I just completed a first draft for an article on Traditional Chinese Medicine and managing the opioid crisis for Integrative Practitioner, an online journal for integrative medicine practitioners. I sent my article to the editor, but because of an email I received this morning from the Academy of Integrative Pain Management, I felt the need to add on more, so I twice revised that article. In that email were two documents that I found really interesting (you can read the whole journal here, if you like), so I have added them in. In case they need to edit those out–get me talking about TCM, integrative medicine, and pain management and I can blab on forever!–I thought I’d share those article and my take on them here.
The first article I read was for the results from a survey of 395 physicians who, between the years 2013 and 2016, took a 21-credit course called, “Opioids, Pain, and Addiction.” Despite having taken that course, and though the article didn’t cover areas where the physicians scored well, there are some glaring errors in their clinical practice. The most surprising one, for me, was that 31% never or rarely asked their chronic pain patients about their current level of pain. A further 25% asked only sometimes.
My first question to each patient is usually, “How are you doing?” or, “Catch me up. What’s going on for you?” If the patient is seeing me for pain, my first concern is whether their pain is better, worse, or the same. It’s baffling to me that for a patient suffering with chronic pain, a question about current pain levels could be forgotten or omitted. What else would we ask? “How’s your favourite baseball team doing?”
But I digress. This is where an integrative medicine team approach is beneficial. If one team member misses asking a question or noting a problem (or improvement), then another practitioner may note it. As stated by the Executive Director of the Academy of Integrative Pain Management, Dr. Bob Twillman, Ph.D., FAPM:
I’m really happy to see that some of the thought leaders in American healthcare are making greater use of complementary and integrative treatments, especially in the context of pain management. It’s always been true that, the more eyes you have on a patient, the greater the likelihood that you will be able to accurately identify existing issues, and these anecdotes reinforce that notion.
In an article from the prestigious Mayo Clinic, they talk about the importance of an integrative medicine team approach, siting a few case studies, which I’ve included below. In these cases, licensed acupuncturists and massage therapists discovered serious medical situations that required further treatment. Without their hands-on approach, these issues may have been missed or certainly treatment would likely have been delayed.
“Case 1
A 43-year-old female, who underwent partial small bowel resection two days earlier, complained of back pain from prolonged time in the hospital bed. The surgical team requested massage therapy to help improve patient comfort. As part of the initial assessment, the massage therapist noted localized warmth over the anterior left lower quadrant which the patient verbalized was tender to palpation. The therapist immediately stopped the massage and notified the nursing staff and surgical service of the patient’s symptoms. The patient was found to have an intestinal leak and infection in the abdominal cavity and was taken to surgery the same day.
Case 2
A 31-year-old female was referred for acupuncture therapy to help manage left upper trapezius pain that had been present for one year. During the initial consultation, the acupuncturist palpated a mass measuring approximately 1 × 5 × 4 cm within the trapezius and rhomboid region; it was warm to the touch and painful upon palpation. The acupuncturist contacted the referring physician and made her aware of the new finding. An ultrasound was ordered, and it revealed a hypoechoic solid mass with significant blood flow. An ultra-sound-guided biopsy was later performed with the results coming back positive for spindle cell sarcoma.
Case 3
A surgical service requested massage therapy for a 68-year-old female hospital patient who had undergone recent breast surgery and now complained of low back pain and anxiety. As part of the assessment, the therapist noted swelling and warmth in the patient’s right lower leg. The patient was asymptomatic. The therapist notified nursing staff who contacted the surgical service. Ultrasound confirmed the presence of deep venous thrombosis.
Case 4
A 57-year-old female with breast cancer initially was referred to acupuncture services to address side effects associated with chemotherapy and radiotherapy. She responded well to acupuncture and was seen intermittently for periodic muscle pains and osteoarthritis symptoms. Approximately two years after her initial course of acupuncture treatment, she was again referred for acupuncture therapy, this time to treat left shoulder pain, which had been preliminarily diagnosed as a rotator cuff tendinitis. The pain did not respond to acupuncture, in contradistinction to her previous successes with treatment. The acupuncturist notified the referring oncologist about the atypical results. The oncologists investigated further, ultimately obtaining magnetic resonance imaging which revealed multifocal appearing lesions on the left scapula. A positron emission tomography scan revealed three lesions in the left scapula as well as metastatic lesions in the T2 and T9 vertebrae. Biopsy was positive for metastatic breast cancer.”
Integrative Medicine Vancouver
It’s not surprising. A team approach is the way to go, especially when you are managing a complex medical condition. That’s why I’m so fortunate to work with two integrative medicine Vancouver teams!
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