Contraindications – Why they matter.

Safety first

Do you recall, on your first visit to a new dentist, you were given a patient record form to fill up? The form contains a portion for you to declare any pre-existing conditions you have, for example drug allergy, recent operation, medical history, etc. One of the key information your dental care provider aims to obtain in this initial step is to uncover the the presence of contraindication(s).

The word contraindication comes from two words – contra and indication. In medical terms, an indication refers to the presence of a health problem/disease, or using a certain treatment to address a health problem. For example, an antiseptic solution is indicated to sterilise a cut or graze. A contraindication is the opposite of indication. It refers to a condition or situation which makes a patient unsuitable to receive a specific treatment, procedure or therapy.

In the practice of complementary therapies such as massage therapy and aromatherapy, contraindications are the first thing that your therapist will check for before getting hands on. The reason being, the delivery of these therapies have direct impact on our body functions from the respiratory, circulatory and nervous systems to the digestive, urinary, integumentary (skin) and musculoskeletal systems. Patients or clients with existing health conditions who wish to engage these alternatives could risk adverse reactions that may be at best unpleasant and uncomfortable, or at worst life threatening.

As the introductory sign above portrays, the guiding principle in contraindications is Safety First.

Contraindications can be grouped as absolute or restrictive.

In absolute contraindications, it is mandatory that the client has his or her doctor’s permission before starting the therapy in request. Typically, the client would already have been receiving medical attention. The requested therapy could critically interfere with the current medication, or be detrimental to the condition. Below are some examples of absolute contraindications.

  • Pregnancy – The safety of both the mother and the foetus is of key priority and concern.
  • Clients with nervous/psychotic background – There is risk of triggering or aggravating nerve conditions such as spasms since complementary therapies directly affect the nerves and reflexes.
  • Clients with heart conditions such as high blood pressure or clients with pacemakers – Massage should be avoided because the therapy itself promotes circulation and blood flow which is in conflict with the existing condition.
  • Clients with asthma –  Complementary therapies directly influence the respiratory system and may trigger reactions leading to asthmatic episodes.

When there is absolute contraindications, the doctor of the client must be consulted. Without the doctor’s written approval, the attending therapist must not proceed. However, there are instances in which the client signs an informed consent to indemnify the therapist against the outcomes or reactions resulting from the therapy. It is at the sole discretion of the therapist to proceed or otherwise.

In restrictive contraindications, the client may be advised to postpone the therapy session. Clients with symptoms like fever and diarrhea or vomiting are advised to rest and recover, and to return on another day. This would also prevent the therapist from catching the infection. Similarly, for clients with skin diseases and infections, the therapist has the right to decline delivering therapy, to adhere to due diligence in preventing the spread of infection.

As massage involves the physical manipulations of body tissues and could possibly break or tear weaker scar tissues, post operation clients are advised to rest for at least 6 months (for minor operation) and at least 2 years (for major operation) before undertaking alternative remedies. Informing the doctor and getting approval is also highly recommended. For milder cases such as localised swelling or wounds, the affected area must be covered and avoided during the therapy. After the client has been advised on the restrictive contraindication effects, the therapist will seek to document an informed consent from the client.

Here is a sample of Contraindications List that your therapist will provide you at the start of each session.

Where complementary therapies are concerned, drawing out the presence of contraindication, if any, is an important first step in client consultation. It determines whether the client is safe and fit to receive an alternative therapeutic procedure, as well as enables the therapist to deliver his or her professional practice in a safe and informed manner. These objectives work jointly towards a safe, effective and practical therapy plan for the client.

It is the aim of your therapist to provide care and relief in your best interest, the same way your dentist would. You can help them to help you, with your salient inputs of personal particulars, including contraindications.

Sources

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