Background: Reiki is a complementary energy therapy aimed at reducing symptoms and improving quality of life. This study evaluated the effects of four consecutive 20-min Reiki Level 2 sessions on pain intensity and quality of life in hemodialysis (HD) patients who had previously received Reiki Level 1. It also compared follow-up outcomes between Level 1 and Level 2 applications. Methods: A double-blind, randomized controlled, pre-test–post-test retrospective comparative design was employed. The intervention group (prior Reiki Level 1 recipients) received four days of Reiki Level 2. The placebo control group, which previously received sham Reiki, had no further intervention. Data were collected using the Patient Identification Form, Visual Analog Scale for Pain (VAS-Pain), Kidney Disease Quality of Life Short Form (KDQOL™-36), and Psychodynamic Response List. Results: VAS-Pain scores significantly decreased in the intervention group post-Reiki Level 2. While KDQOL™-36 subscales showed no significant group differences, mental component scores improved in the intervention group. Reiki Level 1 was more effective in pain reduction, whereas Level 2 yielded greater improvements in symptom, problem, mental health, and disease effect scores. Conclusions: Both Reiki levels positively impacted mental health, symptom burden, and quality of life. However, Reiki Level 1 was superior in reducing pain intensity, while Reiki Level 2 offered broader quality-of-life benefits. Trial registration: This study was registered under the Clinical Trials Protocol Registration System (NCT06519136) prior to data collection. The full protocol and registration details are available at: https://clinicaltrials.gov/study/NCT06519136.
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