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Asking Patients the Right Questions
When was the last time you asked a patient a question? Maybe 30 seconds ago? But, are you asking the right questions to elicit valuable and useful information? As a healthcare provider, you've likely spent hundreds of hours learning to ask the right questions to gather critical health information from your patients.
An Alarming Lack of Accountability
Accountability seems to be a lost quality today. The simple act of taking responsibility and doing the right thing just doesn't happen as often as it should. Maybe it is the litigious nature of our society.
Health and Wellness Partnership
Yo San University of Traditional Chinese Medicine and The Wellness Center at the LAC + USC Historic General Hospital recently joined forces to extend care to the residents of Boyle Heights area of Los Angeles.
Identify & Adjust the Apex Posterior Sacrum
Low back pain involving an apex posterior sacrum (+θX-axis misalignment) typically presents with signs of lumbosacral joint impingement or facet syndrome.
Misconceptions & Opportunities With Medicare
As I speak around the country on how to properly document Medicare patient encounters, I get questions regarding opting out of Medicare. There are many misconceptions about opting out of Medicare, including just what it means to opt out.
Day in the Life of an Advanced-Practice DC
Can you tell us a little about your background in the profession? Why did you want to become a DC? I studied at Boston University from 1968-1972 as a pre-med student majoring in biology.
Transparency is Key at ASA First Annual Meeting
On March 4th and 5th the American Society of Acupuncturists (ASA) held a successful first annual meeting in Albuquerque, New Mexico.
Energy: For Life and For Death
Energy is a deep topic in Traditional Chinese Medicine. Qi is understood to underlie all of existence, animated or not, and the qi of the living is studied with special attention.
News in Brief
Northwestern Student Honored for Addressing Concussions Head-On; Northwestern Announces New CFO; Life U. to Provide Unique Opportunity.
Building Relationships and Referral Networks with Allopathic Practitioners
Dr. Doug, an orthopedist of 20 years, had heard stories from patients who tried acupuncture. While he was able to address many of their complaints effectively, some appeared to gain additional benefit when their care included TCM.
Roots in the Community, Branches Far Beyond
The Jung Tao School of Classical Chinese Medicine (JTS) was founded in 1998 by Sean Christian Marshall in Sugar Grove, North Carolina, a small community near Boone in the state's westernmost mountains.
Excited to Share the Science of Chiropractic: An Interview With Dr. Heidi Haavik
Dr. Heidi Haavik has become known in the circle of chiropractic researchers as not only a rising star, but also one willing to do research that can have a major impact in the scientific world and how chiropractic is perceived.
Specialized Pro-Resolving Mediators: 21st Century Inflammation Fighters
Specialized pro-resolving mediators, or SPMs, are a portion of the omega-3 fatty-acid spectrum that have been shown to have a powerful effect on reducing inflammation.
The Value of Melatonin in Breast Cancer Prevention and Adjunctive Treatment
Although melatonin (MLT) is best known for its sleep-aid properties and as a natural remedy to prevent jet lag, extensive experimental studies suggest it possesses anticancer activity through several biological mechanisms.
An Interview with Amanda Shayle
JW: Can you share with us some of your history and how you became an acupuncturist? What did you do prior to becoming an acupuncturist? Where did you go to school?
Constructing Our Reality: The Primary Channels and Perception, Part 1
My favorite topic of discussion within Chinese medicine is the acupuncture channel systems. First of all, each of us have them. They are part of our bodies; not something external to us. To learn about the acupuncture channels is to learn about ourselves.
Let's Streamline Your Front Desk
Your front office can be your greatest source of efficiency or a constant bottleneck. Increasing the productivity of this area without sacrificing the quality of patient interaction can be a little tricky.
NCCAOM Launches New Membership Organization
The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) recently launched a new national membership organization, the NCCAOM Academy of Diplomates.
The Art of Listening
One of the most important clinical concepts for me was voiced by the legendary physician William Osler. "Listen to your patient, he/she is telling you the diagnosis." After treating literally thousands of patients, it can become almost second nature to quickly discover clues which reveal the underlying diagnosis.
Filling the Gap: The Role of Alternative Practitioners in a Broken Health Care System
I have been asked many times what got me into alternative medicine. My answer is simple: I want to truly help and make a difference in people's health.
The Rest of the Patient Story
I've written previously about allowing a patient to tell you their story – about taking the time to listen and engage all the aspects of their case history, the injury in question, and the related issues.
F4CP Launches New Social Media Campaign
The Foundation for Chiropractic Progress has launched a new service to help member doctors: a social media campaign called "Accelerator."
Designing a Fitness Plan (Part 4): Blending Pain Relief With Healthy Aging
Pain relief is still the No. 1 reason patients come to my office. However, most of my patients have other goals as well, such as: "I want to lose 10 to 20 pounds"; "I feel old and want to slow down the aging process"; "My doctor says I am becoming a diabetic and need to exercise"; or "I'm tired and want more energy."
How Many of Your Patients Have Sarcopenia?
Figure 1 demonstrates the typical appearance of sarcopenia in the paravertebral muscles. Have you considered evaluating your patients for this problem? Sarcopenia is the progressive loss of skeletal muscle mass and function that affects the older population.
November, 2005, Vol. 05, Issue 11
By Erik Dalton, PhD
Most of the human race suffers some form of neck and back pain during their lifetime just as common as a headache, stomach ache or knee pain. "Until it was turned into a medical condition in the early 20th century, back pain was considered an inevitable human experience," said Canadian surgeon Hamilton Hall, MD."There is no simple cure because there is usually not a clear-cut precipitating trigger associated with many forms of musculoskeletal pain," notes Hall.
Despite the liberal use of the words "back injury" across modern societies, most episodes of back pain do not have an obvious cause. "Research indicates that approximately two of every three people who experience pain in the spine are unable to identify any specific event that may have caused their problems," states Hall. Back pain simply happens!
The modern perspective that neck and back pain is a variable, intermittent illness rather than a one-time condition should not be considered a threatening event for our clients. In the vast majority of cases, recurrences of these painful conditions are not signs of advancing disease, an omen of chronic disability or even a cause for significant worry.
Some researchers draw an analogy between back pain and upper respiratory infections. Many individuals get colds or respiratory infections several times each year, yet are typically not viewed as a significant threat to their health. Colds don't require high-tech diagnostic testing, heroic treatment interventions or significant absence from work. These conditions, like most cases of neck/back pain, simply are bumps in the road.
However, some have begun to question the possibility of previously unrecognized neurobiological processes that might unravel the question: Why are some people more susceptible to pain than others? One interesting new area of pain management research that is gaining a great deal of attention proposes alternative ways that nerve impulses are transmitted and learned by the central nervous system.
For decades, it was thought that spinal cord, brain and peripheral pain transmission pathways were hardwired circuits whose job was simply to communicate pain signals from injured or diseased parts of the body to specific message centers in the brain. But based on recent scientific research, new ideas are emerging on how pain transmission actually works and how the brain has the ability to create the conscious experience of pain.
A process called sensitization has become a topic of great interest to neuroscientists studying transmission mechanisms of painful stimuli. The puzzling question is: How are pain messages actually delivered? A discussion of sensitization might help somatic practitioners better understand why a client's chronic pain can be so severe, but in some cases, seem out of proportion to the degree of injury or disease in the affected body tissues. This understanding also might help explain why specific treatments directed at pain relief often provide'only limited benefit.
The neurobiology of sensitization is extremely complex, but the basic idea behind it is fairly straightforward. When pain signals are transmitted from injured or diseased tissues, these signals can then activate (sensitize) pain circuits in the peripheral nervous system, spinal cord and brain by burning a memory pathway (See Figure).
The process of sensitization can be compared to overly adjusting the volume control on a stereo system, thereby amplifying and sometimes distorting the pain message. This results in a painful condition that is severe and out of proportion to the actual dysfunction or original injury. Sensitization has the innate ability to alter all regions of the central nervous system that process pain messages. This includes the sensing, feeling and thinking centers of the brain. Here lies one explanation why chronic pain often is associated with, not only physical disorders, but also emotional and psychological suffering as well.
Phantom Limb Pain
A perfect example of the workings of sensitization can be found in the sometimes mysterious condition called phantom limb pain. In the presence of phantom limb pain, the client might feel intense pain in an area where the body part is missing. Common examples are seen in amputated arms and legs, as well as in women experiencing abdominal pain years after undergoing a hysterectomy. The difficult-to-treat problem of phantom limb pain is consciously actualized by persistent activation (sensitization) of the pain transmission pathways from the site of amputation up to the brain.
But what about the presence of sensitization in various pain conditions where amputation or surgeries to remove diseased organs don't exist? Too often, manual therapy treatments in such cases are directed to body areas that were once actual pain-generators, (i.e., where the injured or diseased tissues once existed). Regrettably, "chasing the pain" by directing therapy to where the client currently is hurting will have little effect on the sensitized pain pathways in the spinal cord and brain. As a result, little benefit is experienced.
Having said that, the author has found that application of specific deep tissue and assisted stretching techniques to torsioned and compressed joint-related soft tissues co-activates and desensitizes noxious mechanoreceptive activity leading to a reduction in pain. Successful outcomes require the therapist concentrate treatment to areas proximal to the previously injured or amputated tissues (usually beginning in the lamina groove). Proper treatment to deep intrinsic muscles, spinal ligaments, joint capsules, and visceral structures co-activates a wider range of neuro-receptors, which enhances the desensitization process.
Click here for previous articles by Erik Dalton, PhD.
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