JL.

Therapeutic Touch (TT) is an alternative therapy that has gained popularity over the past two decades for helping wounds to heal. Practitioners enter a meditative state and pass their hands above the patient's body to find and correct any imbalances in the patient's 'life energy' or chi. Scientific instruments have been unable to detect this energy. The effect of TT on wound healing has been expounded in anecdotal publications. To identify and review all relevant data to determine the effects of TT on healing acute wounds. For this fourth update, we searched The Cochrane Wounds Group Specialised Register (searched 27 January 2012); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 1); Ovid MEDLINE (2010 to January Week 2 2012); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, January 26, 2012); Ovid EMBASE (2010 to 2012 Week 03); and EBSCO CINAHL (2010 to January 6 2012). All randomised or quasi-randomised controlled trials, which compared the effect of TT with a placebo, another treatment, or no treatment control were considered. Studies which used TT as a stand-alone treatment, or as an adjunct to other therapies, were eligible. One author (DO'M) determined the eligibility for inclusion of all trials in the review. Both authors conducted data extraction and evaluation of trial validity independently. Each trial was assessed using predetermined criteria. No new trials were identified for this update. Four trials in people with experimental wounds were included. The effect of TT on wound healing in these studies was variable. Two trials (n = 44 & 24) demonstrated a significant increase in healing associated with TT, while one trial found significantly worse healing after TT and the other found no significant difference. All trials are at high risk of bias. There is no robust evidence that TT promotes healing of acute wounds.

Cochrane Database Syst Rev. 2012 Jun 13;6:CD002766. O'Mathúna DP, Ashford RL. School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland. donal.omathuna@dcu.ie

Full title: Effect of therapeutic touch on brain activation of preterm infants in response to sensory punctate stimulus: a near-infrared spectroscopy-based study.

The purpose of this study was to determine whether therapeutic touch in preterm infants can ameliorate their sensory punctate stimulus response in terms of brain activation measured by near-infrared spectroscopy. The study included 10 preterm infants at 34-40 weeks' corrected age. Oxyhaemoglobin (Oxy-Hb) concentration, heart rate (HR), arterial oxygen saturation (SaO(2)) and body movements were recorded during low-intensity sensory punctate stimulation for 1 s with and without therapeutic touch by a neonatal development specialist nurse. Each stimulation was followed by a resting phase of 30 s. All measurements were performed with the infants asleep in the prone position. sensory punctate stimulus exposure significantly increased the oxy-Hb concentration but did not affect HR, SaO(2) and body movements. The infants receiving therapeutic touch had significantly decreased oxy-Hb concentrations over time. Therapeutic touch in preterm infants can ameliorate their sensory punctate stimulus response in terms of brain activation, indicated by increased cerebral oxygenation. Therefore, therapeutic touch may have a protective effect on the autoregulation of cerebral blood flow during sensory punctate stimulus in neonates.

Arch Dis Child Fetal Neonatal Ed. 2012 Jul 21. Honda N, Ohgi S, Wada N, Loo KK, Higashimoto Y, Fukuda K. 1Department of Rehabilitation, Kinki University Faculty of Medicine, Osakasayama, Osaka, Japan.

Full title: Effects of Therapeutic Touch on Anxiety, Vital Signs, and Cardiac Dysrhythmia in a Sample of Iranian Women Undergoing Cardiac Catheterization: A Quasi-Experimental Study.

Purpose of the study: To investigate the effects of Therapeutic Touch (TT) on anxiety, vital signs, and cardiac dysrhythmia in women undergoing cardiac catheterization. Design: It was a quasi-experimental study. The participants had no history of hallucination, anxiety, or other psychological problems. Participants had to be conscious and have attained at least sixth-grade literacy level. Participants were randomly assigned into an intervention group (n = 23; received 10-15 minutes TT), a placebo group (n = 23; received 10-15 minutes simulated touch), and a control group (n = 23; did not receive any therapy). Data were collected using Spielberger's anxiety test, cardiac dysrhythmia checklist, and vital signs recording sheet. Statistical analyses were considered to be significant at a = .05 levels. Findings: Sixty-nine women ranging in age from 35 to 65 years participated. TT significantly decreased state anxiety p < 0.0001 but not trait anxiety (p = .88), decreased the incidence of all cardiac dysrhythmias p < 0.0001 except premature ventricular contraction (p = .01), and regulated vital signs p < 0.0001 in the intervention group versus placebo and control group. Conclusions: TT is an effective approach for managing state anxiety, regulating vital signs, and decreasing the incidence of cardiac dysrhythmia during stressful situations, such as cardiac catheterization, in Iranian cardiac patients.

J Holist Nurs. 2012 Jul 24. Zolfaghari M, Eybpoosh S, Hazrati M.

Full title: The implementation and evaluation of therapeutic touch in burn patients: An instructive experience of conducting a scientific study within a non-academic nursing setting.

Evaluation of therapeutic touch (TT) in the nursing of burn patients; post hoc evaluation of the research process in a non-academic nursing setting. 38 burn patients received either TT or nursing presence. On admission, days 2, 5 and 10 of hospitalization, data were collected on anxiety for pain, salivary cortisol, and pain medication. Interviews with nurses were held concerning research in a non-academic setting. Anxiety for pain was more reduced on day 10 in the TT-group. The TT-group was prescribed less morphine on day 1 and 2. On day 2 cortisol level before dressing changes was higher in the TT-group. The situational challenges of this study led to inconsistencies in data collection and a high patient attrition rate, weakening its statistical power. Conducting an effect study within daily nursing practice should not be done with a nursing staff inexperienced in research. Analysis of the remaining data justifies further research on TT for burn patients with pain, anxiety for pain, and cortisol levels as outcomes. Administering and evaluating TT during daily care requires nurses experienced both in TT and research, thus leading to less attrition and missing data, increasing the power of future studies.

Patient Educ Couns. 2012 Sep 17. pii: S0738-3991(12)00340-0. doi: 10.1016/j.pec.2012.08.012. Busch M, Visser A, Eybrechts M, van Komen R, Oen I, Olff M, Dokter J, Boxma H. Van Praag Instituut, Utrecht, The Netherlands. Electronic address: mbusch@vanpraaginstituut.nl.

Complementary and alternative medicine (CAM) is not generally associated with the complexity and intensity of critical care. Most CAM therapies involve slow, calming techniques that seem to be in direct contrast with the fast-paced, highly technical nature of critical care. However, patients in critical care often find themselves coping with the pain and stress of their illness exacerbated by the stress of the critical care environment. Complementary and alternative medicine-related research reveals that complementary therapies, such as Reiki, relieve pain and anxiety and reduce symptoms of stress such as elevated blood pressure and pulse rates. Patients and health care professionals alike have become increasingly interested in complementary and alternative therapies that do not rely on expensive, invasive technology, and are holistic in focus. Reiki is cost-effective, noninvasive, and can easily be incorporated into patient care. The purpose of this article is to examine the science of Reiki therapy and to explore Reiki as a valuable nursing intervention.

Crit Care Nurs Q. 2011 Jul-Sep;34(3):213-7. Toms R. Nelda C. Stark College of Nursing, Texas Woman's University, Houston, TX 77030, USA. rtoms@twu.edu

Full title: Touching ethics: assessing the applicability of ethical rules for safe touch in CAM--outcomes of a CAM (complementary and alternative medicine) practitioner survey in Israel.

INTRODUCTION: Recently, ethical guidelines regarding safe touch in CAM were developed in Israel. Publishing ethical codes does not imply that they will actually help practitioners to meet ethical care standards. The effectiveness of ethical rules depends on familiarity with the code and its content. In addition, critical self-examination of the code by individual members of the profession is required to reflect on the moral commitments encompassed in the code. METHODS: For the purpose of dynamic self-appraisal, we devised a survey to assess how CAM practitioners view the suggested ethical guidelines for safe touch. We surveyed 781 CAM practitioners regarding their perspectives on the safe-touch code. RESULTS: There was a high level of agreement with general statements regarding ethics pertaining to safe touch with a mean rate of agreement of 4.61 out of a maximum of 5. Practitioners concurred substantially with practice guidelines for appropriate touch with a mean rate of agreement of 4.16 out of a maximum of 5. Attitudes toward the necessity to touch intimate areas for treatment purposes varied with 78.6% of respondents strongly disagreeing with any notion of need to touch intimate areas during treatment. 7.9% neither disagreed nor agreed, 7.9% slightly agreed, and 7.6% strongly agreed with the need for touching intimate areas during treatment. There was a direct correlation between disagreement with touching intimate areas for therapeutic purposes and agreement with general statements regarding ethics of safe touch (Spearman r=0.177, p<0.0001), and practice guidelines for appropriate touch (r=0.092, p=0.012). CONCLUSION: A substantial number of practitioners agreed with the code, although some findings regarding the need to touch intimate area during treatments were disturbing. Our findings can serve as a basis for ethical code development and implementation, as well as for educating CAM practitioners on the ethics of touch.

Complement Ther Med. 2011 Feb;19(1):12-8. Epub 2010 Dec 24. Schiff E, Ben-Arye E, Shilo M, Levy M, Schachter L, Weitchner N, Golan O, Stone J. Department of Internal Medicine, Bnai-Zion Hospital, Haifa, Israel. eschiff@bezeqint.net

Holism is the philosophy of understanding people by addressing factors that affect people in all situations. The goal of holistic nursing is to help patients integrate appropriate self-care into their lives. By providing holistic care, the perioperative nurse can help surgical patients experience fewer problems (eg, surgical trauma, pain, anesthetic complications), reach discharge more quickly, attain satisfaction with health care, and more easily resume normal activities. Holistic nursing may include the use of music, guided imagery, therapeutic massage, play therapy, touch therapy, and communication skills. Successful surgery for the patient means not only recovering but regaining physical, mental, and spiritual health as a whole.

AORN J. 2011 Apr;93(4):482-7; quiz 488-90. Selimen D, Andsoy II. Surgical Nursing Department, Marmara University, Istanbul, Turkey.

BACKGROUND: This paper critiques the model for non-verbal communication referred to as SOLER (which stands for: "Sit squarely"; "Open posture"; "Lean towards the other"; "Eye contact; "Relax"). It has been approximately thirty years since Egan (1975) introduced his acronym SOLER as an aid for teaching and learning about non-verbal communication. AIM: There is evidence that the SOLER framework has been widely used in nurse education with little published critical appraisal. A new acronym that might be appropriate for non-verbal communication skills training and education is proposed and this is SURETY (which stands for "Sit at an angle"; "Uncross legs and arms"; "Relax"; "Eye contact"; "Touch"; "Your intuition"). THE NEW MODEL: The proposed model advances the SOLER model by including the use of touch and the importance of individual intuition is emphasised. The model encourages student nurse educators to also think about therapeutic space when they teach skills of non-verbal communication.

Nurse Educ Pract. 2011 Apr 12. Stickley T. School of Nursing, Midwifery and Physiotherapy, Faculty of Medicine and Health Sciences, University of Nottingham, Duncan MacMillan House, Porchester Road, Nottingham NG3 6AA, United Kingdom.

ABSTRACT:BACKGROUND: Most research on the impact of mind-body training does not ask about participants' baseline experience, expectations, or preferences for training. To better plan participant-centered mind-body intervention trials for nurses to reduce occupational stress, such descriptive information would be valuable. METHODS: We conducted an anonymous email survey between April and June, 2010 of North American nurses interested in mind-body training to reduce stress. The e-survey included: demographic characteristics, health conditions and stress levels; experiences with mind-body practices; expected health benefits; training preferences; and willingness to participate in future randomized controlled trials. RESULTS: Of the 342 respondents, 96% were women and 92% were Caucasian. Most (73%) reported one or more health conditions, notably anxiety (49%); back pain (41%); GI problems such as irritable bowel syndrome (34%); or depression (33%). Their median occupational stress level was 4 (0 = none; 5 = extreme stress). Nearly all (99%) reported already using one or more mind-body practices to reduce stress: intercessory prayer (86%), breath-focused meditation (49%), healing or therapeutic touch (39%), yoga/tai chi/qi gong (34%), or mindfulness-based meditation (18%). The greatest expected benefits were for greater spiritual well-being (56%); serenity, calm, or inner peace (54%); better mood (51%); more compassion (50%); or better sleep (42%). Most (65%) wanted additional training; convenience (74% essential or very important), was more important than the program's reputation (49%) or scientific evidence about effectiveness (32%) in program selection. Most (65%) were willing to participate in a randomized trial of mind-body training; among these, most were willing to collect salivary cortisol (60%), or serum biomarkers (53%) to assess the impact of training. CONCLUSIONS: Most nurses interested in mind-body training already engage in such practices. They have greater expectations about spiritual and emotional than physical benefits, but are willing to participate in studies and to collect biomarker data. Recruitment may depend more on convenience than a program's scientific basis or reputation. Knowledge of participants' baseline experiences, expectations, and preferences helps inform future training and research on mind-body approaches to reduce stress.

BMC Complement Altern Med. 2011 Apr 11;11:26. Kemper K, Bulla S, Krueger D, Ott MJ, McCool JA, Gardiner P. Center for Integrative Medicine, Wake Forest University Baptist Medical Center; Winston-Salem, NC, USA. kkemper@wfubmc.edu.

Central neuropathic itch can be a lifelong debilitating condition and treatment challenge. We report a patient with a traumatic brain injury with severe intractable pruritus who failed extensive pharmacologic and nonpharmacologic treatment but responded to a holistic approach using healing touch. We discuss the complexity of this type of neuropathic itch and present a holistic approach as an adjunct to therapy in reducing itch intensity. This case presentation along with the literature discussed suggests a therapeutic strategy for the management of complicated central neuropathic itch.

J Am Acad Dermatol. 2011 May;64(5):955-9. Epub 2011 Feb 3. Curtis AR, Tegeler C, Burdette J, Yosipovitch G. Department of Dermatology, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina 27157, USA. acurtis@wfubmc.edu

Many clinical disorders, whether neurological (e.g. Alzheimer's disease) or neuropsychiatric (e.g. schizophrenia and depression), exhibit cognitive symptoms that require pharmacological treatment. Cognition is multi-faceted and includes processes of perception, attention, working memory, long-term memory, executive function, language and social cognition. This article reviews how it is feasible to model many aspects of human cognition with the use of appropriate animal models and associated techniques, including the use of computer controlled tests (e.g. touch-screens), for optimising translation of experimental research to the clinic. When investigating clinical disorders, test batteries should aim to profile cognitive function in order to determine which aspects are impaired and which are preserved. In this review we have paid particular attention to the validation of translational methods; this may be done through the application of common theoretical principles, by comparing the effects of psychological manipulations and, wherever feasible, with the demonstration of homologous neural circuitry or equivalent pharmacological actions in the animal and human paradigms. Of particular importance is the use of 'back-translation' to ensure that the animal model has validity, for example, in predicting the effects of therapeutic drugs already found in human studies. It is made clear that the choice of appropriate behavioral tests is an important element of animal models of neuropsychiatric or neurological disorder; however, of course it is also important to select appropriate manipulations, whether genetic, neurodevelopmental, neurotoxic, or pharmacological, for simulating the neural substrates relevant to the disorders that lead to predictable behavioral and cognitive impairments, for optimising the testing of candidate compounds.

Biochem Pharmacol. 2011 Jun 15;81(12):1356-66. Epub 2011 Jan 8. Keeler JF, Robbins TW. Dept. of Expt. Psychology, University of Cambridge, Downing Street, Cambridge CB2 3EB, UK; Dept. of Behavioural and Clinical Neuroscience, University of Cambridge, Downing Street, Cambridge CB2 3EB, UK.

Placebo analgesic effects appear to be related to patients' perception of the therapeutic intervention. In this paper, we review quantitative findings of how the relationship with the physician and the verbal suggestions given for relief may influence patients' perception of a treatment and how patients' expectations and emotional feelings may affect treatment outcome. We also present qualitative data from interviews with patients who have experienced pain relief following a placebo or an active treatment. A special focus is given to the temporal development of placebo analgesia at psychological and neurophysiological levels. Finally, we discuss the extent to which the quantitative and qualitative findings supplement or contrast with each other, and we touch upon possible implications of patients' direct experience as central for placebo analgesia.

Philos Trans R Soc Lond B Biol Sci. 2011 Jun 27;366(1572):1913-21. Vase L, Nørskov KN, Petersen GL, Price DD. Department of Psychology, Aarhus University, , Jens Christian Skous Vej 4, 8000 Aarhus C, Denmark.

This article includes a review of the literature on research related to energy healing and pain from 1980 through 2008. The types of energy healing considered include Reiki, therapeutic touch, and healing touch. There has been limited research testing these holistic interventions and their effect on pain even though there is attention to the modalities in the nursing practice literature. Recommendations for future research include studies with larger and diverse samples and comparisons among the various modalities.

Fazzino DL, Griffin MT, McNulty RS, Fitzpatrick JJ. Holist Nurs Pract. 2010 Mar-Apr;24(2):79-88. Prepare Me 4 Surgery, Encinitas, California, USA.

The aim of this article is to provide a cursory review of some of the literature relating to loneliness, existentialism and touch. With reference to the critical incident analysis (see Box 1), a reflection on the learning that has been achieved both intrapersonally and interpersonally will also be provided. A consideration of how exactly this experience of structured reflection may be used to enhance and develop practice will also be explored. The review will analyze the key concepts of loneliness, existentialism, the therapeutic relationship and touch within the realms of nursing practice, specifically in relation to death and dying. This article seeks to highlight the importance of having an understanding of loneliness in nursing, particularly when caring for patients who are dying.

Playfair C. Br J Nurs. 2010 Jan 28-Feb 10;19(2):122, 124-6. The Royal Sussex County Hospital, East Sussex.

OBJECTIVE: Recently, the importance of non-pharmacological therapies for dementia has come to the fore. In the present study, we examined the curative effects of aromatherapy in dementia in 28 elderly people, 17 of whom had Alzheimer's disease (AD).

METHODS: After a control period of 28 days, aromatherapy was performed over the following 28 days, with a wash out period of another 28 days. Aromatherapy consisted of the use of rosemary and lemon essential oils in the morning, and lavender and orange in the evening. To determine the effects of aromatherapy, patients were evaluated using the Japanese version of the Gottfries, Brane, Steen scale (GBSS-J), Functional Assessment Staging of Alzheimer's disease (FAST), a revised version of Hasegawa's Dementia Scale (HDS-R), and the Touch Panel-type Dementia Assessment Scale (TDAS) four times: before the control period, after the control period, after aromatherapy, and after the washout period.

RESULTS: All patients showed significant improvement in personal orientation related to cognitive function on both the GBSS-J and TDAS after therapy. In particular, patients with AD showed significant improvement in total TDAS scores. Result of routine laboratory tests showed no significant changes, suggesting that there were no side-effects associated with the use of aromatherapy. Results from Zarit's score showed no significant changes, suggesting that caregivers had no effect on the improved patient scores seen in the other tests.

CONCLUSIONS: In conclusion, we found aromatherapy an efficacious non-pharmacological therapy for dementia. Aromatherapy may have some potential for improving cognitive function, especially in AD patients.

Jimbo D, Kimura Y, Taniguchi M, Inoue M, Urakami K. Psychogeriatrics. 2009 Dec;9(4):173-9. Department of Biological Regulation, School of Health Science, Faculty of Medicine, Tottori University, Yonago, Japan.

Full Title A study of the feasibility of introducing therapeutic touch into the operative environment with patients undergoing cerebral angiography.

The purpose of this pilot study was to determine whether Therapeutic Touch (TT) can be effectively used in the operative setting and whether it could produce positive outcomes in the period from cerebral angiography to discharge. The specific outcomes to be assessed were blood pressure, pulse, and respirations. TT is an intervention that involves the intentional direction of energy for the purpose of healing. The present study was developed within the conceptual framework of Rogers's model of unitary human beings. Data were collected at a center for endovascular surgery. The participants were 40 men and women aged between 18 and 80 years who were referred to the center for cerebral angiograms. The participants were English-speaking, ambulatory patients, with no history of prior cerebral angiograms and no psychiatric diagnosis. The design was a randomized, single-blind experiment. The research data were collected in the normal course of the angiogram procedure and recovery room. The blood pressure, pulse, and respirations were routinely noted before, during, and after the procedure. The study was significant in three aspects: (a) it was the first study to develop a protocol for delivering TT in the preoperative course of neurological patients, (b) the study is conceptualized within Rogers's conceptual model of unitary human beings, and (c) the study explored the impact of TT on selected outcomes in endovascular patients. A protocol for delivering TT in the operative setting was successfully developed and implemented. The efficacy of TT on the blood pressure, respirations, and pulse of the experimental group was not statistically significant. The reasons for this finding are explored, and suggestions are made for future research.

Madrid MM, Barrett EA, Winstead-Fry P. J Holist Nurs. 2010 Sep;28(3):168-74 Center for Endovascular Surgery, Roosevelt Hospital, New York City, New York, USA.

OBJECTIVES: The goal of this research is to design a novel model using protein folding to study Therapeutic Touch, a noncontact form of energy manipulation healing. Presented is a feasibility study suggesting that the denaturation path of ribonuclease A may be a useful model to study the energy exchange underlying therapeutic touch.

DESIGN: The folding of ribonuclease A serves as a controlled energy-requiring system in which energy manipulation can be measured by the degree of folding achieved. A kinetic assay and fluorescence spectroscopy are used to assess the enzyme-folding state.

RESULTS: The data suggest that the kinetic assay is a useful means of assessing the degree of refolding, and specifically, the enzyme function. However, fluorescence spectroscopy was not shown to be an effective measurement of enzyme structure for the purposes of this work.

CONCLUSIONS: More research is needed to assess the underlying mechanism of therapeutic touch to complement the existing studies. An enzyme-folding model may provide a useful means of studying the energy exchange in therapeutic touch.

Strickland ML, Boylan HM. J Altern Complement Med. 2010 Jul;16(7):715-21. Drexel University College of Medicine, Philadelphia, PA, USA.

The understanding of migraine has moved well beyond its traditional characterization as a "vascular headache." In considering the basic neurobiology of migraine, it is important to begin with the concept of migraine as not merely a headache, but rather a heterogeneous array of episodic symptoms. Among the array of phenomena experienced by migraine patients are visual disturbances, nausea, cognitive dysfunction, fatigue, and sensitivity to light, sound, smell, and touch. These symptoms may occur independently or in any combination, and in some patients occur even in the absence of headache. The diversity and variability of symptoms experienced by migraine patients belies a complex neurobiology, involving multiple cellular, neurochemical, and neurophysiological processes occurring at multiple neuroanatomical sites. Migraine is a multifaceted neurobiological phenomenon that involves activation of diverse neurochemical and cellular signaling pathways in multiple regions of the brain. Propagated waves of cellular activity in the cortex, possibly involving distinct glial and vascular signaling mechanisms, can occur along with activation of brainstem centers and nociceptive pathways. Whether different brain regions become involved in a linear sequence, or as parallel processes, is uncertain. The modulation of brain signaling by genetic factors, and by sex and sex hormones, provides important clues regarding the fundamental mechanisms by which migraine is initiated and sustained. Each of these mechanisms may represent distinct therapeutic targets for this complex and commonly disabling disorder.

Charles A, Brennan KC. Handb Clin Neurol. 2010;97:99-108.

Full Title Effects of Reiki on anxiety, depression, pain, and physiological factors in community-dwelling older adults.

The purpose of this study was to evaluate the effect of Reiki as an alternative and complementary approach to treating community-dwelling older adults who experience pain, depression, and/or anxiety. Participants (N = 20) were randomly assigned to either an experimental or wait list control group. The pre- and posttest measures included the Hamilton Anxiety Scale, Geriatric Depression Scale-Short Form, Faces Pain Scale, and heart rate and blood pressure. The research design included an experimental component to examine changes in these measures and a descriptive component (semi-structured interview) to elicit information about the experience of having Reiki treatments. Significant differences were observed between the experimental and treatment groups on measures of pain, depression, and anxiety; no changes in heart rate and blood pressure were noted. Content analysis of treatment notes and interviews revealed five broad categories of responses: Relaxation; Improved Physical Symptoms, Mood, and Well-Being; Curiosity and a Desire to Learn More; Enhanced Self-Care; and Sensory and Cognitive Responses to Reiki.

Richeson NE, Spross JA, Lutz K, Peng C. Res Gerontol Nurs. 2010 Jul;3(3):187-99. doi: 10.3928/19404921-20100601-01. College of Nursing and Health Professions, University of Southern Maine, Portland, Maine 04104-9300, USA. richeson@usm.maine.edu

Purpose: The Reiki Master Teacher group at a large academic, urban medical center studied the effects of Reiki on work-related stress in Registered Nurse Reiki I class participants. Research suggests that work-related stress is an influential factor in nursing burn out and retention. Reiki, an ancient form of Oriental "energy work" or healing, has been found to decrease stress. Methods: The Perceived Stress Scale tool was administered prior to the Reiki I class and after three weeks of practicing self-Reiki. Findings: Seventeen participants returned follow-up data. Results indicated that practicing Reiki more often resulted in reduced perceived stress levels. Conclusions: Data from this small pilot study supports educating nurses about Reiki practice to decrease work-related stress.

Cuneo CL, Cooper MR, Drew CS, Naoum-Heffernan C, Sherman T, Walz K, Weinberg J. J Holist Nurs. 2010 Aug 10.

BACKGROUND: Reiki is used by a growing number of people but little is known about the scientific basis for its use.

PURPOSE: The Touchstone Process was developed as an ongoing process to systematically analyze published, peer-reviewed studies of Reiki, the results being made accessible to the public online.

METHOD: Thirteen scientifically qualified experts in the field of Reiki were assembled into 3 teams to retrieve, evaluate, and summarize articles using standardized, piloted evaluation forms.

RESULTS: Summaries of 26 Reiki articles, including strengths and weaknesses, were posted on a newly developed Web site ( www.centerforreikiresearch.org), together with an overall summary of the status of Reiki research and guidelines for future research: The Touchstone Process determined that only 12 articles were based on a robust experimental design and utilized well-established outcome parameters. Of these articles, 2 provided no support, 5 provided some support, and 5 demonstrated strong evidence for the use of Reiki as a healing modality.

CONCLUSION: There is a need for further high-quality studies in this area.

Baldwin AL, Vitale A, Brownell E, Scicinski J, Kearns M, Rand W. Holist Nurs Pract. 2010 Sep-Oct;24(5):260-76. Department of Physiology, College of Medicine, University of Arizona, Tucson, AZ 85724, USA. abaldwin@u.arizona.edu

Background: Spiritual healing, probably the oldest documented paramedical intervention, is a neglected area of research. In order to conduct further research into the effects of healing, a valid and reliable outcome measure is needed that captures the experience of individuals receiving healing (healees) and is not burdensome to complete. We aimed to develop such a measure. Methods: A mixed methods design was used. Focus groups and cognitive interviews were used to generate and refine questionnaire items grounded in the experiences and language of healees (Study 1). The resulting questionnaire was tested and its formal psychometric properties were evaluated (Study 2). Participants were recruited from a spiritual healing sanctuary and via individual healers (including registered spiritual healers, Reiki practitioners, healers affiliated with churches). Results: In Study 1, 24 participants took part in 7 focus groups and 6 cognitive interviews. 29 common effects were identified and grouped into 7 discrete dimensions that appeared to characterize potentially sustainable effects reported by participants following their experiences of spiritual healing. In Study 2, 393 participants returned completed baseline questionnaires, 243 of whom completed the questionnaire again 1-6 weeks later. Exploratory factor analysis generated 5 subscales, based on 20 of the items: outlook, energy, health, relationships and emotional balance. These subscales demonstrated acceptable internal consistency, convergent validity and test-retest reliability. Three of the subscales and the whole questionnaire demonstrated good sensitivity to change. Conclusions: We have produced a psychometrically sound healing impact questionnaire that is acceptable to healees, healers and researchers for use in future evaluations of spiritual healing.

Bishop FL, Barlow F, Walker J, McDermott C, Lewith GT. Psychother Psychosom. 2010 Aug 20;79(6):350-362. University of Southampton School of Medicine, Aldermoor Health Centre, Southampton, UK.

Full Title Effects of complementary therapies on clinical outcomes in patients being treated with radiation therapy for prostate cancer.

BACKGROUND.: This pilot randomized controlled trial (RCT) examined the clinical effects of 2 complementary (CAM) therapies, relaxation response therapy (RRT) and Reiki therapy, in men being treated with external beam radiotherapy (EBRx) for prostate cancer. METHODS.: Study participants were randomly assigned to weekly RRT, Reiki therapy twice weekly, or wait-list control. Well-validated instruments measured anxiety (STAI), depression (CES-D), and quality of life in cancer patients (FACT-G) at randomization and 3 subsequent time points. RESULTS.: Fifty-four men were randomized, and 16 of 18 (89%) of RRT and 15 of 18 (83%) of Reiki patients completed the intervention protocol. No statistically significant difference was found between the RRT, Reiki, and control groups on total scores for the STAI, CES-D, or FACT-G instruments at any time point. However, at the end of the intervention, significant improvement was found on the emotional well-being subscale of the FACT-G quality of life scale in the RRT group compared with the Reiki and control groups (P = .01). In participants who were classified as "anxious" at baseline, statistically significant improvement occurred in the RRT group (P = .02), and a positive trend was found in the Reiki group (P = .10). CONCLUSIONS.: This pilot study documented the feasibility of conducting a RCT of CAM therapies in men undergoing EBRx for prostate cancer. Relaxation response therapy improved emotional well being and eased anxiety in participants. Reiki therapy also had a positive effect in anxious patients. A larger study to verify and better define the benefits of these therapies in men with prostate cancer is warranted. Cancer 2010. (c) 2010 American Cancer Society.

Beard C, Stason WB, Wang Q, Manola J, Dean-Clower E, Dusek JA, Decristofaro S, Webster A, Rosenthal DS, Benson H. Cancer. 2010 Aug 27. Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts.

The understanding of migraine has moved well beyond its traditional characterization as a "vascular headache." In considering the basic neurobiology of migraine, it is important to begin with the concept of migraine as not merely a headache, but rather a heterogeneous array of episodic symptoms. Among the array of phenomena experienced by migraine patients are visual disturbances, nausea, cognitive dysfunction, fatigue, and sensitivity to light, sound, smell, and touch. These symptoms may occur independently or in any combination, and in some patients occur even in the absence of headache. The diversity and variability of symptoms experienced by migraine patients belies a complex neurobiology, involving multiple cellular, neurochemical, and neurophysiological processes occurring at multiple neuroanatomical sites. Migraine is a multifaceted neurobiological phenomenon that involves activation of diverse neurochemical and cellular signaling pathways in multiple regions of the brain. Propagated waves of cellular activity in the cortex, possibly involving distinct glial and vascular signaling mechanisms, can occur along with activation of brainstem centers and nociceptive pathways. Whether different brain regions become involved in a linear sequence, or as parallel processes, is uncertain. The modulation of brain signaling by genetic factors, and by sex and sex hormones, provides important clues regarding the fundamental mechanisms by which migraine is initiated and sustained. Each of these mechanisms may represent distinct therapeutic targets for this complex and commonly disabling disorder.

Charles A, Brennan KC. Handb Clin Neurol. 2010;97C:99-108.

Full Title: A randomised controlled single-blind trial of the effects of Reiki and positive imagery on well-being and salivary cortisol.

The study investigated whether participants who received Reiki would show greater health and well-being benefits than a group who received no Reiki. A method of blinding participants to Reiki was also tested, where non-contact Reiki or No-Reiki with random assignment was given to 35 healthy psychology undergraduates whose attention was absorbed in one of three tasks involving self-hypnosis/relaxation. Participants experienced ten 20-min intervention sessions over a period of two and a half to 12 weeks. Reiki was directed by the experimenter who sat behind the participants as they were absorbed in the tasks. Self-report measures of illness symptoms, mood and sleep were assessed pre-post-intervention as was salivary cortisol. While the Reiki group had a tendency towards a reduction in illness symptoms, a substantive increase was seen in the No-Reiki. The Reiki group also had a near-significant comparative reduction in stress, although they also had significantly higher baseline illness symptoms and stress scores. The Reiki blinding was successful - the groups did not differ statistically in their beliefs regarding group membership. The results are suggestive that the Reiki buffered the substantive decline in health in the course of the academic year seen in the No-Reiki group.

Brain Res Bull. 2010 Jan 15;81(1):66-72. Bowden D, Goddard L, Gruzelier J. Psychology Department, Goldsmiths, University of London, ITC Building, New Cross, London SE14 6NW, United Kingdom. deborahebowden@hotmail.co.uk

BACKGROUND: Between 75-90% of nursing home (NH) residents with dementia develop behavioral symptoms (BSD) which may be associated with a stress response. Therapeutic touch has been shown to decrease restlessness in NH residents, however the mechanism is unknown. The purpose of this randomized controlled trial (RCT) was to examine the effect of therapeutic touch on BSD and basal cortisol levels among NH residents with dementia. PARTICIPANTS AND METHODS: Using a double blind experimental interrupted time series ABAB design, 65 participants were assigned to one of three groups. The experimental group received therapeutic touch with contact on the neck and shoulders delivered twice daily for 3 days (administered over 2 separate treatment periods); the placebo group received a mimic treatment identical in appearance, and the control group received routine care. Study outcomes were BSD, measured by the modified Agitated Behavior Rating Scale (mABRS), and salivary cortisol levels, measured by enzyme-linked immunosorbent assay (ELISA). RESULTS: 64 residents, aged 67-93 years (M = 85.5, SD = 5.50), completed the study. Restlessness was significantly reduced in the experimental group compared to the control group (p = 0.03). There was a significant difference in morning cortisol variability among groups across time periods (<0.0001). Findings suggest that therapeutic touch may be effective for management of symptoms like restlessness coupled with stress reduction. At a time when cost containment is a consideration in health care, therapeutic touch is an intervention that is non-invasive, readily learned, and can provide a non-pharmacologic alternative for selected persons with BSD. Copyright 2009 S. Karger AG, Basel.

Forsch Komplementmed. 2009 Jun;16(3):181-9. Epub 2009 Jun 5. Woods DL, Beck C, Sinha K. School of Nursing, University of California Los Angeles, CA 90095-6919, USA. lwoods@sonnet.ucla.edu

PURPOSE: To better understand how Therapeutic Touch can be used in today's health care arena, this integrative literature review will examine current research that will help answer the question, Does Therapeutic Touch reduce pain? METHOD: An extensive search was conducted of the online databases MEDLINE, CINAHL, Cochrane Library, EMBASE, PsychLIT, and PubMed to retrieve research articles published from 1997 to 2007. FINDINGS: Seven studies that were conducted between 1997 and 2004 were found and only five of the seven were included as pertinent evidence to answer the question. All of the research that was reviewed to answer whether Therapeutic Touch could significantly reduce pain revealed a majority of statistically significant positive results for implementing this intervention.

CONCLUSION: Because there are no identified risks to Therapeutic Touch as a pain relief measure, it is safe to recommend despite the limitations of current research. IMPLICATIONS: Therapeutic Touch should be considered among the many possible nursing interventions for the treatment of pain.

J Holist Nurs. 2009 Jun;27(2):85-92. Epub 2009 Mar 19. Monroe CM. New York University, USA. carolynmonroe2008@hotmail.com

Full Title: Effectiveness of the application of therapeutic touch on weight, complications, and length of hospital stay in preterm newborns attended in a neonatal unit

OBJECTIVE: To determine the effectiveness of therapeutic touch on weight, the presence of postnatal complications, and length of hospital stay in preterm newborns, as well as on parental satisfaction with the care provided. METHOD: We performed an experimental study in the Neonatal Intensive Care Unit of the Virgen Macarena University Hospital in Seville (Spain). Seventy eight premature neonates were randomly assigned to one of the comparison groups (39 in the control group and 39 in the experimental group). The outcome variables of weight, length of hospital stay, the presence of complications, and parental satisfaction were evaluated. Control variables related to maternal socio-demographic and clinic characteristics were also measured. The intervention was based on the application of therapeutic touch. RESULTS: The mean weight in grams was 1,867.80 (SD=149.72) in the experimental group and 1,860 (SD=181.92) in the control group (t=0.148; p=0.883). Length of hospital stay was 16.82 (SD=6.47) in the experimental group and 20.30 (SD=8.04) in the control group (t=2.100; p=0.039). Complications developed in 5.3% of the premature neonates in the experimental group and in 20% of those in the control group (chi(2)=3.78; p=0.049). The odds ratio for developing complications was 1.673 (CI 1.089-2.571). CONCLUSIONS: The application of therapeutic touch reduces the length of hospital stay and the presence of complications. Nevertheless, further research in larger samples is required.

Enferm Clin. 2009 Jan-Feb;19(1):11-5. Epub 2009 Feb 6. Domínguez Rosales R, Albar Marín MJ, Tena García B, Ruíz Pérez MT, Garzón Real MJ, Rosado Poveda MA, González Caro E. Hospital Universitario Virgen Macarena, Sevilla, España.

Full Title: A double-blind randomized controlled pilot trial examining the safety and efficacy of therapeutic touch in premature infants

PURPOSE: To explore the hypothesis that nontouch therapy such as therapeutic touch (TT) reduces stress to a clinically important degree and is safe to use in preterm infants. DESIGN: A pilot randomized, double-blind, controlled trial. SUBJECTS: Two groups of 10 infants were enrolled and randomly assigned to treatment or nontreatment groups. Gestational age was less than 29 weeks. Demographic descriptions of the 2 groups were statistically similar. METHODS: The observer and staff were blinded to assignment; the TT practitioner was blinded to observed measurements. Each infant received either TT or no therapeutic touch (NTT) for 5 minutes on 3 consecutive days at the same time of day, behind a curtain. Heart period variability (HPV) was measured 5 minutes before, during, and after the treatment phase. RESULTS: Examination of the parameters of oxygen saturation and episodes of apnea demonstrated no increase in adverse events in TT group compared with NTT group. Repeated-measures multivariate analysis of variance on HPV revealed differences in the interaction of group assignment with low-frequency, high-frequency, and low-to-high- frequency ratio interaction (F2,143 = 8.076, P = .000) and for group, day, and low-frequency, high-frequency, and low-to-high-frequency ratio (F2,288 = 3.146, P = .015), and in the posttreatment time period (F1,16 = 6.259, P = .024), reflective of greater parasympathetic activity in TT group. CONCLUSION: In this pilot trial, HPV showed an increase for the TT group compared with the NTT group. The study reveals no adverse effects of TT in preterm infants.

Adv Neonatal Care. 2008 Dec;8(6):315-33. Whitley JA, Rich BL. Neonatal Nurseries, McMaster Children's Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada. julie4453@cogeco.ca

This is quantitative research conducted with 42 students of a public university using the Therapeutic Touch - Krieger-Kunz Method and the application of a questionnaire validated in Brazil to assess anxiety in three sessions. Subjects were divided into two groups: experimental (1), in which the complementary therapy was used; and control (2), in which a mock of the technique, with no therapeutic intention, was applied. The objective was to identify the gradual influence of that health complementary therapy upon the students' state of anxiety. The analysis of the data showed a statistically significant reduction of the state of anxiety in both groups, with pd' 0.05.

Rev Bras Enferm. 2008 Nov-Dec;61(6):841-6. Gomes VM, Silva MJ, Araújo EA. Departamento de Enfermagem Médico-Cirúrgica, Escola de Enfermagem, Universidade de São Paulo, São Paulo, SP.

by Barbara Goulding, RM

I would like to start off by talking about touch healing with Reiki energies. There are various positions used by the healer or practitioner to use in a healing session. Many practitioners would choose to use the touch method as it's more personal and gives the energy a direct contact with the client. The typical session starts out at the top of the client's head and works it's way down the body as directed by the energy needed by the client and sometimes by the practitioner. The typical session lasts 45 minutes for a full body healing session. How long the sessions are would be determined by the practitioner and considering the needs of the client involved. There are sessions that can be done from a chair with the client in an upright position and the healer works at the shoulder level during that session. Other sessions are done on a Reiki or massage table where the client is laying down on their back and the healer works from the top of the head and down the length of the client to the feet. In either case it is up to the client to decide what is most comfortable for them.

I prefer to use the hands-off method of healing as it's good for those who have a fear of another person being in their body space. The energy works with the body's auric system or etheric body and flows to where it is needed most anyway. The healer then works their hands two inches above the client and is guided either by the energies or intuition as to where to move the hands to next. The method does not matter in either case because the healing energies go to where they are needed by the client and that is what is done in all sessions.

[More]

To better understand how Therapeutic Touch can be used in today's health care arena, this integrative literature review will examine current research that will help answer the question, Does Therapeutic Touch reduce pain? Method: An extensive search was conducted of the online databases MEDLINE, CINAHL, Cochrane Library, EMBASE, PsychLIT, and PubMed to retrieve research articles published from 1997 to 2007. Findings: Seven studies that were conducted between 1997 and 2004 were found and only five of the seven were included as pertinent evidence to answer the question. All of the research that was reviewed to answer whether Therapeutic Touch could significantly reduce pain revealed a majority of statistically significant positive results for implementing this intervention. Conclusion: Because there are no identified risks to Therapeutic Touch as a pain relief measure, it is safe to recommend despite the limitations of current research. Implications: Therapeutic Touch should be considered among the many possible nursing interventions for the treatment of pain.

J Holist Nurs. 2009 Mar 19. Monroe CM.

The purpose of this study was to investigate the effects of non-contact therapeutic touch on post-surgical pain in an elderly population receiving occupational therapy in an acute care hospital unit in the United States. Ninety participants were randomly assigned to three groups (experimental, control and placebo) using a three-group experimental pre-test-post-test design and a randomized clinical trial. The experimental group received the non-contact touch intervention, the control group received routine care and the placebo group received the sound of a metronome set at a steady slow pace. Objective measures included the Memorial Pain Scale, the Tellegen Absorption Scale, the Health Attribution Scale and measures of pulse rate and pupil size, which were performed as repeated measures. In the experimental group, 22 out of 30 (73%) demonstrated a statistically significant decrease in pain intensity scores from pre-test to post-test (t [7] = 7.24, p < 0.01) and were better able to participate in occupations. Further research is recommended to replicate this study. 2009 John Wiley & Sons, Ltd

Occup Ther Int. 2009;16(1):44-56. McCormack GL. Department of Occupational Therapy and Occupational Science, University of Missouri-Columbia, Columbia, MO 65211-4240, USA. mccormackg@health.missouri.edu

To explore the hypothesis that nontouch therapy such as therapeutic touch (TT) reduces stress to a clinically important degree and is safe to use in preterm infants. DESIGN: A pilot randomized, double-blind, controlled trial. SUBJECTS: Two groups of 10 infants were enrolled and randomly assigned to treatment or nontreatment groups. Gestational age was less than 29 weeks. Demographic descriptions of the 2 groups were statistically similar. METHODS: The observer and staff were blinded to assignment; the TT practitioner was blinded to observed measurements. Each infant received either TT or no therapeutic touch (NTT) for 5 minutes on 3 consecutive days at the same time of day, behind a curtain. Heart period variability (HPV) was measured 5 minutes before, during, and after the treatment phase. RESULTS: Examination of the parameters of oxygen saturation and episodes of apnea demonstrated no increase in adverse events in TT group compared with NTT group. Repeated-measures multivariate analysis of variance on HPV revealed differences in the interaction of group assignment with low-frequency, high-frequency, and low-to-high- frequency ratio interaction (F2,143 = 8.076, P = .000) and for group, day, and low-frequency, high-frequency, and low-to-high-frequency ratio (F2,288 = 3.146, P = .015), and in the posttreatment time period (F1,16 = 6.259, P = .024), reflective of greater parasympathetic activity in TT group. CONCLUSION: In this pilot trial, HPV showed an increase for the TT group compared with the NTT group. The study reveals no adverse effects of TT in preterm infants.

Adv Neonatal Care. 2008 Dec;8(6):315-33. Whitley JA, Rich BL. Neonatal Nurseries, McMaster Children's Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada. julie4453@cogeco.ca

Fibromyalgia is a common, chronic pain condition for which patients frequently use complementary and alternative medicine, including Reiki. Our objective was to determine whether Reiki is beneficial as an adjunctive fibromyalgia treatment. DESIGN: This was a factorial designed, randomized, sham-controlled trial in which participants, data collection staff, and data analysts were blinded to treatment group. SETTING/LOCATION: The study setting was private medical offices in the Seattle, Washington metropolitan area. SUBJECTS: The subjects were comprised 100 adults with fibromyalgia. INTERVENTION: Four (4) groups received twice-weekly treatment for 8 weeks by either a Reiki master or actor randomized to use direct touch or no touch (distant therapy). OUTCOME MEASURES: The primary outcome was subjective pain as measured by visual analog scale at weeks 4, 8, and 20 (3 months following end of treatment). Secondary outcomes were physical and mental functioning, medication use, and health provider visits. Participant blinding and adverse effects were ascertained by self-report. Improvement between groups was examined in an intention-to-treat analysis. RESULTS: Neither Reiki nor touch had any effect on pain or any of the secondary outcomes. All outcome measures were nearly identical among the 4 treatment groups during the course of the trial. CONCLUSION: Neither Reiki nor touch improved the symptoms of fibromyalgia. Energy medicine modalities such as Reiki should be rigorously studied before being recommended to patients with chronic pain symptoms.

J Altern Complement Med. 2008 Nov;14(9):1115-22. Assefi N, Bogart A, Goldberg J, Buchwald D. Department of Medicine, University of Washington, Seattle, WA, USA.

This pilot study explored the experience of participating in a Therapeutic Touch practice group. A qualitative descriptive-exploratory method was used, involving 12 members of practice groups in Ontario and British Columbia, Canada. Analysis of the data using an extraction-synthesis process yielded four themes: (a) learning with others through sharing and hands-on experience is valued; (b) connecting with a network of supportive relationships that sustain self and Therapeutic Touch practice; (c) comfort-discomfort arising with self, others, or ideas; and (d) meaningful changes emerge while experiencing group energy and Therapeutic Touch. The findings expand current knowledge about the positive aspects of participating in practice groups and provide a beginning understanding of member discomfort, which had not been previously reported. This knowledge will be useful to Therapeutic Touch organizations, practice group leaders, and group members. It will also guide health care agencies and practitioners of other healing modalities who may be considering establishing practice groups.

J Holist Nurs. 2008 Sep;26(3):161-8; discussion 169-72. Moore T, Ting B, Rossiter-Thornton M. The Centre for Movement Disorders, Markham, Ontario. tmooremscn@rogers.com

Pain is a global public health problem affecting the lives of large numbers of patients and their families. Touch therapies (Healing Touch (HT), Therapeutic Touch (TT) and Reiki) have been found to relieve pain, but some reviews have suggested there is insufficient evidence to support their use.

OBJECTIVES: To evaluate the effectiveness of touch therapies (including HT, TT, and Reiki) on relieving both acute and chronic pain; to determine any adverse effect of touch therapies. SEARCH STRATEGY: Various electronic databases, including The Cochrane Library, MEDLINE, EMBASE, CINAHL, AMED and others from their inception to June 2008 were searched. Reference lists and bibliographies of relevant articles and organizations were checked. Experts in touch therapies were contacted.

SELECTION CRITERIA: Randomized Controlled Trials (RCTs) or Controlled Clinical Trials (CCTs) evaluating the effect of touch on any type of pain were included. Similarly, only studies using a sham placebo or a 'no treatment' control was included.

DATA COLLECTION AND ANALYSIS: Data was extracted and quality assessment was conducted by two independent review authors. The mean pain intensity for completing all treatment sessions was extracted. Pain intensity from different pain measurement scales were standardized into a single scale. Comparisons between the effects of treatment groups and that of control groups were made.

MAIN RESULTS: Twenty four studies involving 1153 participants met the inclusion criteria. There were five, sixteen and three studies on HT, TT and Reiki respectively. Participants exposed to touch had on average of 0.83 units (on a 0 to ten scale) lower pain intensity than unexposed participants (95% Confidence Interval: -1.16 to -0.50). Results of trials conducted by more experienced practitioners appeared to yield greater effects in pain reduction. It is also apparent that these trials yielding greater effects were from the Reiki studies. Whether more experienced practitioners or certain types of touch therapy brought better pain reduction should be further investigated. Two of the five studies evaluating analgesic usage supported the claim that touch therapies minimized analgesic usage. The placebo effect was also explored. No statistically significant (P = 0.29) placebo effect was identified.

AUTHORS' CONCLUSIONS: Touch therapies may have a modest effect in pain relief. More studies on HT and Reiki in relieving pain are needed. More studies including children are also required to evaluate the effect of touch on children.

Cochrane Database Syst Rev. 2008 Oct 8;(4):CD006535. So PS, Jiang Y, Qin Y. Surgery, Prince of Wales Hospital, Ward 3D, Prince of Wales Hospital, Ngan Shing Street Shatin, Hong Kong, Hong Kong, China, HKSAR. Sophiaso@gmail.com

Complementary and alternative medicine (CAM) techniques are commonly used in hospitals and private medical facilities; however, the effectiveness of many of these practices has not been thoroughly studied in a scientific manner. Developed by Dr. Dolores Krieger and Dora Kunz, Therapeutic Touch is one of these CAM practices and is a highly disciplined five-step process by which a practitioner can generate energy through their hands to promote healing. There are numerous clinical studies on the effects of TT but few in vitro studies. Our purpose was to determine if Therapeutic Touch had any effect on osteoblast proliferation, differentiation, and mineralization in vitro. TT was performed twice a week for 10 min each on human osteoblasts (HOBs) and on an osteosarcoma-derived cell line, SaOs-2. No significant differences were found in DNA synthesis, assayed by [(3)H]-thymidine incorporation at 1 or 2 weeks for SaOs-2 or 1 week for HOBs. However, after four TT treatments in 2 weeks, TT significantly (p = 0.03) increased HOB DNA synthesis compared to controls.

Immunocytochemistry for Proliferating Cell Nuclear Antigen (PCNA) confirmed these data. At 2 weeks in differentiation medium, TT significantly increased mineralization in HOBs (p = 0.016) and decreased mineralization in SaOs-2 (p = 0.0007), compared to controls. Additionally, Northern blot analysis indicated a TT-induced increase in mRNA expression for Type I collagen, bone sialoprotein, and alkaline phosphatase in HOBs and a decrease of these bone markers in SaOs-2 cells. In conclusion, Therapeutic Touch appears to increase human osteoblast DNA synthesis, differentiation and mineralization, and decrease differentiation and mineralization in a human osteosarcoma-derived cell line. (c) 2008 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

J Orthop Res. 2008 Nov;26(11):1541-6. Jhaveri A, Walsh SJ, Wang Y, McCarthy M, Gronowicz G. Department of Orthopaedics, University of Connecticut Health Center, Farmington, Connecticut 06030-3105, USA.

CONTEXT: The use of complementary therapies in conjunction with conventional care has great potential to address patient pain, complication rates, and recovery time. Few studies of such therapies have been conducted in hospital settings where some of the most stressful procedures are performed on a regular basis. OBJECTIVE: We hypothesized that patients receiving healing touch (HT) would see improved outcomes. DESIGN: Patients were randomized into 1 of 3 treatment groups: no intervention, partial intervention (visitors), and an HT group. SETTING: This study was conducted in an acute-care hospital in a large metropolitan area. PATIENTS OR OTHER PARTICIPANTS: Patients undergoing first-time elective coronary artery bypass surgery were invited to participate. There were 237 study subjects. INTERVENTION: HT is an energy-based therapeutic approach to healing that arose out of nursing in the early 1980s. HT aids relaxation and supports the body's natural healing process. MAIN OUTCOME MEASURES: This study consisted of 6 outcome measures: postoperative length of stay, incidence of postoperative atrial fibrillation, use of anti-emetic medication, amount of narcotic pain medication, functional status, and anxiety. RESULTS: Analysis was conducted for all patients and separately by inpatient/outpatient status. Though no significant decrease in the use of pain medication, anti-emetic medication, or incidence of atrial fibrillation was observed, significant differences were noted in anxiety scores and length ofstay. All HT patients showed a greater decrease in anxiety scores when compared to the visitor and control groups. In addition, there was a significant difference in outpatient HT length of stay when compared to the visitor and control groups.

MacIntyre B, Hamilton J, Fricke T, Ma W, Mehle S, Michel M. Cardiovascular Telemetry, HealthEast Saint Joseph's Hospital, St Paul, Minnesota, USA. Altern Ther Health Med. 2008 Jul-Aug;14(4):24-32.