Reflexology for low back pain: 2008 Annual evidence update

Commentary by Dr George Lewith, University of Southampton


Poole H, Glenn S, Murphy P. A randomised controlled study of reflexology for the management of chronic low back pain. European Journal of Pain. 2007;11(8):878-87. 

Quinn F, Hughes CM, Baxter GD. Reflexology in the management of low back pain: A pilot randomised controlled trial. Complementary Therapies in Medicine. 2008, 16(1):3-8.


Both of these studies involved similar groups of patients with chronic low back pain.  Poole presents a large study (n = 243) in which the patients were randomised to reflexology, relaxation (possibly as an attention control) and treatment as usual. The reflexology was provided by a group of 5 professional and trained reflexologists. They made available 6 treatments of one hour duration over a 6-8 week period. Similarly, relaxation was provided by 4 trained therapists over 6 weeks using progressive muscle relaxation. Treatment as usual involved medication (both prescribed and over the counter), osteopathy, acupuncture, physiotherapy, aromatherapy, sports massage, chiropractic and Reiki. The outcomes were the Oswestry Low Back Pain Questionnaire, Beck Depression Inventory, a Visual Analogue Score for pain and the SF36. All groups showed similar improvement over time in all outcome measures, suggesting that no particular treatment was superior to any other.


Quinn et al. report a small trial of 19 patients designed as a pilot to evaluate reflexology versus a sham procedure. Seven patients received reflexology and 8 sham and outcome was assessed using a combination of visual analogue scale for pain, Roland Morris Disability Questionnaire and McGill Pain Questionnaire. Real or sham treatment was provided weekly over a 6 week period with follow-up at 12 and 18 weeks. Unfortunately there was no real attempt to assess the credibility of the sham procedure but this tiny pilot study does suggest that reflexology may have a specific effect on low back pain.


These two studies, taken together, suggest that there is a possibility that reflexology may have a treatment specific effect but it is unlikely that reflexology offers treatment advantages over other interventions for the management of chronic low back pain. Further work is clearly needed and these conclusions are tentative. 

 

Link back to 2008 Annual evidence update on CAM for low back pain