Issue link: https://www.massageandbodyworkdigital.com/i/885423
38 m a s s a g e & b o d y w o r k n o v e m b e r / d e c e m b e r 2 0 1 7 This is not universally accurate, but a client who reports these symptoms in the spring or summer, and who doesn't get relief from massage, is a good person to refer to a primary care physician. See the "Diagnostic Criteria for PMR and GCA," page 37 for more details. COMORBIDITIES, COMPLICATIONS, AND DIFFERENTIALS PMR and GCA are conditions with a well-recognized etiology and a predictably positive response to treatment with steroidal anti-inflammatories. But they can resemble many other conditions, and they can be comorbid with other conditions as well. And to have a successful outcome, other confusing overlapping problems must be ruled out, or identified and treated separately. This allows for treatment before complications develop, which is important. Comorbidities Consider a female client who is Caucasian and middle-aged. Can you think of conditions that are common in this population that present with achy joints and/ or headaches? Of course you can: the short list includes osteoporosis, osteoarthritis, fibromyalgia, hypothyroidism, and depression, among others—any of which can be confused with or comorbid with PMR and GCA. The challenge is that treatment strategies for these overlapping conditions are very different, and unless all the issues are addressed, the person is likely to be stuck in a painful state. Complications Sometimes complications of diseases are also their signs and symptoms. This is the case for GCA, which, as we've discussed, can lead to headaches and scalp pain; jaw, throat, and tongue inflammation; low fever; and general malaise. GCA is also associated with distal edema and Raynaud's phenomenon (a condition that is discussed in the March/ Consequences of Long-Term Steroid Use Steroids work PMR and GCA respond so well to oral corticosteroids (specifically prednisone or prednisolone) that this treatment is often used as a diagnostic confirmation. Left untreated, PMR-related pain may persist for months or years, and GCA can lead to life-threatening complications. But with appropriate steroid use, the period of pain and risk can be reduced to a matter of days; these are truly miraculous drugs for this situation. But there's a catch A person with PMR or CGA is typically treated with steroids for many months, and sometimes years. Primary care physicians must slowly taper off doses to allow the body to return to full function— this may take a long time. And the longer steroid treatment lasts, the higher the risk for adverse events. Here is a short list of adverse events associated with steroidal anti- inflammatories that are particularly relevant to massage therapists: • Increased bruising and slowed wound healing • Myopathy (muscle wasting) • Bone thinning and vertebral collapse (especially since most patients are middle-aged and elderly Caucasian women—exactly the same group most at risk for osteoporosis) • Avascular necrosis (the head of the femur degenerates due to poor blood supply) • Steroid-induced diabetes • High blood pressure • Extreme mood swings • Increased vulnerability to infections How do massage therapists make appropriate accommodations for these risks? It is impossible to fully catalog all the possibilities. But let's be sure that when we gather information, we find out both what medications our clients use and what side effects those medications may be causing. Then, we can be sure to offer the pressure, positioning, and type of massage therapy that is most likely to magnify the benefits of our work, while minimizing the risks.