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 our April 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. While it was impossible to include all the reponses in our print article, we felt it important that you see all the responses from your colleagues.
(Note: the order seen below is based on the order in which we received the response)
John L. Stump, DC, PhD, EdD, Fairhope, Alabama: 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!
Christopher Wolcott, Chicago, Illinois: 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.
Guarch Ibanez B, Bunuel Alvarez JC, Lopez 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.
Ray Pendergraft, Redondo Beach, California: 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% 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 1800mg per day omega 3s 1200mg per day.
Another anecdotal one is pomegranate juice 4oz per day. Again let's stress that it is food.
Michael Berglund, Kenosha, Wisconsin: 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.
David Dolinar, Florissant, Missouri: Kinesiology tape [pb]
Douglas Kennedy, Boulder, Colorado: 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!
Todd Austin, Virden, Illinois: Our clinic's arsenal of several different Low Level Laser Therapy (LLLT) devices. LLLT is very effective at least 70% of the time. In fact, LLLT quickly reduces inflammation, increases ROM & improves the ability of the once-damaged cells and tissues to handle additional stress. Using LLLT prior to the chiropractic adjustment helps to make my job as a chiropractic physician easier, as it prepares the patient for the adjustment.
In a perfect world, LLLT would be used to prevent all musculoskeletal surgeries. From my personal experience, I'm batting 1,000 when it comes to preventing neck surgeries with a combination of LLLT & chiropractic since I acquired my lasers 5 years ago. Unfortunately, I've had 2 shoulder pain patients in the past year that have needed surgery anyway. But, I've discovered that if we laser vigorously leading up to the surgery, we can provide the surgeon with the best possible product to work with. If we continue to laser post-surgically, the rehab & recovery is much less painful and happens much more quickly.
There are also some other chiropractors in my area that don't offer low level laser therapy. They refer patients in need of LLLT to me, and I gladly refer them back to their original D.C. for their chiropractic care.
I've also treated many non-chiropractic problems with LLLT: including burns, bad bruises, poison ivy, other unexplained skin rashes, detached rib cartilages, shin splints and pilonidal cysts. Some of these folks became patients in our clinic solely for LLLT treatments.
The bottom line is as a chiropractor, a husband and a father, I can't imagine my life without LLLT in it!
Loreen Daigle, Middlebury, Connecticut: 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.
Ralph Bencivengo, Hamilton, New Jersey: Nutritional advice. Omega threes for anti-inflammation aids in pain reduction as does other supplements.
Dr Ralph Krutulis, Jamesville, New York: Nutrigenomic modulation of inflammation is the primary non-structural approach I use for drug free pain reduction.
First I look at hydration; how dry is their "garden". I tell patients to "stand on your bathroom scale every morning, look at that number, divide it in half, that is how much pure water you need per day in ounces".
Depending on the pain, ice may be indicated, as may the addition of Magnesium in the glycinate form. I use several products from Metagenics with great success; their Acute Phase packs for muscular injuries, Kaprex for arthritic pain, Essential Fatty acids and Vits C and D3 for many pro-inflammatory pain complaints. Some acute pain and chronic pain protocols look identical, some are very divergent where i help the patient to make lifestyle changes to reduce chronic source of pain such as helping them go gluten free with migraine patients.
No matter the pain, there is almost always an approach that can lower the patient's pain through specific nutrition modulation. This has added tens of thousands of dollars to my practice and hundreds of patients referred to me simply as I do clinical nutrition and many of my peers do not.
Ralph Stokes, Dallas, Texas: Decompression therapy and Standard Process Boswellia Complex.
David Weber, East Dubuque, Illinois: 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.
William Doggett, Albuquerque, New Mexico: The question becomes misleading if you use the FDA definition of drug. To paraphrase their statement, any substance ingested or administered internally for therapeutic purpose is a drug. In that regard giving oswalia, grapefruit extract, bromaline, or any herbal anti-inflammatory is giving or prescribing a drug. [pb]
Stephen Brandenburg, Bartlett, Tennessee: Utilizing ultrasound and electrical stimulation modalities has assisted many of my patients in relieving pain.
Jim Webley, Burlington, Wisconsin: Ancillary modalities such as IF current and ice for acute conditions; US along with myofascial release, IASTM for sub-acute/chronic conditions.
Cynthia Leeder, Carlsbad, California: I have several different protocols that I use
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.
Rosemary Kaszans, Brunswick, Georgia: I have found that acupuncture points, using both electro- and needle acupuncture for treatment in these areas, is extremely effective in reducing or eliminating pain. A dozen years ago I took the course offered by John Amaro, DC, and this has changed the way I practice. For instance, not only is the area around the pain important to address, but also the more distal points in the ankles and feet, or the hands and wrists. I have had wonderful success helping patients with pain and am grateful for the knowledge of the ancient art of acupuncture.
Terry Wiley, Alamosa, Colorado: 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 patients 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.
Susan Sykes, North Carolina: I have found that anything that reduces inflammation is very valuable. I recommend an eating plan based on David Seaman's nutritional protocols. In addition we use an herbal supplement, call Inflam-ceuctic or proteolytic enzymes, such as Enzyme Forte to reduce inflammation levels. Most recently we are evaluating the use of magnesium lotion for muscle pain and tension.
Don Schmolder, Manhattan Beach, California: 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.
Juan-Carlos Portillo, San Jose, California: Since 1999 I have been offering my clients "enzyme replacement therapy". Dr. Howard Loomis, the founder has an Institute that he runs out of Madison, WI. It has completely changed how I practice, as I can finally get to the most common cause of chronic muscle contraction.... digestive stress. Using enzymes, with herbs to deliver nutrients past an incompetent digestive system, we can help patients return to homeostasis.[pb]
Donald Berry, Frederick, Maryland: I am a Corrective Exercise Specialist, a Functional Movement Specialist and a Kettle Bell Instructor. If you want patients pain free they have to learn how to move again.
Michael Van Antwerp, Broken Arrow, Oklahoma: Soft tissue edge tool. (Therapy Edge)
Trigger point release. (Post-isometric relaxation)
Cooling spray. (Biofreeze)
K-taping. (Kinesio Tex)
Exercises/stretches.
Anti-inflammatory, muscle relaxation supplements. (Orthomolecular Soft Tissue Support - one of the best ever).
Acupuncture.
Karen Erickson, New York: 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.
George Simmons, Albuquerque, New Mexico: Frequency Specific Microcurrent Myofascial needling, Graston/FAKTR PaleoMedetranian diet advice as per Dr. Alex Vasquez, Fish oil, source of combined ALA/GLA, White willow bark, boswelia, devils claw
Dexter DiMarco, Lake Worth, Florida: OPC 3 From NutraMetrix natural reduces inflammation. I usually combine this with Calcium & D3. It takes a while to work, but over the long run much better than any NSAIDS OTC. It doesn't effect the G.I tract.
Paul, Eckley, Walled Lake, Michigan: I have found the homeopathic formula Traumeel taken both topically as a odorless cream and orally to be helpful for pain relief in addition to adjusting.
Doris Doheny, Athens, Pennsylvania: 1. Ice compress with recommendations on usage of a flexible ice pack. 2. Biofreeze 3. Stretching exercises 4. Herbal anti-inflammatories, like Turmeric, Boswelia Serrata, 5. Dietary recommendations to avoid foods that promote inflammation.
Russel Sher, Asheville, North Carolina: Boswelia complex from Mediherb is a herbal complex composed of Boswelia, Curcumin, Ginger, and Celery seed - designed to reduce inflammation and pain with the celery seed focused on improving joint health. Also, protease enzymes are effective
Frank Sessa, DC, Clearwater, Florida: Being a licensed Active Release Techniques provider has allowed me to effectively treat painful myofascial conditions. I've had great success treating acute and chronic injuries in athletes, specifically Mixed Martial Arts fighters. Utilizing ART in my practice has helped decrease recovery time and reduce pain in athletes, and anyone that is suffering from a painful overuse injury.
Craig Stellpflug, Scottsdale, Arizona: 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.
Cyrous Salimian, Tehran, Iran, Ontario: In my practice i visit almost 50-60 p.ts/day. My main solution for pain, is using Ice/ Hot pack, exercises and vitamins( D+ mg + Ca, vit E, B complex, VitC), reassuring patients about their problems that will resolve gradually to help their mind
Regards Cyrous Salimian, MD, DC
[pb]
David Friedman, Scottsdale, Arizona: 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.
Dr. Margaret Rogers Van Coops, Lake Havasu City, Arizona: Since being in the womb and birth the brain stores memory of the first stimulated neural pathways for pain, fear, anger and trust (guilt). If the child has a negative coding absorbed from the mother then a life pattern of energy becomes the norm. Later in life these 5 neural pathways create an s pattern in the physical body. The weight, structure of bones and walk result in deformity. We all burn neural pathways in order to live.
Everyone's pattern is different, depending on their experiences. I have found that a treatment with Crystal Acupuncture & Teragram Therapy along with chiropractic manipulation will take them out of pain and also redirect their energy pattern to form a new neural pathway. Since we have a choice of 144 pathways and only use six of them as habit (i.e. driving to work the same way daily when there are many other choices of roads to use.) Making new neural pathways to the brain can effectively transform a person and aid them to overcome illness. My books On Crystal Acupuncture & Teragram Therapy as well as others available on Amazon will tell all.
Shannon Score, Burnsville, Minnesota: I use a product called EFAC, Esterified Fatty Acid Complex. there is a topical cream which has been shown to absorb through the dermis at the University of Minnesota and they tested 1300 times the equivalent dose without toxicity. It also comes in a capsule and has been researched in The Journal of Rheumatology and The Journal of Strength and Conditioning with very significant results. I use the capsule for chronic, degenerative pain and the cream for acute pain with outstanding results. It also has been awarded a patent for the treatment of periodontal disease, the first substance to stimulate healing of infection and regeneration of gum, as well as bone tissue.
Beverly Kerr, Indiana: 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.
Tracy Watson, DC, Cary, North Carolina: What I do...& have been doing for 35 years... Is to stimulate a patient's body to function as normality as it can. Each body/person has different abilities, depending on how they have treated their body and the attention they have sought for their body. Some are simply too late, and I'm sorry. It is never too late to slow the progression!
Michael Holloway, San Antonio, Texas: In addressing various pain syndromes patients may present with outside of or in addition to chiropractic care, I tend to look at their diet first and then towards nutritional supplements/herbals second. The combination of the two appears to work best. Removing those foods that tend to be generally inflammatory to the body is a good starting point, including sugar in all its forms and any sensitivities they may also suffer from (think dairy, wheat, etc.). I carry quite a bit of Standard Process & MediHerb products in my clinic. MediHerb's Boswelia Complex is quite useful as is their Saligesic. SP's various enzyme formulas are also effective at relieving inflammation (e.g. Zypan, Multizyme).
James Pamplin, Plymouth, New Hampshire: Cryotherapy for superficial acute pain Acupuncture for deep acute pain. Laser therapy for chronic pain.
Rick Monsour, Gilroy, California: I have used wei labs for pain from strain/sprains and disc herniations, they have a wonderful dermal patch called fast patches and white patches that really work well, also I use a company that uses natural therapies based on a genetic approach to healing focusing on the mitochondria that is designed to create a more youthful expression on the genes. This has been helpful for more chronic pain from fibromylagia to rheumatoid arthritis.
Robert Wolff, Vernon, Texas: Fibromyalgia pain that is chronic and very much inflamed: Products from Standard Process: *Spleen PMG *Cataplex G *Cataplex ACP
Found results in one to seven days. Usually found a sugar-handling problem so I put them on a Phase I balancing your body's chemistry.
[pb]
Robert Wolff, Vernon, Texas: Chronic back pain with antalgic posture I have found putting on corset with ice on lower back 20 minutes on and 10 minutes off for 3 times in a roll and do that three times per day for one week along with Baldrian Plus & Inflammax Forte by Vitaminerals the large bottles of each and have patient take till all is gone in both bottles. The patient will run out of the Baldrian Plus first; then have patient finish up on the Inflammax Forte. Significant improvement is noted by the end of the 3rd to 7th day.
Elizabeth McConnell, Iowa: I am having some amazing results with a TeeraQuant TQ Solo cold laser. This particular model has the cold laser with 3 different programs, IR, visible red and a static magnetic field. Works great on musculoskeletal along with an ugly TMJ I'm dealing with right now.
Clyde Esch, Dayton, Ohio: 4 lead TENS with appropriate PPM, ice
John B. Martinez, New Jersey: There are a number of nutritional formulas and Chinese herb formulas that help with pain. Acupuncture is very helpful. Exercises (i.e. Cox) can be helpful. Ergonomic training is helpful. Trigger point therapy.
Mark Baxter, Las Vegas, Nevada: For peripheral neuropathy, including diabetic neuropathy: Controlled-release Alpha Lipoic Acid 300 mg BID in conjunction with Acetyl-L-Carnitine 500 mg BID.
For musculo-skeletal 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.
Lynn Allison, Saratoga Springs, New York: Craniosacral therapy
Glen Peterson, Raleigh, North Carolina: 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.
Anthony Morovati, Glendale, California: By far the best non-invasive pain management modality I have been able to find in the last 20 years, is the ACUSCOPE and MYOPULSE system. Of course, not in a passive application, rather in an active application. I was trained by Janet Travel, MD, White house physician to President Kennedy and Johnson, in how to use these modalities for non-invasive pain control.
Brian Seitz, Hillsboro, Oregon: I have found that patients with widespread, generalized myalgia and tenderness to touch often have vitamin D3 insufficiency or deficiency. Supplementation, 5000-10000 IU/day initially often results in less diffuse pain within days or a couple weeks. In the absence of adequate sunlight exposure a maintenance dose of 4000-8000IU may be required to maintain benefit.
Dave Sossamon, Johnson City, Tennessee: Massage, fomentation, ice, US, Muscle Stim. both AC and Direct current, cervical or lumbosacral supports, Formula 303.
J Douglas Brown DC, DACNB, Sumiton, Alabama: By placing two electrode pads one on each side of the axis close to the center, I have been 98% successful in stopping a migraine in progress. The treatment usually takes about 5 minutes. I use this technique for acute migraine. 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.
