To help you enhance your practice and increase your bottom line, Dynamic Chiropractic PracticeINSIGHTS asks practicing doctors of chiropractic, like you, for ideas and solutions that have been tested in real-world environments. In this issue, we asked: "What drug-free approach has been the most effective in addressing your patients pain? (not including an adjustment/manipulation)?"
Of all the questions we've asked, this was by far the one that received the most responses we've seen yet. This question seemed to hit a nerve and produced such varied responses that to incorporate them all in this article would be exhaustive. Instead, we pulled out the responses that we felt were most informative and included them in this summary.
Anti-Inflammation Remedies
As chiropractors, you face client pain complaints daily, and most of you have developed your own detailed treatment plan specific to the complaint. The majority of you mentioned some form of nutritional therapy to reduce inflammation, relieve pain and also prevent pain. Michael Berglund of Wisconsin summed it up with: "We all practice the art of chiropractic so we know what spinal and non-spinal manipulation does for pain. Most of us who do herbal/nutritional therapy know of the power of turmeric, boswelia and even fish oil as anti-inflammatory agents, but I was surprised that high dose quercetin (6-12 grams) was also very powerful in cases of chronic pain."
And while some responses were general, some of you were more specific and gave clear outlines of your treatment plans. For example, Cynthia Leeder of California gave five different plans, stating: "I use several different protocols.
1) If anyone calls in for treatment as a result of a recent accident, I always tell them to go to the health food store or come by the office and pick up some Traumeel (BHI-Heel) and start taking it. I tell them to take 1 tablet every 15 minutes for 3 hours then to cut back to 1 every hour for day 1; 1 every 2 hours on day 2 and 1 3x a day until they can get in to see me. I find homeopathics incredibly valuable for most muscle trauma.
"2) I also use another homeopathic by the same company called Spascupreel and it seems to work wonders on muscle spasms and cramps. These products can be ordered from Natural Partners in addition to ordering from BHI-Heel.
"3) I find turmeric really works wonders for pain in general. I have a product that has turmeric, ginger and bioflavonoids that people swear by. The nice thing about turmeric is that even though they are working on getting the inflammation out, it is also working on their brain; it has been shown to help with beginning stages of Alzheimer's.
"4) For severe pain, I have found a product called "Neprinol" from Arthur Andrew Medical that has serrapeptase and nattokinase that work wonders with nasty stuff - it also works on dissolving tumors - sadly it is very expensive too.
"5) I also make sure they are on an anti-inflammatory diet: no sugar, alcohol, gluten, dairy, preservatives, chemicals, high amounts of EPA/DHA, digestive enzymes. A chiropractic treatment that seems to work wonders is doing cranial adjustments."
Mark Baxter of Las Vegas also gave specific treatments for certain conditions. Baxter said: "For peripheral neuropathy, including diabetic neuropathy: Controlled-release Alpha Lipoic Acid 300 mg BID in conjunction with Acetyl-L-Carnitine 500 mg BID.
"For musculoskeletal pain: Something for muscle spasm that includes calcium, magnesium, valerian root, passaflora and hops. The calcium and magnesium should be in very absorbable forms (not carbonate or oxides) and the valerian and passaflora are GABA agonists, which help to relax the mind as well as the body and decrease the brain's PERCEPTION of pain. Keep in mind that chronic pain depletes Serotonin, GABA and Dopamine and other Catecholamines (which in turn amplify pain perception); so nutrients that address Serotonin (such as Tryptophan, 5HTP, and Vitamin D) and Dopamine & Catecholamines (amino acids phenylalanine and tyrosine, with co-factors such as folic acid or 5MTHF, vitamin B6 or Piridoxal-5-Phosphate, iron, copper and vitamin C).
"Anti-inflammatory nutrients are also extremely helpful for pain patients and should include a good, purified fish oil concentrate as a source of EPA, Vitamin D3, bioflavonoid, boswelia, curcumin and ginger. In addition, proteolytic enzymes taken on an empty stomach (as long as there are no stomach ulcers) can be of substantial benefit as well."
Terry Wiley of Colorado addresses pain conditions as well as common cold and flu symptoms using nutritional therapy along with the Loomis protocol. Wiley said: "Pain relief for sprains and strains and for immune response with colds, flu and other viral or bacterial stress has responded with protease enzymes. I find the plant enzymes are extremely helpful in building the patient's immune system and taking days off of the healing time or the time to run its course. The Loomis protocol is what I follow. Many times pain is referred from an organ or system under stress and that needs to be relieved first and the adjustments will perform much better when administered to the subluxation complex."
[pb]Topicals
While many of you named nutritional supplements as your remedies, others chose common topicals to relieve pain. Loreen Daigle of Connecticut said: "I have found Biofreeze to help before an adjustment when muscles are spasmed. A patient also found that Biofreeze rubbed into muscles that were cramping after standing a long time at work stopped it immediately. Remembering the old remedy of bromelain for the appropriate swelling and inflammation has been helpful for pain relief in a portion of patients."
David Weber of Illinois recently discovered therapeutic taping to be effective in treating pain. He said: "I have been using Kinesio Tex taping procedures for one year after taking the two weekend course. I have found it to be an invaluable aid in everything from edema reduction to reduction of muscle tension/spasm."
And Beverly Kerr of Indiana prefers the old-fashioned remedy of ice to treat a client's pain. Kerr said: "An ice pack applied to the area of pain has been the most effective drug-free method of pain relief in my 20 years of practice. I recommend 20 minutes per hour on the low back, and 15 minutes per hour for all other areas. For busy patients, I set a minimum of 3 times per day. I sell the 5"x10" gel-type ice packs for $3 each. I can purchase them from Scrip for around $1. I keep them in sight on a table in the adjusting room and also in the reception area. They sell themselves and are so easy to use that patients comply with the recommendations. After trying it, most patients are grateful to find such an inexpensive pain solution that has no bad side effects."
Alternative Methods
The integration of alternative methods such as acupuncture, laser therapy and electrical stimulation are quite common in chiropractic practice. And according to your responses, many of you refer to them for pain treatment. Douglas Kennedy of Colorado believes acupuncture is pain's best medicine. Kennedy said: "Best Pain Control: I use Deep Acupuncture every single day at work, and it is by far, the best thing I have ever used. Check out Dr. C. Chan Gunn's info on the internet: there is great science behind it!"
John L. Stump of Alabama, a long-time believer of acupuncture, also finds laser therapy useful. Stump said: "I have been teaching and using acupuncture for the past 35 years for pain control with very good success. The only thing that is any better at times is laser therapy in certain cases. Between these two modalities pain relief is only a few weeks away!"
J. Douglas Brown of Alabama gave his method of treatment for migraines using electrode pads. "By placing two electrode pads, one on each side of the axis close to the center, I have been 98 percent successful in stopping a migraine in progress. The treatment usually takes about 5 minutes. I use this technique for acute migraine." He cautions: "Always remember though, to ask if this is the first or the worst migraine the patient has ever had. If so, I suggest a stat MRI to rule out other causes (i.e. aneurysm, tumor or bleed)."
Physical Therapy
Glen Peterson of North Carolina uses strengthening exercises to address his client's pain issues. He states: "I have found that a great benefit to my patients for reducing pain in the cervical spine as well as upper thoracic pain and occipital and cervicogenic headaches is a combination use of the cervical posture pump and cervical strengthening exercises. Even patients that have had previous surgical intervention including but not limited to plate fusions with hardware, still respond very well to attempts to correct the normal cervical kyphosis. By bringing the chin back and re-introducing the cervical curve, much less impact of stressed and hypertonic cervical musculature causes neural involvement. Pressure at the disc level, even for a patient that has little or no disc material present at the site of pain still shows pain reduction by attempted correction of the cervical curve. I have found personally that my patients over the last 3-4 years have shown remarkable results with use of the posture pump with ongoing cervical exercise to include both retraction and extension."
Combination of Treatments
Many of you preferred to use a combination of those methods already mentioned. David Friedman of Arizona uses a combination of acupuncture, laser treatment and exercise to counter painful conditions. "We have used a cold laser instrument effectively for many conditions, in conjunction with the adjustments. We also use a non-needle acupuncture instrument and have good results with that, as well. We also prescribe specific exercises based on the patient's condition."
[pb]Ray Pendergraft of California states that while there are numerous options, he goes with his tride and true treatments. Pendergraft said: "Chiropractic is based on the idea that if the body works as naturally as possible, it will be as healthy and pain free as possible. We restore motion and this changes the master control system in a positive way. Besides this primary approach, additional help is often found in the dietary and home changes we use. While there are a million of these ideas good and bad, here are the ones I've used for over 30 years. For acute pain, the most consistent help comes from ice 20 minutes per hour on the area of pain. Turmeric 1800mg (95 percent curcumin) per day helps noticeably about half the time. This is anecdotal, but it's just food in a capsule. Omega 3 fish oil 2400mg per day of omega 3s NOT oil! It sounds like a lot, but again it is food in a capsule. I usually give them a two-day supply just to see if it helps before selling it to them. For more chronic pain including arthritis, regular stretching is essential. Glucosamine/chondroitin sulfate 1800 mg per day omega 3s 1200mg per day. Another anecdotal one is pomegranate juice 4oz per day. Again let's stress that it is food."
Karen Erickson of New York was the only response that included essential oils with her treatment plan. She briefly states: "Homeopathic Remedies: Traumeel and Zeel for soft tissue and joint pain respectively. Essential Oils applied topically: peppermint, wintergreen, clove, helichrsym. Supplements: containing ginger, turmeric, bioflavonoid, quercetin. Chinese Herbal Patches: that patients wear on painful area for 3 days."
Sinuses, Gluten-Sensitivity and Others
Responses that addressed conditions such as sinusitis and gluten-sensitivity were rare but should be mentioned. Christopher Wolcott of Chicago, the windy city, has remedies for addressing sinus irritation. He states: "The dry air of the winter months irritates the lining of the paranasal sinuses causing swelling, which sets the stage for sinus pain, congestion and potential infection. We focus on preventing infection by encouraging all our patients (particularly those prone to sinusitis) to utilize nasal irrigation followed by steam inhalation nightly before bed. From November through February we also encourage 5,000 IU D3, 25,000 IU beta-carotene, and daily probiotics all to bolster the immune system. Antibiotics for acute sinusitis appear to be relatively ineffective.1 Local and oral decongestants, while effective in the short-term, host several undesirable side effects including excitability, nervousness, insomnia, transient hypertension, heart palpitations, dizziness, nasal dryness, and rebound congestion.2 When a patient presents with sinus congestion, our treatment protocol consists of: hot moist packs over the frontal/maxillary sinuses with eucalyptus aromatherapy, followed by needle acupuncture or acupressure to local sinus points LI 20, ST 2-3, GB 14, and Yintang, followed by manual sinus percussion, and finally spinal manipulation of the upper thoracic and cervical spine. Patients love the results and often present specifically for this treatment. References: 1. Guarch Ibáñez B, Buñuel Álvarez JC, López Bermejo A, Mayol Canals L. [The role of antibiotics in acute sinusitis: a systematic review and meta analysis.]. An Pediatr (Barc). 2011 Jan 13. [Epub ahead of print] Spanish. PubMed PMID: 21237732. 2. www.drugs.com."
Proactive solutions such as incorporating a gluten-free diet will aid in mobility and pain relief, believes Craig Stellpflug of Arizona. Stellpflug said: "One word... GLUTEN! As a neurodevelopment specialist, I find that gluten interferes with leptin. Leptin is a hormone that does three main things in the human body. It tells the brain when the tummy is full. It signals fat cells to metabolize. And finally, leptin normalizes peripheral pain receptor sensation in the spine. I have found that in the vast majority of my Fibromyalgia patients that gluten sensitivity (not necessarily Celiac) is the biggest exacerbator of pain. In order to nail this bad-boy down it takes one committed patient to become a gluten Nazi. If a product doesn't say "gluten free" it probably has gluten injected in it somewhere. I recently found that one piece of Chicklet's gum a day contains enough gluten to send one of my autism patients to the time out corner in day care. Gluten is the most highly complex protein that the human digestive system comes in frequent contact with. It contains disulfide bonds like those found in rubber. So in conclusion, if you encounter the patient with elevated pain levels bordering psychosis, try a gluten free diet before referring them out to a pain specialist. After all... chiropractic care takes into consideration the whole patient and not just a part."
Higher Power
And finally, Don Schmolder of California was the only response to mention turning to a higher power for treatment. Schmolder said: "I have learned and grown into over 24 years of practice and at 49 years of age that personal prayer and prayer with patients takes pain to another level of tolerance and often acceptance if not total relief that is often neglected regardless of the entity of the pain."
