2015 OPSC Annual Convention. syllabus. February 4-8, 2015 Hyatt Regency Mission Bay San Diego, California

Transcription

1 2015 OPSC Annual Convention syllabus February 4-8, 2015 Hyatt Regency Mission Bay San Diego, California

2 SATURDAY, FEBRUARY 7, 2015: 7:00am - 8:00am Osteopathic Approaches to Chronic Pain * Presented by Brian Loveless, DO * California Pain / End-of-Life Care

3 PRESENTATION Learning Objectives and Self ASSESSMENT questions LEARNING OBJECTIVES 1. Recall the 5 model approach to Osteopathic management 2. Use the 5 models to formulate a treatment plan 3. Apply Osteopathic manipulation to common dysfunctions in chronic pain SELF ASSESSMENT QUESTIONS 1. The mechanical model represents: a. Social components of health b. Endocrine/immune systems and nutritional status c. Altered respiratory mechanics and impaired circulation d. CNS/ANS/PNS balance e. Posture, motion, and gait 2. The biopsychosocial model represents: a. Social components of health b. Altered respiratory mechanics and impaired circulation c. Posture, motion, and gait d. Endocrine/immune systems and nutritional status e. CNS/ANS/PNS balance 3. The respiratory-circulatory model represents: a. Social components of health b. Endocrine/immune systems and nutritional status c. Posture, motion, and gait d. Altered respiratory mechanics and impaired circulation e. CNS/ANS/PNS balance 4. The metabolic-nutritional model represents: a. Altered respiratory mechanics and impaired circulation b. Posture, motion, and gait c. CNS/ANS/PNS balance d. Social components of health e. Endocrine/immune systems and nutritional status 5. The neurological model represents: a. CNS/ANS/PNS balance b. Altered respiratory mechanics and impaired circulation c. Posture, motion, and gait d. Endocrine/immune systems and nutritional status e. Social components of health 6. The most common finding in Greenman s chronic low back pain group was: a. Restriction of anterior nutation of the sacral base b. Dysfunction at the symphysis pubis c. Nonneutral dysfunction in the lumbar spine d. Innominate shear dysfunction e. Short leg/pelvic tilt syndrome 7. Which of the following is contained in the IASP definition of pain? a. Pain due to a stimulus which does not normally provoke pain b. An abnormally painful reaction to a stimulus c. Increased sensitivity to stimulation d. An unpleasant sensory and emotional experience e. A disturbance of function of pathological change in a nerve OPSC s 54th Annual Convention and Exposition Syllabus 546

4 Osteopathic Approaches to Chronic Pain Brian Loveless, DO NMM/OMM +1 Resident Chino Valley Medical Center OPSC s 54th Annual Convention and Exposition Syllabus 547

5 Learning Objectives After the lecture and lab session the learner will: Recall the 5 model approach to Osteopathic management Use the 5 models to formulate a treatment plan Apply osteopathic manipulation to common dysfunctions in chronic pain OPSC s 54th Annual Convention and Exposition Syllabus 548

6 5 Models Mechanical Neurologic Respiratory-Circulatory Metabolic-Nutritional Biopsychosocial Department of Neuromusculoskeletal Medicine/ Osteopathic Manipulative Medicine at Western University of Health Sciences, College of Osteopathic Medicine of the Pacific. Osteopathic Principles and Diagnosis. 1st ed. Pomona, CA: :pp OPSC s 54th Annual Convention and Exposition Syllabus 549

7 Mechanical Posture, Motion, Gait Altered joint relationships Muscle imbalances Fascial abnormalities OPSC s 54th Annual Convention and Exposition Syllabus 550

8 Neurologic CNS/ANS/PNS balance Viscero-somatic reflexes Somato-visceral reflexes Facilitated spinal segments Also neuroendocrine, neuroimmune, neurocirculatory elements OPSC s 54th Annual Convention and Exposition Syllabus 551

9 Respiratory-Circulatory Altered respiratory mechanics/impaired circulation of fluids Decreased air movement Venous stasis Lymphedema OPSC s 54th Annual Convention and Exposition Syllabus 552

10 Metabolic-Nutritional Metabolic processes: Endocrine system Immune response Nutritional status OPSC s 54th Annual Convention and Exposition Syllabus 553

11 Biopsychosocial Social components of health status Cultural Spiritual Behavioral responses/adaptation OPSC s 54th Annual Convention and Exposition Syllabus 554

12 What is pain? International Association for the Study of Pain: Pain: An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. "Part III: Pain Terms, A Current List with Definitions and Notes on Usage" (pp ) Classification of Chronic Pain, Second Edition, IASP Task Force on Taxonomy, edited by H. Merskey and N. Bogduk, IASP Press, Seattle, OPSC s 54th Annual Convention and Exposition Syllabus 555

13 What is Pain? Note: Pain is always subjective. Each individual learns the application of the word through experiences related to injury in early life. Biologists recognize that those stimuli which cause pain are liable to damage tissue. Accordingly, pain is that experience we associate with actual or potential tissue damage Many people report pain in the absence of tissue damage or any likely pathophysiological cause; usually this happens for psychological reasons. There is usually no way to distinguish their experience from that due to tissue damage if we take the subjective report. If they regard their experience as pain, and if they report it in the same ways as pain caused by tissue damage, it should be accepted as pain. OPSC s 54th Annual Convention and Exposition Syllabus 556

14 What is Chronic Pain? No specific definition exists, but generally it is defined as pain persisting longer than 3-6 months It produces changes in the central nervous system Repetitive activity in the C-fibers Augmentation of activity in the dorsal horn Release of substance P and other neurokinins Prolongation and amplification of nociceptive activity even in the absence of an inciting event Mercadante, S. Pathophysiology of chronic pain. In: Bruera, E, Higginson IJ, et al. Textbook of Palliative Medicine. Boca Raton, FL: CRC Press; 2006: OPSC s 54th Annual Convention and Exposition Syllabus 557

15 Results of chronic pain Sleep disturbance Decreased libido Irritability Depression Decreased activity level Deterioration in interpersonal relationships Change in work status Increased preoccupation with health and physical function Jerome, JA. Pain Management In: Chila AG, executive ed, Carreiro, JE, Dowling DJ, et al. Foundations of Osteopathic Medicine. 3 rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2011: 215. OPSC s 54th Annual Convention and Exposition Syllabus 558

16 Application of 5 Models OPSC s 54th Annual Convention and Exposition Syllabus 559

17 Neurologic Myofascial trigger points may eventually lead to central sensitization as discussed previously Close association with myofascial trigger points and nearby articular dysfunctions Help to decrease the overall sensory load onto the nervous system, decreasing sensitization Elevated sympathetic tone related to pain, anxiety, stress OPSC s 54th Annual Convention and Exposition Syllabus 560

18 Respiratory-Circulatory Inflammatory cytokines flood the region of pain Lymphatic drainage of the local region can facilitate drainage of the inflammatory milieu Thoracic inlet, thoracic diaphragm, pelvic diaphragm OPSC s 54th Annual Convention and Exposition Syllabus 561

19 Metabolic-Nutritional Pro-inflammatory foods High omega-6 oils, especially processed/industrial Gluten/Dairy? Meats (processed)? OPSC s 54th Annual Convention and Exposition Syllabus 562

20 Biopsychosocial Time during OMT session for talk Somato-emotional release Increased ROM, decreased pain leads to increased activity OPSC s 54th Annual Convention and Exposition Syllabus 563

21 Mechanical Address somatic dysfunction where found Gait/postural evaluation/treatment PT/ATC for functional movement screen OPSC s 54th Annual Convention and Exposition Syllabus 564

22 Dirty Half-Dozen Nonneutral dysfunction in the lumbar spine (84%) Dysfunction at the symphysis pubis (75%) Restriction of anterior nutation of the sacral base (48.6%) Innominate shear dysfunction (24%, 2:1 female) Short leg/pelvic tilt syndrome (63%) Muscle imbalance in the trunk and lower extremities (almost all) Greenman, P, and B Tait. "Structural Diagnosis in Chronic Low Back Pain." Manual Medicine. 3. (1988): Print. OPSC s 54th Annual Convention and Exposition Syllabus 565

23 RETURN TO TABLE OF CONTENTS OPSC s 54th Annual Convention and Exposition Syllabus 566