ketoprofen (Orudis), ketorolac (Toradol), magnesium salicylate (Doan’s Pills), meclofenamate sodium, mefenamic acid (Ponstel), meloxicam (Mobic), nabumetone (Relafen), naproxen (Aleve,* Naprosyn); ocyaprozin (Daypro), piroxicam (Feldane), rofecoxib (Vioxx) withdrawn, salicylsalicylic (Disalcid), sodium salicylate, sulindac (Clinoril), suprofen (Profenal), tolmetin (Tolectin), valdecoxib (Bextra) withdrawn. The NSAIDs include a large and chemically diverse group of drugs that possess analgesic, anti-inflammatory, and antipyretic (fever-reducing) properties. There are dozens of NSAIDs on the market, with new ones constantly becoming available. Some can be purchased as over-the-counter preparations, but larger doses of those drugs or other preparations are available only by prescription. NSAIDs span a number of chemical categories, with a range of different pharmacokinetics and pharmacodynamics. The anti- inflammatory abilities of NSAIDS are a function of their ability to inhibit the production of prostaglandins, which are responsible for producing inflammation and pain. Prostaglandins are a powerful hormone-like substance, derived from arachidonic acid, found in many body tissues and produced in response to trauma. Prostaglandin production may alter blood pressure, metabolism and smooth muscle activity. NSAIDs have a number of potentially serious side effects. The most common is irritation of the stomach. NSAIDs are very useful in treating joint pain, swelling, and muscle pain. Although all NSAIDs appear to work in the same way, not every one has the same effect on every person. Individuals should use only one NSAID at any given time. Most NSAIDS are an appropriate treatment for rheumatoid arthritis, psoriatic arthritis, and arthritis associated with inflammatory bowel disease (IBD); osteoarthritis, sprains and strains. Originally, aspirin was the only choice of NSAID. Now many other effective NSAIDs exist, many without the most common negative side effects of aspirin. The most common side effect from NSAIDs is stomach upset or indigestion, especially in older patients. Taking NSAIDs with food or milk or immediately following a meal lessens the chance of this occurring. Some NSAIDs products are less likely to upset the stomach. NSAIDs also prevent platelets (blood cells that help blood clot after an injury) from working correctly. When platelets don’t function as they should, bleeding is more difficult to stop. NSAIDs can also irritate the stomach and cause bleeding. Stools that are darker than normal or unusual bruising, are both signs of bleeding, and a client who experiences these should be referred to a doctor. Other side effects include kidney problems and stomach ulcers. NSAIDs should be used only under CLOSE physician supervision if a client: ● Has asthma. There are three types of NSAIDs: Salicylates (acetylated, such as aspirin, and non-acetylated), the traditional NSAIDs, and COX-2 selective inhibitors. All NSAIDs are gastric irritants , although newer formulations cause less gastric acid, in general, than aspirin. All newer NSAIDS are analgesic, anti-inflammatory, and antipyretic, and most [except the COX-2-selective agents and non-acetylated salicylates (see below)] inhibit platelet aggression. ● Has liver problems. ● Has heart problems. ● Has kidney problems.
anticoagulants, platelet inhibitors, aspirin, and other NSAIDs. Petrissage, for example, may cause bruising in an individual taking any of these medications. Massage techniques like deep kneading, ischernic compressions, and cross fiber frictions may need to be modified or avoided. While these techniques do not damage normal healthy connective tissue, they may produce bruising and inflammation in those taking medications that alter blood clotting. Massage therapists should not perform any techniques that create inflammation or damage tissue. In any case where pain perception may be altered, feedback mechanisms for pressure and intensity of massage are not reliable because medications may alter normal pain responses that act as warning signs of potential injury to the tissues during massage treatment. Techniques or modalities that would normally cause some discomfort are more easily tolerated than they should be. A client, for example, may have a more normal range of motion, or movement without the level of pain and discomfort usually associated with the same amount stress on their tissues. As anti-inflammatories and analgesics are primarily used to relieve pain, therapists should reduce the intensity of the massage, in general, until the client’s comfort and safety is assured. Assessing individuals using topical anti-inflammatories or analgesics may be difficult in that these body tissues may appear healthier and more resilient than they actually are. Practitioners who are unaware of the medication may be more aggressive than is appropriate or required, with greater risk of bruising. Be aware that any complaint of gastrointestinal pain and discomfort among individuals using NSAIDS is significant, as these medications can cause ulcers and bleeding of the gastrointestinal tract, both of which can become life- threatening if not addressed. If the client has been diagnosed and is being treated for these side effects, abdominal massage and hydrotherapy are contraindicated until the condition has resolved. Corticosteroids cause atrophy and weaken connective tissues, including skin, fascia, ligaments, and muscle, joint capsules, bones, and tendons. When injected into joints for arthritis, steroids can induce breakdown of articular cartilage. Corticosteroids also impair the body’s ability to repair body tissues normally, resulting in longer healing periods and fragile tissue after any injury. Corticosteroids also have immunosuppressant effects that make an individual more susceptible to infection, so hand washing and being in good health are important to the client’s health and safety. Individuals taking corticosteroids for long periods may notice changes in skin sensitivity and altered reactions to heat and cold. Normal function and sensitivity of the skin are compromised to the extent that skin rolling, friction, and wringing techniques can result in bruising and inflammation of the tissues. Any massage strokes that involve placing direct pressure or stress on tissue structures will need to be reviewed. Avoid heavy tapotement, passive forced stretching, muscle stripping, deep kneading, frictions or joint mobilization. For tissues affected by topical steroid applications, exercise caution and modify the depth of pressure when working on tissues. Nonsteroidal anti inflammatory drugs (NSAIDs) Aspirin, acetylsalicylic acid, celecoxib (Celebrex), choline salicylate (Arthropan), diclofenac (Voltaren), diflunisal (Dolobid), etodolac (Lodine), fenoprofen (Nalfon), flurbiprofen (Ansaid), ibuprofen (Motrin, Advil*), indomethacin (Indocin), Aspirin (acetylsalicyclic acid, ASA Bayer) Commonly known as aspirin , acetylsalicyclic acid is this country’s most widely used drug, both singularly and in combination with many prescription and patent medicines. Used for many different aches and pains, aspirin can injure
the stomach, interfere with the absorption of several vitamins (especially C, K, and folic acid), and pose a special risk for pregnant women and patients with ulcers.
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