Approximately 25% of all babies in North America are delivered via Caesarean section (C-section)1
; alleviating pain early is important, as studies have shown that postoperative pain negatively affects a mother's ability to care for and breastfeed her infant.2
To alleviate postoperative pain, opioids are commonly used after C-section.3
For example, codeine, a common opioid, is a prodrug, and it is the relative biotransformation of codeine into morphine by the highly polymorphic cytochrome P450 enzyme 2D6 (CYP2D6) that is the single most important factor determining codeine analgesia in adults. Approximately 5–10% of ingested codeine is converted into morphine; however, this percentage can increase dramatically in individuals who have multiple copies of the CYP2D6 allele.4
We now know that morphine passes into breast milk. In 2005, a published study alerted the medical community to a case where a full-term breast-fed baby died from a morphine overdose as a result of his mother taking Tylenol no 3 with codeine to manage her pain; the mother had several copies of the CYP2D6 allele and had converted more than 10% of codeine into morphine.5 6
Maternal breast milk is considered the optimal nutrition for infants, and the American Academy of Pediatrics recommends exclusive breastfeeding for the first 6 months of life.7
To ensure that all mothers who are recovering from C-sections and wish to breastfeed are able to do so safely, alternatives to opioids are sought.
Several complementary and alternative medicine therapies are used to alleviate pain. In an attempt to reduce or eliminate the need for opioid pain medication, we sought to examine the effect of distant reiki on pain. Reiki, an ancient Japanese form of hands-on healing, used to alleviate pain and depression,8
is classified as an Energy Medicine by the National Center for Complementary and Alternative Medicine (NCCAM).9
Despite being an ancient Japanese practice, reiki is practised by over 1.5 million Americans, and its popularity is growing.10
It was promoted by Dr Oz, prominent cardiothoracic surgeon, host of the Dr Oz Show and frequent Oprah guest, as his ‘ultimate complementary and alternative medicine therapy for 2010.’11
However, while it is commonly practised, there is no agreed-upon theory for how reiki might work, and its mechanism of action is still unknown.8
Reiki practitioners believe that they can direct healing energy through their hands to their patients. To direct this energy, practitioners maintain a meditative presence and place their hands lightly over the person they are treating to aid in the patient's natural ability to heal. Reiki can be practised either proximally, with the patient located beside the practitioner, or distally, with the patient and practitioner in separate locations. Both types of reiki rely on the premise of a universal source of healing energy which a reiki practitioner can direct through intention.
A distant reiki treatment is like distant prayer, in that the practitioners are thinking of their patients from a distance. In distant reiki, reiki practitioners first undertake a specific protocol which allows them to send the healing energy to the patient. Second, practitioners mentally ask the person who is absent if he or she consents to treatment. Lastly, if practitioners do not hear a response or if they hear ‘yes’ in their head, they follow the same procedure as for traditional reiki, but they place their hands on a substitute (eg, pillow) for the person being treated; if they hear ‘no,’ the session ends immediately.
Reiki may work. Several studies have found a reduction in pain when using reiki12–15
; furthermore, one of the studies found that women who received reiki after hysterectomy reported less pain and requested fewer analgesics.12
While there were no studies which specifically evaluated distant reiki for pain, one study found that distant reiki was as effective as traditional reiki in the management of depression and anxiety. The authors concluded that the distant reiki was as efficacious as traditional reiki, and the healing power of reiki was not due to placebo.16
However, despite widespread and growing popularity, there is a dearth of well-conducted published scientific literature supporting or refuting reiki's efficacy. A recent systematic review of reiki found that while the vast majority of studies had positive therapeutic effects, all available studies scored poorly when methodological quality was measured using Jadad8
; thus, definitive conclusions about efficacy could not be made. A common source of potential bias was the lack of blinding of participants and assessors when using traditional reiki. Patient and medical-staff blinding to treatment allocation in a clinical trial is particularly important when the response criteria are subjective, such as alleviation of pain.17
To overcome this limitation, we employed distant reiki in our trial.
Given the need for alternate pain-control treatments for breastfeeding mothers owing to the risk of morphine exposure in neonates, and the reduced pain observed in the women who received reiki after hysterectomy, our objective was to determine if distant reiki is effective in reducing pain after elective C-section, through a randomised double-blinded study.