Chapter 2: Care for Special Populations 2 CE Hours
Learning objectives Develop and implement a clinical reasoning protocol to serve individuals with special needs. Explain the concepts of “therapeutic change” and “condition management,” and their practical significance to massage therapy and palliative care. List some of the benefits of massage for people with chronic and terminal illness.
Explain the etiology of chronic illness and the differences between acute and chronic illness. List some special considerations for elderly clients. Define therapeutic change, condition management and palliative care, and describe a context for each. Identify indications for massage therapy in chronic illness and explain the benefits of those indications.
THE HEALING POWER OF TOUCH
The concept that touching has curative powers is not new, but touch as healing has been comparatively slow to catch on in the United States. Until recently, massage was neither recognized by physicians nor insurance companies as a viable treatment option. That is beginning to change as statistics show, for example, that premature babies who receive massage are discharged from the hospital six days sooner on average than those who don’t receive massage, resulting in a savings of about $6 billion annually. More and more, Americans are beginning to realize the benefits of massage, with over 75 million visits noted in recent years 1 . Touch is the first sense to develop in humans, and may be the last to fade. Touch can reduce the heart rate and lower blood pressure, even for people in comas. Touch also triggers the release of endorphins, the “feel good” chemicals that are also pain suppressants. Studies document positive results using massage to treat conditions as varied as hyperactivity, diabetes, asthma, autism, and burns. Therapeutic massage has been
shown to alleviate pain and stress, reducing the need for narcotic or psychotropic medications, and reducing the potential for negative side effects that are associated with medication. This chapter will focus on the benefits of therapeutic massage among individuals requiring specialized care, and suggest important considerations for clients with special needs, including: ● Chronic pain. ● Chronic illness.
● The elderly. ● Cancer care. ● Terminal illness and palliative care.
No matter what your client’s age, physical condition, or category of specialized care required, always address each client as an individual, noting his or her unique nature and personality, including his/her specific needs and wishes.
CHRONIC PAIN
According to the National Institutes for Health, more than one- third of all adults will experience chronic pain at some point in their lives. Chronic pain is pain that persists or returns for varying periods of time (usually longer than six months). Chronic pain often involves deep somatic and visceral tissues. The painful area can be indefinite or poorly localized, and the quality of pain may change over time. Massage is the second most sought-after form of pain relief, after pain medication, and is a safe and effective way to relieve pain in both elderly and young populations 2 . In fact, pain management programs at hospitals, rehabilitation centers and other facilities are increasingly adopting massage as a tool to combat chronic pain. Clients experiencing chronic pain should be under the care of a physician who will investigate the cause of the pain. Studies suggest that massage can relieve chronic back pain, tension, and post-traumatic headaches 3 more effectively than other common therapies, and reduces pain and muscle spasms, such as those associated with heart bypass surgery. Massage increases the release of endorphins, helping decrease the perception of pain and the accompanying stress, anxiety, and depression that are associated with it. Getting through a day with chronic pain can feel overwhelming. At night, pain, and the stress related to it, can keep you awake, making you less able to face the next day. Worry often accompanies chronic pain, concern regarding its source and what can be done to make it go away. Chronic pain can affect an individual’s ability to work, and treatment can be a financial drain. Normal activities may become difficult, and fears of dependency on others for either financial support or physical care may exacerbate feelings of stress and depression, adding to the pain.
In some cases, injury or illness also produces a pain cycle, a complicated series of events that reinforce one another, producing chronic or constant pain over a long period of time. Chronic pain is a heavy emotional weight. It is associated with a substantial amount of stress, and can take a heavy toll on an individual’s emotional and physical stamina, wearing their patience. Massage can be effective in pain management, interrupting the cycle of pain through the release of endorphins, and alleviating pain to a substantial degree. Reducing stress, promoting relaxation, and lessening the need for pharmaceutical intervention are significant benefits for clients with chronic pain, but massage may also help people learn to cope more effectively with their pain. By treating the whole body, rather than a localized area, massage can reorient the individual, increasing awareness of the body, and helping them focus on something outside of the pain. Chronic pain causes the muscles around any painful area to “tense up.” This action, known as “guarding,” supports and protects the damaged area. Usually, over time, as the muscles relax, the pain is relieved. With persistent or chronic pain, muscles contract but do not release. In their contracted state, muscles can press on nerves, causing numbness, tingling, and more pain. Massage can help stretch the muscles, and stimulates the nervous system, which can also help relax tense muscles. The more pain we experience, the more diminished is our capacity for any kind of movement or exercise. The cycle of pain continues when the reduction in movement decreases circulation and flexibility and increases the pain. The cycle of pain also encourages the development of trigger points at areas with poor circulation. These points become increasingly irritated, and refer pain and tingling sensations from the muscles and connective tissues to other parts of the body. Referred pain responds well to
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