You wake up with it. You go to sleep with this. Chronic pain, by definition, does not go away. Millions of people live with chronic back or neck pain every day. Chronic pain is technically defined as pain that persists for 12 weeks or even longer, even after the injury has healed. Thankfully, while many individuals with chronic pain might feel hopeless to attain relief, there are a variety of treatments which may help manage the pain, such as laser treatment.
Contents
How does laser therapy benefit chronic pain?
The idea that light energy can accelerate recovery in tissues, can reduce inflammation and pain, relax muscles, and stimulate nerve wracking with the use of a lase appears to be farfetched. Science, however, tells us these effects may be true. The inquiry is, to what extent does this work and is this based on power and wavelength?
“Wavelength and power determine the capacity of this laser to penetrate in the body. Once you are in the infrared spectrum and above 800 nanometers in wavelength, laser power penetrates like x-rays, but to attain depth you need significant energy or power,” Dr. Bruce Coren states.
Two Classes of Lasers Used for Chronic Pain
There are two classes of lasers being used as a part of physical therapy for chronic pain management and relief; class 3 and 4. “Class 3 lasers are significantly less than 500 milliwatts (mw) in electricity while class 4 lasers are higher than 500 mw,” Dr. Coren stated. Class 3 lasers are occasionally referred to as cold capsules, as well as the treatment might be known as LLLT for low-level laser treatment. In contrast, class 4 laser therapy is sometimes called HPLT for high-power laser treatment.
“The vast majority of neuro-musculoskeletal conditions respond better to some higher power and a higher dosage, which can be a function of energy output and time,” Dr. Coren commented. “The top results will be obtained using a laser which has 30 watts of electricity or more. A 10-minute treatment using a 30-watt laser can produce 18,000 joules, which gives a significant pain relieving, anti inflammatory and healing impact.”
Patients usually begin to feel better after one or two treatments, even though 5 or more might be needed to solve the issue. “The more persistent and extensive the injury the more treatments are often needed,” he added.
Properties of High-Power Laser Therapy
Dr. Coren spoke about the valuable properties of laser therapy and described their unique benefits and effects:
Pain Relief: “Laser therapy decreases nerve sensitivity by decreasing bradykinin; a pain eliciting compound. It normalizes ion channels, known as the gatekeepers. and releases endorphins, the body’s natural pain reliever, and enkephalins, related to endorphins. It also has a pain-blocking effect on certain nerve fibers.”
Anti-inflammatory/Healing: “Laser therapy increases ATP, which can be stored energy (ATP is the acronym for adenosine triphosphate). The cells also regenerate faster. Laser therapy causes a widening of veins and the arteries around the injury which helps to remove mobile debris and increase oxygen and nutrients. White blood cell action is enhanced which leads to the more rapid repair procedure. Some molecules that increase inflammation have been reduced, and antioxidants such as superoxide dismutase are increased with laser therapy.
Accelerated Tissue Repair and Cellular Growth: “Photons of light from lasers penetrate deeply into tissues and accelerate mobile reproduction and development. As a result of exposure to laser light therapy, the tissues of both ligaments, tendons, nerves and muscles are are repaired faster”, as stated above.
Improved Vascular Activity: “Laser light raises the formation of new cells in damaged tissue, which speeds up the recovery process, and closes wounds quickly.”
Trigger and Acupuncture Points: “Laser is particularly helpful in extinguishing painful trigger points. It’s also an effective way of stimulating acupuncture points without the distress related to needling.”
Reduced Fibrous Tissue Formation: “Laser treatment lowers the formation of scar tissue after tissue damage from repetitive motion injuries, cuts, wounds, scrapes or surgery.”
Faster Wound Healing: “Laser light stimulates the building blocks of collagen, which is important for the wound healing of damaged tissues. Collagen is the essential protein needed to replace tissue or to repair injuries. Consequently, the laser is powerful on open wounds and burns.”
Stem Cell Activation: “Laser therapy raises the amount of stem cells, which enhances healing.”
Where is Laser Therapy Administered?
High-power lasers are typically found in physical therapy clinics and chiropractic offices. Neck, back or joint pain usually responds positively to laser therapy.
“Lasers are also very powerful for inflammatory conditions, including peripheral neuropathy, tendonitis, bursitis, and capsulitis. Strains, sprains, and repetitive movement injuries all have an inflammatory component and can be successfully treated with laser,” he remarked. “There is no particular condition that reacts more quickly to laser. But some patients will react faster than others for exactly the same state as individual healing rates can vary.”
Laser therapy can be utilized as a stand-alone treatment, or with rehabilitative exercise treatment. “Rehabilitative exercises and laser treatment complement each other nicely,” explained Dr. Coren.
Laser Therapy Precautions
There are a few precautions with laser therapy. Eye protection is needed for both the therapist and patient, and laser shouldn’t be performed over malignancies, pacemakers, spinal stimulators or over the midsection of pregnant women.
Recommendations
High-power laser therapy is one of the quickest, most productive modalities therapists now have to deal with inflammation and pain. “Regrettably, laser therapy isn’t covered by insurance, and high-power lasers can be hard to find as they are expensive. Most importantly results are achieved by the amount of energy generated, 18,000-30,000 joules per treatment being the sweet spot,” Dr. Coren concluded.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�
By Dr. Alex Jimenez
Additional Topics: Wellness
Overall health and wellness are essential towards maintaining the proper mental and physical balance in the body. From eating a balanced nutrition as well as exercising and participating in physical activities, to sleeping a healthy amount of time on a regular basis, following the best health and wellness tips can ultimately help maintain overall well-being. Eating plenty of fruits and vegetables can go a long way towards helping people become healthy.
Wellness Chiropractor, Dr. Alexander Jimenez takes a look at discussing nutrition with patients in a clinical setting.
Contents
How Clinicians Can Do Better
Despite overwhelming evidence that relatively small dietary changes can significantly improve health, clinicians seldom discuss nutrition with their patients. Poor nutritional intake and nutrition-related health conditions, such as cardiovascular disease (CVD), diabetes, obesity, hypertension, and many cancers, are highly prevalent in the United States,1 yet only 12% of office visits include counseling about diet.2 Even among high- risk patients with CVD, diabetes, or hyperlipidemia, only 1 in 5 receive nutrition counseling.2 It is likely that many patients receive most of their nutrition information from other, and often unreliable, sources.
These data may reflect the minimal training, time, and reimbursement allocated to nutrition counseling (and preventive services in general) in clinical practice.3 Most physicians and other health care professionals receive limited education on nutrition in medical school (or other professional schools) or in postgraduate training. Just 25% of medical schools offer a dedicated nutrition course, a decline since the status of nutrition education in US medical schools was first assessed in 1985, and few medical schools achieve the 30 hours of nutrition education recommended by the National Academy of Sciences.4 As a result, physicians report inadequate nutrition knowledge and low self-efficacy for counseling patients about diet.3 In addition, time pressures, especially in primary care, limit opportunities to counsel on nutrition or address preventive issues beyond patients� acute complaints. Lack of time is frequently cited as the greatest barrier to counseling on nutrition and obesity.3
Moreover, nutrition and behavioral counseling have traditionally been non-reimbursed services. Few state Medicaid programs cover nutrition or obesity counseling, and before 2012, Medicare explicitly excluded coverage for obesity counseling; although now a reimbursed service for Medicare beneficiaries, just 1% of eligible Medicare beneficiaries receive this counseling.5 Dietitian counseling is also excluded by Medicare, unless patients have diabetes or renal disease. Although the Affordable Care Act mandates coverage for services graded A or B by the US Preventive Services Task Force, including nutrition counseling for patients with CVD risk factors and obesity counseling for patients with a body mass index of 30 or greater, existing private health insurance benefits are in- consistent, and the covered services are often unclear to both clinicians and patients, thereby limiting use.
Furthermore, health behavior change counseling is often frustrating given the current food environment, in which less nutritious foods tend to be less expensive, larger portioned, more easily accessible, and more heavily marketed than healthier options, making patient adherence 6 to nutrition advice challenging. Conflicting and confusing nutrition messages from popular books, blogs, and other media further complicate patient decision making.
Despite these unfavorable trends, there has been progress in this area. The evidence base supporting the benefits of nutrition intervention and behavioral counseling is expanding. Renewed focus on nutrition education in health care professional training is being driven by both student demand and the health care system. Although time pressures and reimbursement remain impediments, incentives and reimbursement options for nutrition and behavioral counseling are growing, and value-based care and health care team approaches hold promise to better align time demands and incentives for long-term care management. Initiatives to integrate clinical care and community resources offer opportunities to leverage resources that alleviate the clinician�s time commitment. There is evidence of some success; for instance, the amount of sugar-sweetened beverages consumed by individuals in the United States has declined substantially over the past 10 years.7
Clinicians can take the following reasonable steps to include nutrition counseling into the flow of daily practice:
1. Start the conversation. Several short, validated screen- ing questionnaires are available to quickly assess need for nutrition counseling, such as the Starting the Conversation tool8 (Table). This approach can be efficiently used prior to seeing the patient at an appointment, either delivered by medical assistants as part of vital sign assessment or as prescreening paperwork for patients to complete online or in the waiting room.
2. Structure the encounter.�Using methods such as the �5 A�s� (assess, advise, agree, assist, arrange), which has been adapted from tobacco counseling. Motivational interviewing, which has documented efficacy in numerous behavior change settings, is particularly helpful to engage patients who are not yet committed or are hesitant to consider behavioral change.
3. Focus on small steps. Changing lifelong nutrition behaviors can seem overwhelming, but even exceedingly small shifts can have an effect (Table). For example, increasing fruit intake by just 1 serving per day has the estimated potential to reduce cardiovascular mortality risk by 8%, the equivalent of 60 000 fewer deaths annually in the United States and 1.6 million deaths globally.9 Other examples include reducing intake of sugar-sweetened beverages, fast food meals, processed meats, and sweets, while increasing vegetables, legumes, nuts, and whole grains. Emphasize to patients that every food choice is an opportunity to accrue benefits, and even small ones add up. Small substitutions still allow for �treats,� such as replacing potato chips and cheese dip with tortilla chips and salsa, the latter lowering trans fats and saturated fat and increasing whole grain and vegetable intake (Table).
4. Use available resources. Numerous extracurricular resources are readily available for clinicians. The Nutrition in Medicine program offers online, evidence-based nutrition education and tutorials for clinicians and an online, core nutrition curriculum for medical students. The Dietary Guidelines for Americans offers evidence- based and freely available nutrition guidance, tutorials, and tools for clinicians and patients alike. A companion website, Choose My Plate, offers nutrition and counseling advice for clinicians and handy resources for patients, including recently added videos with useful examples of small substitutions that patients will appreciate.
5. Do not do it all at once. Expecting to create long-term behavioral change during a single episode of care is a recipe for frustration and failure, for both the patient and clinician. Empowering and sup- porting patients is an ongoing process, not a 1-time curative event. Use a few minutes at the close of a patient visit to identify opportunities for future counseling, offer to serve as a resource, and be- gin a discussion and support that can be reinforced over time. Take solace in knowing that small initial steps can quickly improve health; for example, reducing trans fats at a single meal (eg, replacing baked goods with fruit or nuts or fried foods with non-fried alternatives) promptly improves endothelial function.10
6. Do not do it all alone.�The primary care physician need not be the sole clinician who provides nutrition counseling. Proactive use of physician extenders (eg, physician assistants, nurses, medical assistants, and health coaches) and referrals can alleviate much of the burden for the busy clinician. Receptionists can distribute assessment and screening questionnaires for patients to complete in the waiting room; medical assistants can document behavioral change progress while assessing vital signs; administrative staff can identify and con- tact patients who are overdue for interaction. Large practices may benefit from including nutrition or health coaches on staff. Referring to clinical specialists and community-based support programs can significantly extend the clinician�s reach.7 In addition to registered dietitians, numerous clinical and community resources are available and often covered by insurance plans. Board-certified obesity medicine specialists, certified diabetes educators, and physician nutrition specialists are available as referrals in many areas. Diabetes Prevention Program group counseling sessions are now covered by Medicare and available throughout communities, such as in many YMCA sites, and electronically.
Summary
Although there is no conclusive evidence that these steps will improve diet and health outcomes for patients, there is virtually no harm in counseling and the potential gains, especially at the population level, are substantial. Nutrition and health behavior change must become a core competency for virtually all physicians and any other health professionals working with patients who have or are at risk for nutrition-related chronic disease.
A Healthier You
Scott Kahan, MD, MPH Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; and George Washington University School of Medicine, Washington, DC.
JoAnn E. Manson, MD, DrPH Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts; and Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
ARTICLE INFORMATION
Published Online: September 7, 2017. doi:10.1001/jama.2017.10434 Conflict of Interest Disclosures: All authors have
completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.
REFERENCES
1. Ward BW, Schiller JS, Goodman RA. Multiple chronic conditions among US adults: a 2012 update. Prev Chronic Dis. 2014;11:E62.
2. Office of Disease Prevention and Health Promotion. Healthy People 2020. www.healthypeople.gov/2020/data-search/Search-the-Data#srch=nutrition. Accessed January 23, 2017.
3. Kolasa KM, Rickett K. Barriers to providing nutrition counseling cited by physicians. Nutr Clin Pract. 2010;25(5):502-509.
4. Adams KM, Kohlmeier M, Zeisel SH. Nutrition education in U.S. medical schools: latest update of a national survey. Acad Med. 2010;85(9):1537-1542.
5. Batsis JA, Bynum JPW. Uptake of the Centers for Medicare and Medicaid obesity benefit: 2012-2013. Obesity (Silver Spring). 2016;24(9):1983-1988.
6. Kahan S, Cheskin LJ. Obesity and eating behaviors and behavior change. In: Kahan S, Gielen AC, Fagan PJ, Green LW, eds. Health Behavior Change in Populations. Baltimore, MD: Johns Hopkins University Press; 2014:chap 13.
7. Rehm CD, Pe�alvo JL, Afshin A, Mozaffarian D. Dietary intake among US adults, 1999-2012.JAMA. 2016;315(23):2542-2553.
8. Paxton AE, Strycker LA, Toobert DJ, Ammerman AS, Glasgow RE. Starting the conversation performance of a brief dietary assessment and intervention tool for health professionals. Am J Prev Med. 2011;40(1):67-71.
9. Mozaffarian D, Capewell S. United Nations� dietary policies to prevent cardiovascular disease. BMJ. 2011;343:d5747.
10. Williams MJA, Sutherland WHF, McCormick MP, de Jong SA, Walker RJ, Wilkins GT. Impaired endothelial function following a meal rich in used cooking fat.J Am Coll Cardiol. 1999;33(4):1050-1055
You hear that you are supposed to stay busy through your chronic pain and you believe, “But how? Actions make my pain worse. Just getting through the day at work is agony, and today the doctor expects me to perform extra tasks?” This is the point where a physical therapist may help.
Contents
How can a physical therapist help with my chronic pain?
Physical therapists can give you a personalized strengthening and workout plan, besides helping you learn how to manage your own “daily life” chronic pain symptoms. The physical therapist will do a thorough physical evaluation to assess your chronic pain and its impact. They will also ask about your therapy goals: do you wish to learn how to better handle your pain? What would be helpful to learn from physical therapy? Using that information, the physical therapist will create a therapy plan especially for you.
Physical Therapy is Active and Passive
Physical therapy includes both active and passive treatments. Passive treatments help to unwind you and your physique. As you don’t need to actively participate, they’re known as passive. Your physical treatment program may begin with treatments that are passive, but the goal is to get into treatments that are more active. These are exercises which strengthen your body and help you handle the pain that is chronic.
Passive physical therapy treatments include:
Deep Tissue Massage: This technique targets spasms and chronic muscle strain that perhaps builds up through life stress. You could have spasms or muscular strain because of strains or sprains. The physical therapist uses direct pressure and friction to attempt to release the tension in your soft tissues (ligaments, tendons, muscles).
Hot and Cold Therapies: Your physical therapist may alternate between cold and warm therapies. The physical therapist attempts to gain more blood to the target area by applying hot treatment because an increased blood circulation brings more oxygen and nutrients to this region. Blood circulation is essential to remove waste byproducts made by muscle spasms, and in addition, it helps relieve symptoms associated with chronic pain. Cold treatment, also called cryotherapy, slows circulation, helping to decrease inflammation, muscle spasms, and pain. You might be given an ice pack or even be given an ice massage. Another alternative that is part of cryotherapy is a spray which cools the tissues. After cold therapy, your physical therapist may have you stretch the affected muscles.
TENS (transcutaneous electric nerve stimulation): A TENS machine stimulates your muscles through factor (but safe) intensities of electrical current. TENS helps reduce muscle spasms, and it might increase the own body’s production of endorphins, your pain killers. The TENS gear your therapist utilizes is big. But a more compact machine for “at home” use is also available. Whether big or small, a TENS unit may be a very helpful therapy.
Ultrasound: By increasing blood flow, an ultrasound helps decrease pain, numbness, swelling, stiffness, and muscle spasms. It does this by creating heat that enhances circulation, sending sound waves deep in your muscle cells.
At the active portion of physical therapy, your physical therapist will teach you different exercises to increase your flexibility, strength, core stability, and range of motion (how readily your joints move). Remember, your physical therapy program is individualized, taking under account medical history and your health. Your exercises may not be suitable for another person with chronic pain, especially since pain is such a subjective, personal experience.
Other Areas of Physical Therapy
You will learn to fix your posture and incorporate ergonomic principles in your daily activities, if necessary. This is all part of this “self-care” or “self-treatment” aspect of physical therapy. During physical therapy, you learn good habits and principles that let you take better care of your body. Staying active is an significant part chronic pain therapy. The therapist can help you figure out the best kind of workout for you.
7 Tips for Exercising When You Have Chronic Pain
Too much of the wrong activity can cause chronic pain to worsen. If jogging or running are out of the question, you may be able to handle and enjoy cycling, which can be easier on painful knees and hips. Other forms of physical therapy, including aerobics done in warm water, help to alleviate inflammation; plus the buoyancy of the water protects the body against the stress of gravity and from movements that may otherwise result in pain. No matter which type of exercise you choose, use caution not to move too fast or too much, or do so much that it becomes worse.
7 Tips for Exercising When You Have Chronic Pain
Talk to you doctor before you begin an exercise program.
Start slowly and gradually increase your efforts as you gain strength, flexibility, and confidence.
Move at your own pace. Never try to keep up with a class or a group if doing so is painful.
Exercise every day, if possible.
Strive for a balanced routine of cardiovascular, strengthening, and stretching exercise.
Accept that you will be able to do more on some days than others.
Be patient with your progress. Overexertion makes pain worse and can strain muscles.
A person’s sleep patterns are improved by exercise. When curative sleep patterns improve, chronic pain symptoms usually do too. Physically active individuals sleep longer and more deeply than people that are sedentary. Exercise also helps to relieve sleep apnea, a common disruptive sleep disorder that that abruptly stops the breath..
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�
By Dr. Alex Jimenez
Additional Topics: Wellness
Overall health and wellness are essential towards maintaining the proper mental and physical balance in the body. From eating a balanced nutrition as well as exercising and participating in physical activities, to sleeping a healthy amount of time on a regular basis, following the best health and wellness tips can ultimately help maintain overall well-being. Eating plenty of fruits and vegetables can go a long way towards helping people become healthy.
El Paso, Tx. Wellness chiropractor, Dr. Alexander Jimenez examines Functional Medicine.�What it�is and how it can help in having a healthy lifestyle.
Contents
The Challenge
Of total healthcare costs in the United States, more than 86% is due to chronic conditions.1 In 2015, health care spending reached $3.2 trillion, accounting for 17.8% of GDP.2 This exceeded the combined federal expenditures for national defense, homeland security, education, and welfare. By 2023, if we don�t change how we confront this challenge, annual healthcare costs in the U.S. will rise to over $4 trillion,3,4 the equivalent�in a single year�of four Iraq wars, making the cost of care using the current model economically unsustainable. If our health outcomes were commensurate with such costs, we might decide they were worth it. Unfortunately, the U.S. spends twice the median per-capita costs of other industrialized countries, as calculated by the Organization for Economic Cooperation and Development (OECD),5 despite having relatively poor outcomes for such a massive investment.6
Our current healthcare model fails to confront both the causes of and solutions for chronic disease and must be replaced with a model of comprehensive care geared to effectively treating and reversing this escalating crisis.This transformation requires something different than is usually available in our very expensive healthcare system.7
A Contributing Factor�Outdated Clinical Model
Despite notable advances in treating and preventing infectious disease and trauma, the acute-care model that dominated 20th century medicine has not been effective in treating and preventing chronic disease.
Adopting a new operating system for 21st century medicine requires that we:
Recognize and validate more appropriate and successful clinical models
Re-shape the education and clinical practices of health professionals to help them achieve proficiency in the assessment, treatment, and prevention of chronic disease
Reimburse equitably for lifestyle medicine and expanded preventive strategies, acknowledging that the greatest health threats now arise from how we live, work, eat, play, and move
This problem can�t be solved by drugs and surgery, however helpful those tools may be in managing acute signs and symptoms. It can�t be solved be adding new or unconventional tools, such as botanical medicine and acupuncture, to a failing model. It can�t be solved by pharmacogenomics (although advances in that discipline should help reduce deaths from inappropriately prescribed medication�estimated to be the fourth leading cause of hospital deaths12). The costly riddle of chronic disease can only be solved by shifting our focus from suppression and management of symptoms to addressing their underlying causes. Specifically, we must integrate what we know about how the human body works with individualized, patient-centered, science-based care that addresses the causes of complex, chronic disease, which are rooted in lifestyle choices, environmental exposures, and genetic influences.
This perspective is completely congruent with what we might call the �omics� revolution. Formerly, scientists believed that once we deciphered the human genome we would be able to answer almost all the questions about the origins of disease.What we actually learned, however, is that human biology is far more complex than that. In fact, humans are not genetically hardwired for most diseases; instead, gene expression is altered by myriad influences, including environment, lifestyle, diet, activity patterns, psycho-social-spiritual factors, and stress.These lifestyle choices and environmental exposures can push us toward (or away from) disease by turning on�or o � certain genes.That insight has helped to fuel the global interest in Functional Medicine, which has that principle at its very core.
A Strategic Response
Functional Medicine directly addresses the underlying causes of disease by using a systems-oriented approach with transformative clinical concepts, original tools, an advanced process of care (see box below), and by engaging both patient and practitioner in a therapeutic partnership.
Functional Medicine practitioners look closely at the myriad interactions among genetic, environmental, and lifestyle factors that can influence long-term health and complex, chronic disease (see Figure 1).A major premise of Functional Medicine is that, with science, clinical wisdom, and innovative tools, we can identify many of the underlying causes of chronic disease and intervene to remediate the clinical imbalances, even before overt disease is present.
Functional Medicine exemplifies just the kind of systems-oriented, personalized medicine that is needed to transform clinical practice.The Functional Medicine model of comprehensive care and primary prevention for complex, chronic illness is grounded in both science (evidence about common underlying mechanisms and pathways of disease as well as evidence about the contributions of environmental and lifestyle factors to disease) and art (the healing partnership and the search for insight in the therapeutic encounter).
What Is Functional Medicine?
Functional Medicine asks how and why illness occurs and restores health by addressing the root causes of disease for each individual. It is an approach to health care that conceptualizes health and illness as part of a continuum in which all components of the human biological system interact dynamically with the environment, producing patterns and effects that change over time. Functional Medicine helps clinicians identify and ameliorate dysfunctions in the physiology and biochemistry of the human body as a primary method of improving patient health. Chronic disease is almost always preceded by a period of declining function in one or more of the body�s systems. Functional Medicine is often described as the clinical application of systems biology. Restoring health requires reversing (or substantially improving) the specific dysfunctions that have contributed to the disease state. Each patient represents a unique, complex, and interwoven set of environmental and lifestyle influences on intrinsic functionality (their genetic vulnerabilities) that have set the stage for the development of disease or the maintenance of health.
To manage the complexity inherent in this approach, IFM has created practical models for obtaining and evaluating clinical information that lead to individualized, patient-centered, science-based therapies. Functional Medicine concepts, practices, and tools have evolved considerably over a 30-year period, reflecting the dramatic growth in the evidence base concerning the key common pathways to disease (e.g., inflammation, oxidative stress); the role of diet, stress, and physical activity; the emerging sciences of genomics, proteomics, and metabolomics; and the effects of environmental toxins (in the air, water, soil, etc.) on health.
Elements Of Functional Medicine
The knowledge base�or �footprint��of Functional Medicine is shaped by six core foundations:
Gene-Environment Interaction: Functional Medicine is based on understanding the metabolic processes of each individual at the cellular level. By knowing how each person�s genes and environment interact to create their unique biochemical phenotype, it is possible to design targeted interventions that correct the specific issues that lead to destructive processes such as inflammation and oxidation, which are at the root of many diseases.
Upstream Signal Modulation: Functional Medicine interventions seek to influence biochemical pathways �upstream� and prevent the overproduction of damaging end products, rather than blocking the effects of those end products. For example, instead of using drugs that block the last step in the production of inflammatory mediators (NSAIDs, etc.), Functional Medicine treatments seek to prevent the upregulation of those mediators in the first place.
Multimodal Treatment Plans: The Functional Medicine approach uses a broad range of interventions to achieve optimal health including diet, nutrition, exercise and movement; stress management; sleep and rest, phytonutrient, nutritional and pharmaceutical supplementation; and various other restorative and reparative therapies.These interventions are all tailored to address the antecedents, triggers, and mediators of disease or dysfunction in each individual patient.
Understanding the Patient in Context: Functional Medicine uses a structured process to uncover the significant life events of each patient�s history to gain a better understanding of who they are as an individual. IFM tools (the �Timeline� and the �Matrix� model) are integral to this process for the role they play in organizing clinical data and mediating clinical insights.This approach to the clinical encounter ensures that the patient is heard, engenders the therapeutic relationship, expands therapeutic options, and improves the collaboration between patient and clinician.
Systems Biology-Based Approach: Functional Medicine uses systems biology to understand and identify how core imbalances in specific biological systems can manifest in other parts of the body. Rather than an organ systems-based approach, Functional Medicine addresses core physiological processes that cross anatomical boundaries including: assimilation of nutrients, cellular defense and repair, structural integrity, cellular communication and transport mechanisms, energy production, and biotransformation.The �Functional Medicine Matrix� is the clinician�s key tool for understanding these network effects and provides the basis for the design of effective multimodal treatment strategies.
Patient-Centered and Directed: Functional Medicine practitioners work with the patient to find the most appropriate and acceptable treatment plan to correct, balance, and optimize the fundamental underlying issues in the realms of mind, body, and spirit. Beginning with a detailed and personalized history, the patient is welcomed into the process of exploring their story and the potential causes of their health issues. Patients and providers work together to determine the diagnostic process, set achievable health goals, and design an appropriate therapeutic approach.
To assist clinicians in understanding and applying Functional Medicine, IFM has created a highly innovative way of representing the patient�s signs, symptoms, and common pathways of disease. Adapting, organizing, and integrating into the Functional Medicine Matrix the seven biological systems in which core clinical imbalances are found actually creates an intellectual bridge between the rich basic science literature concerning physiological mechanisms of disease and the clinical studies, clinical diagnoses, and clinical experience acquired during medical training.These core clinical imbalances serve to marry the mechanisms of disease with the manifestations and diagnoses of disease.
Structural integrity: sub-cellular membranes to musculoskeletal integrity
Using this construct, it is possible to see that one disease/condition may have multiple causes (i.e., multiple clinical imbalances), just as one fundamental imbalance may be at the root of many seemingly disparate conditions (see Figure 2).
Constructing The Model & Putting It Into Practice
The scientific community has made incredible strides in helping practitioners understand how environment and lifestyle, interacting continuously through an individual�s genetic heritage, psychosocial experiences, and personal beliefs, can impair one or all of the seven core clinical imbalances. IFM has developed concepts and tools that help to collect, organize, and make sense of the data gathered from an expanded history, physical exam, and laboratory evaluation, including:
The GOTOIT system, which presents a logical method for eliciting the patient�s whole story and ensuring that assessment and treatment are in accord with that story:
G = Gather Information
O = Organization Information
T = Tell the Complete Story Back to the Patient
O = Order and Prioritize
I = InitiateTreatment
T = Track Outcomes
The Functional Medicine Timeline, which helps to connect key events in the patient�s life with the onset of symptoms of dysfunction.
The Functional Medicine Matrix, which provides a unique and succinct way to organize and analyze all of a patient�s health data (see Figure 3).
The patient�s lifestyle influences are entered across the bottom of the Matrix, and the Antecedents,Triggers, and Mediators (ATMs) of disease/dysfunction are entered in the upper left corner.The centrality of the patient�s mind, spirit, and emotions, with which all other elements interact, is clearly shown in the figure. Using this information architecture, the clinician can create a comprehensive snapshot of the patient�s story and visualize the most important clinical elements of Functional Medicine:
1. Identifying each patient�s ATMs of disease and dysfunction.
2. Discovering the factors in the patient�s lifestyle and environment that influence the expression of health or disease.
3. Applying all the data collected about a patient to a matrix of biological systems, within which disturbances in function originate and are expressed.
4. Integrating all this information to create a comprehensive picture of what is causing the patient�s problems, where they are originating, what has influenced their development, and�as a result of this critical analysis�where to intervene to begin reversing the disease process or substantially improving health.
A Functional Medicine treatment plan may involve one or more of a broad range of therapies, including many different dietary interventions (e.g., elimination diet, high phytonutrient diversity diet, low glycemic-load diet), nutraceuticals (e.g., vitamins, minerals, essential fatty acids, botanicals), and lifestyle changes (e.g., improving sleep quality/quantity, increasing physical activity, decreasing stress and learning stress management techniques, quitting smoking). Nutrition is so vital to the practice of Functional Medicine that IFM has established a core emphasis on Functional Nutrition and has funded the development of a set of unique, innovative tools for developing and applying dietary recommendations.
Scientific support for the Functional Medicine approach to treatment can be found in a large and rapidly expanding evidence base about the therapeutic effects of nutrition (including both dietary choices and the clinical use of vitamins, minerals, and other nutrients such as sh oils)13,15,15; botanicals16,17,18; exercise19 (aerobics, strength training, flexibility); stress management 20; detoxification 21,22,23; acupuncture�24,25,26; manual medicine (massage, manipulation)27,28,29; and mind/body techniques 30,31,32 such as meditation, guided imagery, and biofeedback.
All of this work is done within the context of an equal partnership between the practitioner and patient.The practitioner engages the patient in a collaborative relationship, respecting the patient�s role and knowledge of self, and ensuring that the patient learns to take responsibility for their own choices and for complying with the recommended interventions. Learning to assess a patient�s readiness to change and then providing the necessary guidance, training, and support are just as important as ordering the right lab tests and prescribing the right therapies.
Summary
The practice of Functional Medicine involves four essential components: (1) eliciting the patient�s complete story during the Functional Medicine intake; (2) identifying and addressing the challenges of the patient�s modifiable lifestyle factors and environmental exposures; (3) organizing the patient�s clinical imbalances by underlying causes of disease in a systems biology matrix framework; and (4) establishing a mutually empowering partnership between practitioner and patient.
A great strength of Functional Medicine is its relevance to all healthcare disciplines and medical specialties, any of which can�to the degree allowed by their training and licensure�apply a Functional Medicine approach, using the Matrix as a basic template for organizing and coupling knowledge and data. In addition to providing a more effective approach to preventing, treating, and reversing complex chronic disease, Functional Medicine can also provide a common language and a uni ed model that can be applied across a wide variety of health professions to facilitate integrated care.
Functional Medicine is playing a key role in the effort to solve the modern epidemic of chronic disease that is creating a health crisis both nationally and globally. Because chronic disease is a food- and lifestyle-driven, environment- and genetics-influenced phenomenon, we must have an approach to care that integrates all these elements in the context of the patient�s complete story. Functional Medicine does just that and provides an original and creative approach to the collection and analysis of this broad array of information. Using all the concepts and tools that IFM has developed, Functional Medicine practitioners contribute vital skills for treating and reversing complex, chronic disease.
3 DeVol R, Bedroussian A. An unhealthy America: the economic burden of chronic disease�charting a new course to save lives and increase productivity and economic growth. Milken Institute; 2007. Accessed April 14, 2017, assets1c.milkeninstitute.org/assets/Publication/ResearchReport/PDF/chronic_disease_report.pdf.
4 Bodenheimer T, Chen E, Bennett H. Confronting the growing burden of chronic disease: can the U.S. health care workforce do the job? Health Aff. 2009;28(1):64-74. doi: 10.1377/hlthaff.28.1.64.
5 Bureau of Labor Education, University of Maine. The U.S. Health Care System: Best in the World, Or Just the Most Expensive? 2001. Accessed April 14, 2017, www.suddenlysenior.com/pdf_files/U.S.healthcare.pdf.
6 Radley DC, McCarthy D, Hayes SL. Aiming higher: results from the Commonwealth Fund scorecard on state health system performance (2017 ed.). The Commonwealth Fund; 2017. Accessed April 14, 2017, www.commonwealthfund.org/interactives/2017/mar/state-scorecard/.
7 Jones DS, Hofmann L, Quinn S. 21st century medicine: a new model for medical education and practice. Gig Harbor, WA: The Institute for Functional Medicine; 2011.
8 Jones DS, Hofmann L, Quinn S. 21st century medicine: a new model for medical education and practice. Gig Harbor, WA: The Institute for Functional Medicine; 2009.
9 Willett WC. Balancing life-style and genomics research for disease prevention. Science. 2002; 296(5568):695-97. doi: 10.1126/science.1071055.
10 Thorpe KE, Florence CS, Howard H, Joski P. The rising prevalence of treated disease: effects on private health insurance spending. Health Aff. 2005;Suppl Web Exclusives: W5-317-W5-325. doi: 10.1377/hlthaff.w5.317.
11 Heaney RP. Long-latency deficiency disease: insights from calcium and vitamin D. Am J Clin Nutr. 2003;78(5):912-9.
12 Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA. 1998; 279(15):1200-05.
13 Ames BN, Elson-Schwab I, Silver EA. High-dose vitamin therapy stimulates variant enzymes with decreased coenzyme binding affinity (increased K(m)): relevance to genetic disease and polymorphisms. Am J Clin Nutr. 2002;75(4):616-58.
14 Lands B. Prevent the cause, not just the symptoms. Prostaglandins Other Lipid Mediat. 201;96(1-4):90-3. doi: 10.1016/j.prostaglandins.2011.07.003.
15 Sofi F, Abbate R, Gensini GF, Casini A. Accruing evidence on benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis. Am J Clin Nutr. 2010;92(5):1189-96. doi: 10.3945/ajcn.2010.29673.
16 Mulrow C, Lawrence V, Jacobs B, et al. Milk thistle: effects on liver disease and cirrhosis and clinical adverse effects (No. 21). Rockville, MD: Agency for Healthcare Research and Quality; 2000. Accessed April 14, 2017, www.pkids.org/files/milkthistle.pdf.
17 National Center for Complementary and Integrative Health. Green Tea; 2016. Accessed April 14, 2017, nccih.nih.gov/health/greentea.
18 National Center for Complementary and Integrative Health. St. John�s Wort; 2016. Accessed April 14, 2017, nccih.nih.gov/health/stjohnswort/ataglance.htm.
19 McArdle WD, Katch EI, Katch VL. Exercise Physiology: Energy, Nutrition, and Human Performance. Philadelphia: Lippincott Williams and Wilkins; 2001.
20 McCraty R, Childre D. Coherence: bridging personal, social, and global health. Altern Ther Health Med. 2010;16(4):10-24.
21 Yi B, Kasai H, Lee HS, Kang Y, Park JY, Yang M. Inhibition by wheat sprout (Triticum aestivum) juice of bisphenol A-induced oxidative stress in young women. Mutat Res. 2011;724(1-2):64-68. doi: 10.1016/j.mrgentox.2011.06.007.
22 Johnson CH, Patterson AD, Idle JR, Gonzalez FJ. Xenobiotic metabolomics: major impact on the metabolome. Annu Rev Pharmacol Toxicol. 2012;52:37-56. doi: 10.1146/annurev-pharmtox-010611-134748.
23 Scapagnini G, Caruso C, Calabrese V. Therapeutic potential of dietary polyphenols against brain ageing and neurodegenerative disorders. Adv Exp Med Biol. 2010;698:27-35.
24 Colak MC, Kavakli A, Kilin� A, Rahman A. Postoperative pain and respiratory function in patients treated with electroacupuncture following coronary surgery. Neurosciences (Riyadh). 2010;15(1):7-10.
25 Cao H, Pan X, Li H, Liu J. Acupuncture for treatment of insomnia: a systematic review of randomized controlled trials. J Altern Complement Med. 2009;15(11):1171-86. doi: 10.1089/acm.2009.0041.
26 Lee A, Fan LT. Stimulation of the wrist acupuncture point P6 for preventing postoperative nausea and vomiting. Cochrane Database Syst Rev. 2009;15(2):CD003281. doi: 10.1002/14651858.
27 Rubinstein SM, Leboeuf-Yde C, Knol DL, de Koekkoek TE, Pfeifle CE, van Tulder MW. The benefits outweigh the risks for patient undergoing chiropractic care for neck pain: a prospective, multicenter, cohort study. J Manipulative Physiol Ter. 2007;30(6):408-1. doi: 10.1016/j.jmpt.2007.04.013.
28 Beyerman KL, Palmerino MB, Zohn LE, Kane GM, Foster KA. Efficacy of treating low back pain and dysfunction secondary to osteoarthritis: chiropractic care compared to moist heat alone. J Manipulative Physiol Ther. 2006;29(2):107-14. doi: 10.1016/j.jmpt.2005.10.005.
29 Kshettry VR, Carole LF, Henly SJ, Sendelbach S, Kummer B. Complementary alternative medical therapies for heart surgery patients: feasibility, safety, and impact. Ann Thorac Surg. 2006;81(1):201-5. doi: 10.1016/j.athoracsur.2005.06.016.
30 Ornish D, Magbanua MJM, Weidner G, et al. Changes in prostate gene expression in men undergoing an intensive nutrition and lifestyle intervention. PNAS. 2008;105(24):8369-74. doi: 10.1073/pnas.0803080105.
31 Xiong GL, Doraiswamy PM. Does meditation enhance cognition and brain plasticity? Ann NY Acad Sci. 2009;1172:63-9. doi: 10.1196/annals.1393.002.
32 H�lzel BK, Carmody J, Vangel M, et al. Mindfulness practice leads to increases in regional brain gray matter density. Psychiatry Res. 2011;191(1):36-43. doi: 10.1016/j.pscychresns.2010.08.006.
Many individuals in the United States suffer from chronic pain without understanding the source of their painful symptoms or why these have triggered from the start. A healthcare professional can help a patient understand their chronic pain but it’s important for the person to first comprehend the function of their own body.
Contents
Why does chronic pain occur?
To understand chronic pain, you need to comprehend the anatomy of the nervous system. Throughout the body, the nervous system transmits messages to and from the brain, and it’s a system is very complex and intricate.
The central nervous system primarily consists of the the spinal cord and the brain. Branching off the spinal cord is the peripheral nervous system; both the central or peripheral nervous systems can be impacted by neuropathic pain, a kind of chronic pain which is commonly caused by a malfunction of the nerves.
Anatomy of Chronic Pain
The peripheral nervous system has 31 pairs of nerve roots which stretch from the spinal cord to the various areas of the body. These nerves help you feel (those are the sensory nerves) and move (those are the motor nerves). Following is a graph that shows you just how many pairs of spinal nerves are at each level of the spine.
SPINAL CORD
31 Pairs � Spinal Nerves
Cervical
8 pair
Thoracic
12 pair
Lumbar
5 pair
Sacral
5 pair
Coccyx
1 pair
The peripheral nervous system is further divided into:
The somatic nervous system, which has nerves that go into the musculoskeletal system (bones, ligaments, joints, tendons) along with the epidermis. It is what helps you feel pain.
The autonomic nervous system, which operates on the “involuntary” functions of the body. That means that it makes sure that your heart keeps pumping and your food is digested by you without even thinking of it.
Nociceptors are yet another important part of your nerves, and you want to understand them if you would like to know certain forms of chronic pain. Nociceptors are receptors at nerve endings, that function when something occurs that causes pain and they’re triggered. If you slam your finger in the car door, the nociceptors on your finger will turn on and send a pain message through the nerve to the spinal cord and forth into the brain. Two minutes until you slammed your finger, however, the nociceptor was not active because there was no stimulus (or harm) to make it react.
It is believed that a single cause of chronic pain may be due to malfunctioning nociceptors. They may be constantly sending pain messages even if there is no direct cause. Continuing the above example, state that your finger is treated after you slammed it but you still continue to feel discomfort. The nociceptors in the nerves of your finger might be malfunctioning within this case. This could result in chronic pain symptoms.
Symptoms of Chronic Pain
Chronic pain, long-term, persistent pain, is a very subjective experience, however, we can’t mention something as categorical as, “all chronic pain patients will experience chronic pain this way.” Instead, it’s more likely to say that chronic pain can take on many forms and may manifest into a variety of symptoms. Such may include:
throbbing
aching
shooting
electric
burning
sharp
feeling stiff
feeling tight
feeling sore
Chronic pain may result in other issues, especially social and emotional ones. Pain may:
Result in sleeplessness,
Drain you of energy,
Lead to depression,
Make you not want to do activities you typically like,
Weaken your immune system because a lot of your body’s energy is spent dealing with all the pain.
Lots of these other issues build off each other, which means you might hear the term “vicious cycle” when speaking about chronic pain. For instance: The pain makes it hard to sleep through the night, and that means you’re excessively tired the following day. You don’t want to go to work since you’re so tired, or do anything else. Your self-esteem begins to draw out even more, as you are not too active, in the end even withdrawing from social events.
To acquire the very best remedy for chronic pain, you must take inventory of just how much it is affecting your life–outside the physical pain. You can’t simply take care of the chronic pain on your own. Seek for a solution along with the help of medical professionals and your physician can assist you to live your own life coping with chronic pain.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�
By Dr. Alex Jimenez
Additional Topics: Wellness
Overall health and wellness are essential towards maintaining the proper mental and physical balance in the body. From eating a balanced nutrition as well as exercising and participating in physical activities, to sleeping a healthy amount of time on a regular basis, following the best health and wellness tips can ultimately help maintain overall well-being. Eating plenty of fruits and vegetables can go a long way towards helping people become healthy.
Exercise, together with a balanced nutrition and plenty of sleep, are the basis of overall health and wellness. For some individuals, however, chronic pain can prevent them from engaging in physical activities. As a matter of fact, researchers recommend people to participate in exercise to improve their pain symptoms.
Contents
Can exercise help with chronic pain?
Chronic pain is persistent, or constant pain, which could last for weeks, months, even years after the origin of the symptoms have healed. Chronic pain can range from mild to severe. It may continue day after day or come and go. Chronic pain can interfere with your life, keeping you from doing what you have to do everyday. It may take a toll on your own self-esteem and cause you to feel depressed, angry, stressed, anxious and frustrated.
The stress of persistent chronic pain takes a toll on the entire body; muscles tighten and become rigid, making even the simplest tasks difficult and/or impossible. Our inclination to stop moving in the presence of pain is a human reflex, however, it deconditions muscles and perpetuates pain. The more you hurt, the less you move, the less you are able to accomplish tasks. A sedentary lifestyle increases pain and makes for poor overall wellness. But, physical activity can work against pain, reducing the risk for heart disease, diabetes, cancer, and many other diseases.
Exercise for Chronic Pain
A progressive physical fitness regimen can provide benefits for your body and mind, putting you on a course to a brighter future, restoring your functionality, and elevating your mood. A sizable quantity of research bears this out. An analysis of 33 distinct studies concluded that exercise reduces pain and improves physical functionality linked to atherosclerosis, rheumatoid arthritis, and fibromyalgia, some of the most common causes of chronic pain. Additionally, it generates similar benefits for other debilitating conditions, such as neck and back pain, as well as chest pain after breast surgery. Even something as simple as walking, which stimulates blood circulation and increases endorphins, can help to suppress the symptoms of chronic pain in the body.
6 Ways Regular Exercise Affects Chronic Pain
It decreases pain.
It enhances energy levels and reduces fatigue.
It uplifts mood and lessens feelings of depression.
It enriches joint health.
It raises overall daily functionality.
It will help to control weight (when combined with a healthy diet).
While fitness has been ultimately proven to be beneficial towards chronic pain relief, not just any exercise will offer these positive outcomes. Movement is good medicine, although pursuing even the least demanding movement may seem unfathomable when pain fatigues you. Although you might not feel the motivation or energy to exercise, the kind of activity you participate is the thing which will restore your performance and can boost your pain tolerance. Exercising may be hard and cause some discomfort, but it should never be so strenuous that it’s harmful.
Any brand new exercise program should be undertaken only with the guidance of your doctor or a qualified healthcare professional, preferably one who’s experienced with your type of pain. Physical therapists are licensed professionals who hold either a Doctor of Physical Therapy (D.P.T.) or a Masters of Physical Therapy (M.P.T.) degree. A fantastic therapist may guide you through movements which do not intensify your pain or lead to damage or injury to joints and muscles. An experienced healthcare professional can show you how you can move and help you to securely push your limitations, resulting in extensive rehabilitation than you might achieve on your own.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�
By Dr. Alex Jimenez
Additional Topics: Wellness
Overall health and wellness are essential towards maintaining the proper mental and physical balance in the body. From eating a balanced nutrition as well as exercising and participating in physical activities, to sleeping a healthy amount of time on a regular basis, following the best health and wellness tips can ultimately help maintain overall well-being. Eating plenty of fruits and vegetables can go a long way towards helping people become healthy.
Chronic pain, lingering, persistent pain, may not respond well to conventional therapy options. If such is the case, you may want to try complementary and alternative medications (CAM). CAM is a phrase used for practices and therapies that are not currently considered part of conventional medicine. However, pain relief is found by many patients.
For everyone in the exact same manner, they may not work like any other remedies, so because you determine what works best for life and the pain, you may need to try CAM therapies. Complementary and alternative treatments can either complement (used in conjunction with) or become an alternative to traditional “Western” medicine.
For chronic pain, you might want to try:
Contents
Acupuncture/Acupressure
As per a recent research published in the British Medical Journal, acupuncture is effective in treating chronic neck pain. In a questionnaire ran for neck pain patients on treatment options, patients reported that they were more satisfied with acupuncture than with traditional injections.
A German study also recently found that acupuncture was more effective than conventional non-surgical therapy options (physical therapy, medication, and exercise) for low back pain. The findings of the study were published in the September 24, 2007, version of Archives of Internal Medicine.
Developed in China, acupuncture utilizes needles, without a medicine. to care for your chronic pain. Practitioners feel that you’ve got an energy force called your Chi (it may also be spelled Qi, however, both forms are pronounced “chee”). You can develop illness, like back pain when this force is blocked. You want to free up your body stations, which professionals call your meridians. Acupuncture works to restore a healthy flow of Chi.
Acupuncture needles are nearly as thin as strands of hair follicles. According to your symptoms and diagnosis that is exact, the needles will be inserted by a practitioner. The professional will aim points that are exact within the meridians of your body, and the needles will be left in for 20-40 minutes. It’s been indicated that acupuncture needles cause your body to release specific neurochemicals, like endorphins or serotonin, and they help in the healing process.
Acupressure works like acupuncture since it focuses on these meridians. Instead of needles, the pro uses fingers his/her thumbs, and elbows.
Herbal Remedies/Supplements
Research before attempting any herbal remedies and speak with your physician. There might be side effects which you’re unaware of or a herbal remedy could interfere with other treatments.
Since there are many types of chronic pain, it’s difficult to list all possible remedies or supplements that may help reduce your kind of pain. Your best alternative is to speak to somebody with the proper knowledge on herbal remedies and how they work. But until you get started taking a nutritional supplement or an herbal remedy, talk to your physician.
Massage
Massage is a way to unwind from dealing with a strain of pain throughout your entire body, which is tense. It can help relieve muscle inflammation and pain which may be caused as a result of chronic pain. Physical therapists or massage specialists will know the best, most recommended type of massage for your specific chronic pain.
Mind-Body Therapies
Our thoughts are powerful items, and also therapies can help you learn how to use your head to control your perception of pain and other ailments. Mind-body remedies include:
Meditation
Relaxation techniques
Hypnosis
Mind-body therapies can teach you how to pay attention to the signs that your body is sending you. Biofeedback is a good instance of this. Through relaxation training and methods, you understand how to control your body reactions which could aggravate your chronic pain. Calm muscles that are stressed, among other things, slow your pulse, and you can learn to lower your body temperature, all which can help control chronic pain.
Chiropractic Care for Chronic Pain
If you have chronic back pain, Chiropractic care may be a treatment alternative for you. Various chiropractic care remedies can help you manage chronic pain. Chronic pain is and it does not reply to the normal pain control methods. Chiropractors can cure pain. They utilize a variety of non-surgical treatments, such as spinal manipulation, to address chronic pain symptoms, like inflammation and muscular tension.
How Does a Chiropractor Manage Chronic Pain?
Before you go to a chiropractor it’s important to know just what is causing your pain. A doctor of chiropractic�will perform some tests in addition to a physical exam to assist him or her to diagnose your pain. Your chiropractor will create a treatment plan when you’re diagnosed with a chronic pain condition. Your treatment plan may include spinal manipulation, manual therapies, and therapeutic exercises.
Work with your chiropractor to come up with a treatment plan. You should be able to gradually increase your daily activities, once your pain is totally addressed. Chiropractic treatments primarily utilize manual manipulations and chiropractic adjustments, especially along the different levels of the spine, to treat a variety of injuries and/or conditions affecting the individuals original spinal health. Treatment may vary depending on the diagnosis.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�
By Dr. Alex Jimenez
Additional Topics: Wellness
Overall health and wellness are essential towards maintaining the proper mental and physical balance in the body. From eating a balanced nutrition as well as exercising and participating in physical activities, to sleeping a healthy amount of time on a regular basis, following the best health and wellness tips can ultimately help maintain overall well-being. Eating plenty of fruits and vegetables can go a long way towards helping people become healthy.
Question: I’ve had back pain for awhile and I was able to function through it for a time. But now it’s taking its toll on me, as well as my family. I never believed in chiropractors, but now I’ll try anything. What should I ask my physician about chiropractic?
El Paso, TX. Chiropractor, Dr. Alexander Jimenez has seen this scenario all too often and is happy to inform anyone about chiropractic care and it’s benefits.
About two out of every three people will likely experience significant low back pain at some point. A doctor might suggest any range of potential treatments and therapies. But one that almost is never considered is a referral for spinal manipulation.
It seems doctors have been mistaken for initial treatment of lower back pain.�It may be time for doctors to rethink their chiropractic biases.
Contents
Spinal Manipulation:
Along with other less traditional therapies like heat, acupuncture and meditation, chiropractic appears to be as powerful as any other medical treatments doctors prescribe and as safe, if not safer.
Physicians are traditionally wary of spinal manipulation (applying pressure on bones and joints), in part because the practitioners are often not doctors. Patients with back pain don’t seem as skeptical. A survey from 2002 through 2008 found that over 30 percent sought chiropractic care, significantly more than those who sought massage, acupuncture or homeopathy.
Researchers have been looking at the evidence supporting spinal manipulation for a while. Nearly 35 years ago, a systematic review assessed the available research found that there may be some short-term benefits from the process. Two reviews from 2003 agreed for the most part, finding that spinal manipulation worked better than a “sham procedure”, or placebo, but no better or worse than other options.
Recently, in The Journal of the American Medical Association, researchers looked for new studies since 2011, in addition to those that had been performed before.
Evidence from 15 randomized controlled trials, which included more than 1,700 patients, revealed that spinal manipulation minimized their back pain of about 10 points on a 100-point scale. The evidence from 12 randomized controlled trials that overlapped of almost 1,400 patients showed that spinal manipulation also resulted in improved mobility and function.
In February, in Annals of Internal Medicine, another systematic review of non-pharmacologic therapies generally agreed with the recent trials. Based on this review, and other evidence, the American College of Physicians released new clinical practice guidelines for the noninvasive treatment of back pain. They recommended that patients should try spinal manipulation, heat, massage and acupuncture as first-line therapies.
What If The Spinal Adjustment Causes Other Injuries:
Because of the fear of those injuries, physicians are hesitant to refer patients to chiropractors or physical therapists for care. However, in the studies outlined above, there were no serious adverse events reported. It is possible to find stories of injury to the spine from improper adjustments, but these are rare, and almost never involve the lower spine.
What About The Cost:
Some doctors are concerned about the cost of chiropractic, especially since many insurance carriers don’t cover chiropractic. Seeing a chiropractor costs more than taking many non-narcotic pain medications. However, more invasive interventions cost a lot of money. In addition, studies have proven that, in general, users of complementary and alternative medicine spend less for back pain compared to users of only traditional medicine.
Medication and surgery may also result in injuries and prescription pain medicines, like opioids, may result in huge costs, particularly when they’re misused.
Some physicians are uncomfortable that they do not have a clear picture of how spinal manipulation actually works. The reality is that doctors don’t understand why a number of other therapies work either.
Back pain is still the issue and no matter what you do, chiropractic is definitely an option to consider.
Chiropractic: Alternative Approach To Treating Chronic Pain
Pain is defined as a physical discomfort caused by illness or injury. Most cases of pain are temporary, or they disappear once the source of the symptom is treated or healed, however, what happens when the pain becomes persistent?
Contents
How can you diagnose chronic pain?
Diagnosing chronic pain can be a long procedure. Because there are lots of possible causes behind the painful symptoms, the health care provider may need to conduct a variety of examinations and tests to attempt to find the source of your own pain. Below are a few of the methods the physician may try to diagnose chronic pain.
Medical History
Your doctor will take a comprehensive health history, going over any injuries, illnesses, and medical problems that run in your family. It is essential to be thorough so that the doctor can take a look at the full assortment of causes because chronic pain can generally be a result after injury or illness.
You’ll also have to be very particular about your pain: description, frequency, intensity, duration, activities that make it worse, even whether it is better at a certain time of day, etc.. It may be a good idea to initiate a pain journal where you record details of your pain. You’ll be better able to share information with the healthcare professional.
Physical, Neurological, and Mental Health Exams
For the physical examination, the physician will see your range of movement (that is how well and how much you can move specific joints), posture, and general physical condition. He or she will make note of any movements that increase or cause you pain.
The neurological examination will test your nerves, so this test is particularly critical for chronic pain. The doctor will test your reflexes, muscle power, and how well it is possible to feel. The physician might test if you can feel a touch in your skin. That may indicate nerve damage if you can’t. The healthcare provider will see whether your pain is currently spreading through the examination, �or whether you came in complaining of back pain.
Because chronic pain frequently has an emotional or psychological element, you might have to have a mental health examination. This is to check for symptoms such as stress or depression, that could develop alongside pain. The health exam may also give your doctor a complete picture of your overall health and wellness.
Diagnostic Tests
To see if there is an injury or identifiable illness causing your chronic pain, the healthcare professional will need to conduct diagnostic tests. For the imaging evaluations (x-rays, MRIs), you may have to go to an imaging center to have these done; the results will probably be sent back to your physician, who will interpret them for you.
Some possible diagnostic tests include:
Blood evaluation: Your doctor may be able to tell if you have specific forms of arthritis or a disease based on a blood test.�A blood test also allows the doctor to check your liver and kidney functions.
Bone scan: To help your doctor detect spinal problems such as osteoarthritis, sacroiliac joint dysfunction, fractures, or illnesses (which can all lead to chronic pain), you could have a bone scan. You will have a small amount of radioactive substance. That can travel through your blood flow and be absorbed by your bones. An area where there is abnormal action, like an inflammation, will absorb substances. A scanner can detect the quantity of radiation from all your muscles and also show the “hot spots” (the areas with more radioactive material) to help your doctor figure out where the issue is.
CT scan: A CT scan, which stands for computerized axial tomography, reveals the bones, but in addition, it reveals the soft tissues and nerves.
EMG: An electromyography (EMG) will check if your muscles are responding well to nerve stimuli.
MRI: An MRI, which stands for magnetic resonance imaging, shows the bones, but in addition, it shows the soft tissues and nerves. MRIs do not expose you to radiation by using magnets to get the picture.
Myelogram: To see whether you have a spinal canal or spinal cord disorder, maybe nerve compression causing weakness and pain, you might need a myelogram. In this evaluation, you’ll have a special dye injected into the fluid that surrounds your spinal cord and nerves. Then you’ll have a CT scan or an x-ray. The image will offer a detailed anatomic picture of your spine of the bones, which will assist your doctor.
NCV: A nerve conduction velocity (NCV) test will help the doctor evaluate your nerves and ascertain if there is any damage. This test is done together using the EMG test.
Nerve block: When the doctor suspects that a particular nerve is damaged and that is what is causing your chronic, they may do a nerve block. This is a special type of injection that may help identify if the nerve is the source of pain.
X-ray: This gives your doctor a clear picture of your bones.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�
By Dr. Alex Jimenez
Additional Topics: Wellness
Overall health and wellness are essential towards maintaining the proper mental and physical balance in the body. From eating a balanced nutrition as well as exercising and participating in physical activities, to sleeping a healthy amount of time on a regular basis, following the best health and wellness tips can ultimately help maintain overall well-being. Eating plenty of fruits and vegetables can go a long way towards helping people become healthy.
Question: I work at a desk all day and have started to feel pain in my neck, back, shoulders and arms. Can chiropractors help with sitting posture and general posture?
El Paso, TX. Chiropractor, Dr. Alexander Jimenez provides insight into proper sitting posture and general posture through chiropractic.
Have people asked you about using a posture brace to help correct their sitting habits? Chiropractic patients with moderate posture problems, meaning that they may be chronic but are not tied to any spinal column or other medical condition, may benefit from a posture back brace to improve this condition. There are a number of great ones available, and you can see more information about some of the top ones here.
A patient such as this will almost certainly enjoy the quick referral as well as the relatively fast results, and chiropractors get an easy opportunity to help people, which explains why many enter the profession in the first place.
But if the patient does have an underlying chiropractic ailment, a back brace will probably do little if any good. These issues are usually easily diagnosed using a quick examination, and afterwards, treatment is relatively straightforward as well.
Contents
Diagnosing Conditions
All good exams begin with thorough health history, because in most cases, family history is among the most powerful indicators about current issues.
Next, observe the individual’s gait, as how someone walks shows a number of issues. For instance, those who stand or walk with their legs abnormally spread might have fallen arches. Because the bottom of the foot isn’t in appropriate contact with the floor, the whole body has been thrown off kilter, resulting in poor posture. While it isn’t really a chiropractic condition, fallen arches are, as simple as, a referral to an orthopedist.
Moreover, if the patient is experiencing pain, the location can be an indicator as to where the muscles may be weak and there is too much strain on the spine or a different region of the body. Muscle weakness is among the leading causes of poor posture. So, follow-up tests that measure muscle strength and range of movement are usually a good idea.
If the gait examination signals issues in a particular area of the body, the professional should concentrate further diagnostic efforts in that region.
Ultimately, one of the most simple and effective evaluations is just holding a yardstick or comparable object against the patient’s back, so the two of you can definitely see any abnormalities. This comprehensive approach generally describes some of the very frequent chiropractic posture issues, including:
Tissue Damage:
If the neck, lower back, mid back, or any other area is weak and/or inflexible, the individual will probably not see very much posture improvement until these conditions are adjusted and the muscles have been strengthened.
Kyphosis:
Hunchback is a degenerative spine condition that’s very prevalent in women over 60. While more advanced cases may be life threatening and may require spinal fusion surgery, most men and women respond well to therapeutic adjustments and other treatments.
Scoliosis:
This condition is much like genetically-induced kyphosis, since there’s no cure but there are several therapies available. In extreme cases, surgery may be necessary.
Un-Level Pelvis/Pelvic Tilt:
A pelvic tilt, a lower sacral base, and a femur head discrepancy can indicate a lower extremity source, but not�whether it is an anatomical or functional short leg. A clinical postural exam with lower extremity screening is the only way to make this determination.
Forward Head Posture:
The anterior positioning of the cervical spine. This posture is sometimes called Scholar’s Neck, Wearsie Neck, Hunch & or Reading Neck.It is a posture problem that is due to several factors including sleeping with the head raised too high, prolonged use of computers and cellphones, lack of developed back muscle strength and deficiency of nutrients like calcium. Potential negative effects include tingling and numbness in the arms, and a burning pain between the shoulder blades.
Treatment
As stated previously, back braces frequently mend postural issues, like slouching. As for structural problems, like scoliosis, more aggressive treatments are needed.
Conventional treatment consists of:
Heat
Massage
Stretching
Strength exercises
Supportive braces
There are a number of biofeedback tools that accurately evaluate patient progress.
As a chiropractor, your patients count on you to get much better. That almost always means accurately assessing the problem, which also means a quick and capable referral or an aggressive and well thought out therapy regimen.
IFM's Find A Practitioner tool is the largest referral network in Functional Medicine, created to help patients locate Functional Medicine practitioners anywhere in the world. IFM Certified Practitioners are listed first in the search results, given their extensive education in Functional Medicine
