With all the debates and foot-dragging on the order of Richard III as to where health care needs to go, I get the unmistakable impression that much of the true conscience of American medicine lies within recent reports from the Institute of Medicine. Just a decade after having released its groundbreaking and eloquent treatise arguing for the reconstruction of the American health care system from the ground up, with an emphasis upon prevention,1 the IOM has struck again with a new and important conceptualization of chronic pain.
For far too long there has been hand-wringing over the fact that a minimum of 116 million Americans experience chronic pain every year, with a national cost ranging between $560 billion and $635 billion.2 This turns out to be a conservative estimate because children and military personnel have not been included. Prevention and pain treatment are thwarted by inadequate treatment, delay or outright inaccessibility of health care.
Chiropractors, are you listening? There are five basic concepts in the IOM report, Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research, that relate to the chiropractic profession directly:2
From these principles evolved a number of directives from the Institute of Medicine, including the following:2
The areas of overlap of these missions and directives with the mission and practice of chiropractic are both numerous and meaningful. We could begin with the root theories of none other than D.D. Palmer, who expressed:
"Life is the expression of tone. In that sentence is the basic principle of chiropractic. Tone is the normal degree of nerve tension. Tone is the expression in function by normal elasticity, strength and excitability of the various organs as observed in a state of health. Consequently, the cause of disease is any variation of tone – nerves too tense or too static."7
This wording is nothing less than the ground substance of the Institute of Medicine putting the focus upon the nervous system's adaptation to (and transmission of) pain. We can then move through the 35 years of the most rigorous outcomes research on acute and chronic low-back pain and, following the latest synthesis of findings, which has been shown to yield the best and most clinically meaningful evidence, demonstrate that spinal manipulative therapy is in fact recommended for most patients with acute and chronic low-back pain.8-9
The inescapable conclusion when you combine the history and capabilities of chiropractic with both mandates from the Institute of Medicine1-2 is to promote chiropractic to the ranks of first health-care provider in instances of chronic low back pain in the absence of red flags. Under the same conditions, the same could be argued for even nonmusculoskeletal conditions10 – all in the interest of the early, noninvasive, and cost-efficient intervention to manage pain and thus satisfy the directive of the Institute of Medicine.
While most patients do not yet regard chiropractic as a means for establishing maintenance care – despite recent key studies providing supportive evidence worth noting11-12 – an interesting directive has recently been put forth by Floreani, who suggests that chiropractors would do well to develop and disseminate the concept that they may be in an ideal position to deliver well-being care, strengthening the capacity of the body to live well.13 What can be said about chiropractic in its current state is that it adheres closely to models of patient-centered care,14 precisely what has been mandated by the Institute of Medicine.
Put quite simply, adhering to the principles of the Institute of Medicine should be of considerable benefit to chiropractors, naturopathic physicians, acupuncturists, applied kinesiologists, homeopaths, and other health care professionals who have gone on record as attempting to serve the needs of the entire patient in an early and more readily treatable stage of dysfunction, if not altogether preventive. Such is not to absolve each of these health care professions of total blame, however, for, like orthodox medicine, each has shown that it is in need of meaningful interdisciplinary collaborations in order to achieve these ultimate goals as stated in the Institute of Medicine reports. Continuing policies of arbitrary and capricious exclusions of health care alternatives in both insurance reimbursements and practice would mean nothing more than that the Institute of Medicine's recent efforts have gone for naught.
References
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.
