Managing Pain With Light Therapy and Therapeutic Touch
Cathy Gatto Brennan
July 29, 2018
Abstract
Pain management is receiving renewed attention in light of the negative side effects of opiods that are currently the treatment of choice for pain management. A search for effective, safe treatment options has the medical field looking to complementary and alternative medicine for solutions. These treatments are not widely known and most are not covered by medical insurance making them less accessible to the general public. Reviewing the research for these modalities can provide an opportunity for education on efficacy and appropriate application for specific symptomology for patients.
Introduction
Pain management is a serious health concern. Chronic pain has been linked to disability, depression, lower quality of life, and high medical costs (Steinberg, Rees, Porter, & Oaklander, 2016). The use of opioids in treating pain, which has been linked to overdose and addiction, has been declared an epidemic. Complementary Alternative Medicine (CAM) offers numerous possible treatments with little to no side effects. These treatments can be applied in a variety of settings, are noninvasive, and generally low cost. Mehl-Madrona, Mainguy, & Plummer (2016) looked at the cost-effectiveness of offering a group facilitated program consisting of CAM techniques to reduce opiate use in patients with chronic pain. The program consisted of a check-in, physical activity, and meditation or guided imagery. They showed a significant decrease in opiate use in the test group while the control had an increase in opiate use. The study showed a break-even for the cost of the group. The use of CAM holds promise in an integrated approach to pain management.
This paper will explore two areas of biofield treatment, light therapy and biofield therapy such as Reiki, Healing Touch, and Therapeutic Touch as they pertain to pain management. Light therapy delivered in the form of low emission diode (LED) and light amplification by stimulation of emitted radiation (laser) will be explored. The biofield therapies while similar have differing philosophies and training, so for simplicity Therapeutic Touch was the modality chosen to be examined in this paper. These modalities were used in managing pain independently and in conjunction with other methods including as a bridge to decrease opioid use. There is an educational component that influences the use of these modalities, particularly around the time needed by the participant to engage in the treatment compared to the less time-intensive addition of medication to the treatment plan.
Light Therapy
Light therapy comes in a wide array of formats. The two primary modes of delivery are through the skin and the eye. Light is a form of electromagnetic energy. Low-level light therapy induces photobiostimulation and photobiomodulation. Light is applied with specific wavelength, frequency, intensity, and timing. Light wavelengths, the distance between one peak and the next peak in a wave, are measured in nanometers and specific wavelength ranges are associated with different colors. The frequency of light, the speed divided by the wavelength is measured in hertz. The intensity, the amount of light energy delivered to an area, is measured in joules/cm2. The time is the length of time the light is applied to the area. These variables play a role in the type of response elicited. A laser uses coherent light where the photons are all on the same frequency and the light is not widely dispersed. LED light uses incoherent light where the photons are at different frequencies and the light is widely dispersed (de Moraes Prianti et al., 2018). Light therapy is used for depression, wound healing, pain, inflammation, mood stabilization, skin regeneration, acne, and cell repair (Hamblin & Demidova, 2006). The research is showing mixed results in part due to variable dosages and application methods. The application of light therapy for both acute and chronic pain has seen positive results. The added benefit of decreased inflammation and increased oxygenation may be a factor in those results. There is some evidence that points to improved results with two or more lower dose treatments rather than a single larger dose treatment. LED light use generally uses a broader delivery method. The exact mechanism of photobiostimulation and photobiomodulation is not fully understood. It is thought to involve mitochondria, which increases ATP production. There is also a modulation of cytokine production and reactive oxygen species, which act to sensitize nociceptive neurons decreasing the sensation of pain (Martins et al., 2016). Laser light treatment, because it is coherent and highly focused, can also be used on acupressure points to stimulate the flow of energy in specific meridians. Light therapy is considered to be a safe modality. Skin irritation can be a side effect but because the light is not thermal burns are not generally a concern. Care should be taken around the eyes. There are a wide variety of devices that are used to deliver light therapy including FDA-approved medical devices and home use devices. Consulting a trained practitioner, particularly in determining the proper dosing for the condition being treated, enhances safety and efficacy.
Therapeutic Touch
According to the Therapeutic Touch International organization (2018), Dolores Krieger and Dora Kunz founded therapeutic Touch (TT) in 1973. TT is based on the concept that human beings are energy-based and an interruption in energetic flow results in symptoms and disease processes. A trained TT practitioner uses their hands to palpate the client’s energy field. The process used by TT practitioners has five stages. The first is to center themselves into a state of focused consciousness. The next stage is to assess the clients’ energy field by holding their hands 2- 6 inches above the clients body and palpating the energy field from head to toe. The third stage is clearing where the TT practitioner creates a symmetrical energy flow for the client by smoothing energy from the center of the body outward and from head to toe. The TT practitioner then intentionally uses universal energy to rebalance specific areas that, when palpating felt blocked, by holding their hands over the specific area. The session is then closed. During the process, there is communication between the client and TT practitioner, which informs the process. A TT treatment generally lasts 15 – 20 minutes. TT practitioners receive 12 hours of basic training, 14 hours of intermediate training, and a year of mentoring before being approved to practice independently.
The results of TT research has been mixed with some research showing success but having difficulty in replicating the results. The quality of the research is also called into question. A significant barrier is the effect of a sham practitioner may still influence a clients energy field. There is at this point in time no standard methodology to measure the human energy field making it difficult to measure energetic results. TT has been shown to increase the relaxation response, stimulate the immune system, improve side effects for chemotherapy and radiation, and decrease pain levels (Jamison, & Grohman, 2015). It is considered a safe modality with virtually no direct side effects. The largest complaint is the perception of giving false hope and influencing patients to seek alternative therapies rather than allopathic medicine. The philosophy of TT is to support the human energy system in collaboration with other treatments. This is unfounded in a medical model of integrated health where patients are given unbiased information on all available treatments and encouraged to actively participate in their plan of care.
Applications of Low-Level Light Therapy for Acute and Chronic Pain
The use of low-level light therapy has application for both chronic and acute pain. Mu-Lien et al. (2016) studied the use of laser acupuncture for chronic low back pain. They had 40 participants, half in the laser acupuncture and cupping group and half in a sham laser acupuncture and cupping group. Both groups were treated for 10 minutes to the Weizhong acupuncture points between the hours of 3 p.m. and 6 p.m. for six consecutive days. The laser group received a monochromatic, coherent, 808 nm, 40 mW, 20Hz, 15 J/cm2 laser treatment to the acupuncture points. In the sham group the laser machine was nonfunctional. The measures used were the visual analog scale (VAS) and plasma cortisol levels. Plasma cortisol levels were measured at baseline and after the five days of treatment. The VAS was measured at baseline and each day 15 minutes after the treatment. All participants wore dark glasses to shield their vision of the machine. Both groups showed a statistically significant decrease in plasma cortisol levels with a greater decrease in the laser group. The laser groups also showed a statistically significant decrease in the VAS scores after days four and five. The premise of the study was that low back pain originates from low yang energy by increasing the qi circulation on the bladder meridian yang energy would increase and low back pain would be decreased or resolved.
Molina-Torres et al. (2016) conducted research with participants having both Fibromyalgia and Temporal Mandibular Disease (TMD). They used a monochromatic, 50 W, 1.5 Hz, 3J/cm2 laser to tender points for two minutes each once a week for 12 weeks. There were two groups of 28 participants. One group received laser treatment the other group wore an occlusal splint for at least eight hours during sleep each day. The measures used were VAS, Wide Spread Pain Index (WPI), Symptom Severity Scale (SSS), Patients Global Impression of Change (PGIC), Pittsburg Quality of Sleep Questionnaire (PSQI), and assessment of mouth opening, vertical overlap of incisors, and joint sounds upon opening and closing mouth. The study did not find any statistically significant differences between the groups. Both groups did show statistically significant improvement in VAS, WPI, SSS, joint sounds, and mouth opening. The occlusal splint group also had a statistically significant improvement in PSQI measures. The use of laser treatment with the chronic pain of the participants was effective and warrants further research.
The use of coherent low-level light, light with wavelengths between 600 – 1000 nm is thought to trigger photon absorption by cellular photon receptors. The Nitric Oxide hypothesis attempts to explain the process induce by light therapy. It states that the nitric oxide within tissues reacts to the light causing vasodilation. This decreases swelling and subsequently pain. It also stimulates reactive oxygen series and cytokines, which aid in the healing of soft tissue (Dima, Francio, Towery, & Davani, 2017). This likely plays a role in the use of lasers for acute pain.
There is evidence that low-level light therapy can diminish acute pain. In patients with acute wrist fracture Acosta-Olivio, Siller-Adame, Tames-Mata, Vilchez-Cavazos, and Pena-Martinez ( 2017) found statistically significant improvements in pain and wrist mobility after receiving laser therapy. They studied 52 participants with similar acute wrist fractures. 26 participants received 980 nm, 50 mW laser treatment to specific acupuncture points on the hands and feet three times per week for 10 sessions. The 26 participants in the control group did not receive laser treatment or a sham treatment. The measures used were the VAS, grip force, and mobility. After the fifth session, the laser group showed a statistically significant decrease in pain and at the end of the study, the laser group showed a statistically significant improvement in wrist mobility compared to the control. The grip force did not show a significant change.
In another study, by Prianti et al. (2018) using a noncoherent LED light at 627nm and 10 J/cm2, the participants sustained acute ankle sprains. All participants were prescribed PRICE – protection, rest, ice, compression, and elevation. 20 were provided with six days of LED light therapy and the other 20 were given a sham LED treatment. The participants could not see the LED machine. Pain levels were assessed at day one, day three, and day six using the VAS and the McGill Pain Questionnaire. The LED light group showed a statistically significant decrease in pain. This result was increased on day three and day six. There was also noted to be a decrease in swelling in the LED light group. De Moraes Prianti et al. (2018) surmised that the soft tissue damage that is prevalent with a sprain is particularly susceptible to low-level light therapy due to the microvascular damage that leads to swelling. The light is readily absorbed by cells and there is an increase in photobiomodulation which enhances circulation reducing swelling. The use of the LED light therapy is cost-effective as the units are less expensive and durable and some are available for individual use at home.
Applications of Therapeutic Touch for Acute and Chronic Pain
TT has applications in pain management for both acute and chronic pain. Aghabati, Mohammadi, & Esmaiel (2010) studied TT as it applied to pain and fatigue in patients with chemotherapy. They studied 90 participants divided into three groups of 30. All participants were female. The TT group received a 30 minute TT treatment daily from 10 a.m. to 10:30 a.m. for five days. The placebo group received a sham TT treatment for 30 minutes daily from 10 a.m. to 10:30 a.m. for five days. The practitioner mimicked the hand movements of TT and mentally counted backward for 100 by sevens during the treatment. The control group received no TT treatment. The measures used were the VAS and the Rhoten Fatigue Scale. The measures were completed before and after each treatment. There was a statistically significant improvement in pain after day one for the TT group. After day 2 both the TT group and the placebo group showed a statistically significant improvement in pain compared to the control. There was a slight improvement in pain for the TT group over the placebo group that decreased until day five when it was marginal. The fatigue ratings showed a similar pattern. Because the TT and placebo groups had a positive linear trend the researchers surmised that a strong placebo effect was present in the TT group. The presence of a practitioner had positive effects on patient symptomology. The intention of the TT practitioner appears to have had minor effects in symptom improvement.
Tabatabaee et al. (2016) conducted a clinical trial using TT with cancer patients. They had 90 participants, all-male, distributed equally between three groups. The TT group received seven TT sessions over a four-week period. The placebo group received seven sham TT sessions over a four-week period. The control received no TT sessions. The measure was the Brief Pain Inventory given at baseline and at the end of the four weeks. There was a statistically significant decrease in the pain scores for the TT group. The control showed no change in scores. The placebo group showed slight decreases in pain scores. The researchers found TT to be an effective complementary treatment for managing pain in cancer patients.
The use of TT with acute pain in neonates was explored by Mir, Vashai, Sadeghi, Boskabadi, & Khorshahi (2018). They studied neonates who were receiving heel sticks. There were 75 neonates separated into three groups of 25. The TT group received a 15 minutes session of TT prior to the heel stick. The warming group received a warm water bottle applied to the heel for five minutes prior to the heel stick. The control group received no intervention prior to heel stick. The measures were the Neonatal Pain Scale, cry, facial expression, and pattern of breathing, hand movement, leg movement, heart rete, and respiration. The neonates heart rate showed a minimal increase in the TT group and the greatest increase in the control group. The respiratory rate increase was the greatest in the warming group. The cry duration in the TT group was statistically significant lower than the other two groups. The warming group had a statistically significant increase in cry duration. The researchers noted that the use of heat might have increased pain receptivity. The use of TT was effective in decreasing pain in the neonate.
A retrospective study on palliative care patients receiving TT was completed by Senderovich et al. (2016) to assess for the viability of a TT program with palliative care patients. The TT was administered twice a week for five to seven minutes. They found that the patients who received the TT treatments expressed an increase in relaxation, a decrease in anxiety, and greater ease in sleeping. The TT practitioner recorded respiratory rates and 39 of the 114 patients showed a decrease in respiratory rate. The subjective comments of the recipients were a noted increase in comfort levels and peace. The researchers made the recommendation to offer a TT program to the palliative care patients.
Therapeutic Touch and Light Therapy Are They Similar?
Both of these modalities use energy to promote healing. The use of light therapy has a more solid scientific basis although it is even noted in the research we do not fully understand the mechanisms that it employs. While TT refers to universal energy, which has not yet been satisfactorily quantified, it is tuning in to the human energy field, which is becoming increasingly more difficult to deny. Despite this difference, both modalities use the subtle energy field to influence health and well-being. The tools of the trade for light therapy are machines that harness and focus low-level light. A person much be taught to utilize the machine. In TT the tools of the trade are human hands, sensation, and intention. These are taught to a practitioner yet at this point in time is not measurable. Both modalities have had success in treating pain with light therapy having more research to support it.
Future research using stringent methodology would be beneficial. The challenge with TT is in applying a sham treatment there is human-to-human interaction which has an effect on the participant psychologically as well as energetically. The call for research using a single modality rather than comparing one modality against another would provide clearer guidance in moving forward with each modality. Another area of research would be the ability for participants to self-treat under the general supervision of a practitioner enabling for enhanced treatment options and self-responsibility in care.
Conclusion
There is evidence of efficacy for both low-level light therapy and TT in acute and chronic pain. These modalities offer viable alternative or adjunct therapies to decrease pain without the significant side effects of many of the current treatments. The use of complementary and alternative therapy in healthcare can support an integrative health model. As Gonella, Garrino, & Dimonte, (2014) report there is a growing body of research that indicates biofield therapies have positive effects for not only pain but anxiety, stress, quality of life, management of chronic illness, and mitigating effects of chemotherapy. Many of these modalities are cost-effective and flexible where they can be administered which can enhance patient outcomes. Many of the biofield therapies could have self-care applications to assist in the prevention and long-term treatment of chronic illness. There is an education component for both medical personnel and recipients. As Mehl-Madrona, Mainguy, & Plummer, (2016) found when they implemented an alternative health approach to opiate use in their practice. The participants were very reluctant to participate preferring to continue with their medication status quo. The time and effort needed to educate is significant and must be addressed to be successful.
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