A new California lawsuit may tighten regulatins on opioid prescriptions, making the providers of an opiate alternative such as massage, a hot commodity.

As a massage therapist, you already know massage can be effective for helping relieve chronic pain.

Unfortunately, millions cope with pain by taking opioid drugs such as fentanyl and oxycodone–and many who take them become dependent on them.

In 2015, more than 33,000 people in the U.S. died as a result of misusing opioids, according to the National Institute on Drug Abuse.

Thirty-five counties in California are participating in a lawsuit against several opioid manufacturers, seeking to recover some of the billions of dollars in funding that have had to be directed toward the cost of opioid abuse and help for opioid addicts.

If the outcome of these lawsuits leads to tighter restrictions on opioid prescribing and distribution, there will likely be many people seeking more holistic solutions, such as those offered by California’s more than 40,000 massage therapists, for chronic pain.

The Lawsuit

As reported in the San Francisco Chronicle, 35 California counties have joined the suit, which seeks to hold drug manufacturers responsible for the opioid addiction problem their businesses have helped create, and to punish them for falsely promoting the safety of opioids.

A separate lawsuit is taking shape in Ohio, the Chronicle said, involving more than 500 public entities as plaintiffs against opioid makers; the lawsuits are likely to be combined into one.

The scope of California’s opioid problem is massive, as it is in many states across the nation; the Chronicle noted that one of the counties involved, Contra Costa, reports that 5 percent of its population, more than 50,000 people, have misused opioids.

In Marin County, opioid overdose has surpassed motor vehicle accidents to become the number-one cause of accidental death.

The lawsuits against opioid makers is part of a larger national backpedaling that has seen an elevation of complementary therapies like massage as the U.S. medical establishment comes to realize the benefits of non pharmacological intervention.

In 2017, for example, The American College of Physicians recommended that “physicians and patients should treat acute or subacute low back pain with non-drug therapies such as superficial heat, massage, acupuncture, or spinal manipulation. If drug therapy is desired, physicians and patients should select nonsteroidal anti-inflammatory drugs (NSAIDs) or skeletal muscle relaxants.”

Non-Drug Alternatives

As MASSAGE Magazine has reported, the use of massage as an effective pain intervention has increasingly been recognized as well as researched.

A three-part 2016 study, “The Impact of Massage Therapy on Function in Pain Populations—A Systematic Review and Meta-Analysis of Randomized Controlled Trials,” looked at pain in three different groups: pain in the general population, pain among cancer patients and surgical pain. “Results demonstrate massage therapy is effective for treating pain compared to no treatment,” noted its abstract.

Now that massage has started to amass a significant amount of formal research to back up its benefits, it is more important than ever that massage therapists become research literate. Sharing relevant studies with clients can help them see regular massage as a pain solution, as well as a crucial part of a balanced, healthier lifestyle.

“Painkillers are useful in managing chronic pain conditions, but they should not be used as a long-term solution,” said Sandip Sekhon, founder of Pathways Pain Relief, a clinic specializing in addressing chronic pain.

“Whereas regular massage should form the basis of self-care for both those in pain, and those who are pain-free. [Massage is] essential to maintaining a healthy body and can stop many painful conditions [from] becoming chronic in the first place,” Sekhon said.

Massage therapists have long been aware that massage can help relieve pain, at least as an adjunct therapy to prescription painkillers; some people may also find relief by using massage as an alternative to pharmaceutical intervention. It is critical that both pain sufferers and healthcare providers recognize that non-drug alternatives exist and are effective.

Sometimes opioids are necessary for pain management, but often other interventions can be as effective, without the risk of addiction.

The Academy of Integrative Pain Management’s policy statement on opioid prescription defined its aim as one that seeks to “ensure healthcare professionals have a sound understanding of how to provide quality pain care, have access to nonpharmacological therapies for their patients, and when necessary, are educated to prescribe opioids sparingly and safely, along with other concomitant non-opioid and non-pharmacological treatments.”

“There are many circumstances in which medications are an absolutely necessary component in pain management protocols. For example, in acute post-surgical recovery, pain would be unbearable without medication,” said Kiera Nagle, LMT, assistant dean of the Pacific College of Oriental Medicine in New York.

“The bigger concern is over-treating chronic pain with medication which does not allow the patient to adequately perceive and change what may be triggering, causing or exacerbating the pain,” she said.

“Medication works with the brain and the body, but it is foreign to the body, synthetically mimicking the body’s own responses,” Nagle continued.

“The one-on-one connection between a person experiencing pain and a massage therapist allows for a broader spectrum and more nuanced approach to pain management. Many factors can be addressed and considered through the talk and touch processes.”

Long-term use of opioids may actually make pain worse by increasing sensitivity to it, said Sekhon. “As our brains receive fewer pain signals, it becomes more sensitive to any pain signals that do arrive,” he noted. “It can also reduce your brain’s ability to produce its own natural painkillers.”

As always, it is important to remember that diagnosis is outside of any massage therapist’s scope of practice, and that a physician should be consulted before stopping or starting any course of treatment, pharmacological or otherwise.

Help for Opioid Addiction

As MASSAGE Magazine has reported, massage therapy is not only useful for dealing with pain, but can actually help clients who want to quit using painkillers, and even help ease the symptoms of opioid withdrawal, which can include anxiety, abdominal pain, nausea and vomiting, or flu-like symptoms.

“Massage therapy can provide opioid-dependent patients with that additional pain relief they need, without any extra pills,” said Sekhon.

“It provides some key benefits over and above opioids: increasing circulation, mobilizing soft tissue and joints, reducing fear around body manipulation,” Sekhon added. “It also provides chronic pain patients with human interaction and care, which many people overlook but is critical in recovery.”

“Massage therapy is both a literal and figurative dialogue between the therapist and the client,” said Nagle. “Massage therapy provides an avenue for perceiving the pain and the body in a connected way, and helps to foster the client’s own self-awareness about their experience of their pain, and their response to it.”

About the Author

Allison Payne is a former online & associate editor for MASSAGE Magazine, and now a freelance writer and editor based in central Florida. She has written many articles for MASSAGE Magazine and massagemag.com, including “Independent Contractors in California Could Be Affected by Supreme Court Decision” (May 30) and “The Massage Therapist’s Guide to Becoming a Continuing Education Provider” (June).

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