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PCM IV Exam II > Treatment of Chronic Pain, Modalities, & Alternative Medicine > Flashcards

Treatment of Chronic Pain, Modalities, & Alternative Medicine Flashcards

1
Q

Type of medical practice that combines integrative and functional medicine and operates on a philosophy that neither rejects conventional medicine nor accepts alternative therapies uncritically

A

Complementary Alternative Medicine (CAM)

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2
Q

Style of medicine that operates on systems biology-based approach, focusing on identifying and addressing the root cause of disease, looks at individual’s genes, environment, and lifestyle, attention to timelines, and involves in-depth interviews

A

Functional medicine

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3
Q

What is the largest organ in the body and the area in which acupuncture is thought to work?

A

Interstitium

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4
Q

T/F: Licensed physicians in the states of MO or TX can perform acupuncture without any further licensure

A

True

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5
Q

T/F: acupuncture carries a high risk of infection and other complications

A

False — complications are rare and this procedure is considered low risk

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6
Q

_______ kills bacteria, mold, and viruses at 200 ppm, and when full strength at 500 ppm can kill C.diff. It is used by interventional cardiology as well.

A

Nixall

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7
Q

Use of _____ and ______ has conflicting evidence regarding efficacy for reduction in back and knee pain, decreased joint space narrowing, etc. but needs to be taken for months to show benefit. However, risk is low.

A

Glucosamine; chondroitin sulfate

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8
Q

_______ is a natural therapeutic intervention that has shown significant benefit in treatment of LBP, OA, headaches, endometriosis, and fibromyalgia, but the issue is that there are many different types and some types do not show improvement

A

Yoga

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9
Q

What conditions are improved through use of relaxation techniques such as diaphragmatic breathing, guided imagery, mindfulness meditation, and progressive muscle relaxation

A

Tension headache frequency and headache disability

LBP

Improvement in scores of pain intensity, activity interference, physical symptoms, anxiety, and depression

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10
Q

Slow low-impact systemic motion and gentle breathing exercises proven to help balance in elderly as well as increases pain threshold

A

Tai chi

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11
Q

_______ medicine has the potential to heal or replace tissues and organs damaged by age, disease, or trauma, as well as to normalize congenital defects

A

Regenerative

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12
Q

3 primary treatment modalities of regenerative medicine

A

Prolotherapy (formerly sclerotherapy)

Platelet-rich plasma (PRP)

Stem cell therapy

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13
Q

Long-term solution that repairs weak/painful joint/ligamentous areas that works by raising growth factor levels and promotes tissue repair/growth

A

Prolotherapy

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14
Q

Prolotherapy is indicated for MSK pain for what duration of symptoms?

A

> 8 weeks

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15
Q

Indications for prolotherapy

A 
LBP
Sciatica
Disc disease
Neck pain
Headaches
Chronic sprains/strains
Joint pain
Instability
Golfer’s/tennis elbow
Knee pain
Chronic tendonitis
Whiplash injuries
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16
Q

Should prolotherapy be considered BEFORE or AFTER surgery?

A

BEFORE!

17
Q

What is the basic premise of prolotherapy?

A

Chronic MSK pain based on inadequate repair of fibrous CT, resulting in ligament and tendon weakness or laxity (CT insufficiency)

Ligament and tendons have poor blood supply and take longer to heal

Incomplete healing is common

Estimated best repair result will repair CT length to normal but tensile strength is 50-60% of pre-injury state

When tissue is weak, cannot function to support fully and stimulates pain in mechanoreceptors

Chronic pain will continue with use unless structure is restored — this is the basis of prolotherapy!

18
Q

Older, inaccurate term for prolotherapy based on original theory that scar formation was the treatment mechanism; biopsy studies have not shown scar formation but instead show new, normal, thicker, stronger CT after injection

A

Sclerotherapy

19
Q

MOA of prolotherapy

A

Works by causing temporary, low-grade inflammation at site of ligament or tendon weakness

Stimulates new healing cascade

Inflammation activates fibroblasts

Inflammation raises GF levels + fibroblasts = new CT repair

20
Q

Appropriate candidate criteria for prolotherapy

A
  1. Appropriate medical problem
  2. Desire for recovery
  3. No underlying medical conditions which would significantly interfere with healing
  4. Ability and willingness to follow instructions
  5. Willingness to report progress
  6. Willingness to receive painful injections in an effort to recover from injury

[Also ideally pt should not have immunodeficiency, active cancer, systemic steroids/immune suppressants, or NSAIDs]

21
Q

T/F: MRIs can be misleading, so it is important to always correlate imaging results to the patient

A

True

22
Q

Chronic tendonitis is not from inflammation but from collagen degeneration, thus ______ is a new term to describe this process

A

Tendonosis

23
Q

T/F: Traditional NSAIDs and corticosteroids are first-line treatments for pain

A

False — traditional NSAIDs and corticosteroids have been shown to hinder healing

24
Q

With prolotherapy, a tendonois is intentionally turned into a _______ to stimulate the repair process again

A

Tendonitis

25
Q

What percentage of LBP is due to a herniated disc?

A

4%

26
Q

What did the Hackett study show regarding effect of prolotherapy on LBP?

A

Statistically significant decrease in pain and disability

82% of pts considered themselves “cured” up to 12 years f/u

27
Q

2 primary factors in development of disc herniation

A

Increased deteriorating disc pressure

Increased ligamentous laxity

28
Q

4 stages of disc herniation

A
  1. Degeneration
  2. Prolapse
  3. Extrusion
  4. Sequestration
29
Q

With spinal disc disease, weakened ligaments lead to a predisposition to further injury. A change in biomechanics from weak ligaments contributes to osteoarthritis. _______ can help stabilize and strengthen the ligaments around weakened joints and reduce or eliminate pain

A

Prolotherapy

30
Q

What is the most common cause of sciatica, even in cases with numbness?

A

Ligamentous laxity in SI joint

31
Q

What did the Merriman study show regarding prolotherapy vs. fusion for sciatic pain?

A

Conservative tx by prolotherapy was successful in 80-90% of more than 15,000 pts treated with prolotherapy

Prolotherapy had far fewer side effects than with fusion

32
Q

Osteoarthritis almost always begins as ______ weakness

A

Ligament

33
Q

_____ law = bones respond to stress by making new bone

A

Wolff’s

34
Q

T/F: prolotherapy successfully treats meniscal tears when also treating supporting ligaments

A

True

35
Q

Prolotherapy may help in cartilage regeneration due to its ability to raise ____ _____ levels

A

Growth factor

36
Q

How does prolotherapy affect pain med usage?

A

90% of pts on pain meds prior to treatment were able to decrease pain med usage by >50%

PCM IV Exam II (11 decks)

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