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Potential Inter..
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Listed here are some potential interactions between physical agents used in rehabilitation and various pharmacological agents. It is impossible to list all the possible relationships between the vast array of therapeutic drugs and the interventions used in physical therapy and occupational therapy. However, some of the more common interactions are identified here.

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Modality Desired Therapeutic Effect Drugs With Complementary/Synergistic Effects Drugs With Antagonistic Effects Other Drug-Modality Interactions

Cryotherapy

Cold/ice packs

Ice massage

Cold bath

Vapocoolant sprays

Decreased pain, edema, and inflammation

Anti-inflammatory steroids (glucocorticoids); nonsteroidal anti-inflammatory analgesics (aspirin and similar NSAIDs)

Peripheral vasodilators may exacerbate acute local edema.

Some forms of cryotherapy may produce local vasoconstriction that temporarily impedes diffusion of drugs to the site of inflammation.

Muscle relaxation and decreased spasticity

Skeletal muscle relaxants

Nonselective cholinergic agonists may stimulate the neuromuscular junction.

Superficial and Deep Heat

Local application

  • Hot packs

  • Paraffin

  • Infrared

  • Fluidotherapy

  • Diathermy

  • Ultrasound

Decreased muscle/joint pain and stiffness

NSAIDs; opioid analgesics; local anesthetics

Decreased muscle spasms

Skeletal muscle relaxants

Nonselective cholinergic agonists may stimulate the neuromuscular junction.

Increased blood flow to improve tissue healing

Peripheral vasodilators

Systemic vasoconstrictors (e.g., alpha-1 agonists) may decrease perfusion of peripheral tissues.

Systemic Heat

Large whirlpool Hubbard tank

Decreased muscle/joint stiffness in large areas of the body

Opioid and nonopioid analgesics; skeletal muscle relaxants

Severe hypotension may occur if systemic hot whirlpool is administered to patients taking peripheral vasodilators and some antihypertensive drugs (e.g., alpha-1 antagonists, nitrates, direct-acting vasodilators, calcium channel blockers).

Ultraviolet Radiation

Increased wound healing

Various systemic and topical antibiotics

Antibacterial drugs generally increase cutaneous sensitivity to ultraviolet light (i.e., photosensitivity).

Management of skin disorders (acne, rashes)

Systemic and topical antibiotics and anti-inflammatory steroids (glucocorticoids)

Many drugs may cause hypersensitivity reactions that result in skin rashes, itching.

Photosensitivity with antibacterial drugs

Transcutaneous Electrical Nerve Stimulation (TENS)

Decreased pain

Opioid and nonopioid analgesics; certain antiseizure drugs (e.g., gabapentin, pregabalin)

Opioid antagonists (naloxone, naltrexone)

Functional Neuromuscular Electrical Stimulation

Increased skeletal muscle strength and endurance

Low-dose androgens in certain populations (e.g., androgendeficient men)

Skeletal muscle relaxants

Decreased spasticity and muscle spasms

Skeletal muscle relaxants

Nonselective cholinergic agonists may stimulate the neuromuscular junction.

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