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I t p a y s t o b e A B M P C e r t i f i e d : w w w. a b m p . c o m / g o / c e r t i f i e d c e n t r a l 45 vena cava in order to trap clots that may ascend from the lower extremities. Trapped clots can then be melted with natural or supplemented chemicals before they do any damage. The presence of a vena cava filter is not a contraindication for massage, but does suggest that the client has a history of developing threatening clots from the legs or pelvis; this obviously has implications for massage therapy choices. Further, clot-management medication likewise calls for caution with pressure during massage. DIABETIC IMPLANTS Clients who have diabetes may manage their condition with a couple of different devices. Insulin Pumps Insulin pumps are computerized devices carried close to the body that deliver insulin via a catheter inserted through the skin into the fatty tissue below. Insulin is delivered both as a slow, continuous drip and in larger doses after a meal. Insulin pumps carry a risk of the catheter becoming dislodged. Peritoneal Dialysis A peritoneal dialysis system involves a permanent tube in the abdomen through which fluids can be transferred. This uses the peritoneal lining as a substitute for failing kidneys. Diabetes is a common reason to use peritoneal dialysis, but people with kidney damage from other causes may also have this implant. PAIN MANAGEMENT IMPLANTS People who live with chronic, severe pain may use a variety of devices. This is a field with lots of new technology, so the equipment used in this context changes often. Here are a few to be aware of: TENS/PENS Units Transcutaneous electrical nerve stimulation (TENS) and percutaneous electrical nerve stimulation (PENS) units deliver low-level electrical stimulation through electrodes on the skin surface. They are noninvasive and economical, but sometimes ineffective for very severe pain. Intrathecal Pumps Intrathecal analgesia therapy delivery systems use an implanted reservoir of medication and a catheter to deliver a drug directly to the spinal canal. This allows the patient to use much less of the medication, since it doesn't go through the digestive system before reaching the spinal cord. The reservoir is refilled every few months. Patients with intrathecal pumps may have some activity limitations, especially on bending and twisting, but if the pump is stable and functional, it shouldn't affect their ability to receive most types of massage. Spinal Cord Stimulation Spinal cord stimulation involves implanting a pulse generator under the skin of the abdomen and running leads into the spinal canal. Electrical pulses are administered directly to the spinal cord to replace pain signals with a tingling sensation. Spinal cord stimulation is a relatively new intervention with a significant list of possible complications, but it shows promise as a drug-free method of treating severe pain. Patients with this device must not undergo MRI testing because of the implanted metal parts.