American Chiropractic Association - pain

Sensitization (Part 2): Management Strategies

Chronic pain symptoms can be quite different from acute pain symptoms.1 One possible reason is sensitization, a process whereby neurons become more responsive to pain signals and/or translate non-painful stimuli into pain. Part 1 of this series described general neuro-adaptive processes leading to sensitization and clinical diagnostic criteria. Here in Part 2, management strategies for persons with sensitization are described.

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Sensitization (Part 1): Characteristics and Implications

Practitioners use symptoms to guide clinical evaluation and treatment. For example, chest pain on exertion suggests possible need for cardiac evaluation. Pain is a symptom we are trained to explore by asking questions such as, “How severe is your pain?” and “Where is the pain located?” We ask these questions because the answers help point us in the direction of a diagnosis. However, pain symptoms are sometimes unreliable. For people experiencing chronic pain, symptom characteristics may not match patterns found in acute cases. The physiological basis for this alternate pain experience can be the result of peripheral or central sensitization. 

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Opioids: ACA Is a Trusted Resource in Advocacy Circles for Information on Non-drug Approaches

The American Chiropractic Association (ACA) has long been a partner in the fight against opioid misuse by promoting and encouraging the utilization of safe, effective and proven non-drug approaches to pain management, such as chiropractic care. Recently, ACA has joined with national coalitions to promote chiropractic care as a viable, widely available and effective tool to the millions of Americans who experience chronic and acute pain each year. 

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Billing for Dry Needling Services (Needle Insertion Without Injection)

Dry needling has become an accepted procedure for the management of myofascial trigger points, offering a viable option to pain medications and surgical intervention. The procedure can also be applied to specific muscle motor points, spinal segments, and other structures including ligaments, tendons and joint capsules for pain relief. In clinical practice it is often used in conjunction with other physical medicine procedures and modalities to manage pain and improve function. 

Author: Anthony Hamm
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Top 4 Most Commonly Missed Hip Diagnoses

Problems involving the hip are some of the most frequently undiagnosed or misdiagnosed conditions. When a patient presents with hip pain, chiropractors immediately consider the most probable culprits—like greater throchanteric pain syndrome and osteoarthritis. But what if the diagnosis is not so straightforward? A new paper by Lee1 identified the four top undiagnosed causes of hip pain.

 

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Social Factors: A Sometimes-overlooked Opportunity

The biopsychosocial model is a widely recommended method of clinical evaluation and management. The model identifies three important areas. “Bio” refers to evaluating/treating biological problems (e.g., pathology), “psych” refers to psychological health, and “social” refers to a person’s relationships with others and the environment. However, some evidence suggests that practitioners, as a group, may not be addressing “social” components of health as much as they could.

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Research Review: Can Pregnancy-related Pelvic Pain Be Predicted?

Approximately half of pregnant women will experience pelvic girdle pain (PGP) during their pregnancy. PGP is known to lead to pain-related restrictions on physical activity during and after childbirth, and to have a psychological impact on their perceived health, sexual life and general quality of life. The authors of this study aimed to explore the differences in demographics and clinical characteristics at mid-pregnancy and the weekly amount of days with bothersome symptoms throughout the second half of pregnancy in women sub-grouped based on the results of two valid and reliable clinical tests (P4 and ASLR) at 18 weeks of pregnancy. The authors hypothesized that sacroiliac dysfunction and failing force closure diagnosed at mid-pregnancy could be used to predict a course of bothersome symptoms throughout the second half of pregnancy.

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Psychological, Social Factors in Chronic Pain: The Impact on Chiropractic Patients

The current opioid epidemic in the United States brings long overdue attention to nonpharmacological approaches to managing pain.  Among the recommended therapies for low back pain by the American College of Physicians, for example, are spinal manipulation, acupuncture, yoga and cognitive behavioral therapy.  While it may be clear why body-based therapies were recommended, the inclusion of a psychological approach, such as cognitive behavioral therapy, may raise some eyebrows. Researchers Margaret Chesney, PhD, and Christine Goertz, DC, PhD, explore how psychological factors play a role in the experience of chronic pain as well as what patients and their providers should know.

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Research Review: Non-surgical Treatment vs. Self-directed Care to Improve Walking in Lumbar Spinal Stenosis

Lumbar spinal stenosis (LSS) is caused by age-related degenerative changes in older adults and is a leading cause of pain, disability and loss of independence. LSS is also the most common reason for spinal surgery in older adults. However, most patients are managed non-surgically, despite the fact systematic reviews of non-surgical management suggest unproven benefit for improving walking outcomes. This research review looks at a recent, randomized controlled trial designed to compare the effectiveness of a structured, comprehensive, conservative treatment program with a focus on self-management and improved walking ability to a self-directed program in improving walking ability in patients with neurogenic claudication due to LSS.

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ACA and APTA Collaborate on Dry Needling Code

Following a successful nine-year collaboration between the American Chiropractic Association (ACA) and the American Physical Therapy Association (APTA), a new CPT® code for dry needling will likely be available to providers sometime in late 2019, paving the way potentially for proper coverage, national standards and a greater understanding of how this relatively new modality helps patients in pain.

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Article rating: 4.1
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