The massage and bodywork professional must realize that many clients are taking prescribed medications that may impact the type of modalities, procedures, positions, duration and frequency of care they plan. The professional must have information on drug administration routes, drug interactions, dosages, adverse reactions and allergies, safety considerations, medical conditions being treated and other health care providers to contact for further information. Treatment planning guidelines related to client drug information include the following: ● Carefully review the health history form during the interview with the patient. ● Request that the client bring the prescription drug bottles to the initial appointment and list the condition each medication treats. ● Note dosage and frequency for each drug. ● Include the prescribing physician’s information for each drug. ● If the client has pills they cannot identify, in pill organizers for example, the website www.drugs.com provides pill identification. ● Be sure to get information on over the counter medications, supplements, and vitamins being taken. ● Establish the level of compliance for each drug. List the side effects experienced by the client. Discuss whether ● How do you take this drug? Identify IM, IV, implantation, or transdermal patch sites and avoid by at least a hand width. ● How often do you take this drug? ● Have you taken this drug today? ● Have you noticed anything different since you started taking this medication? ● If the client does not know the answers, ask who/which doctor prescribed it and seek further information is necessary. ● Keep inhalers handy. ● Keep emergency medications handy. Interview guidelines for drug use Discuss the following questions for each drug: ● Why was this drug been prescribed?
side effects are discouraging compliance. Ask if client has consulted prescriber or dispensing pharmacist about side effects. (Goodwin, 2016) The client may not realize that other drug options in same class may not cause similar side effects. ● Inquire about any medication changes before each session, document drug and/or dosage changes. ● Have you noticed anything different since you started taking this medication? The client may not connect emerging signs, symptoms with this or another drug: ● Reinforce the importance of accurate information for client safety and comfort. ● For clients taking multiple drugs for multiple or chronic conditions, complete new health history form every 3-4 months. ● Accept the limits of your knowledge and avoid comments, questions about drugs that have been prescribed for a client and refer client questions back to the prescriber. ● Do not offer personal opinions regarding immunization, herbal supplements, pain medication choices, or any other choices made by the client. ● Be sure to identify symptoms that may indicate a medical emergency in relation to the client’s condition, seizure or angina for example, and have an emergency plan in place. ● Clarify that providing service in case of known non- compliance may compromise client safety and your licensure. ● Advise that certain modalities/techniques maybe contraindicated, and that treatment may not be safe without compliance. ● Reports of pain, muscle or joint stiffness unsupported by objective assessment indicate deferral of massage, and referral to the prescriber. ● Alert client that drug-related side effects alleviated by massage may return after massage, for as long as this drug is taken. ● Gastrointestinal : Dry mouth; nausea; acute or chronic diarrhea or constipation: ○ Dry mouth: offer water partway through a session. ○ Nausea, chronic diarrhea: avoid prone position, touch of the abdomen, rocking or jostling. ○ Acute diarrhea is a contraindication to massage. ○ Constipation: offer massage of the abdomen. ● Neurological : Headache, dizziness, drowsiness, and inability to provide accurate feedback about pain, pressure, temperature ○ Headache: offer scalp massage; encourage deep breathing. ○ Dizziness: avoid flat supine or prone positions, rocking or jostling strokes. ○ Drowsiness: ask if client wishes to end with stimulating strokes. ○ Altered perception of sensation: avoid extremes of touch, pressure, temperature. ● Cardiovascular or hypertension ○ Avoid deep pressure, sustained gliding strokes. ● Hypotension ○ Ensure adequate warmth, be prepared to assist the client on/off table, around treatment space. ● Anemia ○ Ensure adequate warmth, avoid overtiring client, if fatigued. ● Endocrine ○ Hypoglycemia ▪ Ensure that client has source of sugar on hand and if not, offer non-diet soda, or fruit juice.
Care for specific medical conditions and pharmacology effects Always be sure to remain within the scope of practice and consult supervisors, state regulations and other healthcare providers if uncertain about treatment related to medical or pharmacological cases. Never proceed if uncertain about the health, safety or best practice for the client. ● Integumentary issues (skin and its appendages; body covering) : Skin: Bruising; rash; lesions; dryness; epidermal fragility; hypersensitivity; lack of touch sensitivity: ○ Keep touch a hand-width away from a bruise, rash, or lesion. ○ Gently palpate, to assess perception of sensation on the skin. ○ Assess skin turgor (elasticity) by gently pulling up a fold of skin; if it remains raised, skin is dehydrated, fragile. ○ Ensure sufficient lubrication. ○ In case of hair loss on head or body hair (alopecia) respect client’s wishes about having head exposed, covered, and touched as the scalp may be itchy or tender. ○ During hair loss process, avoid use of lubricant. ○ Body-wide hair loss leads to easy chilling; offer blanket. ● Musculoskeletal: Muscle pain, joint stiffness, risk for spontaneous fracture: ○ Defer and refer: muscle pain not objectively verified by your assessment, for client taking cholesterol-lowering statin. ○ Avoid deep pressure, vigorous ROM, stretches on client taking corticosteroid for longer than two weeks, or anti- osteoporosis drugs.
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Book Code: MTX1323
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