Background: Multiple treatment modal-ities have been used to treat complications such as pain and fatigue in patients undergoing hemodialysis. However, the combined effectiveness of reflexology and back massage (BM) in relieving pain and fatigue in patients undergoing hemodi-alysis is limited and this study aims to fill this research gap. Materials and methods: A pre-and post-test experimental study design was adopted in which 60 patients (n = 60) undergoing dialysis were randomized into two groups of 30 each using a simple randomization technique. The subjects of experimental group I received foot reflex-ology (FR) and BM, while experimental group II received only BM. The intervention lasted 2 days per week for 4 weeks. To examine the effectiveness of the treatment both before the intervention and at the end of the fourth week, two variables were evaluated: (i) pain intensity, which was measured using the visual analogue scale (VAS) and (ii) fatigue experienced by patients, which was measured using the Fatigue Severity Scale (FSS). Results: Subjects treated with FR and BM showed better reduction in VAS (mean difference: 1.06, 95 confidence interval (CI): 0.299�1.834, p < 0.05) and FSS (mean difference: 6.61, 95 CI: 0.230�11.90, p < 0.05) than the subjects exposed to BM only, with a significance level of 0.05. Conclusion: The combination of FR and BM has been found to be significantly more effective than BM alone in manag-ing the health risks of pain and fatigue in hemodialysis patients. © 2025 Elsevier B.V., All rights reserved.