Blogging to increase awareness of direct access to physical therapy and the benefits of manual therapy, myofascial trigger point therapy, dry needling and movement re-education to reduce pain.
Friday, March 18, 2016
New guidelines helping local doctors to avoid opioid over prescribing
By: Nicole Johnson - Email
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FARGO, N.D. (Valley News Live) - New guidelines for doctors after the CDC reports too many people have become addicted to painkillers.
It's a problem we have seen in our area, and nationally. Opioid over prescribing is a key driver in drug overdose deaths, according to the CDC.
It released voluntary guidelines for primary care doctors, saying go slow, and use less. 40 people overdose on painkillers every day in the United States, and almost 2 million are addicted.
"I would like to say that physicians have had nothing to do with it, but I think we have,” says Sanford's Chief Medical Officer, Dr. Douglas Griffin.
He says the CDC's new recommendations will give more backbone to the fight they have already begun. "This is a difficult position for primary care physicians because people are in pain and they are hurting and you know they have issues these are very tough patients to take care of," says Dr. Griffin.
He says years ago they were encouraged to be liberal with pain medication, which has left patients in a vicious cycle. "They need to have those conversations with their doctor and then look for other alternatives, there are many other medications that can be used," says Dr. Griffin.
Other alternatives, like dry needling. It’s a fairly new practice that's gaining attention. "Basically we are finding an area that seems tight and we are looking for the muscle to twitch a little bit,” says Physical Therapist Drew Zimmerman.
He says people who suffer from chronic pain respond very well to dry needling, saying it could help break a cycle of dependency on medication. "Don't give up, there are lots of different methods out there, there are lots of different practitioners,” says Zimmerman. “Sometimes things get missed just because it doesn't work with one person or one treatment, don't give up."
While the CDC's new guidelines are simply suggestions to doctors, "I think it will make an impact," says Dr. Griffin. He hopes it will create change in this community.
Thursday, March 17, 2016
I know sometimes this seems to foreign or hard to do but it just takes practice.!
Mindfulness Meditation Delivers Opioid-Free Pain Relief, Study Says
Researchers at the Wake Forest Baptist Medical Center published a study that looked into whether meditation uses natural opioids to reduce pain.
The study, led by author, Fadel Zeidan, Ph.D., assistant professor of neurobiology and anatomy found that mindfulness meditation does not employ the endogenous opioid system to reduce pain.
“Our finding was surprising and could be important for the millions of chronic pain sufferers who are seeking a fast-acting, non-opiate-based therapy to alleviate their pain,” said Dr. Zeidan.
The researchers injected study participants with either naloxone, which chemically blocks opioid receptors, or a saline placebo.
In this randomized, double-blinded study, 78 healthy, pain-free volunteers were divided into four groups for the four-day (20 minutes per day) trial. The groups consisted of:
meditation plus naloxone
non-meditation control plus naloxone
meditation plus saline placebo
non-meditation control plus saline placebo.
A thermal probe was used to induce pain by heating a small area of the skin to 102.2 degrees, which is considered very painful by most people. The participants then rated their pain using a sliding scale.
The authors concluded that pain ratings were reduced 24% from the baseline measurement for the group using meditation and naloxone. They noted that this is important because the opioid receptors were chemically blocked, while significantly reducing pain. Pain was also reduced by 21% in the meditation and saline placebo group.
The non-meditation control groups reported increases in pain regardless of whether they got the naloxone or placebo-saline injection.
“Our team has demonstrated across four separate studies that meditation, after a short training period, can reduce experimentally induced pain,” Zeidan said. “And now this study shows that meditation doesn’t work through the body’s opioid system.”
“This study adds to the growing body of evidence that something unique is happening with how meditation reduces pain. These findings are especially significant to those who have built up a tolerance to opiate-based drugs and are looking for a non-addictive way to reduce their pain.”
Zeidan’s team hopes to determine how mindfulness meditation can affect a wide range of chronic pain conditions.
“At the very least, we believe that meditation could be used in conjunction with other traditional drug therapies to enhance pain relief without it producing the addictive side effects and other consequences that may arise from opiate drugs,” he said"
Wednesday, March 16, 2016
Now is a good time to consider safer methods of pain management. Physical Therapy is such a choice. Please read the following new guidelines coming out this week.
CDC Issues New Guidelines for Opioid Prescribing — Physician’s First Watch
The CDC has issued 12 new recommendations for clinicians prescribing opioids for pain outside of cancer treatment or palliative care. The full guideline is published in MMWR.
Among the recommendations:
For chronic pain, the first choices of treatment should be nonpharmacologic or nonopioid. Opioids should be an option only if the expected pain and function benefits outweigh the potential risks.
Patients starting opioids should be prescribed immediate-release opioids at the lowest effective dose, not extended-release/long-acting opioids.
Individual benefits and risks should be reassessed when increasing the dosage to 50 morphine milligram equivalents (MME) or more per day. Dosages of 90 MME or more should be avoided, or clinicians should "carefully justify a decision" to increase the dosage to that level.
For acute pain, an opioid prescription for 3 days or fewer will often be enough. More than 1 week is rarely needed.
Clinicians should regularly evaluate risk factors for opioid-related harms (e.g., history of overdose or substance use disorder) and consider offering naloxone to high-risk patients.
Concurrent prescriptions of opioids and benzodiazepines should be avoided.
Interesting reading !
Monday, March 14, 2016
4 Symptoms of Chronic Stress That You Shouldn’t Be Ignoring
Stress can have an effect on us all. You might feel stress when you have a heavy workload, when dealing with kids misbehaving, or if you are going through a challenging time in your relationship. Stress is everywhere – and a small amount of stress is OK, as it can actually be beneficial to keep you motivated.
However, being under too much stress can wear you down both mentally and physically, leading to different conditions such as anxiety and a whole range of physical symptoms. The first step to controlling your stress levels is to understand the symptoms. But, since a lot of us are so used to being stressed, recognizing these symptoms can be difficult and a lot of the time, people don’t realize that they are stressed until they have reached the breaking point of chronic stress.
LOW ENERGY
When you are under a large amount of stress, your body may begin to shut down. Stress is the body’s natural reaction to harmful situations, and when you feel threatened a chemical reaction occurs in the body which allows you to act in a way that prevents injury. Your heart rate and blood pressure increases, your breathing quickens, and muscles tighten. If you are suffering from chronic stress, too much of this reaction will start to wear out and tire your body.
HEADACHES
There are many different types of headaches, all of which can be brought on by stress. Headaches cause pain, and many can come with a range of other unwanted symptoms such as vomiting and nausea. A tension headache is the most common type of headache which can be caused by stress and anxiety. These headaches usually last for around half an hour and can generally be treated with over-the-counter painkillers. However, if you begin to experience tension headaches more frequently and for longer periods of time, it’s a tell-tale sign of chronic stress.
VARICOSE VEINS
You may be surprised that varicose veins are also a physical symptom of chronic stress. Chronic stress triggers an endocrine system response in which occurs a release of hormones known as corticosteroids. Since chronic stress is a prolonged emotional pressure suffered over a prolonged period of time, long-term exposure to stress causes a high level of these stress hormones in the body which can lead to issues such as high blood pressure and muscular damage, subsequently resulting in varicose veins. Although not all cases of varicose veins are caused by stress, it’s a good idea to visit a vascular doctor to discuss causes and different treatments.
INSOMNIA
Being unable to sleep at night is one of the sure signs of chronic stress. If you find that you’re wide awake each night and unable to wind down even though you’re feeling tired, it could be a result of the stress hormones in your body provoking the ‘fight or flight’ response that renders you unable to relax or fall asleep. Insomnia can lead to many different problems and can cause your stress to worsen.
There are many more physical symptoms of stress which you could experience. If you feel that your stress is taking a toll on your life, speak to your doctor.
I saw this in the newspaper from Louisville ( my hometown ) I am loving how well the technique has been adopted. Is a good idea to know how long your therapist has been performing dry needling, and where they obtained their certification.
Pain sufferers turn to dry needling
Darla Carter, @PrimeDarla 2:46 p.m. EDT October 15, 2015
Muscle pain sufferer Hal Taylorson says the dry needling procedure has relieved his muscle pain more than any other treatment to date. Sam Upshaw, The C-J
As a Buddhist, Hal Taylorson has an aversion to taking medication, but as a neck pain sufferer, he needed some relief.
He started getting dry needling treatments from a physical therapist as an alternative to medication.
The therapy involves inserting thin needles into muscles to ease pain and tension.
Basically, it’s for almost “any patient that has soft-tissue problems, so muscle sprains and strains, even chronic muscle pain,” said Jon Holland, a physical therapist at the University of Louisville Sports Medicine Clinic, part of KentuckyOne Health downtown.
“We also use it for joint problems if the joint problem is being driven by a muscle that’s not functioning properly,” he said.
Therapists target "trigger points" or irritable, hard "knots" within a muscle or connective tissue that may cause pain over a large area, according to an explainer for patients in the Journal of Orthopaedic & Sports Physical Therapy last year. The trigger points are associated with tight muscle bands, and the pain can hinder daily activities and movement.
When a patient comes in for treatment, “we feel where muscles have trigger points or painful areas in them,” Holland said. “Then we put the needle in it and it causes a biochemical reaction that helps the muscle and the trigger point relax."
Taylorson, an interior designer with Chic Designs Interior and Exterior, developed neck pain after a car crash several years ago and has had spine surgery twice. He’s had a half-dozen dry needling treatments over the course of five weeks to soothe muscles in his neck area.
“I have seen a difference,” said Taylorson, who was treated by Holland earlier this week. “It does release a lot of the tension.”
Dry needling is usually done as part of a larger treatment plan that includes other therapies. "It’s a great adjunct to a lot of the interventions that we like to do with patients … and it's very safe," said Chad Garvey, a physical therapist with KORT (the Kentucky Orthopedic Rehab Team) Downtown.
Research on dry needling is limited and the findings have been mixed.
A 2001 systematic review in the Archives of Physical Medicine and Rehabilitation found "direct needling of myofascial trigger points appears to be an effective treatment, but the hypothesis that needling therapies have efficacy beyond placebo is neither supported nor refuted by the evidence from clinical trials."
A 2010 article in the Journal of the American Board of Family Medicine noted that dry needling's effectiveness has been confirmed in "numerous studies" and two comprehensive systematic reviews but that more research is needed.
A systematic review and meta-analysis published this year in the Archives of Physical Medicine and Rehabilitation suggests that dry needling is effective for short- and medium-term relief of neck and shoulder pain.
Dry needling is often used with physical therapy patients who have “hit a plateau with their progress,” Garvey said. “We see a fair amount of folks with significant pain that has not responded to standardized treatments.”
Through the use of dry needling, "we want to try to break the pain cycle and the needle can help access the body’s own pain-relieving chemicals," Garvey said.
If successful, the therapy allows patients "to exercise and move better" after dry needling is performed.
A study in the Journal of Orthopaedic & Sports Physical Therapy last year found dry needling seemed to be helpful for neck pain.
In that study, which involved 17 neck patients, half of them received dry needling and the other half got no treatment. The dry needling group reported decreased pain immediately after treatment and one week later. They also were better able to bend their heads forward and backward and to turn their heads toward the painful side of their necks.
Therapists may manipulate the needles using their fingers alone or with the aid of an electrical stimulator.
The needles vary in size, said Holland, displaying various lengths, from an inch and half long to 4 inches long.
“Some people don’t feel the needle going in at all," Holland said. "Some people do feel a little pressure when the needle goes in. ... Occasionally, you may get a drop of blood but not often.”
Potential side-effects include soreness and less commonly, pain or light-headedness, Holland said. Sometimes, there also is a risk of severe problems, involving the lungs and large blood vessels, according to published literature.
But “the most common by far would be just soreness — like you’ve worked out," Holland said.
Some people confuse dry needling with acupuncture, but the therapies are different, physical therapists say.
Dry needling is “based on a western medicine model," Garvey said. "We only utilize dry needling for neuromusculoskeletal pain and impairments ... and we don’t do it in the guise of treating energy meridians and things that are within Chinese acupuncture medicine.”
Taylorson said he doesn’t feel pain during dry needling nor does he have lingering soreness from it.
“I would not consider it painful,” he said. At the end, “I feel relieved. The tension is gone. As long as I don’t stress the muscles afterwards, it lasts a nice time — several days.”
The number of treatments vary, Holland said.
“You get some results with one (treatment)," he said. "But, typically, we’ll do multiple treatments (such as six to nine)."
Check with your insurance company to see if it will cover the treatments.
The treatment may not be right for everyone. Those it might be inappropriate for include pregnant women, people with bleeding disorders and people who fear needles, Holland said.
If a patient has had surgery, they'd typically have to wait six to 12 weeks before starting dry needling, he said.
But for the right patient, it “gets good results," he said. Courier-Journal reporter Darla Carter can be reached at (502) 582-7068 or dcarter@courier-journal.com.
This is a nice summary for Direct Access to Physical Therapy which in Kentucky is available to all. This comes directly from the American Physical Therapy Association/
Direct Access to Physical Therapy Services: Overview
The Problem
While state law generally allows patients to seek evaluation and treatment from a licensed physical therapist without a prescription or referral from a physician, patients are limited in their ability to do so in many states by arbitrary and unnecessary restrictions. These restrictions are typically in the form of time and visit limits, previous diagnosis requirements, limited patient populations, or requiring a referral for certain types of treatment. These restrictions do not recognize the professional training and expertise of the licensed physical therapist nor do they serve the needs of those patients who require physical therapy but whose care is unnecessarily interrupted by these restrictions..
The Solution
Amend current statutes at the state level to remove arbitrary limitations on direct access to physical therapy services.
Rationale
In the age of health care reform, state legislatures continue to seek solutions that will expand access to the health care services the citizens of their state need while also addressing the growth in health care costs. One of the most effective tools for cost control and increased access is easily attainable yet often overlooked and underutilized by the legislatures - that of direct access to the services of nonphysician health care professionals.
Physical therapy is the case in point. Entry into the profession and practice of the profession are stringently regulated by all states, and as highly trained health care professionals, physical therapists have a proven track record of effectively treating millions of patients. Physical therapists are well-qualified, both through formal education and clinical training, to evaluate a patient's condition, assess his or her physical therapy needs and, if appropriate, safely and effectively treat the patient. Physical therapists are also well-qualified to recognize when patients demonstrate conditions, signs and symptoms that should be evaluated by other health care professionals before therapy is instituted. Physical therapists recognize when it is appropriate to refer patients to these other health care professionals for consultation.
Every state, the District of Columbia, and the US Virgin Islands have all recognized the safety and benefits of direct access to physical therapy by removing from their statutes, all or some of the referral requirements or provisions for a physical therapy evaluation and treatment. However, if your state laws continue to include out-dated and unnecessary barriers to direct patient care by physical therapists, please consider the benefits of reform. By amending the physical therapy practice act in your state, you will be providing your constituents with an additional entry point into the traditional medical system, increased choice in the selection of a health care professional, access to less expensive and more timely care, and a simple, yet, extremely effective way to meet the goals of increased access and cost containment.
For additional information on direct access, please contact APTA's state government affairs department at 800/999-2782, ext. 3161.
Wednesday, February 4, 2015
Chose one
that
Specializes in Dry Needling
with Advance Training
By making your own decision as to your Physical Therapist then you are taking charge of you, as the most important member
of your health care team
You are entitled to choose the most appropriate
health care professional to meet your goals.
You have that Freedom of Choice!
You have the
freedom to choose your own Physical Therapist
How does the
dry needling method work: Mechanism of Action it appears to
allow the sarcomere to resume its resting length3 and activate
inhibitory dorsal horn interneurons? This implies that DN causes
opioid-mediated pain suppression and also blocks any incoming noxious stimulus
into the dorsal horn by activating the serotonergic and noradrenergic
descending inhibitory systems.4
In addition,
the levels of two biochemical drop significantly following DN. There is a
decrease in local concentrations of substance P and calcitonin gene–related
peptide; this development may correlate with the systematic reduction of pain
following deep DN.5
Furthermore,
there are studies currently under way that are using multiple imaging
techniques to visualize the cascade of physiologic changes that are possible
with the introduction of filiform needles into an MTrPs.
Many of us have areas in our body that feel tense all the time or feel like a hard ball in the muscle.By inserting fine
needles into these tight areas, we elicit a “twitch response” or a brief
contraction followed by an immediate and long lasting relaxation.
The
needle can treat very deep parts of the muscle, the technique can achieve
amazing pain relief that you never thought possible.
Muscular tightness and
spasm can lead to compression and irritation of the nerves. When nerves are
irritated, they cause a protective spasm of all the muscles to which they are
connected. This contributes to the decreased mobility and pain in the area.
I treat multiple
orthopedic and neurological conditions helping patient achieve long-term
benefits
I specialize in Dry
Needling, an extremely effective technique that uses a very fine acupuncture
needle to “deactivate” or “shut down” a trigger points or painful knotted areas
in your muscles therapy to improve and maximize a patient’s performance and
ability.
Benefits:
Pain control
1.Normalizes biochemical electrical dysfunction
of motor end plates
2.Reduces muscle tension
Restores/increases motion and function
3.Desensitizes super-sensitive structures
4.Promotes healing response
in tissue Accelerates return to active rehabilitation
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