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
