As we enter into a new century and a new era of controlled national health care, the total evaluation of a chiropractic patient is as important as ever. To be in the new health care system and to interact with all types of physicians for referral both to and from each other, makes the role of lab testing a vital part of the chiropractic physician's total evaluation of the patient.
It is the responsibility of every chiropractic practitioner when accepting a patient to perform an appropriate clinical evaluation to assess the patient's current health status and to identify if the patient is a proper subject for chiropractic care. During the initial consultation, while taking the patient's history, the description of the nature of the pain and the effects of both rest and activity on the pain require attentive listening and evaluation of the symptoms presented. Patients presenting with musculoskeletal pain reveal areas of tenderness, postural asymmetry, decreased range of motion, changes in the texture of the tissue, and asymmetry of the involved joints. This may reveal information that on observation from clinical experience will suggest the diagnosis. For example, the onset of muscle pain from fiber tears is sudden and the pain can be reproduced with repetition of a specific movement; pain from repetitive microtrauma to muscles may be insidious and found at rest; pain that awakens a patient at night is suggestive of a bone tumor; pain arising from joint dysfunction is usually unilateral; and when a patient complains of pain that feels like it comes from the bone, it is usually not a well-localized pain.
Clinical experience will determine what diagnostic testing or procedures are indicated following evaluation of the history as presented by the patient. As in all diagnostic procedures requested by a physician, the test is performed to assist in confirmation of a diagnosis or to rule out a condition/diagnosis.
Laboratory diagnosis courses are taught at all accredited chiropractic colleges today. While there are no specific laboratory tests that are elevated with different symptoms of pain in connection with the musculoskeletal system, certain laboratory tests can be quite specific in the differential diagnosis of soft tissue injury and different causes of joint pain:
John C. Masse, DC
Carol M. Beutler, DC
Donald R. England, DC
Lake Charles, Louisiana
About the authors: John C. Masse, DC, (Palmer 1973 cum laude) is licensed in four states and is a certified thermographer.
Carol Beutler, DC, (Life 1980 cum laude), is licensed in four states. She is a graduate instructor at Life, and has 16 years of hospital experience as a medical laboratory technologist. She is an ACA member, an independent chiropractic reviewer, and is currently enrolled in a three-year postgraduate program on diagnosis and internal disorders.
Donald England, DC, (Palmer 1967), is a member of the Louisiana State Peer Review.
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.
