Complete Your CE Test Online - Click Here ○ ○ Severe muscle stiffness or twitching, loss of coordination. ○ ○ Nausea, vomiting, or diarrhea. ○ ○ Nausea, vomiting, loss of appetite. ○ ○ Weakness or dizziness. ○ ○ Inability to get or keep an erection. ○ ○ Irregular menstruation. ○ ○ Decreased sexual desire. Source: U.S. National Library of Medicine 2017. Buprenorphine common side effects: ○ ○ Back pain. ○ ○ Cough or hoarseness. ○ ○ Difficulty having a bowel movement (stool). ○ ○ Fever or chills. ○ ○ Headache. ○ ○ Lower back or side pain. ○ ○ Nausea, stomach pain, vomiting. ○ ○ Painful or difficult urination. ○ ○ Runny nose, sneezing. ○ ○ Trouble sleeping. Less common: ○ ○ Diarrhea. ○ ○ Feeling faint, dizzy or lightheaded. ○ ○ Feeling of warmth or heat. ○ ○ Flushing or redness of the skin, especially on the face and neck. ○ ○ Lack or loss of strength. ○ ○ Sweating. Serious side effects requiring immediate medical attention: ○ ○ Confusion. ○ ○ Blurred vision. ○ ○ Difficult or troubled breathing. ○ ○ Dizziness, faintness or lightheadedness when getting up suddenly from a lying or sitting position. ○ ○ Drowsiness. ○ ○ Irregular, fast, slow or shallow breathing. ○ ○ Pale or blue lips, fingernails or skin. ○ ○ Pinpoint pupils. ○ ○ Relaxed and calm feeling. ○ ○ Sleepiness. ○ ○ Unusual tiredness or weakness. Source: Drugs.com (2018a). Naltrexone side effects: More common: ○ ○ Abdominal or stomach cramping or pain (mild or moderate). ○ ○ Anxiety, nervousness, restlessness or trouble sleeping. ○ ○ Headache. ○ ○ Joint or muscle pain. ○ ○ Nausea or vomiting. ○ ○ Unusual tiredness. Less common: ○ ○ Chills. ○ ○ Constipation, diarrhea. ○ ○ Cough, hoarseness, runny or stuffy nose, sinus problems, sneezing or sore throat. ○ ○ Dizziness. ○ ○ Fast or pounding heartbeat. ○ ○ Increased thirst. ○ ○ Irritability. ○ ○ Loss of appetite. ○ ○ Sexual problems in males. Serious side effects requiring immediate medical attention: Less common: ○ ○ Skin rash. Rare: ○ ○ Abdominal or stomach pain (severe). ○ ○ Blurred vision, aching, burning, or swollen eyes. ○ ○ Chest pain. ○ ○ Confusion. ○ ○ Discomfort while urinating or frequent urination. ○ ○ Fever. ○ ○ Hallucinations or seeing, hearing or feeling things that are not there. ○ ○ Itching. ○ ○ Mental depression or other mood or mental changes. ○ ○ Ringing or buzzing in the ears. ○ ○ Shortness of breath. ○ ○ Swelling of the face, feet or lower legs. ○ ○ Weight gain. Source: Drugs.com (2018b). Some caution may be necessary when working with those in recovery, however, as they do present certain challenges (DeMatteo, 2017). It may be necessary to be clear and firm in your policies and in setting your boundaries as this population often has trouble following rules and respecting others. There is also an increased likelihood of an emotional release when you are working with clients battling addiction. While addiction is a physical problem, it is also very mental and emotional. Those fighting addiction almost always have some sort of emotional issue that they are holding onto and there is an increased chance for that to surface when they let their guard down on the massage table. East West College suggests: ● ● Treat lightly. Recognize that addiction is often rooted in childhood trauma, including the violation of personal boundaries. Therefore, work carefully, asking for plenty of client feedback. Also maintain clear professional boundaries, as addictive behavior may include crossing professional/personal limitations. ● ● Don’t take it personally. The addict’s journey is his or her own. You can’t force someone to stay on the path. If they relapse, and you become angry in response, they may feel their boundaries have been violated. Provide healing, and then let it go. ● ● Be willing to provide references. If you don’t feel a certain client is within your area of expertise, be willing to refer to a more experienced practitioner. The National Center for Complementary and Integrated Health, a division of the National Institute of Health, provides the following recommendations (NCCIH, 2017): ● ● While often preliminary or conflicting, there is scientific evidence that massage may help with back pain and may improve quality of life for people with depression, cancer and HIV/AIDS. ● ● Massage therapy appears to have few risks if it’s used appropriately and provided by a trained mas-sage professional. ● ● Much of the evidence suggests that these effects are short term and that people need to keep getting massages for the benefits to continue. ● ● People with some conditions such as bleeding disorders or low blood platelet counts should avoid having forceful and deep-tissue massage. People who take anticoagulants (also known as blood thinners) should also avoid them. Massage should not be done in any potentially weak area of the skin, such as wounds. ● ● Deep or intense pressure should not be used over an area where the patient has a tumor or cancer, unless approved by the patient’s health care provider. ● ● Clients should not use massage therapy to replace conventional care or to postpone seeing a health care provider about a medical problem. Of course, this would include substance use issues. References Š Š American Massage Therapy Association (2017). Massage Therapy as an Alternative to Opioids. Retrieved January 16, 2018, from https://www.amtamassage.org/articles/1/News/detail/3680/massage- therapy-as-an-alternative-to-opioids Š Š American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th Ed.). Arlington, VA: American Psychiatric Publishing. Š Š Center for Disease Control and Prevention (2017). Categories of Opioids. Retrieved January 16, 2018, from https://www.cdc.gov/drugoverdose/data/analysis.html Š Š Center for Disease Control and Prevention (2018). Provisional Drug Overdose Death Counts. Retrieved January 16, 2018, from https://www.cdc.gov/drugoverdose/data/analysis.html Š Š Crawford, C., Boyd, C., Paat, C.F., Price, A., Xenakis, L., Yang, E., Zhang, W. (2016) Evidence for Massage Therapy (EMT) Working Group. Population. Pain Med. 2016 May 10. pii: pnw099.PMID: 27165971.Retrieved January 16, 2018, from https://www.ncbi.nlm.nih.gov/pubmed/27165971. Š Š DeMatteo, L. (2017). The Growing Problem of Addiction: Can Massage Therapy Aid in Recovery? Š Š Retrieved January 16, 2018, from http://www.integrativehealthcare.org/mt/archives/2017/07/the- growing-problem-of-addiction-can-massage-therapy-aid-in-recovery.html Š Š Drugs.com (2018a). Buprenorphine Side Effects. Retrieved January 17, 2018, from https://www.drugs. com/sfx/buprenorphine-side-effects.html Š Š Drugs.com (2018b). Naltrexone Side Effects. Retrieved January 17, 2018, from https://www.drugs. com/sfx/naltrexone-side-effects.html Š Š East West College (2016). Massage as a Treatment Tool for Opioid Dependence. Retrieved January 17, 2018, from https://eastwestcollege.com/massage-as-treatment-tool-for-opioid-dependence/ Š Š Finch, M. (2017). How Deep Tissue Massage Can Help You Feel Better While Quitting Opiates. Retrieved January17, 2018, from https://opiateaddictionsupport.com/massage-therapy-for-opiate- addiction-recovery/ Š Š Heller, (2016). Opioid Withdrawal. Retrieved January 16, 2018, from https://medlineplus.gov/ency/ article/000949.htm. Page 50 Massage.EliteCME.com