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to see a list of articles like this one Co-Management of Severe Conditions Prolotherapy as an Adjunct to Chiropractic Care |
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A Letter Released
to Chiropractic Physicians on September 5, 2006 The Role of Analgesics in Efficient Pain Management Holistic practitioners often express
concern that allopathic practitioners use medication to relieve the symptoms
of a biomechanical or neurological lesion without directly addressing the
source of the symptoms. Of course, few
physicians on either side of the allopathic / holistic divide would argue
that pain medicine has no role in the treatment of painful conditions. A quick review of what we already know
about the human neurological response to pain will put the role of analgesics
into perspective. The longer a painful stimulus continues
the more sensitive a person will become to it. Unrelieved pain leads to hyperalgesia – a lowered pain threshold. Prolonged pain stimulates the release of
spinal neurotransmitters that cause the body to recruit nerve fibers not
normally associated with pain.
Recruited nerve fibers cause normally nonpainful stimuli such as
vibration or touch to become painful.
Recruitment can result in long-lasting or even plastic alterations in
our patients’ pain sensory system, setting up chronic pain syndromes.1 During acute pain, a window of opportunity
exists for physicians to provide rapid and appropriate analgesia, mitigate the development of
chronic pain, and relieve patient suffering. In many cases, the original insult to the
body has been resolved, but chronic or plastic alterations in the nervous
system continue to cause hyperalgesia and allodynia – persistent pain. In cases where the pain sensory system has begun the process of
plastic alterations toward chronic pain, rapidly effective pain medications
can interrupt the pain cycle, give nerve fibers the opportunity to “reset”,
un-recruit nerve fibers, and restore more normal pain thresholds. Pain can reach a point of duration
or intensity where it becomes more appropriate to look at pain as a disease
process in and of itself. Pain causes
impaired GI function, imparied pulmonary function,
impaired immunity and healing, insomnia, and increased blood clotting.2 Psychological effects include anger,
resentment, despondency, anxiety, depression, isolation, impaired family
function, marital conflict, and even requests for physician assisted suicide.2 Of course, most of these arguments
about the necessity for rapid and effective analgesia make little mention of
biomechanical lesions which may have caused the pain originally or which may
still contribute to the chronic nature of pain. These arguments also ignore the lasting and
more desirable analgesic effects of manipulative and physiological
therapeutics. Unfortunately, the
safest methods and those with the least side effects, tend to be the methods
that are the slowest acting and the methods requiring greater dedication on
the part of our patients. The ideal
treatment approach to moderate, severe, or chronic pain is one that uses
fast-acting medications to avoid or reverse the neurological sequelae of
pain, while maintaining the ultimate goal of discontinuing drug therapies in
favor of more natural, holistic approaches.
This is where a two-fold approach to pain management
becomes most beneficial to our patients – a physician trained to work with
the body’s natural capacity to heal itself co-managing with a physician who
can expertly coordinate medical approaches as needed. I invite chiropractic physicians
to enlist me, Dr. Neal Taub, MD, ABPM&R, when they have cases of
recalcitrant, moderate to severe pain, or cases of chronic pain. As a physiatrist, board certified in pain
medicine, my role is to co-manage conditions that fall under the physiatrist
realm of expertise. When therapeutic
goals are met, the patient returns to the life-long
care of his or her primary care practitioner.
Call today to discuss co-management options for one of your patients. |
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Home Stroke Rehabilitation About Neal Taub, MD What is a Physiatrist |
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