26 February 2011
Approximately 25% of all babies in North America are delivered via Caesarean section (C-section). Though a common surgical procedure, C-section recovery can be painful. Opioids, specifically codeine, are commonly used to ease pain; however, its active metabolite, morphine, passes into breast milk, and may produce unwanted side effects in neonates; therefore, alternatives to opioids are being sought. Reiki is an ancient Japanese form of healing where practitioners transfer healing energy through light touch and positive healing intention. Although 1.2 million Americans use reiki to reduce pain or depression, there is a lack of strong evidence supporting its effectiveness. A recent systematic review showed existing studies to be of poor methodological quality, with the common limitation of lack of blinding. To overcome this issue, the authors used distant reiki to assess its effectiveness in reducing pain following an elective C-section.
In this randomised, double-blinded study, women who underwent an elective C-section were allocated to either usual care (control, n=40) or three distant reiki sessions in addition to usual care (n=40). Pain was assessed using a visual analogue scale (VAS). The primary endpoint was the Area Under the VAS-Time Curve (AUC) for days 1–3. Secondary measures included: the proportion of women who required opioid medications and dose consumed, rate of healing and vital signs.
AUC for pain was not significantly different in the distant reiki and control groups (mean±SD; 212.1±104.7 vs 223.1±117.8; p=0.96). There were no significant differences in opioid consumption or rate of healing; however, the distant reiki group had a significantly lower heart rate (74.3±8.1 bpm vs 79.8±7.9 bpm, p=0.003) and blood pressure (106.4±9.7 mm Hg vs 111.9±11.0 mm Hg, p=0.02) post surgery.
We engaged a highly experienced reiki master to administer distant reiki removing the placebo effect which was present in all other pain trials. In addition, we maintained a high adherence to protocol, successful blinding of the research team, successful randomisation and patient allocation concealment, and diligent data collection with extremely few data points missed. We had good credibility with research participants, as all but 10 women refused to participate. We evaluated other aspects of healing after elective Caesarean section, beyond patients' perceived pain levels, by including the previously developed and published Milestone Questionnaire.
A potential limitation was the magnitude of pain on which we were attempting to show an impact. Just as acetaminophen is not suitable as pain medication after Caesarean section, distant reiki may also not be suitable for this magnitude of pain. In addition, since some patients were discharged early, our complete dataset is limited to 48 h, with gaps in data for 16 patients (20%) accounted for by carrying the last pain score forward. To ensure that this method did not distort the results, we also evaluated AUC for pain on day 1 and day 2 individually and found no differences between groups for both these time periods.