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Creating Good Business Buzz
What do patients really think about working with you? Rarely do you hear the whole truth. Those who improve may be candid in their gratitude.
Is the New Medicare Reporting Exemption Right for You?
What you've heard is not a rumor – there will be exemptions for providers of Medicare patients, with no penalties assessed for offices that do not do Quality Payment Program (EHR, PQRS, MACRA and MIPS) reporting.
New Relationships, Old Trauma: AOM & Other Healing Strategies
Being in love is one the most beautiful and enjoyable experiences. Most of us are willing to pay almost any price to have that experience, and still often find it elusive or fleeting. Navigating the ups and downs of loving relationships are often challenging — even for the most psychologically balanced among us.
Balancing Spring Challenges
As the winter months come to a close and warmer spring weather appears, patients may begin to present with new challenging pattern presentations.
An Unexpected Diagnosis: The Result of Lacking Communication
A couple years ago I had a case that showed me the importance of open communication between health practitioners. We need to show up with less fear, and let go of our judgments so we can do better for the patient.
Bill With Confidence: Learn What to Collect
Q: I am trying to understand what I may collect from my patient when there is insurance. Do I have to accept the amount allowed by the plan or may I collect up to my billed amount? Please note, I am not a member of any insurance plan.
A Daily Strategy for Heavy-Metal Detox
In modern society, we are constantly exposed to heavy metals such as cadmium, lead and mercury. These heavy metals have no essential biochemical roles in our body, and conversely, can cause us a great deal of harm if they build up to toxic levels.
Eczema & Acupuncture: A Sound Solution (Part 1)
Eczema affects approximately 3.5 percent of the global population and is one of the most common skin complaints seen by dermatologists.
Why I Quit Doing House Calls
My father was a chiropractor who did house calls, so when I became a DC, I figured doing house calls was part of the job. My March article recalled my experience as a small boy, accompanying my dad while he went to patients' homes to treat them.
A Major Role in Back Pain: The Multifidus
Back pain affects roughly 80 percent of the population at one time or another and is one of the leading causes of doctor visits.
Is It Time to Rethink Mental Illness? (Pt. 1)
Invariably, patients will ask their chiropractor about depression or various mental illnesses. Some practitioners will reflexively offer a cervical adjustment, suggest St. John's wort or contemplate a referral to a specialist.
Women's Hormones: A Western & Eastern Perspective
Sometimes it may seem that you require a degree in medicine to understand hormones and how they function.
Universal Design: Principles & Practice
In many respects, universal design serves as the core of ergonomics. It's also a good tool to use when designing a return-to-work program for injured and/or ill patients. Let's take a closer look at universal design and why it should matter to you and your patients.
An Integrated Approach to Chronic Pain
Findings from a unique Medicaid pilot project in Rhode Island involving high-use Medicaid recipients from two health plans were recently presented to the state's Department of Health, demonstrating stellar outcomes with regard to medication use, ER visits, health care costs and patient satisfaction.
The Visual Error Scoring System: A Concussion Tool
Postural stability and oculomotor function are the most easily recognized physical indicators of neurologic motor dysfunction associated with concussions.
News in Brief
ACA Adopts New Governance Model; ACA 2017 Awards; CCA Helps Calif. DCs "Share the Love"; $1 Million to Help Advance the Profession; D'Youville Raises the Bar on Anatomy Education; ErRatum.
Raditation & Your Smartphone: Is it Worth the Risk?
If radial arteries could talk (and in my experience they can to some extent), they would say, "Step away from the smartphone." At least that is the message I am receiving loud and clear as I feel the pulses of many patients.
Clearing Blocks: A Way to Improve Cosmetic Acupuncture
As a Five Element acupuncturist who teaches facial acupuncture classes nationally, I was surprised to learn that one of the basic principles I was taught in school is unfamiliar to most acupuncturists.
Taking the Chiropractic Message to the Press
"There is no better place on earth to have a news event," the National Press Club boasts, and it's easy to understand why: Every year, the 108-year-old Washington, D.C.-based organization hosts countless press conferences on the hottest topics impacting America and often the world.
May, 2011, Vol. 11, Issue 05
Understanding Central Sensitization and Pain
By Leon Chaitow, ND, DO
Central sensitization is defined as 'an augmentation of responsiveness of central pain-signalling neurons to input from low-threshold mechanoreceptors' (Nijs 2009). The evolution of chronic pain has been shown to have strong association with the process of central sensitization, in which there is enhanced sensitivity to various modes of painful and non-painful stimuli (Buchgreitz et al 2006).
Staud (2006) has described the ways in which peripheral pain impulses can lead to central sensitization. In many chronic pain states, including chronic migraine, irritable bowel syndrome, fibromyalgia syndrome, repetitive, persistent or recurrent peripheral nociceptive features can lead to neuroplastic changes in the spinal cord and brain, that results in central sensitization and consequent pain.
Yi-Meng Xu et al (2010) have explained that even the nociceptive input from latent trigger points can contribute to central sensitization, and that only minimal nociceptive input (resulting from touch, pressure or heat) may be required to maintain the chronic pain state, once central sensitization has evolved.
A generalized central sensitization is identified as operating in fibromyalgia syndrome which is also common accompanying diagnosis in patients with chronic headache. Yunus (2007) has described the overlap of a number of chronic pain as Central Sensitivity Syndromes - asserting that in such conditions hyperexitability exists of central neurons resulting from the influence of various neurotransmitter and neurochemical activities, with this (central sensitization) itself being contingent - for both development and maintenance – on abnormal or continued peripheral inputs.
Background to sensitization
Selye (1984) defined both the general adaptation syndrome (GAS) affecting the individual as a whole, and the local adaptation syndrome (LAS), affecting a local area of the body that is subjected to stressors demanding adaptation. The GAS and LAS models explain how adaptation progresses, over time, with modifications to function occurring, leading eventually to adaptive capacity becoming exhausted, and symptoms emerging.
Neuromusculoskeletal adaptive changes involved in such processes can be seen to represent a record of the body's attempts to adapt and adjust to the multiple and varied stresses which have been imposed upon it, over time. The results of repeated postural and traumatic insults over a lifetime, combined with the somatic effects of emotional and psychological origin, will often present a confusing pattern of tense, shortened, bunched, fatigued and, ultimately, fibrous soft-tissues. Some of the many forms of biomechanical stressors that affect the body include the following (Lewit 2009).
Widespread functional changes develop – for example, affecting respiratory function and posture – with implications for the total economy of the body. (Timmons & Ley 1994) In the presence of a constant neurological feedback of impulses to the CNS/brain, from neural reporting stations, there will be increased levels of psychological arousal and a reduction in the ability of the individual, or local hypertonic tissues, to relax effectively, with consequent reinforcement of hypertonicity, and inevitably relative ischemia – an environment ideal for myofascial trigger point evolution (Shah 2005).
Functional patterns of use, of a biologically unsustainable nature, are likely to evolve, leading to chronic musculoskeletal problems and pain. (Crockett et al 2002) At this stage, restoration of normal function would require therapeutic input to address both the multiple changes that have occurred, as well as there being a need for re-education of the individual as to how to use the body, to breathe, and to display posture in more sustainable ways.
For more on the topic of adaptation the following two links will take you to some of my blog postings on this subject:
Soft tissue changes
Soft-tissue changes involving pain, hyper- or hypotonicity, joint dysfunction, antagonist muscle imbalances, overactive synergist muscles, lead to localized areas of hyper-reactivity, in the form of myofascial trigger points, and/or neural entrapment. (Lewit 2009) Additionally, pain due to damage or inflammation of peripheral tissues is clearly capable of causing chronic widespread pain. Another example of a local musculoskeletal disorder associated with chronic pain, frequently seen in manual therapy practice, is arthritis, possibly causing continuous activation of local nociceptors that initiate or sustain, central sensitization.
Reducing the nociceptive barrage Yunus (2007) has suggested that effective manual therapy in sub-acute cases of musculoskeletal dysfunction should be capable of limiting the afferent barrage of noxious input to the central nervous system, so preventing chronicity. Nijs et al (2009) goes further and affirms the importance of decreasing the afferent nociceptive barrage of trigger points, by means of soft-tissue mobilization, in comprehensive care of cases of chronic pain.
Neuromuscular therapies (NMT) aim to reduce the effects of adaptation/compensation as described above, by enhancing musculoskeletal function – including improved posture, respiratory function, and general mobility and stability, and by reducing noxious inputs resulting from the active presence of, for example, myofascial trigger points.
Recognizing Central Sensitization in patients Nijls et al (2010) have summarized the many associated features of central sensitization;
The presence of some or all of these symptom, together with information gathered during the history taking and the medical diagnosis, and confirmatory results from assessments listed below, can all help in recognition of the existence, in a given patient, of central sensitization. In this assessment the following tests have been suggested (Yunus 2007):
Symptom exacerbation, at both symptomatic and distant sites, indicates central sensitization. It is important to note that a variety of other indications may also suggest this, including increased pain during, or following, exercise
A fundamental principle emerges from current understanding of the sensitization process – sensitization can be reversed.
Affaitati et al (2011) have clearly demonstrated – in fibromyalgia - that therapeutic strategies that reduce the overall stress burden, whether these relate to biomechanics, biochemistry or psychosocial features, will reduce central sensitization.
Click here for more information about Leon Chaitow, ND, DO.
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