PAIN AND INFLAMMATION: THE BODY’S IMMUNE RESPONSE
drugs (NSAIDs), such as aspirin and ibuprofen, which can be purchased over-the-counter (without a prescription). Moderate to severe pain may require opioids (also known as narcotics ) such as morphine, fentanyl, hydromorphone, oxycodone, and codeine, which require a prescription. Physicians sometimes prescribe nonopioids along with opioids for moderate to severe pain. Many anti-inflammatory medications are nonopiod analgesics, like aspirin, available without a prescription, and doctors find them appropriate for the treatment of acute and chronic effects. People with inflammation should be treated for both relief from pain and to slow or limit damage to the tissues that is the underlying cause. Nonsteroidal anti-inflammatory drugs (NSAIDs) can reduce inflammation for varying lengths of time. Physical effects Osteoarthritis Rheumatoid Arthritis Affects joints X X Is an autoimmune disease X Bony spurs X X Enlarged or malformed joints X X Treatment Options Clucocorticoids X NSAIDs X X Methotrexate X Pain Management
The immune response involves the activation of cells in the body, in response to foreign organisms or matter, resulting in an acute or chronic inflammatory condition. In some cases, the outcome is beneficial to the host. In other cases, the response itself is damaging to the host. Arthritis is a general term for conditions that affect the joints and surrounding tissues. Joints are places in the body where bones come together, such as the knees, wrists, fingers, toes, and hips. The two most common types of arthritis are osteoarthritis and rheumatoid arthritis. Osteoarthritis (OA) is a painful, degenerative joint disease that often involves the hips, knees, neck, lower back, or the small joints of the hands. OA usually develops in joints that are injured by repeated overuse from performing a particular task or playing a favorite sport, or from carrying around excess body weight. Eventually this injury or repeated impact thins or wears away the cartilage that cushions the ends of the bones in the joint. As a result, the bones rub together, causing a grating sensation. Joint flexibility is reduced, bony spurs develop, and the joint swells. Usually, the first symptom of OA is pain that worsens following exercise or immobility. Treatment usually includes analgesics, topical creams, or nonsteroidal anti-inflammatory medications (known as NSAIDs ); appropriate exercises or physical therapy; joint splinting; or joint replacement surgery for seriously damaged larger joints, such as the knee or hip. Rheumatoid arthritis (RA) is an autoimmune inflammatory disease that usually involves various joints in the fingers, thumbs, wrists, elbows, shoulders, knees, feet, and ankles. An autoimmune disease is one in which the body releases enzymes that attack its own healthy tissues. In RA, these enzymes destroy the linings of joints. This causes pain, swelling, stiffness, malformation, and reduced movement and function. People with RA also may have systemic symptoms, such as fatigue, fever, weight loss, eye inflammation, anemia, subcutaneous nodules (bumps under the skin), or pleurisy (a lung inflammation). Most people with arthritis will use pain management strategies at some time. Regardless of the cause, pain management strategies are similar for people with osteoarthritis and rheumatoid arthritis. These strategies are included in the following chart. This chart provides an overview of some of the similarities and differences between osteoarthritis (OA), and rheumatoid arthritis (RA). Some individuals with these conditions may have a different experience or may require a different medical approach to manage their disorder(s).For mild to moderate pain, your client may use non-opioid (non-narcotic) drugs like acetaminophen and nonsteroidal anti-inflammatory
Pain medication (NSAIDs, narcotics, muscle relaxants
X
X
Rehabilitation
X X
X X
Exercises: postural
Exercises: isometric, isotonic, isokinetic
X
X
Joint splinting Physical therapy Passive exercises
X X X
X X X
Joint replacement surgery (usually for pain, malformation, or impaired mobility)
X
X
Heat and cold
X X X
Massage therapy
X X
Acupuncture
Massage implications related to medications for pain and inflammation Working with individuals taking pain medication requires extra attention to the client’s comfort and positioning. Swollen tissues should be elevated to encourage drainage. Use supports and pillows to cradle body parts comfortably and safely. In cases where pain and inflammation are symptoms of a systemic
medications increase the incidence of their adverse effects. Timing the medication, optimally, around the massage session may be critical, either ensuring that pain medication is kicking in at the appropriate time or is not “masking” pain that serves as the body’s feedback mechanism. Tissues that have reduced or altered sensitivity can be more easily injured from normal use of manual techniques. In many cases, the health and function of the liver and kidneys are critical to maintaining therapeutic levels of medication in the blood. If normal elimination processes are compromised by renal or hepatic dysfunction, adverse effects such as fever and reddish purple bruises on the skin are early indications of drug toxicity. At any indication of drug toxicity related to any drug, massage treatments are contraindicated until the client is evaluated by a physician. Drugs that alter blood-clotting mechanisms predispose users to bruising, so extra care should be used with clients taking
disorder, a shortened session may be appropriate. Individuals in severe pain may not be able to tolerate any additional stress on their tissues. Dizziness, drowsiness, and postural hypotension are common side effects of many medications that can be heightened by massage. The client should sit up slowly and wait a few moments before standing. Because so many medications are associated with side effects including slight dizziness or drowsiness, be sure to assist individuals, especially the elderly, in sitting up, pausing a moment, and getting off the table. It is important that you are aware of all medications your client is taking, both prescription and over-the-counter, as multiple
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Book Code: MGA1224
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