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Osteopathic approach to pain management

Updated: Jun 14, 2022

This lecture introduced the Osteopathic manual medicine approach to chronic pain, including other various treatments and supplements that can be used for chronic pain including acupuncture, glucosamine/chondroitin, vitamin D, and platelet-rich plasma (PRP). It first looks at the statistics regarding the use of complementary and alternative medicine (CAM) and integrative medicine in the US and Korea, which gives us a general idea as to why it is necessary to understand and consider the use of integrative medicine in patient management.

Further, the prevalence of chronic pain in the US and Korea is high. Considering the risks of medication including addiction, CAM or integrative medicine such as Osteopathic manual medicine can be used with analgesics for chronic pain, and a summary of the existing literature and data on contraindications, effects, and safety on various supplements and treatments is given.

[Osteopathic manual therapy (OMT)] Four types of OMT treatments are described with demonstration videos, including myofascial release (MFR) and soft tissue techniques for the neck, muscle energy technique (MET) for the piriformis muscle, carpal spread, and high-velocity low amplitude (HVLA) technique for the thoracic spine.

[Other supplements/treatments for chronic pain] The rationale for use of acupuncture, anti-inflammatory diets, food supplements, and PRP therapy for chronic pain are examined.

[Fibromyalgia] This lecture also covered the diagnostic criteria, contributing factors, prognosis, and treatments for fibromyalgia which accounts for 2-3% of chronic pain worldwide.

Learning Objectives

* Review the prevalence of CAM use and understand the need for discussion of integrative therapies

* Understand the basics of OMT including use for low back pain, safety, and contraindications

* Review the evidence for acupuncture use for knee osteoarthritis (OA), neck disorders, post-operative pain, and chronic pain

* Examine use of glucosamine/chondroitin supplements for OA, vitamin D supplementation for chronic widespread pain

* Review the basics of fibromyalgia, including epidemiology, ACR diagnostic criteria, symptoms, diagnosis, and treatments

* Apply the knowledge gained in the lecture for the benefit of patients visiting #Brahmi_Ayurveda_Clinic, Chikmagalur.

Why Discuss Integrative Therapies?

  • Your patients may ask about the evidence base

    • some of their info may be from social media

  • May prevent:

    • interaction with meds

    • complications from procedures

  • Helps you take better care of the patient

Chronic Pain

  • Estimated 1 in 5 outpatient office visits in the US

  • Challenges in diagnosis and treatment for pts and providers

  • Balance between the proper treatment of pain vs undertreating

  • Many medications for pain have side effects/misuse potential

Osteopathic Medicine

Andrew Taylor Still, MD/DO (1828-1917)

4 Tenets of Osteopathy

  1. A person is a unit of body, mind, and spirit

  2. The body possesses self-regulating mechanisms

  3. Structure and function are interrelated at all levels

  4. Treatment is based on the understanding of these 3 principles

Osteopathic Approach

"To find health should be the object of the doctor. Anyone can find disease."

A.T. Still, M.D., D.O.

Osteopathic Manipulative Treatment (OMT)

Osteopathic Manipulative Treatment:

  • Therapeutic application of manual forces used to improve function

  • Variety of techniques/modalities

Osteopathic Philosophy:

Take into account body, mind, and spirit

  • How is work life?

  • How is home?

  • How is mood/sleep?

Safety of OMT

Adverse events:

  • 1 in 4,00,000 treatments to 1 in 1 million

    • Higher incidence of side effects from meds vs OMT

Potential OMT Contraindications

  • Open wounds

  • Fever > 102 degrees

  • De novo diagnosed carcinoma

  • Osteogenesis imperfecta

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