279: Brief Mindfulness and Reiki Effects on Clinical Pain and Sensory Processing in Knee Osteoarthritis

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic primary musculoskeletal pain, Psychology, Quantitative Sensory testing (static and dynamic, e.g., HPT, PPT, CPM, TSP, offset analgesia)

Background and Aims: Chronic knee osteoarthritis (KOA) pain is prevalent[3,10,13] and often inadequately managed with pharmacologic or surgical approaches.[1,2,9,11,14] Complementary therapies such as mindfulness[4,7] and Reiki[8,12,15] show promise, yet their mechanisms remain imprecisely characterized. In a four-arm, placebo-controlled RCT, we evaluated the clinical efficacy of brief Mindfulness-Oriented Recovery Enhancement (B-MORE)[5,6] and Reiki compared to sham Reiki (i.e., “Feiki”) and waitlist control. We further examined whether these interventions modulated peripheral nociceptive sensitivity and central sensitization using quantitative sensory testing (QST). We hypothesized that mindfulness and Reiki would reduce KOA symptom and measurably impact QST indices.

Methods: Adults with physician-confirmed KOA (N=164) were randomized (1:1:1:1) to B-MORE, Reiki, Feiki, or waitlist. Participants were blinded to the inclusion of the Feiki condition; deception was used to preserve treatment credibility. Active interventions consisted of four weekly 30-minute sessions. Primary clinical outcome was WOMAC total symptom severity assessed at baseline, post-treatment, and 1-month follow-up. A subsample (n=124) completed QST at baseline, post-treatment, and 1-month follow-up, including temporal summation (central sensitization), pressure pain threshold (mechanical sensitivity), and cold pain tolerance. Generalized linear mixed models tested condition × time interactions and main effects under intention-to-treat principles.

Results: At 1-month follow-up, both Reiki (32% reduction) and B-MORE (38% reduction) produced clinically meaningful improvements in WOMAC scores versus waitlist (p≤.023), with mindfulness also outperforming Feiki (p=.004). QST analyses revealed a significant main effect of condition for both temporal summation (p=.023) and pressure pain threshold (p=.045). B-MORE participants demonstrated reduced temporal summation and higher pressure pain thresholds versus all controls (ps≤.036), with effects persisting through 1-month follow-up. Reiki did not significantly differ from controls on QST measures. Cold pain tolerance was unchanged across conditions.

Conclusions: Both Reiki and B-MORE produced clinically meaningful reductions in KOA symptoms. However, only B-MORE demonstrated sustained modulation of central sensitization and mechanical pain sensitivity. These findings align with models of mindfulness-related analgesia involving descending pain regulation and top-down modulation.[16] Reiki’s clinical benefits occurred without QST modulation, implying alternative pathways (e.g., affective or contextual mechanisms). These findings underscore the importance of integrating mechanistic outcomes with clinical endpoints in complementary pain research and support brief mindfulness as a scalable, nonpharmacologic strategy for decreasing KOA symptoms and modifying pain processing.

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Presenting Author: Adam W. Hanley
Submitting Author: Adam Hanley

Senior Author: Eric L. Garland

IASP 2026 Global Year theme of Neuropathic Pain: No

• Adam W. Hanley - Florida State University
• Yoshio Nakamura - University of Utah
• Robert R. Edwards - Brigham and Women’s Hospital, Harvard Medical School
• Eric L. Garland - University of California at San Diego