Issue link: https://www.massageandbodyworkdigital.com/i/1078860
40 m a s s a g e & b o d y w o r k m a r c h / a p r i l 2 0 1 9 for people with opioid use disorder; promoting the use of overdose-reversing drugs; improving surveillance of public health to better understand the scope of the problem; supporting research into pain and addiction; and advancing better practices for pain management. The Joint Commission is a not-for- profit organization that certifies and accredits many health-care organizations. In 2018, it published a statement calling for evidence-based, non-pharmacological treatments for pain management, and massage therapy is specifically listed among those interventional options. The Joint Commission also recommends that pain specialists address psychosocial risk factors for pain and substance use disorder, with realistic goals and multidisciplinary approaches to treatment. They are especially interested in outcomes that lead to improved physical function. This is relevant for us, because functional goals are often well supported in massage therapy research. The American Society of Interventional Pain Physicians (ASIPP) has also weighed in with a three-tiered approach to the opioid crisis. They suggest more aggressive public education regarding the dangers of illicit drug use—specifically for heroin and fentanyl; improved access to non- opioid therapies (including physical therapy and other interventions); and improved access to overdose-preventing drugs. ASIPP also notes dysfunctional incentives for opioid prescriptions in current government policies that they argue make the problem worse rather than better. I hope you can see some common themes here. The HHS, the Joint Commission, the ASIPP, and many other policy-making bodies have identified that opioid addiction is a problem, that people in pain deserve treatment, and that we need to find better ways to meet these needs. This represents a big opportunity for massage therapists. OPPORTUNITIES FOR MASSAGE THERAPISTS: HOW CAN WE HELP? The observation that rubbing the skin can help with pain dates back to the first human who ever compassionately stroked another person's sore body. But having policy- makers understand that skilled massage therapy could be effectively integrated into a multidisciplinary approach to chronic pain management is relatively new. The guidelines now being promoted by the HHS, the Joint Commission, the ASIPP, and others make room for manual therapies in ways we haven't seen before. This provides some unprecedented opportunities, if the profession is ready to step up to them. How do we move forward in this direction? If we want to help the millions of people who struggle with difficult-to-treat pain, and if we want the massage therapy profession to be considered a partner in that effort, we have some hard work to do. However, the word partner in this context is not truly applicable. Until our profession has a higher education infrastructure so people can seek out graduate and advanced degrees in massage therapy, we cannot call ourselves partners with other degreed health-care providers. That said, we have the access, time, and expertise to offer practical help to people with chronic pain that the rest of their health-care team We've been trying to put the brakes on opioid use in the US, but it is a complicated problem. One of the consequences of cutting back on opioid drug prescriptions without offering viable alternatives is that patients may turn to street drugs— heroin and fentanyl—as cheaper and more accessible options. About three- quarters of all new heroin users begin as users of prescription pain medication. STRATEGIES TO MANAGE OPIOID MISUSE All this dire information cries out for a concerted public health effort to find a way to provide access to pain-relieving options while curbing opioid use and decreasing opioid-related deaths. The vast majority of people with substance use disorder don't receive effective treatment. We see that people who are addicted to opioids have the best outcomes with appropriate pharmacological support, along with support groups, community- led prevention strategies, and initiatives that lift the "drug abuser" stigma for improved access and use of services. In 2017, the US Department of Health and Human Services (HHS) declared the opioid crisis a public health emergency and issued a five-point strategy to combat the problem. These include improving access to treatment and recovery services The chances are good that what you were taught in massage school is no longer considered accurate, and the differences may inf luence how you work with clients who live in pain.