We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.
This is Chapter 4 from RC’s best-selling book:
“Basic Principles of Chiropractic Neuroscience”
These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission fromACAPress.
Chapter 8: Clinical Disorders and the Sensory System
This chapter describes those sensory mechanisms, joint signals, and abnormal sensations (eg, pain, thermal abnormalities) that have particular significance within clinical diagnosis. The basis and differentiation of pain are described, as are the related subjects of trigger points and paresthesia. The chapter concludes with a description of the neurologic basis for the evaluation of the sensory system and the sensory fibers of the cranial nerves.
THE ANALYSIS OF PAIN IN THE CLINICAL SETTING
Although all pain does not have organic causes, there is no such thing as “imagined” pain. Pain that can be purely isolated as a structural, functional, or an emotional effect is rare. More likely, all three are superimposed upon and interlaced with each other in various degrees of status. This is also true for neural, vascular, lymphatic, and hormonal mechanisms.
Common Causes of Pain and Paresthesia
The common causes of pain and paresthesia are:
(1) obvious direct trauma or injury;
(2) reflex origins in musculoskeletal lesions, which deep pressure often exaggerates, such as trigger areas;
(3) peripheral nerve injury (eg, causalgia), which results in an intense burning superficial pain;
(4) the presence of nerve inflammations and degeneration of the peripheral or CNS, which frequently cause other changes indicative of such lesions;
We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.
This is Chapter 4 from RC’s best-selling book:
“Basic Principles of Chiropractic Neuroscience”
These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission fromACAPress.
Chapter 4: The Horizontal Neurologic Levels
and Related Clinical Concerns
This chapter describes the basic functional anatomy and clinical considerations of the horizontal aspects of the supratentorial, posterior fossa, spinal, and peripheral levels of the nervous system.
OVERVIEW
The reader should keep in mind that the various aspects of the nervous system as described in this manual (eg, longitudinal and horizontal systems) are only reference guides that are visualizations of a patient’s nervous system in the upright position. They can be likened to the lines of longitude and latitude on a globe of the earth.
Such systems do not exist physically, but they do serve as excellent mental grid-like tools (viewpoints) during localization and areas in which and from which relationships can be described. For example, although the longitudinal systems take a general vertical course within the spinal column there are numerous alterations and they actually become horizontal when decussating. While the horizontal levels are spatially placed in and extend from the CNS in a general segmental manner, they soon take a widely diffuse course as they project toward their destinations. Thus, references to longitudinal and horizontal levels are just general viewpoints.
It is helpful for study purposes to isolate the body into certain systems, as described above, organize systems into organs, organs into tissues, tissues into cells, and cells into their components. However, we should keep in mind that, physically and functionally, there is only one integrated body and it is more than the sum of its parts. And even the body cannot be thought of as truly separate from its external environment. Although we may do this for study purposes, it is a limited viewpoint.
When new research, research reviews or practice guidelines support our current beliefs and practices, enthusiasm comes easily. When the 2007 medical practice guidelines on low back pain (LBP) jointly prepared by the American Pain Society and the American College of Physicians recognized spinal manipulation as the only non-pharmacologic method providing “proven benefits” for acute LBP and as one of several methods (including exercise, rehabilitation, acupuncture and yoga) proven effective for chronic LBP, the American Chiropractic Association and doctors of chiropractic (DCs) everywhere welcomed this as a long-overdue recognition of the value of our primary treatment methods.
But when research challenges our assumptions, our responses are understandably mixed. Such findings, if confirmed in multiple studies, may create pressure to change our practice patterns or threaten reimbursement from insurance companies. Like members of other health professions, DCs do not find such developments pleasant. How we and members of other health professions respond to such research says a great deal about who we are, how fully we practice what we preach, and the depth of our commitment to providing the best possible care to our patients.
The Oxford Project to Investigate Memory and Ageing (OPTIMA) published the results of a key aspect of their study in the online journal Public Library of Science ONE in 2010. In this arm of the study, they investigated the effect of B-vitamin supplementation on various parameters of brain aging and associated cognitive function. The study group consisted of 168 individuals over the age of 70 with mild cognitive impairment.
The treatment group was given daily supplementation of the following B vitamins: folic acid (800 mcg), vitamin B12 (500 mcg) and vitamin B6 (20 mg). The main outcome measured was change in rate of whole brain atrophy on MRI investigation after 24 months of supplementation compared to the placebo group.
Study results showed that the group taking the B-vitamin cocktail experienced a 30-percent slower rate of brain atrophy, on average, and in some cases patients experienced reductions as high as 53 percent. Greater rates of atrophy were associated with lower cognitive test scores.
The authors also observed that, in the control group, the the degree of atrophy was directly related to elevated homocysteine levels.
Assistant Professor, Department of Human Health and Nutritional Sciences, University of Guelph.
CCRF Professorship in Spine Mechanics and Human Neurophysiology
College of Biological Sciences, University of Guelph
Chronic pain is a worldwide epidemic. It is characterized as “pain that persists beyond normal tissue healing time” [1] and is physiologically distinct from acute nociceptive pain. The current research estimates the prevalence of chronic pain in the general population to be anywhere from 10–55%, [2] predominantly affecting the adult population. Studies indicate that the prevalence of chronic pain in the over-60 age group is double that for younger adults. [3] Furthermore, over 80% of elderly (over 65) adults suffer from some form of painful chronic joint disease [4] and greater than 85% of the general population will experience some form of chronic myofascial pain during their lifetime. [5]
Chronic pain has substantial impact on sufferers, often citing significant impairments in physical, social and psychological function. [6] Many patients suffer from progressive health and physical deterioration owing to sleep and appetite disturbances, anxiety, depression, decreased physical energy and activity as well as excessive use of medication. [6] Chronic pain often leads to social withdrawal, impaired personal relationships and job loss. [1] Recent estimates suggest that 50–85% of adults report some degree of pain that may interfere with daily activities and quality of life. [7]
Chronic pain sufferers are five times more likely to utilize health care services than non-pain sufferers. [8] Conservative figures estimate that the annual cost of managing chronic pain in the United States currently exceeds $40 billion annually. [9] Of greatest concern is the fact that the ratio of the over-65:under-65 segments of the population is projected to double by 2050, [10] promising to make chronic pain one of healthcare’s foremost challenges in the future.
If you are a clinician at work in a typical chiropractic practice you see many patients with acute and chronic back pain, neck pain and headaches.
If you are making best efforts to keep up with the ongoing flood of research and evidence-informed clinical guidelines you can feel confident that the scientific evidence now supports your clinical experience that spinal manipulation specifically, and chiropractic management incorporating manual care generally, are very helpful for most patients with these complaints. Therefore for example:
For the great majority of patients with both acute and chronic low-back pain, namely those without diagnostic red flags, spinal manipulation is recommended by evidence-informed guidelines from many authoritative sources – whether chiropractic (the UK Evidence Report from Bronfort, Haas et al. [1]), medical (the 2007 Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society [2]) or interdisciplinary (the European Back Pain Guidelines [3]).
For the great majority of patients with acute and chronic neck pain, and those with cervicogenic headache, spinal manipulation is similarly recommended, most recently and authoritatively by the Bone and Joint Decade Neck Pain Task Force [4]. For headache, including migraine headaches, see evidence reviews and recommendations from the Evidence-Based Practice Center at Duke University [5] and Bryans Descarreaux et al. in Canada [6].
What are we to make, then, of a new systematic review for the Cochrane Collaboration, looking at chronic back pain and published last month in Spine? This is from Rubenstein, van Middelkoop et al., an experienced research team at the VU University, Amsterdam which includes noted epidemiologist Dr. Maurits van Tulder, so will attract attention. It concludes that the evidence suggests “there is no clinically relevant difference between spinal manipulative therapy (SMT) and other interventions for reducing pain and improving function in patients with chronic low-back pain”. [7].
The Foundation for Chiropractic Progress, a not-for-profit organization dedicated to raising awareness about the value of chiropractic care, points to the role of the team Doctors of Chiropractic (DCs) in optimizing functionality, endurance and overall conditioning.
Bill Gates will have the attention of most of the world’s health ministers on Tuesday, when he plans to share one main message: Get your vaccination rates up. Gates is pushing to get countries to increase vaccination rates as an easy, low-cost way to protect their populations. He is scheduled to give the keynote address at the World Health Assembly in Geneva.
“Every percentage point you increase from where we are now to that goal you’re talking about hundreds of children who don’t die and thousands of children who don’t get sick in a way that prevents their brain from developing fully,” he said.
During Tuesday’s speech, Gates will highlight strong results from a new meningitis vaccine in the West African nation of Burkina Faso, where last year there were 66 cases in the first four months. This year the country has seen only one case. A “meningitis belt” runs through Burkina Faso, Chad, Nigeria and Niger. But the new vaccine, which is being given to infants and adults, has shown strong results so far.
“It’s a success story,” Gates said. “For people who live in the meningitis belt the kind of fear and seeing the kids who are made deaf because of it they see it as a huge breakthrough. People immediately come and get this vaccine because they have such a fear of the disease.”
As anyone who has ever raised a teenager knows all too well, telling someone to do something because it’s “good for them” can feel like so much wasted breath. Chiropractors also can find themselves winded from exhorting (encouraging, cajoling, threatening, nagging, etc.) patients to persist with their programs of care and enhance their overall well-being with more frequent chiropractic visits, better nutrition, more sleep, stress management and exercise.
Recent health care trends and research are supporting what you may have already suspected from years in practice: Simply telling people what to do often does not lead to them actually doing it. Showing them how and leading them through it stands a much better chance of working.
Patient Education vs. Coaching
Traditional patient education – loading people up with facts and figures and sending them home with a stack of brochures to tackle on their own – often doesn’t empower patients with the true understanding and skills they’ll need to persist and succeed with a health care regimen. Health coaching leaves less to chance. A health coaching approach provides a more interactive consultation model whereby the coach and patient work together to map out care plans. The coach proactively monitors progress, provides counseling and new strategies for navigating through rough patches, and holds the patient accountable to agreed-upon goals.
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