Proton pump inhibitors Esomeprazole, rabeprazole, lansoprazole, and omeprazole are proton pump inhibitors but the most common is pantoprazole. Pantoprazole works by pumping specific enzymes and ions to the stomach and stopping the secretion of hydrochloric acid. This medicine is used to treat acid reflux, other stomach acidity conditions, and ulcers. There are sometimes serious side effects of pantoprazole and other proton pump inhibitors such as anaphylaxis, skin reactions, nausea, diarrhea, headaches, and acute renal dysfunction (Harvard Health Publishing, 2021). There are no direct interactions between therapeutic massage and proton pump inhibitors; however, you may need to adjust technique or positioning if someone is actively experiencing heart burn or acid reflux, and due to the side effects of the drug, be sure to strongly encourage drinking extra water after the session to avoid nausea and headaches afterward. Proton pump inhibitors assist in the healing of both duodenal and gastric ulcers. Ulcers may be caused by H. pylori or associated with the use of NSAIDs like aspirin. In the case of H. pylori infection, the therapeutic strategy is two-fold: to eliminate the bacteria and heal the ulcer. Elimination of the organism is produced through the proton pump inhibitor’s ability to substantially raise environmental pH in the body, allowing antibiotics to effectively combat H. pylori . Proton pump inhibitors are combined with the antibiotics clarithromycin and amoxicillin (or metronidazole) to clear the infection. Use of proton pump inhibitors is typically used to ensure healing (Harvard Health Publishing, 2021). Side effects of proton pump inhibitors, while not common, are possible. Typical symptoms are diarrhea, abdominal pain, and/or headache. A reduction in acid due to proton pump inhibitor use may contribute to lowered vitamin B12 absorption from food. The reduction in acid may also produce a slightly increased risk to enteric infections like Clostridium difficile (C. diff) . Decreased gastric acidity tends to increase gastric bacterial concentration in individuals taking proton pump inhibitors. It also alters the absorption of some drugs that require intragastric acidity (Harvard Health Publishing, 2021). Laxative drugs Many people use over-the-counter laxatives instead of a high-fiber diet, adequate hydration, and exercise to maintain regularity. Laxatives work though one of four mechanisms: bulk forming, stool softening, osmotic, or stimulant laxatives. Bulk-forming laxatives cannot be digested; instead, they absorb water within the body, turning into a bulky gel that stimulates peristalsis. Bulk- forming laxatives are made from plants like methylcellulose, and synthetic fibers like polycarbophil. In the case of plant fibers, digestion can cause bloating and increased gas emissions (NHS, 2022). Stool surfactant agents, or “softeners,” allow the entry of water and lipids into the stool, softening the material. Docusate (oral or enema) is typically prescribed in hospitalized individuals to prevent constipation. Glycerin suppositories and mineral oil are also commonly used stool softeners. Mineral oil is used by some to prevent and treat constipation or impaction in children or debilitated adults. Long-term use may reduce absorption of vitamins A, D, E, and K. The most commonly used purgatives are sodium phosphate and magnesium citrate, which may cause electrolyte imbalance in elderly or frail individuals or with cardiac disease (Portalatin & Winstead, 2012). Polyethylene glycol (PEG) is used for colonic cleansing prior to endoscopic procedures. This solution contains a
nonabsorbable, osmotically active sugar and salts that do not produce electrolyte shifts or cause the individual to retain fluids, so are safer. For the treatment or prevention of chronic constipation, small doses of PEG may be taken by mouth daily, with minimal cramping or gassy side effects (Yadav et al., 2021). Castor oil is a powerful stimulant laxative hydrolyzed in the upper small intestine to form recinoleic acid, which stimulates intestinal motility. Once commonly used, it has now fallen out of favor for purgative action (Alookaran & Tripp, 2022). Abdominal massage is very beneficial for people who suffer from constipation, who would otherwise need to take laxative drugs. Following the natural order of the large intestine, ascending, transverse, and descending colon, apply firm pressure with stacked hands until your fingertips can palpate the intestine (Choi et al., 2020). Using firm pressure, small circular motions, and vibrations, work in a clockwise direction along the intestine. You may even be able to feel the stuck fecal matter moving through the intestine as you work in more severe cases. The vibration to the intestine is particularly useful as it mimics peristalsis. Peristalsis is the muscle movement of the large intestine that contracts and retracts, moving the feces through the colon down to the anal sphincter. Glucocorticoids/corticosteriods Glucocorticoids/corticosteroids are used to treat a wide variety of conditions and diseases, such as joint pain, cancer, asthma, and allergies. The oral and injected types of corticosteroids form a major part of treatment plans for many chronic pain conditions. Many inflammatory conditions, such as rheumatoid arthritis and gout, are first treated with NSAIDs. If these drugs do not control the symptoms, corticosteroids are often the next line of treatment (Hodgens & Sharman, 2023). Examples of these drugs are betamethasone (Celestone), cortisone, dexamethasone (Decadron), hydrocortisone or cortisol (Cortef), hydrocortone, methylprednisolone (Medrol), prednisolone (Prelone), prednisone (Meticorten), and tramcinolone (Kenacort). There are no direct interactions between therapeutic massage and glucocortoid medications (Dresden, 2023). Corticosteroids are a group of anti-inflammatory drugs similar to the hormone cortisol produced in the body. Corticosteroids reduce the inflammation associated with many diseases, including many forms of arthritis. They can be taken in a variety of forms, such as pills, injections, inhalers, nasal sprays, topical creams, drops, ointments, enemas, foams, and suppositories. Most corticosteroids are available only with a physician’s prescription. However, your patient may use topical creams that are available over the counter (Hodgens & Sharman, 2023). Corticosteroids cause atrophy and weaken connective tissues, including skin, fascia, ligaments, 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 patient’s health and safety (Hodgens & Sharman, 2023). 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
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