Treatment of Chronic Pain, Modalities, & Alternative Medicine Flashcards
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
Complementary Alternative Medicine (CAM)
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
Functional medicine
What is the largest organ in the body and the area in which acupuncture is thought to work?
Interstitium
T/F: Licensed physicians in the states of MO or TX can perform acupuncture without any further licensure
True
T/F: acupuncture carries a high risk of infection and other complications
False — complications are rare and this procedure is considered low risk
_______ 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.
Nixall
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.
Glucosamine; chondroitin sulfate
_______ 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
Yoga
What conditions are improved through use of relaxation techniques such as diaphragmatic breathing, guided imagery, mindfulness meditation, and progressive muscle relaxation
Tension headache frequency and headache disability
LBP
Improvement in scores of pain intensity, activity interference, physical symptoms, anxiety, and depression
Slow low-impact systemic motion and gentle breathing exercises proven to help balance in elderly as well as increases pain threshold
Tai chi
_______ medicine has the potential to heal or replace tissues and organs damaged by age, disease, or trauma, as well as to normalize congenital defects
Regenerative
3 primary treatment modalities of regenerative medicine
Prolotherapy (formerly sclerotherapy)
Platelet-rich plasma (PRP)
Stem cell therapy
Long-term solution that repairs weak/painful joint/ligamentous areas that works by raising growth factor levels and promotes tissue repair/growth
Prolotherapy
Prolotherapy is indicated for MSK pain for what duration of symptoms?
> 8 weeks
Indications for prolotherapy
LBP Sciatica Disc disease Neck pain Headaches Chronic sprains/strains Joint pain Instability Golfer’s/tennis elbow Knee pain Chronic tendonitis Whiplash injuries
Should prolotherapy be considered BEFORE or AFTER surgery?
BEFORE!
What is the basic premise of prolotherapy?
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!
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
Sclerotherapy
MOA of prolotherapy
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
Appropriate candidate criteria for prolotherapy
- Appropriate medical problem
- Desire for recovery
- No underlying medical conditions which would significantly interfere with healing
- Ability and willingness to follow instructions
- Willingness to report progress
- 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]
T/F: MRIs can be misleading, so it is important to always correlate imaging results to the patient
True
Chronic tendonitis is not from inflammation but from collagen degeneration, thus ______ is a new term to describe this process
Tendonosis
T/F: Traditional NSAIDs and corticosteroids are first-line treatments for pain
False — traditional NSAIDs and corticosteroids have been shown to hinder healing
With prolotherapy, a tendonois is intentionally turned into a _______ to stimulate the repair process again
Tendonitis
What percentage of LBP is due to a herniated disc?
4%
What did the Hackett study show regarding effect of prolotherapy on LBP?
Statistically significant decrease in pain and disability
82% of pts considered themselves “cured” up to 12 years f/u
2 primary factors in development of disc herniation
Increased deteriorating disc pressure
Increased ligamentous laxity
4 stages of disc herniation
- Degeneration
- Prolapse
- Extrusion
- Sequestration
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
Prolotherapy
What is the most common cause of sciatica, even in cases with numbness?
Ligamentous laxity in SI joint
What did the Merriman study show regarding prolotherapy vs. fusion for sciatic pain?
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
Osteoarthritis almost always begins as ______ weakness
Ligament
_____ law = bones respond to stress by making new bone
Wolff’s
T/F: prolotherapy successfully treats meniscal tears when also treating supporting ligaments
True
Prolotherapy may help in cartilage regeneration due to its ability to raise ____ _____ levels
Growth factor
How does prolotherapy affect pain med usage?
90% of pts on pain meds prior to treatment were able to decrease pain med usage by >50%
