Why manual therapists must know about medications

Massage therapists are faced with many 
challenges when treating a client who is taking medications. For example, consideration must be given to the patho-physiology of the medical condition or disease, the current symptoms experienced, the health of the person’s tissues and the medications used for managing the condition. The therapist is expected to exercise ‘critical thinking and clinical reasoning’ skills when developing a treatment plan. The diagram to the right ( click on it to make it larger) suggests that both drugs/pharmaceuticals and the application of massage techniques can be used either alone or in combination in the management and/or prevention of many medical conditions. It’s also quite clear that the use of medications and the effects of massage, either alone, or in combination has an effect on the physiological responses of the body. When treating a person who is taking medications, to ensure the outcome is safe and effective the therapist must have knowledge in the following areas:

• A clear understanding of the patho-physiology and the progression of the presenting disease or disorder
• a general understanding of the drug’s pharmacology including it’s side effects
• the ability to integrate and apply the above knowledge to the practice of massage therapy

The internal use of medications will have a systemic effect on the body. This systemic effect is a combination of the drug’s desired effect and it’s side effects. It is therefore reasonable to suggest that the effects of the drug can influence, the outcome of the assessment, the timing of the massage session, the use of specific manual techniques and the recommendations of home care activities.

Below is a summary from The Harvard Mental Health Letter that looks at the side effects associated with the selective serotonin reuptake inhibitors, a widely used group of antidepressant drugs.

In a recent press release by The Harvard Mental Health Letter the potential side effects of the antidepressants drugs that belong to the ‘selective serotonin reuptake inhibitors’ (SSRI, such as Prozac) which are among the most widely prescribed medications, while they are relatively safe and effective, they also have real risks associated with them. The points below provide a good example of how the side effects of a drug may affect the general health, constitution and complaint of a client.

The Harvard Mental Health Letter lists / highlights 4 categories of the side effects developed by patients taking the SSRI’s:

Physical symptoms. May be mild and temporary and include insomnia, rashes, headaches, muscle and joint pain, gastrointestinal irritation including stomach upset, nausea, or diarrhea.

Bleeding problems. A serious potential problem is reduced blood clotting capacity that increases risk for stomach or uterine bleeding. The risk more than doubles if patients are concurrently using non steroidal anti-inflammatory drugs such as aspirin, ibuprofen, naproxen and other members of this group at the same time.

 Sexual effects. Many patients experience either diminished sexual interest, desire, performance, satisfaction, or all four.

 Suicide. While this side effect comes with controversy there is a risk that antidepressants will incite violent or self-destructive actions. There is an increasing number of children and adolescents receiving prescriptions for antidepressants and the research is showing that when compared with a placebo, all antidepressants, including SSRIs, seem to double the risk of suicidal thinking, from 1%–2% to 2%–4%, in both children and adults. (http://www.health.harvard.edu/press_releases/ssri_side_effects.htm).

 Let’s consider another group of drugs, the non steroidal anti-inflammatory drugs.

The non-steroidal anti-inflammatory drugs or NSAIDs are among the most widely used and readily available drugs on the market. Dr. Bryan Bingham in an article entitled “The safety of NSAIDs, and Alternatives” presents many interesting facts about the NSAIDs, their uses and side effects. Below are few of these facts.

• The NSAIDs are generally used for pain relief, headaches and arthritis
• Each year by some estimates, the side effects of long-term NSAID use cause nearly 103,000 hospitalizations and 16,500 deaths
• According to the American Gastroenterological Association an estimated 36 million people take NSAIDs on a daily basis
• Some side effects associated with the commonly used NSAID drug ibuprofen include:
• Chest pain, weakness, shortness of breath, slurred speech, problems with vision or balance, black bloody or tarry stools, coughing up blood or vomit that looks like coffee grounds, blurred vision or problems seeing colors, swelling or rapid weight gain, urinating less than usual or not at all, nausea, stomach pain, low fever, loss of appetite, dark urine, clay colored stools, jaundice, skin rash, bruising, severe tingling, numbness, pain, muscle weakness, fever, headache, neck stiffness, chills, increased sensitivity to light, purple spots on the skin and seizures. 

·       A study published in the British Medical Journal, showed that patients who took NSAIDs on a regular basis started to develop rebound headaches. Rebound headaches are headaches that are brought on by the use of the pain medications. Rebound headaches are not typical with short-term use, however individuals who take pain medications regularly may develop these types of headaches.

Some of the side effects described above from the two classes of drugs, selective serotonin reuptake inhibitors antidepressants and the non steroidal anti-inflammatory drugs include headaches, muscle and joint pain, bruising, severe tingling, numbness, pain, fever, and neck stiffness. These side effects illustrate the importance of why massage therapists need to have knowledge of a drug’s effects, or at least having the ability to ‘look up’ the side effects. The therapist must consider if the complaint of the client is in fact related to a side effect of the drug they are taking. And, if it is related, is massage therapy effective at all?