September 2011
FIGHTING FIRE WITH FIRE Patients see relief from pain where eastern and western medicine collide PAGE 10
CONSERVATIVE CHIROPRACTIC METHODS PAGE 8
PLUS
Ask The Expert: Nutrition ༛ S
September Cooking ༛ S
What is Carpal Tunnel Syndrome? ༛ S
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W ELCOME I n n o vation marvels the mind; j u s t think – some 20 years ago, we li ste ne d to m usic on cass e t t e tape in portable boxes t h e s ize of bowling bags. To d a y, you can store thousands o f a r tists and songs on a tiny c o m p uter chip in a digital m u s i c player that fits in your p o c k et. Not long ago, we were e n t r a nced with the men who w a l k ed on the moon, yet today w e h ave reached Mars with the S p i r i t Rover. The Pony Express c a r r i ed letters and news across t h e U ni te d State s in recor db re a king time – 10 days from c o a s t to coast. Today, an email c a n t ravel to explorers on t h e S outh Pole in a matter of m o m ents. G r a n ted, the most exciting b re a kthroughs and innovations f o r A rizona Pain Specialists are t h o se i n he al th care. It is n o t h ing short of miraculous we a re a ble to see more than 7000 p a t i e nts each month, many of w h o m have advanced, detailed p ro c edures under minimal s e d a tion. Minimally invasive
surgery i s n o t h i n g s h o r t o f tr uly aw e s o m e . We fe e l i n c re dibly luc k y t o b e a b l e t o u s e the ver y l a t e s t i n n o v a t i o n s i n our clin i c a n d o u r p ro c e d u re center t o re d u c e t h e p a i n o f our p at i e n t s . We reco g n i z e t h a t t o h a v e a holist i c m e d i c a l p r a c t i c e , you mu s t b e a b l e t o o ff e r your p a t i e n t s m a n y t re a tment op t i o n s . Or c h i ro p ra c tic team , i n o u r o p i n i o n , i s t h e best in t h e s t a t e . T h e y o ff e r traditio n a l c h i ro p r a c t i c c a re in addit i o n t o e a s t e rn m o d a lities lik e a c u p u n c t u re . Pa i re d with th e l a t e s t t e c h n o l o g i e s o f western m e d i c i n e , w e a re a b l e to prov i d e c o m p re h e n s i v e c a re for our p a t i e n t p a t i e n t s . T h i s is the u l t i m a t e i n i n n o v a t i v e care.
Sanctify them in the tr uth ; y o u r w o r d i s t r u t h . – J o h n 17: 17
September 2011
Fo r t hose with young families, l i k e ours, we wish you the very b e s t as your children likely re t u r n to school this month. M a y the month o f September b r i n g cooler weather,
motiva t i o n f o r u s a l l t o k e e p learnin g a n d g re a t b l e s s i n g s t o you and y o u r fa m i l y. From o u r fa m i l i e s t o yo u rs ,
Pa u l Ly n c h , M D a n d To r y McJunkin, MD A r i z o n a Pa i n S p e c i a l i s t s Fo u n d e r s
Paul Lynch, MD and Tor y McJunkin, MD
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CLINICAL EDITOR: Tory McJunkin, M.D. PUBLISHER: Nick Ryan EDITOR/WRITER: Kelli Donley, Jennifer Gitt
CONTENTS 2
LAYOUT: Addie Mirabella
WELCOME LETTER
CONTACT US
Dr. Paul Lynch and Dr. Tory McJunkin welcome you to the September issue of Arizona Pain Monthly.
BOOST MEDICAL 9977 N 90TH STREET, SUITE 320 SCOTTSDALE, AZ 85258 Phone: 888-627-6121 Email: info@boostmedical.com PRINT SUBSCRIPTION INFORMATION 888-627-6121
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Scottsdale-based nutritionist Megan McNamee MPH, RD knows most Americans are struggling with their weight.
Patients see relief from pain where eastern and western medicine collide.
Use modern innovations to escape the heat of the kitchen. These three, healthy, late-summer recipes are meant for the grill. So, invite your family outside, fire up the barbeque and enjoy a colorful meal prepared in the great outdoors.
9977 N 90th Street, Suite 320 Scottsdale, AZ 85258 Volume #18 Published September, 2011
People feel strongly about chiropractic care – both positively and negatively.
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SEPTEMBER COOKING
Boost Medical
CONSERVATIVE CHIROPRACTIC METHODS
ASK THE EXPERT: NUTRITION
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Published monthly by
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FIGHT FIRE WITH FIRE
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PAIN Q&A What is carpal tunnel syndrome?
September 2011
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AS K T HE E XPERT: NUTRIT I O N S co t t sdale -base d nutr ition i st M e g an Mc N amee MPH, RD k n o w s most Americans are s t r u g gling with their weight. M a k i ng the right food choices i s n o t easy for most; then a g a i n, McNamee says a diet of c a r ro t sticks and apple slices i s n ’t the answer either. She p ro v i des insight to leading a h e a l t hier, more nutritious life – w h i l e reducing pain: Q : We o fte n he ar the imp ort a n ce o f e ati ng a healthy, b ala n c e d diet. Can you remind us why thi s i s i m po rtant? A : Fo o d re ally i s our b est medi c i n e. At each meal we have a n o pportunity to replenish o ur bo di e s wi th cr itical nutr ie n t s w hi le e nj o ying satisf yi n g f lavors. Good nutrition k e e p s us alert and productive t h ro ughout the day and helps u s f e nd off disease down the ro a d . For those of us who deal w i t h pain on a regular basis,
feeding t h e b o d y w h a t i t n e e d s is one m o re w a y w e c a n t a k e a proacti v e s t e p t o w a r d h e a l i n g . Q: Tell u s a b o u t y o u r w o r k . Why are y o u p a s s i o n a t e a b o u t nutritio n ? A: I lov e h o w e v e r y p e r s o n c a n relate t o n u t r i t i o n i n h i s o r her ow n w a y. L e t ’s f a c e i t : w e all hav e t o e a t ! F ro m c h ro n i c dieters t o p re g n a n t w o m e n t o patient s w i t h c e l i a c d i s e a s e , every c l i e n t i s d i ff e re n t , b u t they al l w a n t t o f i g u re o u t h o w to mak e h e a l t h y c h a n g e s w o r k within t h e i r l i f e s t y l e . I t i s v e r y rewardi n g , I c a n h e l p g u i d e people t o w a r d c h a n g e i n a way th a t a c t u a l l y w o r k s . M o s t people k n o w, g e n e r a l l y, w h a t to do; i t ’s h o w t o d o i t t h a t i s the cha l l e n g e . Q: Wha t p h y s i c a l d i ff e re n c e s can p eo p l e s e e by c h a n ging the i r d i e t f o r t h e b e t t e r - b oth sh o rt a n d l o n g - t e rm ? Ho w
S cottsdale-based nutritionist Megan McNamee MPH, RD.
could these help those living with pain? A: Many of my clients report improved energy levels, better sleep, and stabilized hunger levels within the first few w e e k s o f n u t r i t i o n t h e r a p y.
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September 2011
Long-term, clients notice i m p r o v e d s k i n a n d h a i r, p o t e n tial weight loss, and better digestion. Of course, each clie n t ’s n e e d s a n d e x p e r i e n c e s are individual, and clients with pain may experience a change in symptoms depending on their situation. Some people manage pain with food, as a type of emotional eating. I help these clients understand their motives for eating and why they choose certain foods, and then we work together to come up with alternative coping mechanisms. Q : I f you could recommend o ne li fe style c han ge in relat i o n to diet and nutrition for A me r i c ans, what would it b e? A: Most of us drink too much s o d a , d i e t o r r e g u l a r. A l l s o d a depletes the body of essential minerals and may lead to bone loss and tooth enamel erosion. Regular soda, most commonly sweetened with high fructose corn syrup, leads to blood sugar and insulin spikes that may cause excess weight gain and disease progression. Diet soda, though calorie-free, causes many people to crave the sweetness they’re not getting from
t h e a r t i f i c i a l s w e e t e n e r. I r e c ommend my clients switch to unsweetened iced or hot tea, lightly sweetened with stevia o r h o n e y, a n d i n c r e a s e t h e i r c o n s u m p t i o n o f f i l t e r e d w a t e r. W h e n n e c e s s a r y, a d d a l i t t l e bit of 100% juice, cucumbers, or citrus slices for a kick of f l a v o r. Q: Wha t w o u l d y o u l i k e Americ a n s t o b e t h i n k i n g o f , nutr ition a l l y? A: Most t h i n k t h e y h a v e t o count c a l o r i e s o r g o o n a restrict i v e e a t i n g p l a n i n o r d e r to lose w e i g h t . Wh i l e re s t ri c tive ea t i n g m i g h t l e a d t o t e mporary w e i g h t l o s s , i t u s u a l l y causes w e i g h t g a i n w i t h t i m e becaus e i t c a u s e s d e p r i v a t i o n , and thu s b i n g i n g – w h i c h s l o w s the me t a b o l i s m . T h e b e s t w a y to find a w e i g h t t h a t ’s r i g h t for you r b o d y i s t o e a t w h e n you’re h u n g r y, s t o p w h e n you’re s a t i s f i e d o r c o m f o r t a b l y full, pa y a t t e n t i o n t o f o o d a s you ea t a n d s a v o r e a c h b i t e , and ea t f o o d s y o u t r u l y e n j o y. This ph i l o s o p h y, o t h e r w i s e known a s i n t u i t i v e e a t i n g , h a s helped m a n y g e t o ff o f t h e d i e t ro ller c o a s t e r fo r g o o d . Q: Wha t a d v i c e w o u l d y o u g i v e to thos e w h o a re i n p a i n a n d
a re i n t e re s t e d i n c ha n g i n g t h e i r d i e t s fo r t h e b et t er ? A : Pa i n c a n b e d i s t ra c t i n g a n d a l l - c o n s u m i n g . I t c a n a ff e c t our eating habits when we use food to self-soothe or when it zaps our motivation to shop fo r g ro c e ri e s a n d c ook f or ou rselves. Evaluate how pain a ff e c t s y o u r n u t r i t i o n . D o e s it cause you to avoid certain foods or eating situations? Do y o u t u r n t o f a s t f o od b e c a u s e y o u l a c k t h e e n e r g y t o p re p a re your own meals? Seek help f ro m a re g i s t e re d d i e t i t i a n t o learn ways to cope with how p a i n a ff e c t s y o u r l i fe . F i n d o n e a t w w w. e a t r i g h t . o r g . In general, all of us can be n e fi t fro m e a t i n g m ore v eg e t a b l e s a n d f r u i t s an d f e w e r re f i n e d g r a i n s a n d a d d e d s u g a rs . We u s u a l l y f e e l b e t t e r when we normalize our blood s u g a r a n d i n s u l i n re s p o n s e b y balancing carbohydrates, such a s g r a i n s , w i t h p ro t e i n a n d f a t , s u c h a s a l m o n d bu t ter. Fo r m o re i n f o r m a t i o n , contact McNamee – owner o f N u t r i t i o n Tra n s i t i o n s , L L C – a pr iva t e n u t r it ion co n s u l t in g c ompa n y a t w w w. F i n d Yo u r Tra n s i t i o n . c o m , o r M e g a n @ F i n d Yo u r Tra n s i t i o n . c o m
September 2011
SE PTEM BER COOKING
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Use modern innovations to escape the heat of the kitchen. These three, healthy, latesummer recipes are meant for the grill. So, invite your family outside, fire up the barbeque and enjoy a colorful meal prepared in the great outdoors.
SPANISH GRILLED VEGETABLES Ingredients: • 3 large red bell peppers -- seeded, quartered • 4 large Japanese eggplants -- cut lengthwise into 3 slices • 4 medium yellow zucchini -- cut lengthwise into 1/3-inch-thick slices • 8 tablespoons extra-virgin olive oil, divided • 2 garlic cloves, finely chopped • 1/2 teaspoon dried crushed red pepper • 1/2 cup Japanese breadcrumbs • 2 tablespoons red wine vinegar • 1/4 cup chopped fresh parsley • 1/4 cup parmasaen cheese • 2 tablespoons chopped fresh
oregano Directions: Heat the barbeque to medium. Place vegetables on baking sheet and brush with oil; season with salt and pepper. Grill until tender, turning and rearranging as necessary. Heat 3 tablespoons olive oil in medium skillet over medium heat. Add garlic and red pepper; stir about 30 seconds. Add breadcrumbs and cheese; stir until golden. Add vinegar to another bowl; add in 3 tablespoons oil, parsley and oregano. Arrange vegetables on platter. Spoon dressing over vegetables; sprinkle with breadcrumbs and cheese.
GRILLED LEMON SALMON Ingredients: • 6 lemons, thinly sliced into rounds • 1 3-pound center-cut salmon fillet with skin • Coarse kosher salt • Olive oil (for drizzling) • Garlic salt • Freshly ground pepper Directions: Place fish skin side down on a large piece of aluminum foil. Arrange cut
lemons on top and around of filet of fish. Sprinkle with oil, salt and pepper. Gather sides of aluminum foil to create a pouch – add more if necessary. Place fish pouch on the grill – heated to medium. Cook for 9 minutes without opening the pouch. Remove from heat. With a fork, carefully check the fish. Sprinkle with a bit more oil and serve immediately.
GRILLED TROPICAL FRUIT •
Ingredients: 8 bamboo skewers, soaked in water for 4 hours • 4 bananas (in the peel), cut into 2-inch chunks • 1 fresh pineapple, peeled, cut into 2-inch chunks • 1/3 cup cane syrup • Zest and juice of 1/2 lemon Directions: Place fruit on skewers. In a small bowl, add lemon juice and zest to cane syrup. Brush the skewered fruit with the syrup and place on the grill. These should cook within 3 minutes on each side. Once removed from the grill, brush again. Enjoy warm!
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September 2011
CO NS ERVATIVE CH IR OP RACTI C M ET HODS % \ 'U & KD QF H 0RRUH '& People feel strongly about chiropractic care – both positively and negatively. As the chiropractic profession has evolved, this form of care has been widely accepted in the medical community because of its effectiveness and safety in treating pain. More than ever, patients are coming to chiropractors to seek relief from pain. C h i ro practic is a healthcare pro f essi o n that focuses on dis o r d ers o f the  ne u romusculosk ele tal syste m ; moder n chi ro pr a c t o r s u s e t he best sci ent i f i c , no n-drug related treatm e n t s to treat m uscles and j o i nt s . Chiropractic care is u s e d most commonly to treat l o w back pain, neck pain, pain i n t he j o i nts o f th e should e r s , knees and hips, and he a d a c he s. Doctors of chiropractic earn a health degree: doctor of chiropractic (D.C.) and are referred to as chiropractors
or as chiropractic physicians. In Arizona, chiropractors practice a drug-free, handson approach to healthcare that includes patient examination, diagnosis and treatment, but excludes prescription medication. Chiropractors have broad diagnostic skills and can have advanced board certifications in physiotherapy rehabilitative exercises and treatment modalities, as well as acupuncture and other eastern modalities. Chiropractors are well trained to provide nutritional, dietary and lifestyle counseling in relation to symptoms as well. The mo s t c o m m o n t y p e o f treatme n t p e r f o r m e d b y doctors o f c h i ro p r a c t i c i s known a s “ s p i n a l m a n i p u l ation,� – a l s o c a l l e d “ c h i ro p ra ctic adju s t m e n t .�  T h e p u r p o s e of man i p u l a t i o n i s t o re s t o re joint m o b i l i t y b y m a n u a l l y applyin g a c o n t ro l l e d f o rc e into joi n t s t h a t h a v e b e c o m e restrict e d w i t h t h e h a n d s o r
use of specific tools. When y o u r v e r t e b r a e a re a d j u s t e d , t i n y p o c k e t s o f g a s a re re l e a s e d fro m t h e j oin ts, some times making a popping noise. This is the same sound heard when knuckles crack. Wh e n v e rt e bra e be c om e m is a l i g n e d , t h e y c a n p l a ce pres s u re o n t h e s p i n a l n e r v e s a n d cause pain. This condition is known as spinal dysfunction, v e rt e bra l re s t ri c t i o n or s u b l u x a t i o n . T h i s c a n oc c u r a s a re s u l t o f a t i s s u e i n j u r y c a u s e d by a single traumatic event, s u c h a s i m p ro p e r l i f t i n g o f a h e a v y o bj e c t , o r t h rou g h repet i t i v e s t re s s e s s u c h a s s i t t i n g w i t h p o o r s p i n a l p o s t u re f o r an extended period of time. These type of injuries to the j o i n t s a n d s u r ro u n d i n g m u s c l e s c a u s e p h ys i c a l a n d ch em ic a l c h a n g e s t h a t c a n re s u l t i n i n fl a m m a t i o n , p a i n , a n d d im in ished function for the patient. M a n i p u l a t i o n o f t h e a ff e c t e d j o i n t a n d t i s s u e s re s t o re s m o b i l i t y, t h e re b y a l l e v i a t i n g p a i n a n d m u s c l e t i gh t n e s s a n d a l l o w i n g t i s s u e s t o h ea l . C a re fu l h i s t o ry t a k i n g , or t h op e d i c a n d n e u ro l o g ic a l t e s t i n g a re s t a n d a r d s o f p r a c t i c e i n c h i ro p ra c t i c o ffi c e s . T h i s h e l p s t o d e t e r m i n e i f c h i ro p r a c t i c
September 2011
c a re is appropriate and to rule o u t more serious diagnoses li k e canc e r o r fractures. Based upo n the e xam , p ossib le addit i o n a l imaging may be ordered suc h as X-rays or MRI. If there are unusual ne urological f ind i n g s with advanced loss of st reng th o r re fle xes, the chiro p r a ctor will refer the patient t o a spine surgeon or pain m a n agement specialist prior to i n i t i a ting chiropractic care. M o s t patients do n’t realize r i s ks asso c i ate d with chiro p r a c t ic care are far safer than t h o s e associated with the m o st c o m m o n o ver-the-count er no nste ro i dal anti-inf lam m a t o ry drugs (NSAIDS) like ( A D V IL) ibuprofen and (ALEVE) napro xe n. According to a study f ro m the American Journal of G a s t ro e nte ro lo g y, ap p rox im at ely o ne -thi rd of all hosp i t a l i z ations and d eaths related t o g a strointestinal bleeding c a n be attributed to the use o f aspi ri n, o r N SA ID p ainkill e r s. Chi ro prac ti c is widely reco g n i zed as one of the safest no n-i nvasi v e the r ap ies availab l e f o r the tre atment of neu ro m u sculoskeletal complaints. C h i ro practic has an excellent s a f e t y record, but almost all t re a t ments have the potential f o r a dverse effects. The risks
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Chiropractic is a healthcare profession that focuses on disorders of the neuromusculoskeletal system.
associa t e d w i t h c h i ro p r a c t i c , howeve r, a re v e r y s m a l l . M a n y patient s f e e l i m m e d i a t e re l i e f f ollowi n g c h i ro p ra c t i c t re a tment, b u t s o m e m a y e x p e rience m i l d s o re n e s s o r a c h i n g , just as t h e y d o a f t e r s o m e forms o f e x e rc i s e . C u r re n t researc h s h o w s i f p a t i e n t s experie n c e m i n o r d i s c o m f o r t or sore n e s s f o l l o w i n g s p i n a l manipu l a t i o n i t t y p i c a l l y f a d e s within 2 4 h o u r s .  Neck manipulation is a remarkably safe procedure. While some reports have associated upper high-velocity neck manipulation with a certain kind of stroke, or vertebral artery dissection, recent evidence suggests that this type of arterial injury often takes place spontaneously, or following everyday activities such as turning the head while driving, swimming, or having a shampoo in a hair salon. Patients with this condition experience neck pain
and headache that leads them to seek professional care at the office of a doctor of chiropractic or family physician. However, the care provided is not the cause of the injury. The best evidence indicates that the incidence of artery injuries associated with high-velocity upper neck manipulation is extremely rare, about 1 case in 5.85 million manipulations. When compared to the risks associated with over the counter NSAIDs, any risk associated with chiropractic care is far safer than common OTC NSAIDs. C h i ro p r a c t i c c a re c an p ro v i d e immediate and long-term re l i e f , w i t h f e w e r k n o w n s i d e e ffe c t s t h a n bo t h p h a r m a ceu tical and invasive options for p a i n c a re . Fo r m o re in f orm a t i o n a b o u t c h i ro p r a c t i c c a re a n d a l i s t o f d o c t o rs of ch i ro p r a c t i c n a t i o n a l l y, v i s i t t h e A m e r i c a n C h i ro p r a c t i c As s o c i a t i o n : w w w.a ca t od a y. or g
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FIGHTING FIRE WITH FIRE O ne of the most commonly used and well-known easter n treatments recognized today is acupuncture.
Patients S ee Re l i e f from Pain W h e re Easter n and Wester n Me d icine Col l id e % \ - H Q Q L IH U * L WW C h ro n i c p a i n i s a c o n d ition medical experts have b e e n t re a t i n g f o r c en t u r i e s . T h o u s a n d s o f m e t h o d s a re u s e d t o d a y, i n c l u d i n g t h o s e s t e m m i n g fro m e a s t er n m od a li t i e s . Ea s t e rn m o d a l it y t rea tm e n t s w e re c re a t e d w i t h ancient theories of traditional C h i n e s e m e d i c i n e ( TC M ) i n mind. They closely follow the belief that pain and illness a re c a u s e d b y a n i m b a l a n c e i n the normal state and flow of e n e r g y i n t h e b o d y. O n e o f t h e m o s t c o m m o n l y u s ed a n d w el l k n o w n e a s t e rn t re a t m en t s reco g n i z e d t o d a y i s a c u p u n c t u re . TC M t a k e s a h o l i s t i c a p p ro a c h i n h e a l i n g t h e h u m a n b o d y. Those who use this type of m e d i c i n e s e a rc h t o t re a t t h e ro o t o f t h e c a u s e , n o t j u s t the symptoms of an illness. C u r re n t l y re c o g n i z e d b y s o m e private health insurance
September 2011
c o m p anies, acupuncture has b ec om e an addi tional treatm e n t o pti o n fo r p atients suff er i n g wi th c hro nic p ain. L i ce n s e d ac upunctur ists typ ic a l l y perform this procedure u s i n g small needles placed at s p e c ific points on the skin. T h e u lti m ate g o al of the treatm e n t is to restore energy, or c h i . Chi is best described as a f o c us of energy; there are k e y points where this energy c a n best be manipulated. It is b eli e ve d thi s e as ter n modali t y c hannels energy to the p o i n ts where the needles are p l a c e d in order to restore the b o d y ’s natural healthy state. T h i s returns the normal flow of e n er gy thro ug ho ut the b ody. A cupunc ture tak es a non-inva s i v e and drug-free approach to he a l i n g the bo dy. In addition, i t i s a safe procedure, with f e w r isks involve d. While some p a t i e nts may experience slight b r ui si ng o r supe rf icial b leedi n g a t the needle insertion s i t e , many leave the treatment f e e l i ng relaxed. Each session l a s t s approximately one hour. M o s t patients report it to be a pai n f re e pro c e ss . There are many medical techniques used today that
originated from TCM. In this practice, it is strongly believed chronic pain and illnesses are the caused by the body’s flow of energy. If energy is “blocked,” both body and spirit suffer in a number of ways. Eastern p r a c t i c e s h a v e b e e n used to h e l p w i t h n u m e ro u s typ es o f c h ro n i c p a i n i n c l u ding: ba c k p a i n , m i g r a i n e , depres s i o n , a n d a b d o m i n a l p ain. Th e s e t re a t m e n t m o d a lities ca n i n c l u d e , b u t a re n o t limited t o : • Cu p p i n g • Refl e x o l o g y • A cu p re s s u re • Gu a S h a Cup p in g Cuppin g i s a c o m m o n l y u s e d treatme n t t o a s s i s t i n t h e healing p ro c e s s fo r re s p i ra tory pro b l e m s a n d t h e c o m m o n cold. U s e d a l o n g s i d e o t h e r treatme n t s , s u c h a s m a s s a g e and chi ro p r a c t i c c a re , c u p p i n g is cons i d e re d a n e ff e c t i v e w a y to stim u l a t e c i rc u l a t i o n a n d release t e n s i o n . T h i s m o d a l i t y is also u s e d o n p o s t - s u r g i c a l patient s t o re g e n e r a t e b l o o d f low f ro m o p e ra t i v e a re a . Glass, b a m b o o , a n d p l a s t i c cups are m o s t re g u l a r l y u s e d f or trea t m e n t . C u p s a re f i r s t
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h e a t e d a n d p l a c e d in v a r i o u s places on the back. The heat a d d s p re s s u re , a l l o w i n g t h e skin to suction inside the cup. This combination of suction and heat opens up blood flow a n d i s b e l i e v e d t o cl e a r e n e r g y b l o c k a g e , re s t o r i n g t h e b o d y to a healthier state. Cupping i s a l s o m i n i m a l l y i nv a s i v e a n d said to feel much like pinching of the skin, or even similar to a h o t s t o n e m a s s a g e. Re fl e x o l o g y Widely known as a form of m a s s a g e , re f l e x o l o g y f o c u s e s primarily on the feet, and sometimes the hands, to ease a p a t i e n t ’s p a i n . T h i s pr a ctice follows the belief that t h e b o d y ’s e x t re m i t i e s h a r b o r s p e c i f i c re f l e x p o i n t s t h a t a re l i n k e d t o v a r i o us p a r t s o f t h e b o d y, s u c h a s o r g a n s a n d m u s c l e s . Re fl e x o l o g y t rea tment excites the nerves in a p a t i e n t ’s p a i n fu l a rea , in crea s ing blood flow and aiming to c u re t h e s o u rc e o f th e pa in . D r i n g t h i s t re a t m e n t , p re s s u re i s a p p l i e d t o p re c i s e re f l e x p o i n t s i n a n e ffo rt to a l l ev i ate pain. By exciting these key p o i n t s , TC M h a s s h o w n circ u l a t i o n c a n i m p ro v e w h i l e d e c re a s i n g p a i n fu l s y m pt o m s a n d i l l n e s s . Ty p i c a l l y,
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re f l e xology is used to help w i t h arthritis pain, back pain, he a d a c he s, ho rm onal imb ala n c e , and even menstrual pain. A d d i t ionally, the firm nature o f t h is massage therapy has sho wn to he lp th ose ex p er ienci n g h igh levels of stress. E a ch re fle xo lo g y treatment typi c a l l y lasts for one hour and p a t i e nts are encouraged to par t i c i pate i n c o ntinual treatm e n t se ssi o ns. A cupre ssure A cupre ssure has many similari t i e s to acupuncture, however, t h e re are no needles involved w i t h this eastern modality. S i mi lar to re fle xology, acup res s u re treatment is a deep tissue m a s s age using fingers to apply f i r m pressure on key trigger p o i n ts. This treatment follows t h e s ame teachings as TCM. It t o o i s thought to regulate the e n e r gy flow through the body t o re store patien ts to their nat u r al, he althy s tate. Pa t ie n t’s who use this treatm e n t for chronic pain often f i n d that it reduces stress and t ensi o n i n the m uscles. In ad d i t io n, ac upre s sure emp hasi z e s c o m fo rt. Continual acu p re s s ure treatme nt often s o o t hes and calms patients
while th e ra p i s t s fo c u s o n p roviding t h e i r p a t i e n t s w i t h comf ort a n d g o o d h e a l t h . Gua Sh a Gua sh a i s a n a n c i e n t e a s t e r n modali t y t h a t i s u s e d f o r t h e treatme n t o f c h ro n i c a n d a c u t e pain, in f e c t i o u s i l l n e s s , a n d resp i r a t o ry a n d d i g e s t i v e p ro blems. Th i s s p e c i a l i z e d p ro c edure is c o m m o n l y p e r f o r m e d t o promot e n o r m a l c i rc u l a t i o n a n d metabo l i c r a t e s . When b ro k e n d o w n , t h e term gu a m e a n s t o s c r a p e o r scr atch , w h i l e s h a i s t h e i m p l ication o f re d - t o n e d , e l e v a t e d skin r a s h . T h e re a re m a n y method s u s e d t o re l e a s e s h a , however g u a s h a i s m o s t c o mmonly u s e d , a s i t i s k n o w n t o be one o f t h e m o s t e ff e c t i v e releasin g t e c h n i q u e s . When p a t i e n t s u s e g u a s h a a s a treat m e n t , t h e y c a n e x p e c t to feel i m m e d i a t e re l i e f a n d comf ort . T h i s p ro c e d u re i s typ icall y p e rfo rm e d by a c u p unctu ri s t s , m a s s a g e t h e rap ists, a n d p h ys i c a l t h e rap ists. A ro u n d - e d g e d i n s t rument w i l l b e u s e d a l o n g w i t h the app l i c a t i o n o f o i l o n t h e skin. Th e ro u n d - e d g e d t o o l i s then pre s s e d o n t o t h e s k i n a n d moved b a c k a n d f o r t h – m u c h
l i k e a s c ra p i n g m o t ion – crea t i n g fri c t i o n a s a c ou n t er a c t i v e t h e ra p y. Fo l l o w i n g t rea tment, patients can expect to h a v e re d d o t s o n t he s k i n , o f t e n re s e m b l i n g b r u i s i n g o r r u g b u r n . N o t t o w o r r y, t h o u g h , this rash is short lasting and fades within 2-3 days after t re a t m e n t . While the ultimate goal is to p ro v i d e c o m f o r t a n d re s t o re h e a l t h , t h i s t e c h n i q u e ca n a l l eviate, or even rid, internal bl o o d c o n g e s t i o n a n d in f l a m m a t i o n . Gu a s h a c l ea r s s t a gnant blood at the surface of t h e s k i n . T h i s p ro c e d u re i s n o t re c o m m e n d e d f o r p a t i e n t s with new injuries, but can be used if the pain lingers after healing. There are a number of eastern modalities used today that have been passed down through the generations of TCM. Many are now being used in conjunction with western medicine and are recognized treatment options in medical practices and covered by health insurance providers. Whether it is acupuncture, gua sha or cupping – a combination of eastern and western medicine may be the answer to solving your chronic pain condition.
September 2011
PAIN Q&A Wh a t i s Car pal Tunnel Syndrome? % \ 5\D Q & RRS H U C a r p al tunnel syndrome (CTS) i s a common cau se for pain, n u m bness and tingling in the hand , c ause d by comp ression of the median nerve as it travels through the wrist 1,2,3 . A p p roximately 15 of every 1 00, 000 i ndi vi dua ls will ex p er ie n c e CTS per yea r, with women
being a t l e a s t t w i c e a s l i k e l y to b e a ffe c t e d a s m e n 1 . Pain, n u m b n e s s a n d t i n g l i n g usually o c c u r o n t h e p a l m a n d palmar s i d e o f t h e f i r s t t h re e f inger s fro m t h e t h u m b; w e a kness ca n o c c u r i n t h e t h u m b and ad j a c e n t fi n g e rs 1 , 2 . T h e s e
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s y m p t o m s a re d e p e n d e n t u p o n the position of the wrist, but u s u a l l y o c c u r a t n i gh t a n d m a y radiate up the arm as far as t h e s h o u l d e r. O t h e r s y m p t o m s c a n i n c l u d e d e c re a s ed d ex t eri t y, a w e a k g r i p , a t ro p h y o f m u s c l e s i n t h e h a n d , a n d f eeli n g s o f h a n d s w e l l i n g 1,3. C o m m o n c a u s e s a n d pred is pos i n g fa c t o rs fo r C T S in cl u d e 1 , 2 : • Re p e t i t i v e s t ra i n a n d prolonged flexion/extension o f t h e w r i s t , n o ta b l y f ro m activities such as driving, re a d i n g , t y p i n g , a n d
Car pal tunnel syndrome (CTS) is a common cause for pain, numbness and tingling in the hand, caused by compression of the median ner ve as it travels through the wrist.
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ho ldi ng a te lep hone R he um ato i d ar thr itis D iabe te s Wr i st f r ac t u re and asso ciate d swe lli ng P re g nanc y/ o ral contr acept i ve use leadi ng to swelling i n the li m bs U nderlying nerve d ysfunc ti o ns
D iag no si s and Tre a tm e nt D i a g nosis of CTS is performed b y a doctor and is based on t h e a bo v e sym ptoms 1 . A p hys i c i a n may perform a variety of physi c al m aneuver s and/ o r n erve conduct ion studies to co nf i r m the di ag n osis 2 , 3 . T h e goals of treatment are to re d u ce pain, numbness and t i n g l ing and prevent loss of m o t or func ti o n/ disab ility 1 , 3 . Tre a t m e n t o p t i o n s are p lent i f u l , but depend upon the s e v e rity of CTS and patient pre f e re nc e 2 . Mo st mild to mod e r a t e cases of CTS can be e ff e c tively managed with a c o m b ination of conservative t reat me nts whi c h include 1 , 2 , 3 : •
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M inimizing contributory f actors such as repetitive u se/strain Wrist splinting helps keep t h e wri st i n a neutr al p osit i on, limiting prolonged
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ex te n s i o n / fl e x i o n Gluc o c o r t i c o i d s ( s t e ro i d s ) can b e t a k e n o r a l l y o r inje c t e d i n t o t h e c a r p a l tunn e l t o re d u c e i n fl a m m ation a n d c o m p re s s i o n Dee p , p u l s e d u l t r a s o u n d can b e u s e d t o d e c re a s e pain a n d p ro m o t e s o f t tiss u e h e a l i n g Yoga h a s b e e n s h o w n t o b e eff ec t i v e fo r p a i n c o n t ro l
Fo r s y m p t o m s t h a t d o n o t improve with conservative treatment within 6 months, the definitive treatment for m o d e r a t e o r s e v e r e C T S i s s u rgical decompression of the m e d i a n n e r v e . S u r g i c a l i n t e rvention is generally more e ff e c t i v e t h a n c o n s e r v a t i v e treatments with improvement in approximately 85-90% of c a s e s 1 , 2 . S u r g e r y c a n b e p e rformed via open incision or e n d o s c o p i c a l l y 1,3: •
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An op e n re l e a s e i s p e rf or me d v i a s t a n d a rd i n c ision u n d e r l o c a l a n e s t h e s i a , and a l l o w s a s u r g e o n t h e b est v i e w An endoscopic release is performed with scopes and surgical tools through one or two small openings, and can result in less scar tissue
and post-operative pain The prognosis for CTS is good, although a minority of patients, particularly those with advanced CTS, may fail t o i m p r o v e a f t e r s u r g e r y 1. A d d i t i o n a l l y, s c a r r i n g p o s t s u r g e r y c a n l e a d t o a r e c u rrence of symptoms several m o n t h s o r y e a r s l a t e r. T h e best way to treat CTS is to prevent it altogether by minimizing the aggravating and repetitive tasks previously discussed and keeping wrists in a neutral position as often a s p o s s i b l e 1. Ref eren c es 1 S c h e r g e r, J . E . ; e t a l . ( 2 0 0 7 ) . Carpal tunnel syndrome. First Consult. MD Consult Web site, Core Collection. Retrieved from h t t p : // w w w. m d c o n s u l t . c o m . e z p r o x y 2 . l i b ra r y. a r i z o n a . e d u / das/pdxmd/body/2697371553/0?type=med&eid=9-u1.0-_1_ mt_1014449. 2 Sc ot t , K .R.; K o t h a r i , M . J . ( 2 0 1 1 ) . Tre a t m e n t o f c a r p a l t u n n e l s y n d ro m e . I n : U p To D a t e , B a s o w, D S ( E d ) , U pToD a t e, W a l t h a m, MA . 3 Hu n t er, A .A .; S i m m o n s , B . P. ( 2 0 1 0 ) . S u r g e r y f o r c a r p a l t u n n e l s y n d ro m e . I n : U p To D a t e , B a s o w, D S ( E d ) , U pToD a t e, W a l t h a m, MA .
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