American Chiropractic Association - chronic 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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Chronic Pain: Screening for Potential Psychological Factors

Chronic pain symptoms and the ability to manage and cope with them can be strongly influenced by what are generally referred to as psychological factors. These factors have the capacity to substantially hinder clinical improvement, cause symptom aggravation and reduce self-management capacity. Though these concepts are well-supported in the scientific literature, they are not inherently usable. Practical methods of revealing relevant psychological factors are needed. To explore whether psychological factors are clinically relevant, clinicians can ask questions during the consultation and/or use one of several screening questionnaires.

 

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Support H.R. 3654 and Medicare Parity for Chiropractors and Their Patients

The Chiropractic Medicare Coverage Modernization Act of 2019 (H.R. 3654) is bipartisan legislation championed by ACA and introduced in Congress on July 9 by Reps. Brian Higgins (D-N.Y.) and Tom Reed (R-N.Y.). The bill would correct a longstanding oversight and give seniors access to the full array of Medicare services that their doctors of chiropractic are qualified and licensed to provide in their respective states.

Author: Robert Jones
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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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My VA Experience with Cognitive Behavioral Therapy for Chronic Pain

Chronic pain is a complex condition influencing behaviors, thoughts and mood. With opioid issues coming to light, there has been more emphasis and research into multi-faceted, biopsychosocial models to treatment. Cognitive Behavioral Therapy (CBT) is a type of talk-therapy treatment that focuses on addressing and removing the negative impacts chronic pain has on thoughts and functions. The Office of Mental Health and Suicide Prevention (OMHSP) has implemented a national initiative to disseminate Cognitive Behavioral Therapy for Chronic Pain throughout the Veterans Health Administration to make this treatment widely available to veterans.

Author: Jamie Zeman
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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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Mindfulness-Based Stress Reduction Techniques as a Treatment for Healthcare Provider Burnout

Burnout syndrome has been defined as a three-dimensional syndrome characterized by exhaustion, cynicism and inefficiency. It has also been described as the opposite to engagement, which is defined as energy, involvement and efficacy.  One aspect of inefficiency may be a sense of low personal accomplishment – an area often examined in studies on healthcare provider burnout. In her latest ACA Blogs post, VA resident Danielle Aslan, DC, explores how mindfulness-based stress reduction utilized in the VA for patients with chronic pain may also aid healthcare providers.

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Research Review: Manipulation and Mobilization for Treating Chronic Low Back Pain: a Systematic Review and Meta-analysis

Spinal manipulation and mobilization for the treatment of back and neck pain have been the topic of several systematic reviews, with some suggesting that the evidence in support of the view that spinal manipulative therapy is superior to other standard treatments for chronic low back pain is sparse. On the other hand, more recent systematic reviews have reported that spinal manipulation and mobilization are “viable” options for treating pain. Despite this degree of variability among studies, manipulation and mobilization are still considered to be effective treatments when compared with other therapies. The purpose of this systematic review was to unravel these differences and inconsistent findings. 

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