Cautions or Adverse Effects of Massage - Assignment Example

? Cautions on Massage Liza Dipu Nursing 500 Fordham 31 July Cautions on Massage Nurses have been using some of the more than 800 alternative therapies and systems of care that existed for centuries (Snyder and Lindquist, 2006, p. 1). Some of these alternative therapies and systems of care became known as “alternative/complementary therapies.” The term “complementary” is preferred because it emphasized that a therapy is adjunct to conventional care (Snyder, 2006, p. 3). In contrast, the term “alternative” is not preferred because a therapy can be interpreted as something intended to supplant conventional care or western medicine although both terms are being used by the United States National Center for Complementary and Alternative Medicine or NCCAM of the National Institutes of Health (Snyder, 2006, p. 3). The inspiration of the nursing profession, Florence Nightingale, had stressed the importance of creating an environment that supports healing and noted that in such an environment supportive to healing, complementary therapies like music perform an important role (Snyder, 2006, p. 8). Complementary therapies are important for holistic nursing. This is because holistic nursing considers the individual’s interior, collective interior and collective exterior (Dossey, 2009, p. 4). Snyder and Lindquist’s (2010) list of complementary therapies include massage. Citing several sources, Snyder and Taniguki (2010, p.337) identified massage therapy as “one of the most widely used complementary therapies and has been a part of the nurse’s armamentarium for centuries.” In many cases, “massage is combined with other therapies, such as music, aromatherapy, acupressure, or light touch” that it has become difficult to separate the effects of the beneficial specific effects of massage from those of the other therapies (Snyder and Taniguki, 2010, p. 337). However, several studies have reported that massage has beneficial effects for relaxation, improving sleep, and minimizing pain (Snyder and Taniguki, 2010, p. 337). Based on at least two sources, the term “massage” was derived from an Arabic word that means “to press gently” (Snyder and Taniguki, 2010, p. 337). However, the term “massage” was defined by American Massage Therapy Association as “the application of manual techniques and adjunctive therapies with the intention of positively affecting the health and well-being of the client” (Snyder and Taniguki, 2010, pp. 337-338). Snyder and Taniguki emphasized that there is a scientific evidence for the view that massage therapy works. One study indicated that massage promotes relaxation and pain reduction, and stimulates the mechanoreceptors that activate the nonpainful nerve fibers (Snyder and Taniguki, 2010, p. 338). Thus, based on the study, Snyder and Taniguki asserted that massage prevents pain transmission from reaching the consciousness. Studies also suggested that massage can affect the psychoneuroimmunological functions of the mind and body (Snyder and Taniguki, 2010, p. 338). Although anecdotal, there are indications that massage produces positive results in persons afflicted with HIV (Snyder and Taniguki, 2010, p. 339). A study also pointed out that massage is used to decrease aggressive behavior, improve sleep, facilitate communication, improve patient mobility, increase body weights, and increase psychological well-being (Snyder and Taniguki, 2010, p. 344). In practice, nurses explain to a patient the basis why massage therapy has to be used, assess a patient’s history, and secure the consent of a patient (Snyder and Taniguki, 2010, p. 343). Snyder and Taniguki (2010, p. 343) stressed that it is important to find out a patient’s overall response to touch because some people are adverse to touch as a result of negative experience. Others are also hypersensitive to touch and this matter must be factored in by a nurse (Snyder and Taniguki, 2010, p. 343). In overcoming the situation, Snyder and Taniguki (2010, p. 343) recommended that nurses begin with a light touch, increase the pressure only slowly, and assess the massage area for redness, bruises, or rashes. Nurses should be cautioned against using massage for cancer patients because a study expressed a concern that there are suggestions that massage therapy may accelerate metastases and, thus, guidelines were being developed in using massage for cancer patients (Snyder and Taniguki, 2010, p. 343). Further, because blood pressure may be lowered during a massage, Snyder and Taniguki cautioned that patients be monitored for feelings of light-headedness following an initial massage session. Snyder and Taniguki reminded that nurses are required to monitor their patients’ pulse and not only the patients? blood pressure in cardiac conditions to check for possible adverse effects. Furlan et al. (2002) reviewed studies that used randomized or quasi-randomized trials in investigating the effectiveness of massage and only managed to conclude that “massage might be beneficial for patients with sub-acute and chronic non-specified lower back pain” with an emphasis that “the evidence suggests that acupuncture massage is more effective than classic massage, but this needs confirmation” (p. 1896). Moreover, Furlan et al. (2002, p. 1897) reported that studies had shown that massage has little or no effect in relieving pain conditions in headaches, post-exercise muscle pains, cancer pains, and mechanical neck pain. A year after, Ernst (2003) reviewed the broader literature on massage therapy and found that the reported adverse events “include cerebrobascular accidents, displacement of a ureteral stent, embolization of kidney, haematoma, leg ulcers, nerve damage, posterior interosseus syndrome, pseudoaneurism, pulmonary embolism, ruptured uterus, strangulation of neck, thyrotoxicosis and various pain syndromes” (p. 1101). Enrst (2003, p. 1101) added that among several types of massage, “serious adverse effects were associated mostly with massage techniques under than ‘Swedish’ massage.” Clinical trials of massage therapy “rarely mention adverse effects” and many of the adverse cases reported were anecdotal (Ernst, 2003, p. 1102). A 45-year-old man suffered acute extensor paralysis of the metacarpophalangeal joint and inability to abduct the thumb radially around 15 to 20 minutes after a deep massage of the forearm (Ernst, 2003, p. 1102). A 39-year-old woman experienced abdominal discomfort, shoulder pain and nausea 24 hours after a deep tissue massage covering the abdomen (Ernst, 2003). On diagnosis, Ernst reported that the cause of the abdominal discomfort was attributed to the massage and the abdominal CT scan indicated haematoma in the hepatic lobe. The adverse effect on the woman was acute because over the next six months, she took 2 units of packed red cells, had a fever and lost 10.4 kilograms before making a recovery. Four patients who were suffering from neck pain were prescribed massage therapy subsequently reported an acute deterioration of hearing that were verified audiographically (Ernst, 2003). According to Ernst, those who studied the case of the four patients concluded that a causal relationship is likely based on the time sequence of events. In another case, a pulmonary embolus was diagnosed in a 72-year-old woman after a vigorous massage on the leg (Ernst, 2003, p. 1104). Other cases cited by Ernst review of literature include a report of acute back swelling after a vigorous back massage, a severe loin pain after a back massage that dislodged the thrombus in the graft into the left kidney, and a report of a mechanical massage on a diabetic that led to an infected leg ulcer. Given all the reports, Ernst (2003, p. 1105) concluded that “massage therapies are not totally devoid of risks” but nevertheless the risk is “probably low” even if “incidence of adverse events is unknown.” Again, through a review of literature, Humphreys (2010) investigated the possible adverse events in children treated by manual therapy and compared her study with those for adults. Manual therapy includes massage and “high velocity spinal manipulation” (Humphreys, 2010, p. 1). Humphreys reported (2010, p. 1) that although her review found “no serious or catastrophic adverse events were reported in the clinical studies or systematic review” that she examined, “an accurate estimate from high quality pediatric studies is currently not available.” At the same time, for adults, she reported that the estimate is that 0.003% to 0.13% of manual therapy may have resulted to serious adverse events. Humphreys (2010, p. 4) also reported that one study was able to confirm that “approximately half of adult patients treated by manual therapy are likely to experience minor to moderate adverse event after treatment, particularly after the first treatment.” According to her review, “the adverse events typically begin within 24 hours after treatment” and were mostly resolved within 48 hours (Humphreys, 2010, p. 4). Finally, in a publication, the NIH or the National Institutes of Health (2010, p. 1) declared that “scientific evidence on massage therapy is limited.” The NIH elaborated (2010, p. 1) that “scientists are not yet certain what changes occur in the body during massage, whether they influence health, and if so, how.” Nevertheless, the NIH (2010, p. 1) pointed out that “massage therapy appears to have few serious risks if it is used appropriately and provided by a trained massage professional.” Further, 13 clinical trials provided evidence that “massage might be useful for chronic low-back pain” (NIH, 2010, p. 3). A study of 300 patients in several sites even concluded that “massage may help relieve pain and improve mood” for advanced cancer patients (NIH, 2010, p. 3). The NIH identified (2010, p. 3) four cautions on the use of massage therapy. First, vigorous massage should be avoided on people with bleeding disorder, low platelet count, and people taking blood-thinning medications. Second, massage should not be done on areas with blood clots, fractures, wounds, infection, weakened bones, or cases where there was a recent surgery. Third, although massage may be generally safe for cancer patients, direct pressure over a tumor must not be done. Finally or fourth, pregnant women should be advised to consult their health provider before employing massage therapy. The NIH 2010 document provided a good conclusion and summing up for this review. The NIH 2010 cautions were founded on basic medical science given that studies on the risks of massage therapy are still inadequate to make solid conclusions even if all studies suggest from low to serious risks in employing massage therapy. References American Psychological Association. (2009). Publication manual of the American Psychological Association. 6th ed. Washington: American Psychological Association. Dossey, B. M. (2009). Integral and holistic nursing: Local to global. In: B.M. Dossey and L. Keegan (Eds.), Holistic nursing: A handbook for practice (5th ed., pp. 3-46). Sudbury, Massachusetts: Jones and Bartlet Publishers. Ernst, E. (2003). The safety of massage therapy. Rheumatology, 42, 1101-1106. Furlan, A., Brosseau, L., Imamura, M. and Irvin, E. (2002). Massage for low-back pain: A systematic review within the framework of the Cochrane collaboration back review group. SPINE, 27 (17), 1896-1910. Humphreys, B. K. (2010). Possible adverse events in children treated by manual therapy: A review. Chiropractic & Osteopathy, 18 (12), 1-7. NIH. (2010). Massage therapy: An introduction. U.S. Department of Health and Human Services: National Institutes of Health. Snyder, M. (2006). An overview of complementary/alternative therapies. In: M. Snyder and R. Linquist (Eds.), Complementary and alternative therapies in nursing (5th ed., pp. 3-15). New York: Springer Publishing Company. Snyder, M. and Lindquist, R. (2006). Complementary and alternative therapies in nursing. 5th ed. New York: Springer Publishing Company. Snyder, M. and Taniguki, S. (2010). Massage. In: Snyder, M. and Lindquist (Eds.), Complementary and alternative therapies in nursing (6th ed., pp. 337-348). New York: Springer Publishing Company. Read More