Drugs, Surgery and Insurance Reimbursement of Massage Therapy
I still look at the prescriptions in my desk drawer as a reminder. a reminder that Western medicine doesn't have all of the answers. I had gone in to see a well-known doctor in New York City for what I now know was simple muscle spasm and tightness in my neck due to stress/anxiety. He prescribed Vioxx and Paxil and sent me on my way. Before departing, (this was before I became a massage therapist) I asked him what he thought about massage as an option. Memorably, he said that massage is fine, but that you become dependent on someone else for your healing. He stated this as a negative. Aside from his espousing a true Western ideal of rugged independence, the irony was lost on him. Can you imagine the hundreds, even thousands of people who you are "dependent" on for pharmaceuticals. Just think of the research and development, clinical trials, manufacturing facilities, marketing and distribution networks. Now that's dependence! Still, this isn't an article about bad-mouthing Western medicine. We all understand that our current medical system is quite good on many fronts and many of us wouldn't be alive now if it weren't for Western medicine. Yet, why was he prescribing an anti-depressant and arthritis drug for simple muscle spasm? Later, I would learn of a massive court settlement regarding Vioxx as a possible cause of stroke and heart attack as well as a correlation between Paxil and increased suicide risk. What this anecdote really demonstrates is that modern medicine is still baffled by simple pain processes. Yes, there is a relationship between serotonin levels in the bloodstream and pain. So, on some level, it makes sense to prescribe a serotonin reuptake inhibitor to lock this hormone in the blood for longer periods. But it's also a two way street, that is, it makes sense that chronic pain would cause depression, but few people consider that depression may cause chronic pain. This is the mind-body connection that massage therapists and other practitioners recognize and embrace whole-heartedly. The strongest pain killers available are already inside your body. We just have to release them through exercise, massage or other activities. Our body has amazing healing potential. We can stimulate our own healing and create a catalyst for change that doesn't involve drugs or surgery. The Western approach is to medicate or go in and cut it out. But shouldn't we try the least invasive method(s) first? Shouldn't we work to boost immunity and prevent? Many pain processes are a signal that a lifestyle change needs to take place. Pain is a good thing because it's a warning sign. It tells you that you're moving inefficiently; your posture needs work; your diet is out of balance; you're not fulfilling your spiritual calling; your relationships are suffering and so on. There's no need to cloak it with drugs. The real change, the hard change, has to come from you. And that's the conversation that too many doctors aren't having with their patients, partly because there's no time, but also, because they've been trained to treat the end result. But it's far easier to intervene early through preventative measures such as simple wellness massage. There is an interesting dynamic going on within the massage therapy field. We received state licensing in MA just last year, in 2008, which is largely recognized as a building block towards insurance reimbursement and incorporation into the medical field. Yet, it has always been our non-medical approach that made us so popular. Clients flock to massage therapists because of the non-clinical atmosphere and the soft brand of pain relief that we offer. Hospitals have picked
up on this and completed major overhauls of their establishments. Medical spas have been blockbuster successes throughout the U.S. demonstrating the connection between beauty and health. It's often said that massage therapy is part art and part science. The question for us, now, as a profession, is whether we will lose the intuitive side, lose the artistic elements and forfeit our emphasis on holism and environment in order to join an establishment that many people feel is still on the wrong track. It is my hope that the medical establishment and massage therapists will each start to become a little more like each other and meet somewhere in the middle. Massage therapists can benefit from the new standardization of curriculums which is going on now. They can benefit from a stronger emphasis on sciences and medical terminology. And hospitals can have a partner to help with those tough chronic pain cases. They can have more options than drugs or surgery. In the past, physical therapy has been the modality that the medical establishment has given their stamp of approval to--therapeutic exercises, machines and some limited hands-on work. Chiropractic was a close second though still often on the outskirts of mainstream medicine. While both of these options have worked for many patients, massage therapy has a number of important advantages. Firstly, we don't have the time constraint. It is not unusual for a massage therapist to spend upwards of one and a half to two hours with a client. PT's (Physical Therapists) and DC's (Doctors of Chiropractic) usually book at 15 or 20 minute intervals sometimes seeing multiple patients at the same time. Also, physical therapy has taken on a technological aspect that many feel has made for an imperfect substitution to hands-on work. However, because the level of schooling is higher for PT's and DC's, this often brings them greater respect than massage therapists within the medical establishment. Massage therapists are experts on soft tissue and muscle. That is our scope of practice. Chiropractors are experts at joints and PT's know therapeutic exercise primarily. There is certainly overlap among the three, but they are also distinct. Increasingly, we're seeing healthcare teams involved in patient care--signaling a new trend toward interdisciplinary approaches to pain processes. I commend Southwestern Vermont Medical Center in Bennington for their Integrated Therapies Program where massage therapists and acupuncturists work side-by-side with doctors. Just think.natural drug-free pain management is available right now for everyone. As a doctor, wouldn't you rather give someone a prescription for massage instead of pharmaceuticals? As an insurance company, wouldn't you rather pay $60 for a massage instead of thousands for drugs and surgery? It's up to us as consumers of healthcare services to make sure that we continue in the right direction. I hope that you support legislation to mandate insurance reimbursement of massage with a doctor's prescription. Call your local congressman now or lend your support to ABMP (Associated Bodyworkers & Massage Professionals) and AMTA (American Massage Therapy Association), our two main professional associations, as they continue to lobby Congress on this important issue. Todd Fiorentino is the Department Chair of Mildred Elley's Massage Therapy Program in Pittsfield, MA. He is a licensed massage therapist and MA State Department of Education approved instructor. Mildred Elley runs a 900-hour program in therapeutic massage; see www.mildred-elley.edu for more information. Mr. Fiorentino also runs Energy Rising Massage Therapy, a private massage practice in North Adams, which can be found online at www.energyrising.net.
European Journal of Neurology 2008, 15 (Suppl. 1): 14–20Non-motor symptoms in ParkinsonÕs diseaseW. PoeweDepartment of Neurology, Medical University of Innsbruck, Innsbruck, AustriaAlthough still considered a paradigmatic movement disorder, ParkinsonÕs disease(PD) is associated with a broad spectrum of non-motor symptoms. These includedisorders of mood and aﬀect with apathy, anhedonia a
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