A Simple Miracle: Treatment for Mysterious Foot Pain
Under the old ICD-9 diagnosis codes, there was actually a diagnosis for "adventures in medical mismanagement" to describe patients who had been run down the rabbit hole of poor case management and care. I encountered one of those patients in my office today.
Electrotherapy Gives Hope for Patients With Spinal Cord Injury
There has been little optimism for recovery from a spinal cord injury because the central nervous system does not repair itself well. The severity of the injury depends on the affected area.
2018 Gallup-Palmer Report: Key Findings
The fourth annual Gallup – Palmer College report is out; here are some of the key findings excerpted directly from the executive summary regarding Americans' experiences with chiropractic care relative to the management of neck and back pain:
VA Chiropractic Reduces Veterans' Use of Opioids?
Utilization of pain medication – particularly opioids – has been massively high in among veterans for decades, but Veterans Administration guidelines that recommend nonpharmacological first-line treatment options create a greater opportunity than ever for VA chiropractors to make a dent in the opioid and overall pain-management crisis.
The Top 5 Strategies to Manage Your Reputation Online
You don't need an acupuncture website anymore! Okay, maybe that statement is a little over the top. But it's not that far from the truth. A recent study on Google searches revealed that 34 percent of all searches resulted in no clicks at all.
Knocking Down the Doors: Big Media Success for F4CP
Three articles authored by a DC or a chiropractic organization and promoting the value of chiropractic care – par for the course if you're Dynamic Chiropractic, but if you're Forbes, BOSS Magazine and Becker's Spine Review, three media outlets tailored toward high-level executives and decision-makers, we're talking about an entirely different story.
A New President for AOMA: A Conversation With Mary Faria
Dr. Faria was formerly a health care executive for over 30 years, the last 17 of those years as vice president and chief operating officer of Seton Southwest Hospital in Austin. She chairs the board of Austin Mayor's Health and Fitness Council.
VA Choice Claims Denied? Here's How You Can Get Paid
The VA Choice Program (PC3 as well) indeed pays for chiropractic care including manipulation (CMT 98940-98943) and some physical medicine services.
Cynicism and Burnout: It Can Happen to You
Trying to achieve fulfillment as a doctor in today's health care environment is a "rigged game" and physicians are programmed to burn out. At least this is the opinion of Dike Drummond, MD, in his thehappymd.com blog.
News in Brief
A Comprehensive Model of Spine Care; Dr. Christine Goertz Appointed Vice Chair of PCORI Board of Governors.
Malpractice Insurance: Understanding the Cover Letter
Purchasing medical liability insurance is quick, easy and not terribly expensive. The benefits are clearly listed on a certificate—but do you really know what you are getting with that peace of mind?
Bad for the Back! Exercises That Can Prevent Healing
The questions "Who gets well? Who doesn't? Why?" prompted the following observations based on my close to 40 years of chiropractic practice.
A Guide to CBD Dosing: The Correlation Between Dose & Potency
There is an abundance of information available about the daily use of whole plant hemp CBD oil to help maintain and support a healthy lifestyle, however there remains a lack of sound guidance on CBD oil dosing.
Goodbye, Year of the Dog: Two-Thousand-Eighteen Comes to a Close
As Year of the Dog (2018) comes to a close we can look back and see the progress this profession has made. For example, the International Classification of Diseases (ICD) added traditional medicine codes, which were released in June.
The Raw Food Debate: Practitioners Discuss Nutrition & TCM
Licensed acupuncturist and fellow blogger Elissa Gonda joins this month's column for a conversation about raw food diets. She brings her perspective on the healing potential of a raw primal diet.
The Truth About Malpractice Claims Against DCs (Pt. 1)
Over the past 20 years of active practice, I have seen a number of scary case scenarios regarding signs, symptoms and patient presentations in my office. These presentations scream, This patient is going through an event or This patient does not need chiropractic care, they need emergency care.
Dietary Supplements That Help Restless Leg Syndrome
It is estimated that 7-10 percent (possibly up to 15 percent) of the U.S. population has restless leg syndrome. It is a bit more common in women than men.
Year in Review: DC's Best of the Best for 2018
As 2018 winds down, let's highlight the most popular articles in Dynamic Chiropractic by month (December – this issue – excluded, of course).
A Soy Isoflavone That Packs a Punch: Genistein
Soybeans contains unique substances called isoflavones, most notably genistein and daidzein, which have been shown to block the buildup the dangerous type of testosterone in the prostate gland linked to prostate enlargement and prostate cancer.
Reaching for Our Roots: Healing Digestion With a Simple Traditional Therapy
Are you ignoring a powerful tool in your doctor's bag? Many acupuncturists realize that Spleen Qi deficiency has reached epidemic proportions in the U.S. Yet, we don't prioritize educating our patients about the importance of warm, cooked foods.
Map It: Understanding the Customer's Journey
One of the biggest marketing mistakes most practice owners or administrators make is not putting themselves in their prospective or current patients' shoes. How do they think and feel about you and your practice? What makes them take action?
ACA Champions H.R. 7157; ICA Voices Major Concerns
While the American Chiropractic Association recently penned an open letter – signed by not only the ACA, but also the Congress of Chiropractic State Associations, Association of Chiropractic Colleges, Clinical Compass and a number of state associations.
Exercise Therapy Following Motor Vehicle Trauma (Pt. 2)
In cases of cervical spine trauma, particularly trauma related to a motor vehicle accident, my plan is to teach the patient one exercise per session and build a progression. This is an effective approach I call an "activation circuit."
Reality Check: Do We Need to Try Harder?
While waiting for a flight to a recent chiropractic event, I overheard the ticket agent at the gate next to mine on his cellphone. His side of the conversation went something like this: "Where are you now? How long before you think you can be at the gate? OK, that will work, see you soon."
When Computers Cause UCS: Adjusting Strategy
With the widespread use of mobile devices such as smartphones and tablets, the incidence of "text neck" has reached almost epidemic proportions. But there is another challenge to the spinal health and well-being of our technology-driven society.
Acupuncture in Hospital Systems: Transitioning From Tolerated to Celebrated
I've had the pleasure of working with Susan Luria, Director of University Hospitals Health Systems Connor Integrative Health Network (CIHN) for the past year on the Integrative Health Policy Consortium (IHPC) Board of Directors and Federal Policy Committee.
February, 2011, Vol. 11, Issue 02
Chasing the Pain, Part 2
A Look at Depression
By Rita Woods, LMT
In my past article "Chasing the Pain", I reported that pain (especially leg pain) may be the result of medications your clients are taking. A thorough medical intake questionnaire that includes medications is imperative for customizing and evaluating your massage plan for each client.Identifying the cause of pain and plan of treatment involves more than subjective and objective observations.
You must begin to look beyond the obvious and consider a wider range of potential causes for their pain. This is especially true if you are not getting the positive results you had expected with your treatment plan. Today, I'm adding another perspective to chasing the pain: depression.
You've probably seen the TV commercial with the slogan: "Depression Hurts". It's an advertisement for a medication used to treat depression. Pain and depression are closely related. They share many of the same neurotransmitters and nerve pathways. Major depression and chronic pain can become a vicious cycle.
On average, 65 percent of depressed people also complain of pain. Chronic pain can lead to depression as it disrupts your daily activities, eating habits, personality and behavior and sleep patterns. In the U.S., 32 million people report pain lasting longer than one year, often without a known physical cause. In primary care practices, up to 80 percent of depressed patients present exclusively with physical symptoms that can include: headache, abdominal pain, and musculoskeletal pains in the lower back, joints, and neck.1
The following is a typical post I found when researching what people actually feel when they are depressed:
"I don't even know where to begin. I'm finding myself getting mad over the smallest things. I find myself crying afterwards because I feel I'm hurting my family. I don't think I'm a good husband or father and I don't understand why my family even wants me around... I would like to add I have this lower back pain that came from nowhere, meaning I didn't do anything physical to cause it, and it is pretty bad."
The low back pain described by this man is not uncommon in people suffering from depression. If he were to come into your massage practice hoping that you could ease or alleviate his low back pain, it would be helpful for you to know he suffers from depression.
Remember that some of the overlap between depression and chronic pain can be explained by biology as they share some of the same neurotransmitters (chemical messengers traveling between nerves). They also share some of the same nerve pathways. According to a Harvard Health publication, almost every drug used in psychiatry can also serve as a pain medication. This is a true mind-body connection.
Massage Therapy and Depression
For the purposes of this article, I will over-simplify that process and focus only on issues that fall within our scope of practice. As massage therapists, we do not deal with emotional and psychological issues but we know from research that massage can help lessen feelings of anxiety, stress and depression. The neurotransmitters, norepinephrine and serotonin (among others), help regulate mood and the perception of pain. Neurotransmitters follow both an ascending and descending pathway, some traveling through the brain and some through the spinal column.
When the regulation of these neurotransmitters fails many things can happen including depression and the sensation of pain. Even if there is no physical reason for the pain, the brain senses pain due to the disruption of the neurotransmitters following the nerve pathways. The NIH reports that clinical investigators have tested chronic pain patients and found that they often have lower-than-normal levels of endorphins in their spinal fluid.
Let's be clear, I'm not saying that all people with pain are automatically depressed, nor all people who are depressed have physical pain. But with the predominance of stress and depression in today's world, you will certainly have some clients suffering from pain that is related to their neurochemistry and not a physical injury. Your treatment plan should include types of massage geared at reducing stress chemicals and increasing the pain-relieving and mood-enhancing chemistry. Instead of chasing the pain, you should reevaluate your treatment plan if the client is showing no signs of improvement.
Swedish massage in particular may enhance well-being by stimulating the release of endorphins (natural painkillers and mood elevators) and reducing levels of certain stress hormones. Additionally, the researchers at the School of Medicine at UCLA found that participants who received a single Swedish massage session had a significant decrease in the hormone arginine-vasopressin (which plays a role in regulating blood pressure and water retention).
In a group of studies by the Touch Research Institute which included about 500 men, women, and children with depression or stress problems, researchers measured the stress hormone cortisol in participants before and immediately after massage. Massage therapy lowered levels by up to 53 percent. Massage also increased serotonin and dopamine, neurotransmitters that help reduce depression. Massaged subjects were less depressed and anxious and showed behavioral and stress hormone changes including a decrease in anxious behavior.
Once again, it's important to emphasize the importance of your client's intake form. Include questions about anxiety, stress and depression. Having this knowledge may help you establish a more successful treatment plan and achieve greater benefits for your client. January and February are typically the worst months for people who suffer from a specific type of depression called Seasonal Affective Disorder (SAD). So now is a good time to call your clients and remind them to make an appointment.
Click here for previous articles by Rita Woods, LMT.
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