Dosing, Cancer and Reflexology

"Dose: exact amount of a medicine or extent of some other treatment to be given or taken at one time or at stated intervals." Webster's New World Dictionary

Thanks to the work of Dr. Nancy Stephenson, the concept of dosing has come to reflexology. Dr. Stephenson, associate professor of nursing at Eastern Carolina University in Greenville, NC and certified reflexologist, has conducted four studies exploring specific aspects of reflexology work applied to alleviate pain with cancer patients. Through her research she has established "dosing" parameters, how much reflexology is applied to what effect. In addition, she has demonstrated that "partners," trained family members, can reduce the pain of a cancer patient.

Such work makes Dr. Stephenson's studies unique among twenty-one studies about reflexology and cancer. All show significant improvements in physical and emotional symptoms of those experiencing cancer, specifically demonstrating that reflexology aids cancer care: lessens pain; decreases nausea, vomiting and fatigue; improves quality of life and quality of sleep; lifts mood; and lessens anxiety and stress.

Dr. Stephenson's interest in reflexology started during her doctoral studies at the University of South Carolina at Columbia when a committee member suggested she write an article about reflexology. Over the following year, she became certified by the International Institute of Reflexology and then expanded her interest in reflexology to research.

For her doctoral dissertation, Dr. Stephenson "used a crossover design to compare reflexology with usual care in 23 inpatients with cancer." Her results found a significant decrease in pain and anxiety for those who received a reflexology session compared to those who had not. See (1). For her postdoctoral studies at the University of North Carolina at Chapel Hill she studied 36 patients with cancer and "found a significant decrease in pain and anxiety immediately following the intervention (reflexology)... (establishing) a dosage time of 30 minutes."

In further research of effects and duration, she found that reflexology work created a positive and immediate effect on pain with effects dissipated both at 3 hours and 24 hours after intervention. Such work establishes a frequency of application effectiveness and duration for a 30-minute reflexology session. One could say that, just as a dose of pain medication is administered, so too could be a "dose" of reflexology. Now that Stephenson's research has established a three hour window of impact, an effective "dose" could be administered every 3 hours. (2)

The importance of Stephenson's work is in the discussion of dosing in the application of reflexology. While Chinese researchers speak in terms of frequency, duration and intensity in the application of reflexology, encompassing such ideas into the term "dosing" brings reflexology more in line with recognized concepts. Her work specifically addresses cancer care but opens the door for reflexologists to approach their work in any number of situations. After all, a common question for the reflexologist from a client or prospective client is: How long do you think this is going to take? With concrete information from research, the reflexologist can speak with authority to answer the question. (For "dosing" information garnered from research for some 78 health concerns, see Evidence-Based Reflexology for Reflexologists.)

Following another unique course of research, Dr. Stephenson found that, following reflexology work by trained family members (partners), "patients experienced a significant decrease in pain intensity (37%) and anxiety (62%)." (3)

This study addresses important issues of concern: the cost of medical care and the availability of pain reduction when it is needed. "An advantage of teaching partners to implement reflexology is that they are readily available when patients need an intervention and, unlike healthcare providers, partners do not require payment or reimbursement for therapy. Furthermore, patients could continue to receive therapy from partners after being discharged from the hospital. Partner-delivered reflexology provides opportunities for discussion and communication about pain assessment and decisions, mutual goal-setting, and control of pain relief strategies....

Moreover, Dr. Stephenson's research with partner's reflexology specifically demonstrates how reflexology can proved something medicine can't. "In addition to pain and anxiety relief, some of the reflexology partners reported that the experience had social benefits as well. One wife, whose husband died from metastatic melanoma, commented that her husband liked the foot reflexology because it gave them time together during the final three weeks of his life. Another wife commented, months after the death of her husband, "I'm glad that my husband decided to take part in the study. I think it really helped him. I felt so helpless. [Foot reflexology] was one thing that I could do [for him]."

The potential impact of Dr. Stephenson's work is huge for the cancer patient and those concerned with care, in the medical community as well as family members.

Highly recommended is her full research paper on partner reflexology that includes:

(1) Stephenson, N.L., Weinrich, S.P., & Tavakoli, A.S., "The effects of foot reflexology on anxiety and pain in patients with breast and lung cancer," Oncology Nursing Forum, 27, 67-72 (2000)

"This article discusses in detail my second pilot study, the history and definition of reflexology, and how to become certified in reflexology."

(2) Stephenson N, Dalton JA, Carlson J, "The effect of foot reflexology on pain in patients with metastatic cancer," Applied Nursing Research 2003 Nov;16(4):284-6 (PMID: 14608562)

"This article presents results from my third pilot study and includes references for equianalgesic dosing."

(3) Stephenson NL, Swanson M, Dalton J, Keefe FJ, Engelke M. "Partner-delivered reflexology: effects on cancer pain and anxiety," Oncology Nursing Forum 2007 Jan;34(1):127-32. School of Nursing, East Carolina University, Greenville, NC, USA. stephensonn@mail.ecu.edu (PMID: 17562639)

(4) "Researchers Study Reflexology and Its Effect on Cancer Pain" by Crystal Baity (June 8, 2004) (http://www.news.ecu.edu/releases/reflexology.html)

"Stephenson Study Shows Reflexology Delivers Relief" by Crystal Baity (http://www.ecu.edu/cs-admin/news/poe/2007/207/stephenson.cfm)