By Nassim Assefi, MD
Reiki is a form of energy medicine developed in Japan in the late 1800s. According to a vast body of primarily anecdotal literature, it is effective for improving pain and psychological well-being,1-4 while appearing to have few, if any, adverse effects.1,5 Reiki generally is delivered by a practitioner who lightly touches the patient (direct-contact Reiki). Or, Reiki is sent without physical contact with the patient (distant Reiki). With training, Reiki can be self-administered,1 making it a low-cost, low-risk, patient-empowering intervention for chronic conditions.
Although there have been only two small randomized controlled trials of direct-contact Reiki for the treatment of pain and psychological symptoms published to date,3,4 Reiki now is being offered in some hospitals, hospices, and psychotherapy practices in the United States.1 The National Center for Complementary and Alternative Medicine (NCCAM), recognizing the increasing popularity of energy healing in the United States, recently sponsored studies of Reiki for the treatment of diabetic neuropathy and fibromyalgia.
History
Reiki is a Japanese word meaning universal life force. Reiki, like acupuncture, herbal therapies, qigong, and certain forms of massage, is a traditional Asian practice that emphasizes the body’s balanced flow of qi, or vital energy.
Beyond oral history, little has been documented regarding the origins of Reiki. Dr. Mikao Usui, a Japanese monk and educator, is credited with the rediscovery of Reiki in the late 1800s while reading the original Tibetan Buddhist Sutras. The practice of Reiki was limited to Japan until 1935 when a Japanese-American woman, Hawayo Takata, imported Reiki to Hawaii. Takata’s granddaughter, Phyllis Furumoto, founded the Reiki Alliance in 1983 and formalized the training of Reiki into three stages: Reiki I, Reiki II, and Reiki Master.
Training and Certification
Progression through each level involves successful completion of a short course, generally two days to one week in length, followed by practice. There are no prerequisites for Reiki I. Training involves learning the basic hand positions, studying Reiki’s history, and receiving four "attunements" or energy transfers given by a Reiki Master. The Reiki II initiation is achieved at least three months after Reiki I, and includes instruction on focusing Reiki energy, and the delivery of Reiki from a distance. The Reiki Master level, which may be achieved after several years of Reiki practice, implies life-long devotion to healing and qualifies the practitioner to teach Reiki.
Currently, no certification process is required to practice Reiki in the United States, nor is there an objective measure that determines who can progress to Reiki Master. The International Center for Reiki Training reports the initiation of about 100,000 Reiki practitioners since the 1980s.6
Application and Techniques
Direct-contact Reiki between a practitioner of any level and a patient is the most common form of Reiki delivery. This treatment typically is administered with the recipient fully clothed on a treatment table while the practitioner lightly touches designated positions for two to five minutes each. Some patients report deep relaxation during treatment, while others feel more subtle sensations like heat, cold, or tingling. Full treatments may last from 30-90 minutes, although not all positions are necessarily touched during a given Reiki treatment.
There are 13 standard hand positions in direct-contact Reiki—three on the head and neck, four on the thorax and abdomen, and six on the back (see Figure). Depending on the Reiki Master, these may be sub-divided into as many as 15-18 areas.7 The basic positions are hypothesized to correlate with the body’s chakras, meridians, or energy centers. However, many Reiki Masters believe that placement of their hands on any part of body (on so-called auxiliary positions) will result in some therapeutic benefit.7
Distant Reiki purportedly can be delivered in the patient’s presence (i.e., across the room) or from great distances (i.e., across continents). Distant Reiki is taught at the Reiki II level and is optimally administered by Reiki Masters.
Allopathic health care providers have popularized the use of brief Reiki treatments, such as the touching which may naturally occur between a primary care provider and patient during the course of a physical examination.1,2 Reiki also can be self-administered, which both reduces the cost of treating chronic conditions and enhances patients’ sense of self-esteem and control over their symptoms.
Mechanism of Action
To date, there is no biomedical explanation for the reported beneficial effects of Reiki, although many theories such as bioelectromagnetic field emission from human touch or intention to heal have been proposed. If Reiki is shown to be effective in well-controlled, randomized clinical trials, an important step in unraveling its mechanism will be to distinguish it from nonspecific, placebo effects (i.e., separate from attention, compassionate caring, relaxation response, and expectation). Furthermore, direct-contact Reiki can be studied separately from distant Reiki.
Reported Uses
In the United States, Reiki typically has been used in conjunction with Western-based therapies. Unlike homeopathy, which discourages the use of Western therapeutic modalities, Reiki can be easily integrated with allopathic approaches. It is used in the treatment of pain, palliative care, wound healing, amelioration of depression and anxiety, and spiritual well-being.1,2,8-10
Physiological Studies
Although anecdotal case reports abound, there is a paucity of high-quality scientific literature on Reiki. Two non-randomized, poorly controlled studies in heterogeneous populations have documented physiological changes in patients receiving Reiki.
One study of hemoglobin levels in 48 non-anemic adults before and after Reiki I training compared to a control group of 10 medical professionals showed that almost 60% of those receiving Reiki but none of the medical professionals increased their hemoglobin concentrations.11
Another study that attempted to document the relaxation response following a single 30-minute Reiki treatment in 23 patients found increased salivary IgA levels and decreased systolic blood pressure compared to baseline values, but no change in salivary cortisol, peripheral temperature, and EMG-determined muscle tension.12
Finally, a randomized, double-blinded, crossover study compared electrolytes and blood sugar concentrations before, during, and after administration of a combination of Reiki, LeShan (a form of psychic healing), Therapeutic Touch, and qigong therapies in 14 patients; various control conditions were utilized.13 Glucose levels were slightly but significantly different in the patients receiving the combination treatment than the control treatment. However, there was no adjustment for or record of dietary intake and no assessment of blinding, and Reiki was not studied in isolation from the other energy therapies.
Clinical Trials
A comprehensive literature search using PUBMED, PsychLIT, EMBASE, CINAHL, BIOSIS, and the Cochrane Library revealed only two clinical efficacy trials of direct-contact Reiki.
A 1997 study in 20 volunteers experiencing pain from a variety of conditions used Likert and visual analogue scales (VAS) to compare pain before and after a single Reiki treatment.4 Although more than 85% of patients reported significantly improved pain scores following Reiki, these results could be attributed to a placebo effect since a control group was not examined.
A second study randomized 120 patients with diverse chronically painful conditions to 30-minute bi-weekly sessions of Reiki, sham Reiki, progressive muscle relaxation, and magazine reading in a doctor’s office.14 Symptoms were measured by validated scales at three time points: a pre-intervention baseline, at the end of the five-week trial, and three months post-trial. The true Reiki group had significant improvements in pain control, depression, anxiety, and self-esteem compared to the three control groups. However, patient blinding was problematic.
It is unlikely that patients in the latter two groups believed they were receiving Reiki. Furthermore, while sham and true Reiki practitioners touched patients in identical locations, many details—such the practitioners’ manner of introduction, their comfort in touching patients, their way of answering questions, and non-verbal cues—may have revealed the true status of the practitioner to the patients.15
No clinical trials could be identified that examine distant Reiki interventions alone. However, a single randomized double-blinded crossover trial of distant Reiki combined with LeShan healing in which the patients reportedly could not see the healers demonstrated significant improvement in pain control following extraction of impacted lower third molar teeth.16 Two separate operations were performed in 21 patients with bilateral asymptomatic impacted third molars. The first was followed in three hours by either 15-20 minutes of distant Reiki and LeShan or no distant healing; after the second operation, subjects who initially received placebo were assigned to the intervention arm, and vice versa. Although pain relief was significantly improved in the distant healing group up to 4-9 hours postoperatively, the placebo effect cannot be ruled out because blinding to treatment was not assessed and objective measures of pain (i.e., heart rate or analgesic use) were not obtained to confirm the subjective reports.
Conclusion
Applying the paradigm of randomized, double-blinded, placebo-controlled trials, the gold standard for biomedically based interventions, is quite challenging in Reiki and all other energy medicine studies. Because there is no widely accepted mechanism for Reiki’s biologic plausibility, it is difficult to design a placebo that mimics Reiki without inadvertently delivering an active therapy. Furthermore, although successfully blinding patients to the nature of the energy treatment they are receiving is difficult, blinding practitioners to the kind of treatment they are delivering is nearly impossible.
Nevertheless, Reiki offers another possibility for adjunctive therapy without a risk of doing harm. If carefully controlled ongoing and future studies of Reiki show benefit over placebo, they will help validate claims about the beneficial effects of Reiki and other forms of energy medicine, while making conventionally trained physicians pause about the complex nature of the healing process.
Recommendation
Reiki can be recommended as a low-risk, but unproven, adjunctive therapy for pain and psychological symptoms in those who have failed conventional therapies.
Dr. Assefi is Attending (Clinician-Teacher), Departments of Medicine and Obstetrics/Gynecology, Complementary and Alternative Medicine Liaison, School of Medicine, University of Washington in Seattle.
References
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16. Wirth DP, et al. The effect of complementary healing therapy on postoperative pain after surgical removal of impacted third molar teeth. Complement Ther Med 1993;3:133-138.
Assefi N. Reiki for chronic conditions: An overview. Altern Med Alert 2002;5(10):113-116.
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