Effect of Foot Reflexotherapy in Patients with Familial Mediterranean Fewer (FMF) Attack
Introduction: FMF symptoms occur in attacks that last from one-three hours to one-three days. They are fever, abdominal pain, chest pain, achy and swollen joints, a red rash on the legs, muscle aches. Evidences indicate that complementary or integrative approach may heal the symptoms of FMF attacks. The purpose of this study was to present the possible beneficial effects of foot reflexotherapy in patients with FMF attack.
Material and Methods: The subjects of the present study were six patients diagnosed with FMF. Pre- and post-tests were completed by the researcher using a Likert scale. The patients were treated with foot reflexotherapy twice each day during attack.
Results: There was statistically significant decrease in all FMF symptom scores after foot reflexotherapy.
Conclusion: Foot reflexotherapy was beneficial and amazingly effective in patients with FMF attack.
FMF, Foot reflexotherapy, Complementary medicine, Chest pain
Familial Mediterranean Fever (FMF) is a genetic autoinflammatory disorder that causes recurrent fevers and painful inflammation of abdomen, lungs, and joints. FMF is an inherited disorder that usually occurs in people of Mediterranean countries. However, it can affect people in any ethnic group, North African, Jewish, Arab, Armenian, Turkish, Greek, or Italian people are more sensitive against to this disease.
FMF is typically diagnosed during childhood. However, it has no curative treatment, the drug colchicine relieves signs and symptoms of FMF or even prevent them altogether by sticking to the treatment plan. However, in some patients, attacks may be inevitable.
Signs and symptoms of FMF usually begin during childhood. They occur in attacks that last from one-three hours to one-three days. Arthritic attacks may last for weeks or months. Signs and symptoms of familial Mediterranean fever are fever, abdominal pain, chest pain, achy and swollen joints, a red rash on the legs, muscle aches. Between attacks, the patient is completely normal. Symptom-free periods may be as short as a few days or as long as several years.
It has been indicated that foot reflexotherapy had an undeniable role in relieving pain, psychological stress and fatigue in patients with various health problems [1-3] including rheumatoid arthritis , cancer [2,3] and some other disturbances . It has been reported that foot reflexotherapy reduced the psychological stress, heart rate, respiratory rate, and arterial blood pressure in another study . Also, reflexology therapy was reported to reduce pain in patients with low back pain . Furthermore, a randomized controlled study by Siev-Ner et al.  reported that 11-week feet reflexotherapy and massage of the calf area in patients with multiple sclerosis led to improvement in intensity of paresthesias, urinary symptoms, and muscle strength. In a recent study, foot reflexotherapy was reported to have an important role in increase some EEG waves (beta and gamma) related to memory and attention functions of the brain . Also, in a recent study, foot reflexotherapy was suggested to improve inattention, hyperactivity findings in a child with ADHD and, they reported that his enuresis nocturna disappeared completely after foot reflexotherapy of 8 weeks . The action mechanisms of complementary methods including foot reflexotherapy are not exactly known now. But, many scientific studies claim that traditional complementary therapies such as foot reflexotherapy, wet cupping therapy and footbath therapy work for homeostasis, and regulate equilibrium state between sympathetic and parasympathetic autonomic nervous systems and in general increase the parasympathetic tone, while decreasing sympathetic tone [11-16]. The aim of this study was to investigate the possible role of the traditional foot reflexotherapy in relieving of the symptoms in patients with acute FMF attack.
Materials and Methods
The experimental protocol was in accordance with international ethical standards and no inconformity was found in relation to the Helsinki Declaration (1975, revised in 1996-2013) .
Six (6) patients with FMF diagnosed clinically and laboratory were involved in the study. The mean age of the patients was 28.13 years (SD=3.47). The patients with FMF were recruited through advertisements on notice board of a university hospital (Nizamiye Hospital) in Abuja, Nigeria. After a telephone interview, potential participants were invited to the Nile University of Nigeria, College of Health Sciences. The aims and objectives of the study were explicitly explained to the parents of babies before commencement of the study. All patients voluntarily gave a written informed consent to participate in the study.
The subjective data were collected using a Likert scale. The Likert scale is a simple method used for the assessment of variations in the subjective intensity of symptoms of acute attacks in patients with FMF. A score of zero represents no pain and other symptoms, while a score of “3” represents “extreme”.
Foot reflexotherapy was performed according to the recommendation of Hanne Marquardt, a pioneer of this complementary therapy technique . Briefly, using the thumbs and fingers of the working hand, appropriate pressure was applied to specific areas of both feet of each patient. These are as correspond to the projection zones of the brain on the foot and represent classic foot reflexotherapy zones chosen in all reflexotherapies. Reflexotherapy was applied to both feet one time each day (for duration of 20 minutes per session) during acute FMF attack in all patients. Foot reflexotherapy was applied to all patients by one of the authors (SD) who is a senior medical doctor and has many studies on reflexotherapy and other complementary medicine techniques. Further details on the technique have been described .
Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 16.0 for Windows. All data had the normal distribution. The paired sample t-test was used for analysis. A p value of ≤ 0.05 was considered statistically significant.
All patients included in this study had only acute FMF attacks. They continued their routine drug treatments with colchicine. There was statistically significant decrease in all FMF attack symptom scores after foot reflexotherapy except red rash on the legs (Table 1). Fever (t=5.966, p=0.002), chest pain (t=7.906, p=0.001), achyswollen joints (t=3.873, p=0.012), muscle aches (t=4.392, p=0.007) were significantly decreased after foot reflexotherapy (Table 1).
|Fever||Abdominal pain||Chest pain||Achy-swollen joints||Red rash on the legs||Muscle aches|
Table 1: FMF attack symptom scores before / after foot reflexotherapy using a Likert scale for assessment.
The results of this study have shown that foot reflexotherapy is beneficial and amazingly effective in the complementary relieving of acute FMF attack symptoms. This complementary therapy significantly decreased almost all scores of the acute FMF attack symptom scores. Thus, foot reflexotherapy can be used for alleviating acute FMF attack symptoms.
Several reports have showed the therapeutic effectiveness of reflexotherapy [19–22]. This traditional and complementary therapy uses application of deep massage by a trained therapist to specific areas, representing various organs on the ears, hands, and feet . These areas in reflexotherapy are considered as projections of the different organs or tissues of the body. The most widely used region of the body in reflexotherapy is the foot . It has been asserted that reflex arcs related to the different organs and tissues begin from specific small areas on the foot in foot reflexotherapy. Studies have shown that foot reflexotherapy play an important role in reducing the severity of various health problems including gastrointestinal and sleep disorders [1-3,24,25].
Though the mechanisms involved in the effects of foot reflexotherapy on FCIS and associated problems are not fully understood, some authors have suggested a possible role of the neuroimmune system in mediating the positive effects of foot reflexotherapy on the body. Foot reflexotherapy is believed to mediate a balance between sympathetic and parasympathetic divisions of the autonomic nervous system, and also, stimulate the release of neuromediators that act on local and distant sites to regulate physiological processes that maintain a balanced functioning of the body [10,11,26]. Indeed, reflexotherapy has been used to ameliorate the symptoms of numerous disorders in humans, including chronic pain , psychological stress , attention-deficit/hyperactivity disorder . Thus, foot reflexotherapy is a practically harmless treatment technique that can be used to address the maladies of patients in different health conditions.
Many studies have reported that the most complementary medicine applications result in the decrease of psychological stress through decreasing sympathetic activity and increasing parasympathetic activity in the body and support the results of the present study. For example, it has been reported that wet cupping therapy restored sympatho-vagal imbalances and decreased psychological stress by decreasing sympathetic activity and increasing parasympathetic activity . In some recent studies, it was reported that foot reflexotherapy , footbath therapy , and wet cupping therapy increases  beta and gamma activities of the brain EEG in young healthy humans. Also, some different complementary approaches were reported to be very useful to decrease pain in some other pain syndromes, for example, foot bathing therapy for surgical pain in women with cesarean section , moving dry cupping for upper shoulder and neck pain , wet cupping for shoulder pain and neck pain , foot reflexotherapy for acute low back pain , and combination of Effleurage massage and slow deep breathing technique for menstrual pain . Besides, it has been reported that Usik Wiwitan relaxation exercise, a traditional complementary medicine application, decreased systolic and diastolic blood pressures and increased quality of life scores in elderly people  and decreased the anxiety of primipara pregnant women . Also, in a recent study, the back massage had a positive effect on reducing the postprandial blood glucose level in diabetic patients .
Foot reflexotherapy was beneficial and amazingly effective in patients with FMF attack. Therefore, it can be used safely.
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Citation: Senol Dane, Effect of Foot Reflexotherapy in Patients with Familial Mediterranean Fewer (FMF) Attack, J Res Med Dent Sci, 2020, 8 (6): 241-245.
Received Date: Sep 07, 2020 / Accepted Date: Sep 28, 2020 /