Pharmacology and Massage Therapy: Beta-Blockers

One of the most frequently prescribed class of drugs in the United States are the drugs commonly known as beta blockers. They are prescribed for a great variety of conditions that are approved by the FDA and are used "off label" for any number of other conditions.
Some common beta blockers that you may see on your client's medication list include: propranolol (Inderal), metoprolol (Lopressor) and atenolol (Tenormin).
The drugs block the effects of the Sympathetic Nervous System (SNS) by stopping the effect of epinephrine/norepinephrine at the beta receptors in the heart and sometimes also in the lungs and adrenal glands. The SNS is part of the Autonomic Nervous System that regulates the functions of our bodies in response to internal and external factors. The SNS is the branch that stimulates the body to action and when overstimulated is the source of stress effects on the body. By blocking the effects of the SNS at the receptor sites the drugs decrease blood pressure, decrease the force of heart contractions, slow electrical impulse conduction through the heart, decrease heart output and oxygen demand. In those that affect the lungs, constriction of the broncioles can occur.
Side effects that are related to the blocking of the SNS include fatigue, sleepiness, low blood pressure, slow heart rate, fainting, fluid retention, wheezing, irregular heartbeat, edema, Raynaud's syndrome, gas, and nausea and vomiting.
Beta blockers are generally used to treat high blood pressure, irregular heart rhythms and long-term prevention of angina (chest pain) and heart attack. They are also used for such diverse conditions as migraines, anxiety, essential tremors, glaucoma, PMS and perimenopausal symptoms.
As a massage therapist recognize that the body may relax more quickly and deeply for the client taking these meds and that gentle stimulation at the end of the massage may be needed. A drop in blood pressure can also occur with massage, so care in getting the client on and off the table is needed. Other changes to how massage is applied may be required related to the client condition, severity of cardiac disease etc.
References: http://www.mayoclinic.com/health/beta-blockers/HI00059 , http://www.medicinenet.com/beta_blockers/article.htm
Jean Wible, RN, BSN, LMT, NCTMB, HTCP Author of "Pharmacology for Massage Therapy" and "Drug Handbook for Massage Therapists"

Pathology and Massage: Scleroderma by Jean Wible

Scleroderma is an autoimmune disease that affects women 4 times more than men. While its cause is unclear, its symptoms are due to an overproduction of collogen and hardening (sclerosis) of the tissues of the body. Scleroderma can manifest in many ways. It can be local or systemic. It can affect the skin, blood vessels and organs. The most common symptom is changes in the color of the skin and tightening and thickening of the skin.
In localized scleroderma two types of lesions can occur; morphea, which shows as oval patches on the trunk, face and extremities that start as dry, thickened skin and progress to pale centers with purple edges, or linear, where a discolored line or band on arms, legs or forehead appear resembling a scar from a long cut. Localized scleroderma is usually self-limiting and may resolve over time.
Systemic scleroderma is a more serious form of the disease that can involve skin, blood vessels, and organs especially the heart, kidneys, lungs and digestive tract. There are 3 forms; limited systemic scleroderma which has a slow onset and progression but can eventually affect the organs, diffuse scleroderma which has a sudden onset and more rapidly involves the organs, and sine scleroderma which only involves the organs and doesn't manifest in the skin at all.
CREST is the acronym for the common symptoms of scleroderma and stands for Calcinosis, calcium deposits in the skin especially in the fingers, Raynaud's phenomenon, impaired circulation and vascular spasm in the extremities, Esophageal dysmotility or sluggish digestion with reflux, Sclerodactyly, which is hardening of the fingers, and Telangiectasia or discoloration of the skin.
Systemic scleroderma can cause major health problems as it progresses. Ulcerations of the skin can lead to infection and gangrene while fibrosis of lungs, kidney and heart can lead to failure of these organs. While most often a long term, chronic disease systemic scleroderma can be fatal.
Treatment is supportive with immunosuppressant drugs, corticosteroids, pain relievers, and other drugs depending on the symptoms. Physical and occupational therapy are also utilized to help maintain movement and flexibility of the joints as long as possible.
Massage therapy will need to be adjusted depending on the type of scleroderma, the individual symptoms and the severity of the disease. Myofascial techniques will generally be ineffective due to changes in the tissue itself. Deep tissue may be cautioned or contraindicated if skin hardening is severe and circulation compromised. Gentle relaxation massage that is firm and rhythmic can help improve circulation and be soothing to tight tissues as well as help the client to deal with the stress and pain of a chronic disease. Passive and active movement of the joints can also be of help but should be gentle and never forced beyond the physiologic barriers. Energy work and breath work are some of the other modalities that may be used even when massage may be contraindicated.
Further information on this topic can be found at http://www.mayoclinic.com/health/scleroderma/DS00362 , http://www.scleroderma.org/ , or http://www.niams.nih.gov/Health_Info/Scleroderma/default.asp
Jean Wible is a Registerd Nurse, Nationally Certified and Licensed Massage Therapist and Healing Touch Certified Practitioner. Author of "Pharmacology for Massage Therapy" and "Drug Handbook for Massage Therapists" and faculty at the Associate Degree Program in Massage Therapy at The Community College of Baltimore County.

Massage Therapy Week in the News

Massage Therapy Week at CCBC was a celebration of wellness and an appreciation of how Therapeutic Massage can improve your quality of life. Thanks to everyone who stopped by for a massage or to learn more about the Associate's Degree program in Massage Therapy at the Community College of Baltimore County.

Read the article in The Avenue