First Time Chiropractic Adjustment:)

[101N]

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[IlDestriero]

"Praise the lord!"

 

[Ligament]

That cervical traction/high velocity high amplitude technique with the towel must have felt good. Takes balls or ignorance to do that.

Most of the other stuff was BS.

 

[drusso]

That cervical traction/high velocity high amplitude technique with the towel must have felt good. Takes balls or ignorance to do that.

Most of the other stuff was BS.

Don't know why chiropractors tend to favor manipulating the C-spine with rotation in relative extension to the occiput. As Lig knows, DO's are taught the opposite...

http://files.academyofosteopathy.org/MemberResourceGuide/AOAPositionPaperOMTCervicalSpine.pdf

"It has been proposed that thrust techniques that use a combination of hyperextension, rotation and traction of the upper cervical spine will place the patient at greatest risk of injuring the vertebral artery. In a retrospective review of 64 medical legal cases, information on the type of manipulation was available in 39 (61%) of the cases. 51% involved rotation, with the remaining 49% representing a variety of positions including lateral flexion, traction and isolated cases of non-force or neutral position
thrusts. Only 15% reported any form of extension. 21"

Proc (Bayl Univ Med Cent). 2015 Jan;28(1):88-90.
Vertebral artery dissection after a chiropractor neck manipulation.
Jones J1, Jones C1, Nugent K1.
Author information

Abstract
The differential diagnosis for ischemic central nervous system infarcts in young patients includes paradoxic emboli through cardiac shunts, vasculitis, and vascular trauma. We report a young woman who developed headache, vomiting, diplopia, dizziness, and ataxia following neck manipulation by her chiropractor. A computed tomography scan of the head revealed an infarct in the inferior half of the left cerebellar hemisphere and compression of the fourth ventricle causing moderate acute obstructive hydrocephalus. Magnetic resonance angiography revealed severe narrowing and low flow in the intracranial segment of the left distal vertebral artery. The patient was treated with mannitol and a ventriculostomy and had an excellent functional recovery. This report illustrates the potential hazards associated with neck trauma, including chiropractic manipulation. The vertebral arteries are at risk for aneurysm formation and/or dissection, which can cause acute stroke.

 

[Ducttape]

my god. with all thats wrong with that patient, its amazing that patient has any voluntary bowel control left (which i almost lost when he did the cervical manipulation at 8:10).

 

[PinchandBurn]

I cant believe people pay for this?

This quack's way of checking reflexes is priceless.

I have never seen a someone go to a Chiro and feel better. Now I see why...

HOw are these guys paid? I mean he basically 'adjusted' every part of the body. Like 20 ICDs. This would be the equivalent of doing 20 procedures on someone..

 

[drusso]

I cant believe people pay for this?

People?!?! Try entire government and state run health systems!

http://blogs.palmer.edu/news/2015/0...ntary-therapies-over-painkillers-and-surgery/

It's the responsibility of EVERY evidence-based pain physician to inform policymakers about psuedo-science and quack-based pain treatment.

OREGON PRIORITIZES CHIROPRACTIC, COMPLEMENTARY THERAPIES OVER PAINKILLERS AND SURGERY

Could Oregon’s bold move pave the way for more states to initiate similar policies?
Many Oregon patients with chronic back pain will soon discover a host of new treatment options they previously didn’t have—including chiropractic care.

Beginning next year, the Oregon Health Plan (OHP) will prioritize chiropractic and other complementary therapies over painkillers or surgery for patients with back pain. It’s a huge shift from the previous policy, which heavily favored narcotics as the first line of defense against pain.

“We enthusiastically applaud Oregon’s policy initiative,” said Palmer College Chancellor Dennis Marchiori, D.C., Ph.D. “Doctors of chiropractic are trained in the most conservative methods of managing chronically ill patients. We provide an alternative to more invasive treatments, which are increasingly shown to be associated with severe drawbacks like complications, addictions and higher cost. Our inclusion will contribute positively to the overarching goal of maximizing health outcomes, improving patient satisfaction and reducing the cost of care.”

For many patients, painkillers were the only option. Of the 8 percent of OHP patients who sought back pain treatment in 2013, only a narrow sliver met the plan’s requirements for chiropractic care, while more than half received narcotics.

“There should be an array of things for people to choose from, whether it be chiropractic care, naturopathic care, acupuncture, nutrition or massage,” said Dr. Dave Eisen, executive director of The Quest Center for Integrative Health in Portland. “If they don’t work, you use opioids … as a last resort,” he said.

Under the new policy, OHP patients will be able to receive chiropractic treatment—as well as acupuncture, cognitive behavioral therapy, osteopathic manipulation, and physical and occupational therapy—up to 30 times a year.

Why chiropractic care trumps painkillers

The changes to the Oregon Health Plan represent a step in the right direction. Using narcotics as a long-term treatment for chronic pain opens the door to addiction, and health care providers estimate as many as a quarter of patients on long-term opioid treatment end up abusing the drugs.

In fact, officials believe using painkillers as the go-to treatment for back pain may have contributed to Oregon’s status as the nation’s leader in opioid abuse. More than900,000 Oregonians received opioid prescriptions in 2012.

Addiction risks aside, chiropractic care simply works better. While painkillers merely mask the symptoms without addressing the underlying problem, chiropractic treatment aims to heal the imbalance that’s causing the chronic pain.

There’s plenty of research to back up the Oregon Health Plan’s decision. A 2003 studyfound that spinal manipulation offers greater short-term back pain relief than a variety of medications, and in 2004 researchers found chiropractic care more effective than medical care at treating chronic lower back pain.

What this means for Oregon chiropractors

Chiropractors in Oregon can expect to see an influx of OHP patients seeking treatment for ongoing back problems.

“The number of people who qualify under the guidelines for treatment is pretty narrow, and they’re expanding it dramatically, so I think it would certainly almost double,” said Dr. Alison Little of PacificSource Community Solutions, which administers OHP for Central Oregon.

Additionally, chiropractic care providers who have had billing problems with OHP in the past may find the reimbursement rate improved once the new policy kicks in Jan. 1, 2016.

While chiropractic care and other therapies may cost the health plan more in the short term, officials hope it will pay off by resulting in fewer surgeries and a decline in narcotics use, said Denise Taray of the Oregon Pain Management Commission.

“Research is out there that suggests that with back conditions we’re spending a lot of money on health care treatment and services that aren’t improving outcomes,” she said. Fortunately, chiropractic treatment has an excellent track record in that department.

The National Center for Complementary and Integrative Health recently released the results of a National Health Interview Survey on the “Use of Complementary Health Approaches in the U.S.” Visit their site to see the results regarding the “Estimates of Pain Prevalence and Severity in Adults.”

How can chiropractors work to bring about similar policies in more states? Is your state association working toward similar policies in your state and if so, what can you do to help? Let us know in the comments below or contact us to share what you’re doing to move chiropractic forward.

 

[101N]

Personally, I'd rather the dude in the video put on a shaman robe & dance around my patients with a bag of chicken bones and chant about their leg-length disparity, rather than getting them addicted to opioids, doing a bunch of worthless & costly injections that imply their pain is nociceptive (duh), or having a surgeon offer them a long segment fusion.

Here is the OR truth: given that there are no good options for treatment of chronic LBP, HA, or FMS. We are moving the goal posts to harm reduction and cost.

 

[drusso]

Here is the OR truth: given that there are no good options for treatment of chronic LBP, HA, or FMS. We are moving the goal posts to harm reduction and cost.

Why doesn't OHA believe their own GIGO science for what "works" when it comes to treating chronic pain? Maybe because someone on the HERC (Health Evidence Review Committee) LOVES their mu-shoo! Order up!


http://www.oregon.gov/oha/herc/Pages/Roster.aspx


BMJ. 2015 Feb 18;350:h444. doi: 10.1136/bmj.h444.
Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and meta-analysis.
Kamper SJ1, Apeldoorn AT2, Chiarotto A2, Smeets RJ3, Ostelo RW4, Guzman J5, van Tulder MW6.
Author information

Abstract
OBJECTIVE:
To assess the long term effects of multidisciplinary biopsychosocial rehabilitation for patients with chronic low back pain.

DESIGN:
Systematic review and random effects meta-analysis of randomised controlled trials.

DATA SOURCES:
Electronic searches of Cochrane Back Review Group Trials Register, CENTRAL, Medline, Embase, PsycINFO, and CINAHL databases up to February 2014, supplemented by hand searching of reference lists and forward citation tracking of included trials.

STUDY SELECTION CRITERIA:
Trials published in full; participants with low back pain for more than three months; multidisciplinary rehabilitationinvolved a physical component and one or both of a psychological component or a social or work targeted component; multidisciplinary rehabilitationwas delivered by healthcare professionals from at least two different professional backgrounds; multidisciplinary rehabilitation was compared with a non- multidisciplinary intervention.

RESULTS:
Forty one trials included a total of 6858 participants with a mean duration of pain of more than one year who often had failed previous treatment. Sixteen trials provided moderate quality evidence that multidisciplinary rehabilitation decreased pain (standardised mean difference 0.21, 95% confidence interval 0.04 to 0.37; equivalent to 0.5 points in a 10 point pain scale) and disability (0.23, 0.06 to 0.40; equivalent to 1.5 points in a 24 point Roland-Morris index) compared with usual care. Nineteen trials provided low quality evidence that multidisciplinary rehabilitation decreasedpain (standardised mean difference 0.51, -0.01 to 1.04) and disability (0.68, 0.16 to 1.19) compared with physical treatments, but significant statistical heterogeneity across trials was present. Eight trials provided moderate quality evidence that multidisciplinary rehabilitation improves the odds of being at work one year after intervention (odds ratio 1.87, 95% confidence interval 1.39 to 2.53) compared with physical treatments. Seven trials provided moderate quality evidence that multidisciplinary rehabilitation does not improve the odds of being at work (odds ratio 1.04, 0.73 to 1.47) compared with usual care. Two trials that compared multidisciplinary rehabilitation with surgery found little difference in outcomes and an increased risk of adverse events with surgery.

CONCLUSIONS:
Multidisciplinary biopsychosocial rehabilitation interventions were more effective than usual care (moderate quality evidence) and physical treatments (low quality evidence) in decreasing pain and disability in people with chronic low back pain. For work outcomes, multidisciplinaryrehabilitation seems to be more effective than physical treatment but not more effective than usual care.

© Kamper et al 2015.

 

[101N]

Dave: Your:

 

[jesspt]

Don't know why chiropractors tend to favor manipulating the C-spine with rotation in relative extension to the occiput. As Lig knows, DO's are taught the opposite...

http://files.academyofosteopathy.org/MemberResourceGuide/AOAPositionPaperOMTCervicalSpine.pdf

"It has been proposed that thrust techniques that use a combination of hyperextension, rotation and traction of the upper cervical spine will place the patient at greatest risk of injuring the vertebral artery. In a retrospective review of 64 medical legal cases, information on the type of manipulation was available in 39 (61%) of the cases. 51% involved rotation, with the remaining 49% representing a variety of positions including lateral flexion, traction and isolated cases of non-force or neutral position
thrusts. Only 15% reported any form of extension. 21"

Proc (Bayl Univ Med Cent). 2015 Jan;28(1):88-90.
Vertebral artery dissection after a chiropractor neck manipulation.
Jones J1, Jones C1, Nugent K1.
Author information

Abstract
The differential diagnosis for ischemic central nervous system infarcts in young patients includes paradoxic emboli through cardiac shunts, vasculitis, and vascular trauma. We report a young woman who developed headache, vomiting, diplopia, dizziness, and ataxia following neck manipulation by her chiropractor. A computed tomography scan of the head revealed an infarct in the inferior half of the left cerebellar hemisphere and compression of the fourth ventricle causing moderate acute obstructive hydrocephalus. Magnetic resonance angiography revealed severe narrowing and low flow in the intracranial segment of the left distal vertebral artery. The patient was treated with mannitol and a ventriculostomy and had an excellent functional recovery. This report illustrates the potential hazards associated with neck trauma, including chiropractic manipulation. The vertebral arteries are at risk for aneurysm formation and/or dissection, which can cause acute stroke.

They favor it because it's easier to do than an HVLA in neutral or flexion. And DOs aren't the only ones taught the opposite.

So. Much. Wrong. In this video.

 

[drusso]

Dave: Your:

In case you missed it:

HERC Member Roster:

Vern Saboe, DC, is a practicing chiropractic physician with 30 years experience who is board certified in orthopedics, neurology and forensic science. He served on the Oregon Board of Chiropractic Examiners and is Past President of the Chiropractic Association of Oregon.
Alternative & Complementary Medicine Provider
Term: 1/1/12-12/31/15

http://www.drvernsaboe.com/aboutdrsaboe.html

Patient and Professional Advocacy

Dr. Saboe routinely lectures to his peers speaking on the subjects of orthopedics, neurology, and forensic science and has written many articles relative to these areas of practice. He has been the recipient of numerous awards and twice selected as “Chiropractor of the Year” by his peers (2003 and 2005). In 2015 Dr. Saboe’s peers on the national level, selected him to receive both the American Chiropractic Association’s “Delegate of the Year Award” and the “F. Dow Bates Political Action Award” the presentations were held in Washington, DC. He is past president of the Oregon Chiropractic Association (2003-2005), the American College of Chiropractic Orthopedists (2008), and currently serves as Oregon’s delegate to the American Chiropractic Association (ACA) since 1994. He also serves on the ACA’s Legislative Commission, Military and Veterans Affairs Committee, and Taskforce on Economics and Qualify of Care. Dr. Saboe is the chief paid lobbyist for the Oregon Chiropractic Association and advocates for chiropractic patient issues in Salem as well as in Washington, DC. In 2010 Dr. Saboe was appointed by Oregon Governor John Kitzhaber, MD., to the Governor’s Health System Transformation Team and in 2011 Governor Kitzhaber appointed Dr. Saboe to the Health Evidence Review Commission (HERC). Dr. Saboe serves on the Evidence-based Guidelines Subcommittee of HERC as well as providing peer review for guideline drafts produced by OHSU’s Center for Evidence-based Policy established in 2003 by Governor Kitzhaber. In 2013, Director of the Oregon Health Authority (OHA) Bruce Goldberg, MD, appointed Dr. Saboe to the OHA's Integrative Medical Advisory Committee. He also serves as a Medical Advisor in quality management for Providence Health Plans and serves on Regence-CareCore's Physical Medicine Advisory Committee.

Yes, Ladies & Gentlemen, that's how it's done in Oregon: A wink, a nod, a little sly smile. Helps to know people in high places (Thanks Kitz! Thanks Roger!). Appoint the Chiropractic Profession's chief lobbyist to the "Evidence Committee" for allocating health care resources. What could go wrong??

 

[101N]

Like us, some chiropractors are good folks and some not. Vern's a lot less costly - and harmful - than you and me So, given that you have no data to suggest that what we do is more efficacious than that he does, why don't you just let him do what he does?

 

[Mad Jack]

 

[101N]

 

[jonnylingo]

A must read for pain/spine docs:

http://scienceinmedicine.org/policy/papers/Chiropractic.pdf

 

[drusso]

Like us, some chiropractors are good folks and some not. Vern's a lot less costly - and harmful - than you and me So, given that you have no data to suggest that what we do is more efficacious than that he does, why don't you just let him do what he does?

Spinal manipulation as a modality is distinct from chiropractic as a system of treatment. The former is a physical modality/skill no different from suturing or driving a needle. It can studied and applied in a rational manner. In my experience, it's not good for chronic pain but useful for selected acute and sub-acute musculoskeletal pain problems. Chiropractic is a pseudo-scientific belief system based upon illusory diagnosis and fraudulent treatment.

I don't care how people spend their own money when it comes to their personal health care. I care deeply how policymakers allocate resources from the public treasury for health care. In my view, the process and decision-making that resulted in expanding poor, vulnerable groups of patients to pseudo-scientific chiropractic care; meta-physical, mu-shoo, mumbo-jumbo is nothing short of a breach of the public trust and fiduciary negligence. A Medicaid patient in Oregon with a lower extremity crush injury can get his chi adjusted and neck popped endlessly but can't get a spinal cord stimulator implanted for his neuropathic pain. Medically-complex, co-occurring pain/substance use disordered patients do not need placebos. They need real medicine. They need case management. They need specialty-coordinated care. Paying for pseudo-scientific garbage drains needed resources from other parts of the system. Moving the goal posts and calling it "harm reduction" is disingenuous to the public and dangerous to patients.

Pharma killed multi-disciplinary pain rehabilitation with the justification that pills would be cheaper. Now, quackery/GIGO science/politically-greased pseudo-scientific witchdoctors want to kill comprehensive pain care using the same justification. You can't fix problems with the same thinking that created them. Policymakers need to understand that there is no "quick fix" for the opioid abuse/misuse/addiction epidemic in this country. No amount of finger-pointing, hand-wringing, or magical thinking will help people with complex pain and addiction escape their cycle of despair. Instead, policymakers must be willing to "double-down" and pay for integrated physical/mental health, comprehensive pain care, addiction treatment, care coordination, and rehabilitation. That's the message that our specialty's "thought leaders" should be promoting.

 

[101N]

I agree that the current iatrogenic addiction crisis is a symptom of the chronic pain problem in the US. And that the pain problem is bigger - though less deadly - than the addiction problem. The problem is "which" chronic pain treatment reliably produces measurable gain? Until we have data to support 'treatment x' the focus will be on minimizing harm and cost.

IMO IPM is not the answer - in OR or elsewhere- for the vast majority of CNP.

 

[Ducttape]

You must factor in to the equation that treatments rendered and that become standard become difficult if not impossible to discontinue.

We do not possess any reliable EBM that shows moderate evidence for benefit for chiropractic or acupuncture. Once govnt insurance starts paying for it, just like IPM, it will become exceedingly hard to retract payment for such dubious therapies.

This is not cost containment.

 

[101N]

You must factor in to the equation that treatments rendered and that become standard become difficult if not impossible to discontinue.

We do not possess any reliable EBM that shows moderate evidence for benefit for chiropractic or acupuncture. Once govnt insurance starts paying for it, just like IPM, it will become exceedingly hard to retract payment for such dubious therapies.

This is not cost containment.

Yes, entitlements are difficult to get rid of. I personally would like to see some criteria met, or a sunset clause goes into effect. But, even without
there will be big push back from payers if costs spiral upward.

It may not be cost containment.

 

[freddydpt]

OMG the guy is screaming throughout the entire session? I mobilize every day and I never make patients scream (adhesive capsulitis excluded - but I haven't done that in a looooong time).

 

[101N]

OMG the guy is screaming throughout the entire session? I mobilize every day and I never make patients scream (adhesive capsulitis excluded - but I haven't done that in a looooong time).

This is central sensitization by definition. Eventually this patient then comes to see me, and gives me his litany of
pseudo-diagnoses - multiple
'severe' herniated discs, sacroiliitis, a leg length disparity, adhesive capsulitis... - it makes it so
much harder for him to accept the fact that the 'pain' comes from his brain.

I hope this doesnt reflect current chiropractic training or care.

 

[SSdoc33]

This is central sensitization by definition. Eventually this patient then comes to see me, and gives me his litany of
pseudo-diagnoses - multiple
'severe' herniated discs, sacroiliitis, a leg length disparity, adhesive capsulitis... - it makes it so
much harder for him to accept the fact that the 'pain' comes from his brain.

I hope this doesnt reflect current chiropractic training or care.

so do you really tell this to everybody? that its "in their head"? what if they have a big acute disc? what if the have severe facet OA? what if it is somewhere in the middle?

i actually agree with you that often times there is a significant central sensitization issue going on, but i cant imagine patients accept this diagnosis very readily. your online reviews/profile would support me on this.....

 

[drusso]

This is central sensitization by definition. Eventually this patient then comes to see me, and gives me his litany of pseudo-diagnoses - multiple 'severe' herniated discs, sacroiliitis, a leg length disparity, adhesive capsulitis... - it makes it so much harder for him to accept the fact that the 'pain' comes from his brain.

I think that there is much more central sensitization present in patients than what clinicians typically apportion. But, there is no rule in life that says you can't have more than one thing wrong with you. We don't have a large evidence base to guide treatment for patients with co-occurring CS and nociceptive pain. The problem still remains: How do you treat each problem-- in isolation and synergistically--we see this all the time in other areas of medicine: I give the ACE-inhibitor and the blood pressure improves but the renal function worsens, etc.

Eur J Pain. 2014 Nov;18(10):1367-75. doi: 10.1002/j.1532-2149.2014.499.x. Epub 2014 Apr 3.
Evidence for central sensitization in patients with osteoarthritis pain: a systematic literature review.
Lluch E1, Torres R, Nijs J, Van Oosterwijck J.
Author information

Abstract
Hyperexcitability of the central nervous system (CNS) has been suggested to play an important role in the chronic pain experienced by osteoarthritis (OA) patients. A systematic review following PRISMA guidelines was performed to evaluate the existing evidence from the literature related to the presence of central sensitization (CS) in patients with OA.Electronic databases PubMed and Web of Science were searched to identify relevant articles using pre-defined keywords regarding CS and OA. Full-text clinical reports addressing studies of CS in human adults with chronic complaints due to osteoarthritis were included and screened for methodological quality by two independent reviewers. From the 40 articles that were initially eligible for methodological quality assessment, 36 articles achieved sufficient scores and therefore were discussed. The majority of these studies were case-control studies and addressed OA of the knee joint. Different subjective and objective parameters considered manifestations of CS, which have been previously reported in other chronic pain conditions such as whiplash or rheumatoid arthritis, were established in subjects with OA pain. Overall results suggest that, although peripheral mechanisms are involved in OA pain, hypersensitivity of the CNS plays a significant role in a subgroup of subjects within this population. Although the majority of the literature provides evidence for the presence of CS in chronic OA pain, clinical identification and treatment of CS in OA is still in its infancy, and future studies with good methodological quality are necessary.

© 2014 European Pain Federation - EFIC®

 

[101N]

"i actually agree with you that often times there is a significant central sensitization issue going on, but i cant imagine patients accept this diagnosis very readily. your online reviews/profile would support me on this....."

Yes, this is key. Many patients with CS are EXQUISITELY sensitive/resistant to the diagnosis. There are a lot of reasons for this, secondary gain, 'face saving', drug seeking, etc.
Most physicians avoid broaching the subject having been burned with complaints, bad Press-Ganey scores (MPS scores @ Kaiser), retaliatory slander on
physician rating sites, etc. But patients don't get to self diagnosis their CNP, and our old guard needs stop facilitating pseudo-diagnoses if we actually
want to come up with a treatment plan that has some chance of success.

Clauw says the 800lb gorilla in CNP is CS, I believe it, particularly in working-aged, but non-working, adults with CNP. Word about this needs to
escape academia and seep into exam rooms around the country. If you dx CS in CNP it has to be triaged to #1 in the Ddx list. IMO, the prescription
Rx epidemic is a symptom of the bigger problem of CS.

 

[drusso]

"i actually agree with you that often times there is a significant central sensitization issue going on, but i cant imagine patients accept this diagnosis very readily. your online reviews/profile would support me on this....."

Yes, this is key. Many patients with CS are EXQUISITELY sensitive/resistant to the diagnosis. There are a lot of reasons for this, secondary gain, 'face saving', drug seeking, etc.
Most physicians avoid broaching the subject having been burned with complaints, bad Press-Ganey scores (MPS scores @ Kaiser), retaliatory slander on
physician rating sites, etc. But patients don't get to self diagnosis their CNP, and our old guard needs stop facilitating pseudo-diagnoses if we actually
want to come up with a treatment plan that has some chance of success.

Clauw says the 800lb gorilla in CNP is CS, I believe it, particularly in working-aged, but non-working, adults with CNP. Word about this needs to
escape academia and seep into exam rooms around the country. If you dx CS in CNP it has to be triaged to #1 in the Ddx list. IMO, the prescription
Rx epidemic is a symptom of the bigger problem of CS.

I think that you're conflating many different related concepts: Central sensitization is a bona-fide neurophysiological process that can be demonstrated in multiple animal models ranging from worms to primates. Most of the worms came from very well functioning families and were not receiving disability-related compensation and yet could still be experimentally manipulated to show objective markers of CS in-vivo.

Somatoform disorders, malingering, etc are psychiatric disorders. Caveat emptor.

Drug-seeking, diversion, etc are sociopathic problems. These people need to be dispositioned to the criminal justice system.

I think what populates waiting rooms of most pain clinics is a "gumbo" of real disease, real altered pain processing systems, chemical coping, undetected substance use disorders, and psychiatric illness. In my view of how this speciality is supposed to work, the pain specialist says, "I can help you with your femoroacetabular arthritis with an injection, we're going to reduce your Norco 10/325 from 8 per day to 4 per day and I would like to see you on the lowest dose possible, let's try some low dose gabapentin at night to help your sleep, you seem very depressed would you like to try to an SRNI or speak to our clinical social worker about a referral for longitudinal mental health services?"

 

[Ducttape]

is 101N combining "real altered pain processing systems, chemical coping, undetected substance use disorders, and psychiatric illness" into an amalgam of CS?

what effect will you have on these issues if you convince yourself that you are treating a "real disease", with medications as aggressive as opioids? how does use of these medications adversely affect a barely coping undetected substance abuse patient? or are we deciding that the patient has one true "real disease" that in effect enables them to believe that they have significant problems?

 

[drusso]

is 101N combining "real altered pain processing systems, chemical coping, undetected substance use disorders, and psychiatric illness" into an amalgam of CS?

what effect will you have on these issues if you convince yourself that you are treating a "real disease", with medications as aggressive as opioids? how does use of these medications adversely affect a barely coping undetected substance abuse patient? or are we deciding that the patient has one true "real disease" that in effect enables them to believe that they have significant problems?

I think that is the "essence of the craft" of this specialty. I'm not certain that we are scientifically sophisticated enough yet to make "standard work" out of un-refined oatmeal/gumbo that most typically presents as "chronic pain." We can come a long way by training PCP's to be better diagnosticians--learn to recognize and detect CS, mental health disorders, maladaptive coping, etc. I believe that the role of the pain consultant/specialist is guide the PCP through this. "I can do X,Y,Z injection for your patient and you might realistically expect this kind of result for this amount of time, but here's all the other issues that the PATIENT must work on in order to recover from their chronic pain..."

 

[Ligament]

I have this cervical "tug" done to my neck and it works wonders. Chiropractic helps my thoracic pain a lot. Lasts about 3-4 months at a stretch. So this stuff can work. I think the whole believe system is bogus however.