What is the evidence regarding reflexology's effectiveness in treating specific medical conditions, its key health benefits, and its impact on longevity?

Evidence Regarding Reflexology

Reflexology has limited evidence for effectiveness in most medical conditions, with the strongest (though still weak) evidence supporting its use as an adjunctive therapy for cancer-related pain during systemic treatment and chemotherapy-induced peripheral neuropathy (CIPN), but it should not be considered a primary treatment and has no demonstrated impact on longevity.

Key Health Benefits - Limited and Condition-Specific

Cancer-Related Applications (Strongest Available Evidence)

Pain Management During Systemic Cancer Treatment:

• Reflexology can be incorporated into systemic cancer treatment for pain management 1
• Seven randomized trials showed six with significantly less pain in reflexology groups compared to controls during chemotherapy, chemoradiotherapy, targeted, and/or hormonal therapy 1
• Three larger trials (>90 patients per arm) demonstrated benefit, though methodological quality varied 1
• The Society for Integrative Oncology-ASCO guidelines state reflexology can be incorporated into systemic cancer treatment based on moderate evidence 1

Chemotherapy-Induced Peripheral Neuropathy (CIPN):

• Two small RCTs (approximately 30 patients per arm) evaluated reflexology for CIPN symptoms 1
• One trial showed improvement in sensory functions but no difference in peripheral neuropathy-related pain severity 1
• Aromatherapy self-foot reflexology (three times weekly, 15 minutes per foot, 18 sessions over 6 weeks) showed lower peripheral neuropathy symptoms, less interference with daily activities, higher peripheral skin temperature, and positive effects on mood 1
• Despite low evidence levels, aromatherapy self-foot-reflexology may be considered as part of self-care for CIPN pain to improve patient self-efficacy 1

Quality of Life in Cancer Patients:

• Reflexology can be considered for improving quality of life among breast cancer patients, though evidence strength is rated as "D" (weakest category) 1

Depression and Mood Symptoms - Conflicting Evidence

During Active Cancer Treatment:

• Four RCTs examined reflexology for depressive symptoms with highly conflicting results 1
• Two trials with low risk of bias (N=286 and N=183) in breast cancer patients showed no benefit during chemotherapy or surgery 1
• Two trials in gynecologic cancers (moderate to high risk of bias) showed small benefits: 0.38-point difference on HADS-depression and 18% reduction in BAI 1
• Reflexology may be considered as an adjunct treatment for depressive symptoms only for patients with specific interest in this therapy, but larger high-quality studies are needed 1

General Medical Conditions - Insufficient Evidence

Systematic Review Findings:

• Multiple systematic reviews from 2008-2014 consistently conclude that the best clinical evidence does not demonstrate convincingly that reflexology is effective for any medical condition 2, 3, 4
• A 2011 systematic review of 23 RCTs found nine high-quality RCTs generated negative findings, while only five generated positive findings 2
• A 2009 systematic review of 18 RCTs examining conditions including anovulation, asthma, back pain, dementia, diabetes, cancer, pregnancy-related foot edema, headache, irritable bowel syndrome, menopause, multiple sclerosis, postoperative state, and premenstrual syndrome found most higher-quality trials did not generate positive findings 3
• Only one condition (urinary symptoms associated with multiple sclerosis) showed large treatment effect size; all other conditions showed negligible effect 4

Physiological and Biochemical Outcomes:

• A 2014 systematic review of 17 RCTs examining 34 objective outcome measures found only three studies showed significant between-group changes (blood pressure, cardiac index, salivary amylase) in favor of reflexology 5
• Overall quality of studies was low 5

Treatment of Specific Conditions

Conditions with Some Supporting Evidence (All Low Quality):

Chronic Pain (Non-Cancer):

• One military pain clinic study (N=311) showed median 2-point reduction on 10-point pain scale (43% reduction for males, 41% for females) after single treatment session 6
• This represents immediate post-treatment effect only, with no long-term follow-up 6

Conditions Mentioned in Low-Quality Studies:

• Diabetes, premenstrual syndrome, multiple sclerosis, symptomatic idiopathic detrusor over-activity, and dementia showed some positive results, but important caveats remain regarding study quality 2

Conditions Where Reflexology Should NOT Be Recommended:

Breast Cancer - Depression During Treatment:

• Two well-designed trials (N=286 and N=183) with low risk of bias showed no benefit 1

Most General Medical Conditions:

• Routine provision of reflexology is not recommended for most conditions based on lack of evidence 4

Impact on Longevity

No evidence exists regarding reflexology's impact on longevity. None of the reviewed guidelines, systematic reviews, or randomized controlled trials examined mortality or lifespan as an outcome measure related to reflexology interventions.

Critical Caveats and Common Pitfalls

Methodological Quality Issues:

• Most reflexology studies have small sample sizes (often <50 patients per arm) 1
• High or unclear risk of bias is common across studies 1
• Inconsistent blinding of participants, health professionals, data collectors, and data analysts 1
• Overall quality of evidence is rated as "low" even in the most favorable assessments 1

Safety Profile:

• No side effects were reported in CIPN studies 1
• Potential benefits likely outweigh potential harms given favorable risk-benefit ratio 1

Clinical Implementation Considerations:

• Reflexology interventions varied widely: provided by professional reflexologists versus trained caregivers versus self-administered 1
• Treatment frequency ranged from twice daily for 20 minutes to three times weekly for 15 minutes per foot 1
• Duration of treatment courses ranged from 4-6 weeks 1

When to Consider Reflexology:

• As adjunctive therapy during cancer systemic treatment when patients express interest 1
• For CIPN self-care to improve patient self-efficacy and active participation in care 1
• When conventional pain management has been optimized but symptoms persist 1
• Never as a replacement for evidence-based primary treatments