Effect of Reflexology in Treating Cancer Pain: A Meta-Analysis

Context: Pain is a common symptom associated with cancer and its treatment. The conventional treatment does not often relieve cancer pain optimally. The complementary therapies are increasingly used as adjunct therapy alongside pharmacological and conventional treatments in patients. Objectives: The aim of this systematic review was to investigate the existing evidence for reflexology effect on cancer pain through a meta-analysis. Data Sources: In this systematic review, electronic databases including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and PubMed were searched to find relevant studies until December 2018. Study Selection: We included before-after studies and trials of interventions that focused on pain management using reflexology modality as an intervention in patients with cancer regardless of cancer type. The effect of reflexology for patients with cancer pain was investigated as the main outcome. Data Extraction: The extracted information included name of authors, year of publication, study location, type of study, sample size, andoutcomeindicator. Consensuswasreached by discussion in case of disagreement duringeach stage of selection, qualitative assessment, and extraction of data. We assessed heterogeneity using the I2 statistics. The publication bias was explored using the Egger’s and the funnel plot. We meta-analyzed the data and reported the standardized mean difference (SMD) with 95% confidence intervals (CI) using the random-effects model. Meta-analysis was done using the Revman software. Results: Eight studies with 948 participants were analyzed using a random- effects model meta-analysis. Included studies consisted of five randomized clinical trials, one quasi-experimental, and two pre-post design. We observed a positive effect for reflexology in patients with cancer pain compared with usual care (SMD- 0.55 [95% CI-0.82 to 0.21] P 0.001). Conclusions: This systematic review provides sufficient evidence for the effectiveness of reflexology as an effective treatment in cancer pain. But we recommend conducting studies with larger sample size, well-designed trials with sufficient duration and longer follow-up periods with clear details about reflex practitioners, duration of intervention, instrument for pain assessment, and outcome. Meanwhile, patients should be adequately monitored and adverse effects should be reported. All of the aforementioned issues might affect the impact of reflexology adjuvant treatment.