Massage can be effective in treating opioid use disorder as part of the
treatment plan and can take place in any inpatient, outpatient, residential
or hospital setting. Get your monthly body and mind maintenance Massage at www.indopakmassage.com
Throughout 2016, the American Massage Therapy Association (AMTA)
has been actively engaged with several organizations and agencies
regarding massage therapy for pain, and specifically as an alternative
to opioids (AMTA, 2017). AMTA has worked with the Academy of
Integrative Pain Management to foster ongoing dialog on integration of
massage therapy into approaches to pain, instead of using opioids.
In 2017 the American College of Physicians (ACP) developed a
guideline to present the evidence and provide clinical recommendations
on noninvasive treatment of low back pain.
Recommendation 1 involves massage. Given that most patients with acute
or subacute low back pain improve over time regardless of treatment,
clinicians and patients should select nonpharmacological treatment with
superficial heat (moderate-quality evidence), massage, acupuncture
or spinal manipulation (low-quality evidence). If pharmacologic
treatment is desired, clinicians and patients should select nonsteroidal
anti-inflammatory drugs or skeletal muscle relaxants (moderate-quality
evidence). (Grade: strong recommendation).
Low back pain is frequently classified and treated on the basis of
symptom duration, potential cause, presence or absence of radicular
symptoms, and corresponding anatomical or radiographic abnormalities.
Acute back pain is defined as lasting less than four weeks, subacute back
pain lasts between four and 12 weeks, and chronic back pain lasts more
than 12 weeks. Radicular low back pain results in lower extremity pain,
paresthesia, and/or weakness and is a result of nerve root impingement.
Recommendation 2 includes nonpharmacological treatment with
exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-
based stress reduction (moderate-quality evidence), tai chi, yoga, motor
control exercise, progressive relaxation, electromyography biofeedback,
low-level laser therapy, operant therapy, cognitive behavioral therapy,
or spinal manipulation (low-quality evidence). (Grade: strong
Recommendation 3 states that in patients with chronic low back pain
who have had an inadequate response to nonpharmacological therapy,
clinicians and patients should consider pharmacologic treatment with
nonsteroidal anti-inflammatory drugs as first-line therapy, or tramadol
or duloxetine as second-line therapy.
The guideline concludes by stating that clinicians should only consider
opioids as an option in patients who have failed the aforementioned
treatments and only if the potential benefits outweigh the risks for
individual patients and after a discussion of known risks and realistic
benefits with patients. (Grade: weak recommendation, moderate-quality
The East West College of Healing Arts in a 2016 article added the
following support for massage to treat symptoms of opioid use disorder:
Opioid-dependent patients who receive massage therapy may
experience the following positive outcomes:
Increased body awareness
: Opioid use is often rooted in chronic
pain. The opioid user attempts to avoid pain through painkiller
medications. Adept massage therapists can help patients feel what
the pain is actually like in their bodies. While this may at first be
very difficult, over time those with opioid use disorders find the
pain isn’t their whole world. They eventually discover that they can
live with their pain without requiring outside substances.
Effective pain treatment
: A May 2016 study published in The
Journal Pain Medicine found that massage therapy can reduce pain,
minimize anxiety and improve health-related quality of life. All
three outcomes are relevant for those with substance dependency
issues. By providing a drug-free way to relieve pain, massage can
Manage detox symptoms
: Withdrawal symptoms can be intense,
extremely painful, stressful and uncomfortable. Massage can help
by increasing the levels of natural feel-good chemicals in the brain
and decreasing stress hormones like cortisol. For instance, a good
massage increases dopamine levels, the body’s reward chemicals.
By increasing these pleasure chemicals, regular massage can help
addicts withstand withdrawal symptoms.
Deep-tissue massage for managing symptoms during opiate recovery
A deep-tissue massage that incorporates acupressure and trigger-point
therapy has been recommended to help relieve symptoms that clients
may experience while recovering from opiates during phases of tapering
off the drug and withdrawal (Finch, 2017). These techniques create
the release of an abundance of endorphins, which are our endogenous
opioid peptides, natural painkillers, known to reduce pain and produce
a sense of euphoria. Matt Finch reports that in 2010, a meta-analysis in
The Journal of Clinical Psychiatry found that deep-tissue massage leads
to the following benefits:
Reduction of stress hormone levels.
Lowered heart rate.
Elevated mood and relaxation by triggering the release of oxytocin
After 15 minutes of deep-tissue massage techniques, endorphins come
into play and the positive benefits may last for 48 hours.
The mind, body and spirit connection
One of the DSM-5 criteria for diagnosis of opioid use disorder is the
“continued opioid use despite knowledge of having a persistent or
recurrent physical or psychological problem that is likely to have been
caused or exacerbated by the substance.” This represents a disconnect or
avoidance of the harmful psychological and physical effects of the drug
when their only focus is on obtaining more opioids for the next “high,”
regardless of the damaging effects.
According to the East West College 2016 report, this disassociation
occurs when addicts disconnect from their bodies and emotions. During
this time, addicts are unaware of what they are feeling or experiencing.
Therapists hypothesize that this disassociation is rooted in addiction
behavior. In order to continue taking drugs, addicts must ignore their
bodily reactions. The healing process must therefore include some time
for addicts to adjust to actually experiencing life in the moment, in a
Beyond the physiological benefits of massage, techniques can help
clients reconnect to their bodies, be present in the moment, and have a positive experience in the present. This may be something they had not
been able to accomplish during drug use because the painful emotional
and physical symptoms, caused by the adverse effects of opioids, made
living in the present unbearable without drugs.
While patients may be too intimidated to open up in talk therapy, massage
therapy meets them where they are. While receiving massage, patients
need not explain how they feel, nor why. They can simply relax while the
therapist explores and loosens stress points in the body (East West, 2016).
As previously discussed, massage promotes relaxation because it
changes the chemistry of the brain through the release of serotonin and
dopamine. It also provides the benefit of positive touch and a connection
to another person that may have been missing during addiction.
East West concludes:
Massage helps activate parasympathetic vagal pathways by
stimulating pressure receptors. Vagal activation is correlated with
better sleep and less anxiety. Overall, addiction patients “just feel
better” after a massage. They may leave the session saying, “Oh!
That’s what relaxation feels like,” or, “I didn’t know I was so
happy/sad.” Massage helps addicts feel and heal through touch. This
includes opioid addicts.
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