Fear Affects Disability
In his presentation at the World Chiropractic Congress last May, Gordon Waddell, BSc, MD, FRCD, world renowned orthopedic surgeon and long time back pain researcher, made several interesting comments. Dr. Waddell has become identified with his message that "traditional medical management of low-back pain according to the disease model has failed." Dr. Waddell calls for "a completely new approach based on the bio-psychosocial model."
Among his other comments, Dr. Waddell had this to say in London:
"The major psychological disturbances associated with LBP (low-back pain), particularly chronic LBP are anxiety, increased bodily awareness and depressive symptoms. Patients with LBP have no personality abnormality and are not psychiatrically ill but simply depressed by their continued pain and disability and the failure of treatment to provide relief. Psychological distress cannot be assessed reliably by 'clinical impression' but is best measured by simple questionnaires.The medical research community appears to be waking up to the advantages of function based care (manipulation, soft tissue work, exercise, etc.) vs. disfunctional care (bed rest, no activities, etc.). Perhaps soon, they will proceed beyond the musculoskeletal."There is also increasing evidence that patients' own attitudes and beliefs are a major determinant of how they react to pain. Specific fear-avoidance beliefs about LBP may be one of the most powerful influences on disability. Fear-avoidance beliefs are particularly important as they are often aggravated by ill-considered medical information and standard advice to avoid physical activities, rest and stay off work."
In the March, 1993 issue of the Chiropractic Journal of Australia, Dean H. Lines, DC, Dip.(Tert.)Ed., of the Royal Melbourne Institute of Technology presents the paper, "A Holistic Approach to the Treatment of Bronchial Asthma in a Chiropractic Practice." The paper chronicles the results of "three case studies involving two children and a mature adult with medically established diagnosis of bronchial asthma."
Asthma is a great concern in Australia (as with the rest of the western world) because of its cost and prevalence. The cost has been estimated at $209 million involving as many as 20% of Australia's children.
Dr. Lines suggests an approach which combines chiropractic adjustments with "clinical ecology." Clinical ecology is an "approach which has been found useful in identifying food and environmental allergens that may act as triggering factors for asthma attacks."
The author concludes:
"It has been suggested that the current prevalence of asthma can be likened to an epidemic which is out of control.1 With mounting evidence that current medical bronchodilator and inhaled steroid intervention may be contributing to the rising mortality, the conservative, holistic, chiropractic approach presented here may well provide, for many sufferers, a safer, more sustained, and more effective, alternative intervention to present allopathic therapy. To this author's knowledge, no outcomes study comparing current bronchodilator/steroid management regimes has yet been undertaken, particularly any which investigate long-term survival and long-term changes in lung function. It appears that the currently accepted allopathic management regimes still remain consensus-based rather than having been founded on actual clinical trials."Doctors with patients who suffer from asthma may wish to review this paper. For a reprint, please contact:
Chiropractic Journal of Australia
Attention: Mary Ann Chance, DC, Editor
Wagga Wagga, New South Wales
Australia, 2650
Reference:
1. Portterton D. The politics of asthma: out of control. Nurs Times 1992; 88: (2)26-31.
Many relevant diagnostic signs are not performed deliberately by the examiner or by the patient at the examiner’s direction. They are observed as the patient reacts to their condition. Fortin’s finger sign, Minor’s sign, and Vanzetti’s sign are three examples of this principle.
Spearheaded by burgeoning scientific and clinical research literature, psychedelics have reached a level of media coverage and popular interest that has not been seen for over half a century. By “psychedelics,” we are referring to the unique class of substances that includes psilocybin (the active compound found in so-called “magic mushrooms”), LSD, dimethyltryptamine (DMT), ayahuasca, 5-MeO-DMT, and mescaline – each of which occurs in the natural world (except for LSD, which is a semi-synthetic compound).
While working at the Lovelace Medical Center in Albuquerque, N.M., one of the primary care physicians stated that imaging every patient prior to receiving chiropractic was not medically necessary. It was at that point I reconsidered the need for the imaging of every patient to avoid malpractice.
