The guideline concludes by stating that clinicians should only consider opioids as an option in patients who have failed the aforementioned treatments and only if the potential benefits outweigh the risks for individual patients and after a discussion of known risks and realistic benefits with patients. (Grade: weak recommendation, moderate- quality evidence). The East West College of Healing Arts in a 2016 article added the following support for massage to treat symptoms of opioid use disorder: Opioid-dependent patients who receive massage therapy may experience the following positive outcomes: ○ Increased body awareness : Opioid use is often rooted in chronic pain. The opioid user attempts to avoid pain through painkiller medications. Adept massage therapists can help patients feel what the pain is actually like in their bodies. While this may at first be very difficult, over time those with opioid use disorders find the pain isn’t their whole world. They eventually discover that they can live with their pain without requiring outside substances. ○ Effective pain treatment : A May 2016 study published in The Journal Pain Medicine found that massage therapy can reduce pain, minimize anxiety and improve health-related quality of life. All three outcomes are relevant for those with substance dependency issues. By providing a drug-free way to relieve pain, massage can help tremendously. ○ Manage detox symptoms : Withdrawal symptoms can be intense, extremely painful, stressful and uncomfortable. Massage can help by increasing the levels of natural feel-good chemicals in the brain and decreasing stress hormones like cortisol. For instance, a good massage increases dopamine levels, the body’s reward chemicals. By increasing these pleasure chemicals, regular massage can help addicts withstand withdrawal symptoms. Clinical Psychiatry found that deep-tissue massage leads to the following benefits: ● Reduction of stress hormone levels. ● Lowered heart rate. ● Elevated mood and relaxation by triggering the release of oxytocin and serotonin. After 15 minutes of deep-tissue massage techniques, endorphins come into play and the positive benefits may last for 48 hours. Beyond the physiological benefits of massage, techniques can help clients reconnect to their bodies, be present in the moment, and have a positive experience in the present. This may be something they had not been able to accomplish during drug use because the painful emotional and physical symptoms, caused by the adverse effects of opioids, made living in the present unbearable without drugs. While patients may be too intimidated to open up in talk therapy, massage therapy meets them where they are. While receiving massage, patients need not explain how they feel, nor why. They can simply relax while the therapist explores and loosens stress points in the body (East West, 2016). As previously discussed, massage promotes relaxation because it changes the chemistry of the brain through the release of serotonin and dopamine. It also provides the benefit of positive touch and a connection to another person that may have been missing during addiction
In 2017 the American College of Physicians (ACP) developed a guideline to present the evidence and provide clinical recommendations on noninvasive treatment of low back pain. Recommendation 1 involves massage. Given that most patients with acute or subacute low back pain improve over time regardless of treatment, clinicians and patients should select nonpharmacological treatment with superficial heat (moderate-quality evidence), massage, acupuncture or spinal manipulation (low-quality evidence). If pharmacologic treatment is desired, clinicians and patients should select nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants (moderate-quality evidence). (Grade: strong recommendation). Low back pain is frequently classified and treated on the basis of symptom duration, potential cause, presence or absence of radicular symptoms, and corresponding anatomical or radiographic abnormalities. Acute back pain is defined as lasting less than four weeks, subacute back pain lasts between four and 12 weeks, and chronic back pain lasts more than 12 weeks. Radicular low back pain results in lower extremity pain, paresthesia, and/or weakness and is a result of nerve root impingement. Recommendation 2 includes nonpharmacological treatment with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction (moderate-quality evidence), tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation (low-quality evidence). (Grade: strong recommendation). Recommendation 3 states that in patients with chronic low back pain who have had an inadequate response to nonpharmacological therapy, clinicians and patients should consider pharmacologic treatment with nonsteroidal anti- inflammatory drugs as first-line therapy, or tramadol or duloxetine as second-line therapy.
Deep-tissue massage for managing symptoms during opiate recovery A deep-tissue massage that incorporates acupressure and trigger-point therapy has been recommended to help relieve symptoms that clients may experience while recovering from opiates during phases of tapering off the drug and withdrawal (Finch, 2017). These techniques create the release of an abundance of endorphins, which are our endogenous opioid peptides, natural painkillers, known to reduce pain and produce a sense of euphoria. Matt Finch reports that in 2010, a meta-analysis in The Journal of
The mind, body and spirit connection One of the DSM-5 criteria for diagnosis of opioid use disorder is the “continued opioid use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.” This represents a disconnect or avoidance of the harmful psychological and physical effects of the drug when their only focus is on obtaining more opioids for the next “high,” regardless of the damaging effects. According to the East West College 2016 report, this disassociation occurs when addicts disconnect from their bodies and emotions. During this time, addicts are unaware of what they are feeling or experiencing. Therapists hypothesize that this disassociation is rooted in addiction behavior. In order to continue taking drugs, addicts must ignore their bodily reactions. The healing process must therefore include some time for addicts to adjust to actually experiencing life in the moment, in a body-centered way.
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Book Code: MIL1224
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