resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
The Drug Epidemic: Are You Guilty, Too?
Attention-deficit / hyperactivity disorder (ADHD) has become epidemic among children in the United States. According to the Centers for Disease Control and Prevention (CDC), the percentage of school-aged children diagnosed with ADHD has grown from 7.8 percent in 2003 to 11.0 percent in 2011.
Acupuncture's Essential Role
Acupuncture should play a more prominent role in U.S. healthcare during and after this post-Affordable Care Act era when chronic care and population health management are key concerns for all healthcare providers.
Sacroiliac Joint Fusion: Where's the Wisdom?
We should be very skeptical of the purportedly less invasive version of the already defrocked sacroiliac fusion surgery, "minimally invasive" sacroiliac joint fusion; and concerned this procedure simply represents the device manufacturer's attempt to find yet another new market.
Patience vs. Patients
How long have you been in practice? I began my journey more than 20 years ago and opened my first acupuncture clinic in 2008. Just like you, I've learned a lot over the years. Recently, I sat in an interview and was asked what made me successful.
Putting POLITE Into Practice
First came the acronym RICE (Rest, Ice, Compression, Elevation), which eventually became PRICE (Protect, Rest, Ice, Compression, Elevation). Then in 2015, we started hearing POLICE (Protect, Optimal Loading, Ice, Compression, Elevation).
Six Things Every Chiropractor Should Know About Opioids
An increase in addictions and deaths due to opioids has raised significant concern and media attention. We offer this brief overview on this important public health problem for the practicing chiropractor.
Physical Examination in an Evidence-Based World
I have always had a fascination with physical examination procedures, particularly orthopedic tests. The origin of my fascination began just after graduation when I began the chiropractic orthopedics program.
News in Brief
F4CP MEmbership Milestone Reached; ICA Challenging New California Vaccine Law; TCC Names New President; New Provost at UWS.
CE Regulations Are Hurting Chiropractic
During my 35 years in the chiropractic profession, I have been forced to attend available continuing-education programs that were occasionally incredibly beneficial, but frequently not worth my time.
Concerns Regarding CDC Guidelines for Pain Management
In response to the epidemic rates of opioid and heroin addiction, the Centers for Disease Control and Prevention (CDC) set new guidelines for physicians regarding treatment for pain.
We Get Letters & Email
Our Medicare Challenges Aren't an Education Issue; Passion to Succeed: More Pivotal Than GPA?
The Most Important Vitamin You've Never Heard Of: K2
Imagine if one in every three patients who walked through your door was afflicted with a debilitating, yet completely preventable and treatable disease.
Infertility: Managing Irregular Menses
Infertility is an area where Chinese medicine is particularly helpful. In the main, in women below the age of 38 without organic disturbance, the success rate using TCM (Traditional Chinese Medicine) should exceed 85%.
HVLA Technique: Addressing Myths
In the annals of chiropractic history and literature, and in the imagination of the public, there is one manual adjusting technique that can produce a wide range of responses, both from patients and casual observers.
Case Study: 2-Year-Old Suffering From Urinary Reflux
A19-month-old female child presented to my office for treatment. Her mother reported the child had been diagnosed with urinary reflux and associated urinary tract infections, recurrent bouts of otitis media and inability to sleep.
Acupuncture Earns BLS Unique Code
The United States Bureau of Labor Statistics recently announced that acupuncturists will have their own unique occupational code in the 2018 BLS Handbook. The new Standard Occupational Code (SOC) is 29-1291, will be included in the next edition of the BLS Occupational Handbook, which will be published in 2018.
NBCE Fumbles Computerized Testing Process
Imagine being a student again, about to take one of the four tests required to become a doctor of chiropractic. You've studied almost nonstop for the past few weeks. You can feel your anxiety level rise as you sit down in front of the computer screen.
Forward Head Carriage and the Feet: What's the Connection? (Pt. 2)
Clinical evaluation of standing posture using relatively low-tech tools has been confirmed as valid and reliable by several studies. The original device used to evaluate posture was the plumb line, which served as a reference line for the effects of gravity on body alignment.
Comparing Costs of Care: DCs, MDs or PTs - Who Costs More?
In a health care era where evidence is increasingly the benchmark for insurance coverage, patient care and even cultural authority, we get plenty of it courtesy of a retrospective cost analysis spanning 10 years, more than 660,000 "covered lives" and nearly 7.5 million claims from Blue Cross Blue Shield of North Carolina.
The Lung Official
The Lung is known as the "Official Who Receives the Pure Chi From the Heavens." The act of breathing in, known as inspiration, brings oxygen into the body from the atmosphere. Each exhalation or expiration removes and releases carbon dioxide, a waste product of the body, into the atmosphere.
Letter to the Editor
On December 7, 1999, the U.S. FDA reclassified the status of acupuncture needles from class III (investigative devices subject to investigative device exemptions...) to class II (special controls).
Why We Need to Fix the Mechanoreceptors (Part 2)
The muscle spindle, a particular type of mechanoreceptor, is located deep within the muscle belly, encapsulated in fascia made up of intrafusal fibers, all within the extrafusal muscle fibers.
University of Bridgeport Acupuncture Students Make Rounds at Sisters of Notre Dame
Nuns are not stereotypical acupuncture patients, Dr. Jennifer Brett acknowledges with a laugh. But then again, acupuncture has gone mainstream, just like cappuccinos and recycling. "It's changed a lot from the '70s and '80s," said Brett.
October, 2010, Vol. 10, Issue 10
Chasing the Pain
By Rita Woods, LMT
Cholesterol lowering drugs are one of the most widely prescribed medications. Statins, the class of cholesterol lowering drugs are HMG-CoA reductase inhibitors. In short, they suppress the enzymes the liver needs to produce cholesterol naturally.The body makes its own cholesterol which is important for many bodily functions including lubricating the joints. Some people are genetically predisposed to over produce their own cholesterol and some people lack dietary discretion and consume foods high in cholesterol. High cholesterol is viewed as a risk factor for cardiovascular disease which has prompted the prolific use of drugs intended to lower it.
Several types of statins exist such as atorvastatin, cerivastatin, fluvastatin, lovastatin, mevastatin, pitavastatin, pravastatin, rosuvastatin, and simvastatin. These medicines are sold under several different brand names including Lipitor (atorvastatin), Pravachol (pravastatin), Crestor (rosuvastatin), Zocor (simvastatin), Lescol (fluvastatin) and Vytorin (combination of simvastatin and ezetimibe). Mevastatin is a naturally occurring statin that is found in red yeast rice.
Over 20 million people in the United States take statins. Muscle and joint pain are some of the most common side effects of cholesterol lowering statins. These side effects are clearly stated by the drug manufacturers and in some cases, may be serious.
Giving any medical advice is not within our scope of practice. There is no real or implied intent to give advice or join in the great debate about the use or misuse of said drugs.
The intent of this article is to bring to light those side effects that a massage therapist may encounter. They include but are not limited to muscle aches or weakness, tendon problems, muscle cramps and arthralgia.
Encourage your client to read the pamphlets included with their prescription and educate yourself on possible side effects that may play a role in your practice as a bodyworker. Older clients may not have Internet access so keep a copy of The Pill Book in your office as a helpful reference for them (and for you). Typically, the consumer information section on the drug's Web site is short and easy to understand. You may want to copy those pages for some clients. For example, at www.lipitor.com I was able to get clear and concise information.
While muscle and joint pain complaints are common for many people taking statin medications, neuropathy - often experienced as the tingling, numbing, pins and needles feeling in the extremities, has also been cited as a side effect.
In an article "Statins and Risk of Polyneuropathy" (American Academy of Neurology), the authors concluded: "Long-term exposure to statins may substantially increase the risk of polyneuropathy."1
In Annals of Internal Medicine, Michael Jacobs, MD, reported on a case study with the following conclusion: "The appearance, disappearance, and reappearance of symptoms in association with treatment and retreatment with related cholesterol-lowering medications strongly suggest that a peripheral sensory neuropathy may occur with the use of HMG-CoA reductase inhibitors."2
As massage therapists, we are trained to think of pins and needles, tingling and numbness as probably involving nerves or circulation. Medically induced myalgia and neuropathy adds a new dimension to your treatment plan and a new perspective on patient interaction and education.
While the information from clinical and medical sites is helpful, I find that listening to the stories of real people is most helpful when building a basis for dialoging about a condition. One Web site that I found particularly interesting was www.medications.com. While I don't recommend that you take the information as medical advice or as actual case studies, I find it helpful in understanding how the daily activities of these patients has been impacted. These statements would be similar to the subjective comments on your SOAP notes. These anecdotal comments were screened to include only those that provided a direct correlation to the use or cessation of the medication. Let's listen to some of them:
"My body has aches and pains all over. I'm having knee issues and weak ankle issues and also the top part of my arms hurt so bad (feels like symptoms someone with 'frozen shoulder' would have). I have developed lower back pain. I bend over to bathe my puppy and I can barely raise back up."
"The worst of it all, was the shooting pains up and down my right leg all the way down to my foot. It felt like barbed wire being raked across the inside of my leg."
"I get leg cramps, jimmy legs, shooting arm pains and severe back pain. He upped my dose and my back pain is a lot worse than before."
In an article, "Tendon Disorders Due to Statins" (PubMed.gov3), tendons were cited as being affected by statins. According to the article, "French authors have analysed about 100 reports of tendon disorders attributed to statins. The Achilles tendon was most often affected. This adverse effect mainly occurred during the first year of treatment and appeared to be more frequent in patients with diabetes, hyperuricaemia or a history of tendon disorders, and in persons engaging in strenuous sports. In practice, tendinopathy appears to be a rare adverse effect of statins, but patients should be closely monitored during the first year of treatment, especially when they have associated risk factors."
I spoke with a pharmacist about the side effects and asked what complaint he heard most often. "Joint pain. Elbows and knees, especially," he said. "However, back pain is common but I think most people consider that normal. They attribute it to everyday aches and pains but joint pain will be experienced as something different and out of the norm. So they notice that."
Mayo Clinic Cardiologist Thomas Behrenbeck, MD, advises: "If you have muscle aches or other troubling symptoms after starting statin medications, talk to your doctor as soon as possible." In many cases, the symptoms started or worsened after an increase in the drug dose or with the addition of other medications. High blood pressure and diabetes are linked to a higher risk of statin complications, according to a recent paper (Golomb and Evans) in the online edition of American Journal of Cardiovascular Drugs.
It's now more important than ever to get a full medication list from your client as part of your medical intake forms. I interviewed one therapist about her medical questionnaire with the following response, "It's vital to get the list of medications. I had one client who was taking 11 different medications and came to me for migraine headaches. Upon researching the meds, I discovered that three of them listed migraine headaches as a side effect. She was, by the way, on a migraine headache medication. I made a chart for her listing pertinent side effects using reputable medical resources and presented her with the list at her next appointment."
The key for us as therapists is to listen as the client describes their symptoms to determine if it's systemic (meaning all over pain), if it started after beginning a medicine, or if the pain has been triggered by normal activity such as playing tennis. If no known cause can be found, then look to the possibility of medically induced pain. Without a thorough client intake evaluation that includes medications, you may spend time chasing the pain that can never be caught.
Click here for previous articles by Rita Woods, LMT.
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