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 Pain Management in Reflexology

(Carol Samuel, PhD. Cert-Ed, MAR, FFHT)

Although pain is valuable to us because it tells us of impending danger; in its chronic form it serves no useful purpose but it nonetheless affects millions of people worldwide with significant implications on quality of life and on the resources of the medical profession ^{1 2}.  In today's society it appears to be a general consequence of ageing and ill health, thus producing devastating effects for sufferers and their families.  Pain is not however a simple sensory experience; it is also an emotional, social and cognitive one in which it can affect a person's attitude, belief and appraisal of pain.  

It is described by the International Association for the Study of Pain (IASP) as an unpleasant sensation that may be linked to potential or actual tissue damage, and which may possess both physical and emotional experiences. In short, pain is often difficult to describe and sometimes the terminology used cannot, and does not provide justice to the actual pain experience. There are no objective measurements available for pain, no regular blood tests or dipstick tests and that means that it is an extremely personal phenomenon which can be described only by the person experiencing it ^{2 3}. 

In the UK more than 49% of the population experience back pain in any given 12 month period; approximately 90% of these episodes will fix themselves within 6 weeks ⁴.  Nonetheless, pain conditions lasting longer than 3 months (chronic pain) are becoming increasingly difficult to treat and the choice of drug combinations provided in general practice can vary according to the type, location and a patient's personal attitude toward pain relief.  The general rule is to provide pain relieving analgesics at the lowest level appropriate to the patient's pain, and then to move on to a higher potency level until the required relief is obtained ^5-7. 

Patients' may climb the so called ‘analgesic ladder' until they reach a point where they may require a strong opioid-type drug before they acquire any benefit in terms of pain relief.  Alongside this however they may have fears about addiction, tolerance and the lingering side effects of these drugs.  Many are still not receiving adequate pain control and this, unfortunately, has its own set of consequences, not least of which are sleeplessness (65% of pain sufferers) depression (49%), fear and stress ^{2 8}.  Lack of sleep from stress has an effect on the regulation of our immune cells and their function, which means that chronic pain can severely affect the immune system ^9-11.   Stress increases the release of adrenocorticotropic hormones (ACTH) that create metabolic and hormonal changes, further escalating the pain cycle ^{12 13}.  Moreover, because chronic pain is known to induce depression there may be further increases in stress levels ¹⁴. This continual cycle of stress and pain influences immune suppression through the exaggerated release of pro-inflammatory markers ^14-17 which in turn decreases the number of natural killer cells that play a major role in the rejection of tumours and cells infected by viruses ¹⁶.

Patients often have preconceived expectations of pain, particularly if they have had previous experience of pain either personally or through having cared for someone in pain ^{18 19}.    Preconception is associated with negative expectations and when pain control is difficult to achieve it can induce negative attitudes ²⁰.  There is no consistency in pain management across the UK and many primary care facilities lack sufficient funding to be able to offer a variety of services.  Those that do, are unable to keep up with the number of referrals ².

This may all sound rather complex but the science behind chronic pain is not as complicated as it may seem.  Many pain sufferers seek alternative or complementary means of pain relief and reflexology is just one of the many modalities available to them.  We all know that reflexology can be an extremely pleasurable experience but were you aware that pain and pleasure are highly interconnected within the dopamine and endogenous opioid systems of the brain? ^21-23  During noxious (harmful) stimulation an area of the brain known as the Nucleus Accumbens releases endogenous opioids into the hypothalamus which helps to raise the pain threshold ²³.  My research clearly showed that reflexology stimulation (which may be perceived as painful by some clients) increases both pain threshold and pain tolerance ²⁴.

In addition to the pain relieving effects of reflexology, my research also showed that reflexology produces a decrease in heart rate, which suggests that it may also have a beneficial effect on relaxation and stress, and consequently on the immune function.  Whilst reflexology has shown some measureable differences, demonstrating this effect to clients in a meaningful way may be elusive to some practitioners.  Understanding the basic neurophysiology of nociception (pain processing) and providing an effective treatment is important for practitioners; knowing how to measure your clients' pain is vital when a client cannot clearly see the benefits of your treatment.  Evidence shows that emotional responses are based on motivation and reward ^25-27, so in order for your client to truly appreciate the difference your treatment is making, you need to show them.  You can do this by measuring the effectiveness of your treatment, based on your clients' feedback and through the use of pain measurement tools.

My workshop offers you an introduction to Pain Management, it will cover nociception, the use of scales to measure your client's pain, and an introduction to some of the basic Nerve Reflex Points (NRP) for managing neck and back pain.  This workshop is also a great precursor for those of you who wish to further progress your pain management techniques with the use of nerve reflex point therapy taught by Nico Pauly, a Belgian physiotherapist and pain specialist.  For further information on NRP, visit my website www.reflexmaster.co.uk and follow the link under the Reflexology tab or go to http://www.mnt-nr.com/EN/fiche.asp?itemnr=1471.


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19. Coghill RC, MacHaffie JG, Yen YF. Neural Correlates of Interindividual Differences in the Subjective Experience of Pain, 2003.

20. Wiech K, Ploner M, Tracey I. Neurocognitive Aspects of Pain Perception. Cell Press (Review) 2008;Articles in press:1-8.

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22. Urch C. Normal Pain Transmission. Rev Pain 2007;1(1):2-6.

23. Leknes S, Tracey I. A Common Neurobiology for Pain and Pleasure. Nature Neurosci 2008;9:314-320.

24. Samuel CA, Ebenezer IS. Exploratory Study on the Efficacy of Reflexology for Pain Threshold and Tolerance Using an Ice-Pain Experiment and Sham TENS Control. Comp. Ther. Clin. Pract 2013;19:57-62.

25. Esch T, Stefano GB. The Neurobiology of Pleasure, Reward Processes, Addiction and Their Health Implications. Neuroendocrinol Lett 2004;25(4):235-251.

26. Ford G, Finn DP. Clinical Correlates of Stress-Induced Analgesia:  Evidence from Pharmacological Studies. Pain 2008;140:3-7.

27. Becerra L, Borsook D. Signal Valence in the Nucleus Accumbens to Pain Onset and Offset. Eur J Pain 2008;12:866-869.