A chronic pain paradigm described in this issue calls for
identification of the pain mechanism and possible comorbidities, then
the promotion of the patient’s activity and function levels.
A chronic pain paradigm described in this issue calls for identification of the pain mechanism and possible comorbidities, then the promotion of the patient’s activity and function levels. Improved spinal function, of course, can assist a patient’s return to the activities of normal living.
There is good news related to opportunities for rehabilitation specialization in Canada, in the form of a residency program, and the admittance of chiropractors into post-graduate university rehabilitation sciences programs.
There is not such good news in Ontario where the government has shut down the DAC system, replacing neutral assessments with insurer examinations. There are incentives but no requirement for insurers to use chiropractors to determine whether an individual requires chiropractic care. Then there is the slide toward managed care with several insurance companies, led by Aviva Canada Inc., now working with a closed preferred provider list. With these changes, just how well will the consumer be served?
In the U.S., it is thought that chronic pain disables nearly 50 million people who are consequently driven to seek some kind of relief.
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the accrediting body for 18,000 U.S. hospitals, has mandated that pain be assessed and treated, and endorses the use of non-pharmacological treatment in the form of manual, hands-on therapies.
“I believe there is a tremendous role for chiropractic in the rehabilitation process,” says James Dillard, MD, DC, CAc. An assistant clinical professor in the Department of Rehabilitative Medicine at the Columbia University Medical Center, Dr. Dillard is the author of The Chronic Pain Solution, and Alternative Medicine for Dummies. “It is my contention, as a chiropractor and physician,” he says, “that the rehabilitation of proper spinal motion, which can only be done by someone who is skilled in chiropractic manual therapies, is essential to proper rehabilitation of the spine, particularly with people who have had an accident or injury.” Chiropractic manipulation therapy can mobilize segments of the spine that are immobile, a condition that, without effective treatment, may well lead to degenerative changes and chronic pain syndrome. The chiropractor, moreover, is equipped to employ modalities and techniques, recommend exercises and supervise other aspects of therapy. “Only the chiropractor can truly rehabilitate the spine,” says Dillard.
Dillard is the founder and course director of the Integrative Pain Medicine conference, held in early April in New York City. The annual conference, which is open to chiropractors, considers how modern pain medicine can best be integrated with evidence-based complementary and alternative approaches. Dillard’s own presentation was entitled “Manual Therapies for Pain.” He is also scheduled to make a presentation to the Canadian Pain Society this summer in Edmonton, Alberta, June 14 to 17.
In “Encouraging Words from Northern Ontario,” we are offered insight into another type of pain – the pain of loss. Though people who are grieving must go through their own process, they must not be abandoned. People, after all, need real help with their pain.•
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