Dr. Kestner: Some progress in pain management…

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I took some time off last week to combine a mini-vacation with attendance at two very important medical conferences.

The first weekend I attended a conference held in Atlanta involving new advanced acupuncture techniques to improve effectiveness for pain. The conference was attended by members of the medical, chiropractic, physical therapy and acupuncture professions. The primary lecturer, Dr. Yun Tao Ma, holds a Ph. D. from Clemson in neuroscience and has practiced acupuncture for several decades. His presentation was exceptional. He presented important research findings that demonstrate the effect of acupuncture stimulation in the peripheral and central nervous system.

Acupuncture has been used by millions of people around the world for centuries with great success in many painful conditions but until recent years there was little known about how the treatment worked. Thanks to the work of researchers like Dr. Ma, more is being learned each year about how the procedure actually affects the human body. This is important as progress is made to increase the effectiveness of this promising treatment. Some of my patients have already benefited from what I learned at the conference.

After a few days of travel and rest I attended the annual conference of the American Academy of Pain Management (AAPM) in Phoenix. This conference was quite large, with dozens of lecturers and presenters. It was attended by members of practically every profession that deals with chronic pain patients, including medical, osteopathic and chiropractic doctors, nurses, nurse anesthetists, pharmacists, therapists, psychologists, acupuncturists and others.

There is a reason that the conference was so widely appealing. One of the principles of the AAPM is that chronic pain management is most successful when care is coordinated between professionals. In order to work together, it is important for the various providers to understand the treatment of other types of providers.

The effort to improve coordination of care between professionals is important. It is a fact of life that healthcare as we know it is very fragmented. Every office has its own routines, policies and typical protocols. This is unfortunate for people with many conditions, but especially so for patients with chronic pain.

Chronic pain is a complex set of problems that involves changes in the way the central nervous system works, tissue changes, metabolic disturbances and usually behavioral alterations as a result of trying to deal with long-standing dysfunction. To really be successful in alleviating chronic pain, it is often necessary to involve numerous professionals.

The good news is that groups like the AAPM are working to improve communication and integration between various providers that might be necessary to offer treatment to pain patients. At the conference I noticed many animated conversations between various groups of providers as they learned more about what the other group was doing and why.

Much of the education was focused on what drugs to use for patients with various painful conditions. Most medical pain practitioners rely on many pharmaceutical products as their first line of treatment (possible the only treatment). In many cases the doctors are using various drugs “off-label.” This means that the drugs have been approved by the FDA, but not for the treatment of pain. They might be intended for depression, seizures, or other conditions, but have been found to be helpful for some patients with chronic pain. Although this is an important part of providing needed relief for many patients, the drugs do not actually resolve the painful conditions. Unfortunately, they also introduce new problems in the form of side effects, dependence and in some cases, addiction.

A growing trend in pain practice is to coordinate care with providers such as chiropractors and acupuncturists. While the drugs are intended to manage pain, chiropractic care is intended to restore function to reduce or eliminate pain. Similarly, acupuncture works to help restore normal functioning to the nervous system. The goal of both of these types of care is to actually help the body return to normal functioning.

Hopefully, there will be more improvements in the near future to report.

Next week I will tell you three things you can do to ensure you live longer and feel better.

Dr. Mark Kestner
Read more from:
Dr. Mark Kestner, Living Well, Voices
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Members Opinions:
October 19, 2009 at 8:02am
When you feel that doctors have a duty to tell the patient if the doctor is going to make an "off-label" prescription?
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