Saturday, November 7, 2009

Biofield Therapies for Pain: Help or Hype?

Biofield therapies — such as therapeutic touch or healing touch, Reiki, and others — claim to use subtle natural energy for stimulating the body's healing processes and relieving pain. A surprising amount of clinical research has examined the efficacy of these complementary interventions, yet medical practitioners still may be skeptical of their validity.

Concepts of biofield therapies — administered largely by a "laying on of hands" for manipulating an unseen “life force energy” to invoke stress reduction and relaxation that promotes natural healing — are unfamiliar to most Western healthcare providers; some may believe these approaches are frankly outlandish from scientific perspectives. With this in mind, Shamini Jain, from the UCLA Division of Cancer Prevention and Control Research, and Paul J. Mills, from the Department of Psychiatry at the University of California, San Diego, conducted a rigorous systematic review of research into biofield therapies that was recently reported in the International Journal of Behavioral Medicine.

The reviewers identified 15 pain-related clinical trials, most of which examined chronic pain disorders and were randomized placebo-controlled trials (RCTs) of good quality. Overall, the studies suggested a strong level of evidence favoring positive effects of biofield therapies to reduce pain intensity as measured on visual analog scales. Three studies, all high-quality RCTs, examined health-related quality of life (QOL) and found strong evidence of improvements in energy/vitality and physical functioning as a result of therapy. However, 5 studies that incorporated comprehensive pain assessments (eg, the McGill or Multidimensional Pain Inventory) demonstrated inconsistent evidence of biofield therapies benefitting cognitive and functional aspects of pain reduction, and 8 trials examining mood variables (eg, depression, anxiety) reported mixed outcomes for improvements in anxiety and negative mood.

In a separate area of concern, 10 trials looked at biofield therapies for helping patients with cancer and reported moderate evidence for positive effects in relieving acute cancer pain, but conflicting evidence for longer-term benefits of biofield therapies. Similarly, there was a lack of strong evidence favoring these therapies for improving fatigue or quality of life, or in producing relaxation responses in patients with cancer. Looking at investigations of biofield therapies applied in hospitalized patients, 6 trials showed moderate-quality evidence for reductions in acute pain and favorable effects in lowering anxiety, but conflicting evidence for reductions in pain medication consumption.

Commentary: Overall, Jain and Mills conclude that there is strong, good-quality evidence for effects of biofield therapies in decreasing pain intensity in noncancer pain, and moderate evidence to support their short-term analgesic efficacy among patients with cancer or those hospitalized. In some patients, vitality/energy and physical functioning may be improved; however, the evidence is less convincing regarding therapeutic benefits for improving mood or reductions in pain medication consumption.

While the research literature on biofield therapies is not vast, the number of good or high quality clinical trials is surprising when considering the scarcity of research funding for this field. Many of the favorable responses to these therapies might be merely attributed to placebo effects were it not for the fact that most studies were randomized placebo-controlled trials — that is, effects of therapy were significantly better compared with actual placebo. Still, there is much to learn about biofield therapies since there is a lack of large-scale RCTs examining different patient populations having a range of pain conditions, and the research to date has widely varied in methodology. For example, in the many studies examined by Jain and Mills for their review, subjects underwent 1 to 15 healing sessions (mean 4) that ranged from 3 to 90 minutes (mean 23). And, the particular skill or experience of the biofield therapist, as well as the particular technique(s) employed, would seem to be factors that could make significant differences.

Although many traditionally-trained practitioners may remain skeptical, significant numbers of patients apparently seek biofield therapies, often without telling their healthcare providers, and the techniques have been used over millennia in various cultures to allegedly heal physical and mental disorders. In general, complementary and alternative therapies are used by 38% of adults and 12% of children in America, and it is a $34 billion per year business; so, these approaches cannot be easily ignored. The customary caveat — more research is necessary to arrive at definitive conclusions — would seem very appropriate regarding biofield-based therapies for pain. However, as the 16th Century Swiss physician Philipus Aureolus Paracelsus advised, “The art of healing comes from nature, not from the physician. Therefore the physician must start from nature, with an open mind.”

Reference: Jain S, Mills PJ. Biofield therapies: helpful or full of hype? A best-evidence synthesis. Int J Behav Med. 2009(October 24); online ahead of print [access full article here].

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