Massage Therapy Journal Summer 2026

Summer 2026 • 43

Possible side effects from acetaminophen pertinent to massage therapy may include: • Rash, hives, red, itching, peeling or blistering skin • Swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs • Hoarseness, difficulty breathing or swallowing Combination Products: Opioids Plus Other Analgesics: Acetaminophen with codeine (Tylenol #3, Tylenol #4); acetaminophen with hydrocodone (Hycet, Lortab, Norco, Vicodin); Ibuprofen with hydrocodone (Reprexain, Vicoprofen); Acetaminophen with oxycodone (Percocet, Roxicet, Xartemis XR); aspirin with oxycodone (Percodan) Possible side effects pertinent to massage therapy may include: 47 • Dry mouth, rash, itching • Constipation, drowsiness • Lightheadedness, anxiety, mood swings and physical dependence Opioids (single ingredient): Fentanyl (Abstral, Actiq, Duragesic, Fentora, Lazanda, Onsolis, Subsys); Hydrocodone (Bitartrate (Hyslinga ER, Zohydro ER); Hydromorphone (Dilaudid, Dilaudid HP, Exalgo); Meperidine (Demerol); Methadone (Dolophine); Morphine sulfate (MS Contin, Kadian, Avinza); Oxycodone (Oxycontin, Oxecta); Oxymorphone (Opana, Opana ER); Tapentadol (Nucynta, Nucynta ER) Possible side effects pertinent to massage therapy may include: 48 • Tolerance (need to take more of the medication to achieve the same pain relief) • Physical dependence, increased sensitivity to pain • Constipation, nausea, vomiting and dry mouth • Sleepiness and dizziness, confusion and depression • Itching and sweating Opioid agonists/antagonists 49 : Buprenorphine (Butrans, Buprenex); Butorphanol (Butorphanol NS, Stadol); Nalbuphine; Pentazocine (Talwin) NOTE: Opioid agonist-antagonist drugs are considered safer, with fewer side effects than other opioids. Side effects such as those listed above may occur, but to lesser degrees. 49

Medication Types Associated with RA

Prescribed oral medications

Prescribed topicals

NSAIDs

Opioid combinations

Opioids

Natural remedies

OTC topicals

Injections

Clearly, effective pain management for people suffering with RA must be a priority in the overall treatment plan. Mild-to-moderate RA pain can usually be treated with non-opioid analgesics. But for severe pain, opioids and opioid combinations are considered by many to be more effective. 50 That increased effectiveness comes with the potential for and death from accidental overdose. 50 OTC and Prescribed Topical Medications A range of OTC and prescribed topical medications are also used for RA pain relief, with varying degrees of effectiveness and side effects. Because topical applications are absorbed through the skin, interactions with other drugs may be possible. People often erroneously conclude that OTC medications are safe and harmless, but a person with RA should alert their rheumatologist to all medications and products they are ingesting or applying to their skin. Types of topical pain-relieving products available over-the counter include: 51 Capsaicin. A natural, heat-producing substance found in chili peppers, 52 capsaicin ointments, creams and gels deplete nerve cells of a chemical that’s important for sending pain messages. Capsaicin is most effective if used several times a day, and may take up to two weeks to provide relief. Examples include Capzasin and Zostrix.

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