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- Executing /home/rayhawkpas/dev/awdfiles/cron/site_install.php with params 'site_id=12&account_id=1'
- Landing manager MySQL setup: Start
- Filling in sites info...
- Creating site sections...
- 5 site section(s) exist. Skipping...
- Creating about content...
- Site about section id is 7...
- About content exists. Skipping...
- Recreating services content...
- Site service section id is 8...
- Services content exists. Skipping...
- Creating visible library tables...
- Creating data in site_library_pages...
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- Landing manager MySQL setup: End
- Directory exists at: /home/rayhawkorangeimaging/public_html/xml
- <?xml version="1.0" encoding="utf-8"?>
- <!--
- Copyright (c) Rayhawk Corporation. All rights reserved.
- http://www.rayhawkweb.com
- http://www.rayhawk.com
- -->
- <info>
- <client><![CDATA[Apollo Rayhawk]]></client>
- <site_name><![CDATA[Apollo of Irvine]]></site_name>
- <member_since><![CDATA[2010]]></member_since>
- <contact_phone><![CDATA[(949) 679-2200]]></contact_phone>
- <contact_email><![CDATA[john_nguyen@rayhawk.com]]></contact_email>
- <contact_address><![CDATA[16460 Bake Parkway<br />Irvine, CA 92618]]></contact_address>
- </info>
- <!--
- Copyright (c) Rayhawk Corporation. All rights reserved.
- http://www.rayhawkweb.com
- http://www.rayhawk.com
- -->
- Wrote to /home/rayhawkorangeimaging/public_html/xml/info.xml, 663 bytes.
- Directory exists at: /home/rayhawkorangeimaging/public_html/xml/about
- <?xml version="1.0" encoding="utf-8"?>
- <!--
- Copyright (c) Rayhawk Corporation. All rights reserved.
- http://www.rayhawkweb.com
- http://www.rayhawk.com
- -->
- <page>
- <title><![CDATA[About Doctor Proctor]]></title>
- <nonotice/>
- <section>
- <title><![CDATA[About]]></title>
- <anchor><![CDATA[198]]></anchor>
- <content><![CDATA[<p>Doctor Proctor is a Doctor.</p>]]></content>
- </section>
- </page>
- <!--
- Copyright (c) Rayhawk Corporation. All rights reserved.
- http://www.rayhawkweb.com
- http://www.rayhawk.com
- -->
- Wrote to /home/rayhawkorangeimaging/public_html/xml/about/42.xml, 529 bytes.
- Directory exists at: /home/rayhawkorangeimaging/public_html/xml/about
- <?xml version="1.0" encoding="utf-8"?>
- <!--
- Copyright (c) Rayhawk Corporation. All rights reserved.
- http://www.rayhawkweb.com
- http://www.rayhawk.com
- -->
- <index>
- <title><![CDATA[About]]></title>
- <page>
- <title><![CDATA[About Doctor Proctor]]></title>
- <path><![CDATA[42]]></path>
- <keywords><![CDATA[about, Doctor Proctor]]></keywords>
- <content><![CDATA[<p>Doctor Proctor is a Doctor.</p>]]></content>
- </page>
- </index>
- <!--
- Copyright (c) Rayhawk Corporation. All rights reserved.
- http://www.rayhawkweb.com
- http://www.rayhawk.com
- -->
- Wrote to /home/rayhawkorangeimaging/public_html/xml/about/about_index.xml, 565 bytes.
- Directory exists at: /home/rayhawkorangeimaging/public_html/xml/services
- <?xml version="1.0" encoding="utf-8"?>
- <!--
- Copyright (c) Rayhawk Corporation. All rights reserved.
- http://www.rayhawkweb.com
- http://www.rayhawk.com
- -->
- <page>
- <title><![CDATA[Chiropractic Adjustments]]></title>
- <nonotice/>
- <banner>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/banners/6.jpg]]></image>
- <color><![CDATA[dark]]></color>
- <height><![CDATA[360]]></height>
- </banner>
- <icon><![CDATA[http://awdfiles.myrayhawk.com/images/icons/5.png]]></icon>
- <section>
- <title><![CDATA[Introduction To Spinal Adjustments]]></title>
- <anchor><![CDATA[218]]></anchor>
- <content><![CDATA[<p>One of the primary techniques used by Doctors of Chiropractic (D.C.) is "spinal adjustment", also known as a "chiropractic adjustment". In fact, chiropractors are renowned as experts who specialize in performing spinal adjustments. The term "adjustment" refers to the physical adjustment of the spinal vertebrae. The goal of such spinal adjustment is to reduce vertebral subluxation and return the spine to a more natural state of health. The word subluxation is derived from the latin terms Sub ("less than" or "slight") and Luxate ("to dislocate" or "be misaligned"). Accordingly, vertebral subluxation means the slight dislocation or misalignment of the spinal vertebrae.</p> <p> When a patient has a subluxation, chiropractic adjustment can be used to correct the misalignment, which in turn helps enhance joint mobility, reduce pain, reduce muscle spasm, and reduce nerve irritation or impingement. Chiropractic adjustment is a highly refined skill acquired during years of intensive training. The technique involves the manual application of a controlled force into the spinal vertebrae which have become misaligned and hypomobile (limited in their range of motion). This procedure corrects vertebral alignment and is often accompanied by a clicking sound. While this sound might surprise first time chiropractic patients, it is merely the audible release of gas from within the spinal joints.</p> <p> Furthermore, the procedure rarely causes discomfort or pain. In fact, many patients report a sense of immediate relief associated with the chiropractic adjustment and often note positive changes in their symptoms shortly after receiving treatment. If discomfort is experienced it is typically minor and resolves within a matter of days.</p> <p> To achieve optimal results patients may receive several adjustments over multiple chiropractic visits. In addition to chiropractic adjustments, the care plan may also include massage and functional restoration exercises.</p>]]></content>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/spinal_adjustment.jpg]]></image>
- </section>
- <section>
- <title><![CDATA[Vertebral Subluxation Complex (V.S.C)]]></title>
- <anchor><![CDATA[219]]></anchor>
- <content><![CDATA[<p>Vertebral Subluxation Complex is a degenerative condition that left uncared for can worsen and eventually lead to serious consequences. The complex has inter-related components which can disrupt communications between the brain and the rest of the body. This disruption can negatively impact the normal functioning of internal organs.</p> <p> The complex is initiated by either a traumatic event or repetitive stress. The inciting event causes vertebral misalignment and tissue inflammation - both of which are V.S.C. components. Below is a list of the V.S.C. components and a description of how they interact with one another:<br /> VERTEBRAL COMPONENT: Sections of the spinal column can become misaligned due to trauma and repetitive stress. This misalignment can also cause local inflammation which in turn may lead to vertebral hypo-mobility (restriction in the joint's range of motion) due to the formation of fibrotic scar tissue. Such misalignment and hypo-mobility narrows the spine's nerve outlets which compress and irritate the nerve roots (a.k.a. nerve root impingement).<br /> INFLAMMATORY COMPONENT: Tissue around the spinal column becomes inflamed and swollen due to uncorrected misalignment or repetitive stress injuries. With time, this local inflammation results in (i) nerve root inflammation which contributes to the Neural Component of V.S.C., (ii) vertebral hypo-mobility due to the formation of fibrotic scar tissue (see Vertebral Component above), and (iii) irritation and inflammation of local muscle tissue which contributes to the Muscle Component of V.S.C. and can eventually cause fibrotic muscle degeneration.<br /> MUSCLE COMPONENT: Muscles around the spinal column are affected by (i) abnormal nerve signals due to the Neural Component, and (ii) irritation due to the Inflammatory Component. This results in muscle spasms, reduced muscle tone (hypo-tonicity), and muscle weakening (atrophy). These muscular abnormalities further exacerbate the vertebral subluxation and can cause additional misalignments at new vertebral levels.<br /> NEURAL COMPONENT: Nerve roots emerging from the spinal column become compressed and irritated due to vertebral misalignment and local inflammation. This nerve impingement and inflammation results in (i) abnormal neural signals which contribute to the Muscle Component of V.S.C., and (ii) the distortion and disruption of nerve impulses from the brain to the internal organs of the body (see Neuro-Visceral Component below).<br /> NEURO-VISCERAL COMPONENT: Neural information from the brain to the internal organs (a.k.a. viscera) become disrupted or distorted due to nerve impingement and inflammation. This distortion and disruption of nerve impulses can result in a wide range of negative health consequences.</p> <p> As you can see, the Vertebral Subluxation Complex is a disorder that progressively worsens. As the disorder progresses it may cause chronic pain, inflammation, arthritis, loss of vertebral joint mobility, muscle spasm, and muscle weakness.</p> <p> Furthermore, left unchecked V.S.C. can interfere with nerve impulses traveling between the brain and internal organs. In essence, as the complex intensifies it can affect the control and regulation of other parts of your body, which can have devastating health consequences.</p> <p> Qualified chiropractors know the dangers of neglecting V.S.C. and are dedicated to the art and science of spinal adjustment. Using Kinetic Chiropractic&trade; techniques they are experts at detecting and reducing vertebral subluxations.</p> <p> Accordingly, it is vital that patients with back problems or suspected subluxations seek Kinetic Chiropractic&trade; care as soon as possible.</p>]]></content>
- </section>
- <section>
- <title><![CDATA[Ongoing Chiropractic Care]]></title>
- <anchor><![CDATA[220]]></anchor>
- <content><![CDATA[<p>There is a widespread myth that receiving chiropractic care creates a need for continuous spinal adjustment. In the past, people had misconceptions that chiropractors merely cared for a patient's symptoms while neglecting the root condition. It was believed that this superficial approach required a patient to return for further treatments on a perpetual basis.</p> <p> Today, however, many people have realized that chiropractic care is similar to other routine preventative measures such as dental cleanings, optometric exams, periodic blood analysis, and physical examinations. They recognize the spine and the critical nerve impulses it protects are just as important as the other parts of the body. Accordingly, progressive members of society now understand that visiting a chiropractor on a regular basis is a vital component of a healthy lifestyle.</p> <p> In fact, modern-day chiropractors assert that the spine requires occasional adjustments in order to maintain an optimal state of neuromusculoskeletal health. Patients who receive regular chiropractic care have reported many benefits including pain relief, increased energy, and more restful sleep. These benefits combine with a balanced lifestyle to promote wellness and longevity.</p>]]></content>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/ongoing_care.jpg]]></image>
- </section>
- </page>
- <!--
- Copyright (c) Rayhawk Corporation. All rights reserved.
- http://www.rayhawkweb.com
- http://www.rayhawk.com
- -->
- Wrote to /home/rayhawkorangeimaging/public_html/xml/services/47.xml, 8247 bytes.
- Directory exists at: /home/rayhawkorangeimaging/public_html/xml/services
- <?xml version="1.0" encoding="utf-8"?>
- <!--
- Copyright (c) Rayhawk Corporation. All rights reserved.
- http://www.rayhawkweb.com
- http://www.rayhawk.com
- -->
- <page>
- <title><![CDATA[Massage Treatment]]></title>
- <nonotice/>
- <banner>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/banners/8.jpg]]></image>
- <color><![CDATA[light]]></color>
- <height><![CDATA[360]]></height>
- </banner>
- <icon><![CDATA[http://awdfiles.myrayhawk.com/images/icons/6.png]]></icon>
- <section>
- <title><![CDATA[Introduction to Massage]]></title>
- <anchor><![CDATA[221]]></anchor>
- <content><![CDATA[<p>If you are looking for an effective way to relax, re-align, and rejuvenate then you may want to consider massage. Massage can relax muscles, sooth your aches, and restore your body's balance. It rejuvenates and makes us better able to handle all the challenges that come with life. Our experienced, professional therapists believe that each client deserves a great revitalizing experience, exceptional care, and a customized treatment that addresses individual needs. These therapists know most of us have hectic lifestyles, and they want to help relieve the tension associated with our daily stressors.</p> <p> Today many Americans rely on massage to provide relaxation and help achieve a balanced lifestyle. So schedule an appointment and find out how amazing it feels to be pampered by a professional massage therapist.</p>]]></content>
- </section>
- <section>
- <title><![CDATA[The Many Benefits of Massage]]></title>
- <anchor><![CDATA[222]]></anchor>
- <content><![CDATA[<p>Massage has been long recognized to provide numerous health benefits, especially when treatment is received on a regular basis. Below is a list of ways in which massage can help improve your mental and physical state.</p> <p> Massage Can Help Improve:<br /> Circlulation and tissue oxygenation<br /> Concentration<br /> Endorphin release<br /> Energy levels<br /> Immunity<br /> Injury rehabilitation<br /> Joint flexibility<br /> Lymphatic flow<br /> Pain management<br /> Posture</p> <p> Massage Can Help Reduce:<br /> Anxiety<br /> Depression<br /> Fatigue<br /> Headaches / Headache pain<br /> High blood pressure<br /> Low-back pain<br /> Medication dependency<br /> Migraine pain<br /> Muscular tension and stiffness<br /> Stress</p>]]></content>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/benefits_massage.jpg]]></image>
- </section>
- <section>
- <title><![CDATA[Massage, a Gateway to Stress Relief]]></title>
- <anchor><![CDATA[223]]></anchor>
- <content><![CDATA[<p>While the motives to seek massage range from luxurious pampering to therapeutic relief, one of the most valuable benefits is stress relief. This is because stress may contribute to other disease processes and accelerated aging.</p> <p> As most of us realize, completely eliminating anxiety and stress is unrealistic, therefore managing stress becomes a critical component of one's well-being. By alleviating your stress levels massage helps enhance concentration and focus, increase energy levels, reduce fatigue, and improve the quality of sleep. Some people may even experience greater mental clarity and a sense of tranquility that can persist for days after a massage session.</p> <p> All of this can lend to a more productive and fulfilling life.</p> <p> Sapolsky, R.M. Why Zebras Don't Get Ulcers. Third Edition. Henry Holt and Company, New York. 2004</p> <p> Epel, E.S. Accelerated telomere shortening in response to life stress. Proceedings of the<u> National Academy of Sciences. December 7, 2004. 101 (49): 17312 - 17315.</u></p>]]></content>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/massage_gateway.jpg]]></image>
- </section>
- <section>
- <title><![CDATA[Introduction to Massage]]></title>
- <anchor><![CDATA[224]]></anchor>
- <content><![CDATA[<p>If you are looking for an effective way to relax, re-align, and rejuvenate then you may want to consider massage. Massage can relax muscles, sooth your aches, and restore your body's balance. It rejuvenates and makes us better able to handle all the challenges that come with life. Our experienced, professional therapists believe that each client deserves a great revitalizing experience, exceptional care, and a customized treatment that addresses individual needs. These therapists know most of us have hectic lifestyles, and they want to help relieve the tension associated with our daily stressors.</p> <p> Today many Americans rely on massage to provide relaxation and help achieve a balanced lifestyle. So schedule an appointment and find out how amazing it feels to be pampered by a professional massage therapist.</p>]]></content>
- </section>
- <section>
- <title><![CDATA[The Many Benefits of Massage]]></title>
- <anchor><![CDATA[225]]></anchor>
- <content><![CDATA[<p>Massage has been long recognized to provide numerous health benefits, especially when treatment is received on a regular basis. Below is a list of ways in which massage can help improve your mental and physical state.</p> <p> Massage Can Help Improve:<br /> Circlulation and tissue oxygenation<br /> Concentration<br /> Endorphin release<br /> Energy levels<br /> Immunity<br /> Injury rehabilitation<br /> Joint flexibility<br /> Lymphatic flow<br /> Pain management<br /> Posture</p> <p> Massage Can Help Reduce:<br /> Anxiety<br /> Depression<br /> Fatigue<br /> Headaches / Headache pain<br /> High blood pressure<br /> Low-back pain<br /> Medication dependency<br /> Migraine pain<br /> Muscular tension and stiffness<br /> Stress</p>]]></content>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/benefits_massage.jpg]]></image>
- </section>
- <section>
- <title><![CDATA[Massage, a Gateway to Stress Relief]]></title>
- <anchor><![CDATA[226]]></anchor>
- <content><![CDATA[<p>While the motives to seek massage range from luxurious pampering to therapeutic relief, one of the most valuable benefits is stress relief. This is because stress may contribute to other disease processes and accelerated aging.</p> <p> As most of us realize, completely eliminating anxiety and stress is unrealistic, therefore managing stress becomes a critical component of one's well-being. By alleviating your stress levels massage helps enhance concentration and focus, increase energy levels, reduce fatigue, and improve the quality of sleep. Some people may even experience greater mental clarity and a sense of tranquility that can persist for days after a massage session.</p> <p> All of this can lend to a more productive and fulfilling life.</p> <p> Sapolsky, R.M. Why Zebras Don't Get Ulcers. Third Edition. Henry Holt and Company, New York. 2004</p> <p> Epel, E.S. Accelerated telomere shortening in response to life stress. Proceedings of the<u> National Academy of Sciences. December 7, 2004. 101 (49): 17312 - 17315.</u></p>]]></content>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/massage_gateway.jpg]]></image>
- </section>
- </page>
- <!--
- Copyright (c) Rayhawk Corporation. All rights reserved.
- http://www.rayhawkweb.com
- http://www.rayhawk.com
- -->
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- Directory exists at: /home/rayhawkorangeimaging/public_html/xml/services
- <?xml version="1.0" encoding="utf-8"?>
- <!--
- Copyright (c) Rayhawk Corporation. All rights reserved.
- http://www.rayhawkweb.com
- http://www.rayhawk.com
- -->
- <page>
- <title><![CDATA[Nutrition & Fitness]]></title>
- <nonotice/>
- <banner>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/banners/7.jpg]]></image>
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- <anchor><![CDATA[227]]></anchor>
- <content><![CDATA[<p>Content coming soon.</p>]]></content>
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- <section>
- <title><![CDATA[Content Coming Soon]]></title>
- <anchor><![CDATA[228]]></anchor>
- <content><![CDATA[<p>Content coming soon.</p>]]></content>
- </section>
- </page>
- <!--
- Copyright (c) Rayhawk Corporation. All rights reserved.
- http://www.rayhawkweb.com
- http://www.rayhawk.com
- -->
- Wrote to /home/rayhawkorangeimaging/public_html/xml/services/49.xml, 970 bytes.
- Directory exists at: /home/rayhawkorangeimaging/public_html/xml/services
- <?xml version="1.0" encoding="utf-8"?>
- <!--
- Copyright (c) Rayhawk Corporation. All rights reserved.
- http://www.rayhawkweb.com
- http://www.rayhawk.com
- -->
- <index>
- <title><![CDATA[Services]]></title>
- <notoc/>
- <banner>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/banners/5.jpg]]></image>
- <color><![CDATA[dark]]></color>
- <height><![CDATA[250]]></height>
- </banner>
- <page>
- <title><![CDATA[Chiropractic Adjustments]]></title>
- <path><![CDATA[47]]></path>
- <keywords></keywords>
- <banner>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/banners/6.jpg]]></image>
- <color><![CDATA[dark]]></color>
- <height><![CDATA[360]]></height>
- </banner>
- <icon><![CDATA[http://awdfiles.myrayhawk.com/images/icons/5.png]]></icon>
- <content><![CDATA[<p>One of the primary techniques used by Doctors of Chiropractic (D.C.) is "spinal adjustment", also known as a "chiropractic adjustment". In fact, chiropractors are renowned as experts who specialize in performing spinal adjustments. The term "adjustment" refers to the physical adjustment of the spinal vertebrae. The goal of such spinal adjustment is to reduce vertebral subluxation and return the spine to a more natural state of health. The word subluxation is derived from the latin terms Sub ("less than" or "slight") and Luxate ("to dislocate" or "be misaligned"). Accordingly, vertebral subluxation means the slight dislocation or misalignment of the spinal vertebrae.</p> <p> When a patient has a subluxation, chiropractic adjustment can be used to correct the misalignment, which in turn helps enhance joint mobility, reduce pain, reduce muscle spasm, and reduce nerve irritation or impingement. Chiropractic adjustment is a highly refined skill acquired during years of intensive training. The technique involves the manual application of a controlled force into the spinal vertebrae which have become misaligned and hypomobile (limited in their range of motion). This procedure corrects vertebral alignment and is often accompanied by a clicking sound. While this sound might surprise first time chiropractic patients, it is merely the audible release of gas from within the spinal joints.</p> <p> Furthermore, the procedure rarely causes discomfort or pain. In fact, many patients report a sense of immediate relief associated with the chiropractic adjustment and often note positive changes in their symptoms shortly after receiving treatment. If discomfort is experienced it is typically minor and resolves within a matter of days.</p> <p> To achieve optimal results patients may receive several adjustments over multiple chiropractic visits. In addition to chiropractic adjustments, the care plan may also include massage and functional restoration exercises.</p>]]></content>
- </page>
- <page>
- <title><![CDATA[Massage Treatment]]></title>
- <path><![CDATA[48]]></path>
- <keywords></keywords>
- <banner>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/banners/8.jpg]]></image>
- <color><![CDATA[light]]></color>
- <height><![CDATA[360]]></height>
- </banner>
- <icon><![CDATA[http://awdfiles.myrayhawk.com/images/icons/6.png]]></icon>
- <content><![CDATA[<p>If you are looking for an effective way to relax, re-align, and rejuvenate then you may want to consider massage. Massage can relax muscles, sooth your aches, and restore your body's balance. It rejuvenates and makes us better able to handle all the challenges that come with life. Our experienced, professional therapists believe that each client deserves a great revitalizing experience, exceptional care, and a customized treatment that addresses individual needs. These therapists know most of us have hectic lifestyles, and they want to help relieve the tension associated with our daily stressors.</p> <p> Today many Americans rely on massage to provide relaxation and help achieve a balanced lifestyle. So schedule an appointment and find out how amazing it feels to be pampered by a professional massage therapist.</p>]]></content>
- </page>
- <page>
- <title><![CDATA[Nutrition & Fitness]]></title>
- <path><![CDATA[49]]></path>
- <keywords></keywords>
- <banner>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/banners/7.jpg]]></image>
- <color><![CDATA[light]]></color>
- <height><![CDATA[360]]></height>
- </banner>
- <icon><![CDATA[http://awdfiles.myrayhawk.com/images/icons/7.png]]></icon>
- <content><![CDATA[<p>Content coming soon.</p>]]></content>
- </page>
- </index>
- <!--
- Copyright (c) Rayhawk Corporation. All rights reserved.
- http://www.rayhawkweb.com
- http://www.rayhawk.com
- -->
- Wrote to /home/rayhawkorangeimaging/public_html/xml/services/services_index.xml, 4660 bytes.
- Directory exists at: /home/rayhawkorangeimaging/public_html/xml/index
- <?xml version="1.0" encoding="utf-8"?>
- <!--
- Copyright (c) Rayhawk Corporation. All rights reserved.
- http://www.rayhawkweb.com
- http://www.rayhawk.com
- -->
- <index>
- <title><![CDATA[Apollo Rayhawk]]></title>
- <nonotice/>
- <intro>
- <title><![CDATA[Introduction of Apollo Rayhawk]]></title>
- <anchor><![CDATA[intro]]></anchor>
- <content><![CDATA[Get some at Apollo of Irvine, where healthy lives begin.]]></content>
- </intro>
- <section>
- <title><![CDATA[Services / Conditions We Treat]]></title>
- <anchor><![CDATA[services]]></anchor>
- <subject>
- <banner image="http://awdfiles.myrayhawk.com/images/banners/6.jpg" color="dark" height="360"><![CDATA[http://awdfiles.myrayhawk.com/images/banners/6.jpg]]></banner>
- <icon><![CDATA[http://awdfiles.myrayhawk.com/images/icons/5.png]]></icon>
- <title><![CDATA[Chiropractic Adjustments]]></title>
- <path><![CDATA[47]]></path>
- <content><![CDATA[<p>One of the primary techniques used by Doctors of Chiropractic (D.C.) is "spinal adjustment", also known as a "chiropractic adjustment". In fact, chiropractors are renowned as experts who specialize in performing spinal adjustments. The term "adjustment" refers to the physical adjustment of the spinal vertebrae. The goal of such spinal adjustment is to reduce vertebral subluxation and return the spine to a more natural state of health. The word subluxation is derived from the latin terms Sub ("less than" or "slight") and Luxate ("to dislocate" or "be misaligned"). Accordingly, vertebral subluxation means the slight dislocation or misalignment of the spinal vertebrae.</p> <p> When a patient has a subluxation, chiropractic adjustment can be used to correct the misalignment, which in turn helps enhance joint mobility, reduce pain, reduce muscle spasm, and reduce nerve irritation or impingement. Chiropractic adjustment is a highly refined skill acquired during years of intensive training. The technique involves the manual application of a controlled force into the spinal vertebrae which have become misaligned and hypomobile (limited in their range of motion). This procedure corrects vertebral alignment and is often accompanied by a clicking sound. While this sound might surprise first time chiropractic patients, it is merely the audible release of gas from within the spinal joints.</p> <p> Furthermore, the procedure rarely causes discomfort or pain. In fact, many patients report a sense of immediate relief associated with the chiropractic adjustment and often note positive changes in their symptoms shortly after receiving treatment. If discomfort is experienced it is typically minor and resolves within a matter of days.</p> <p> To achieve optimal results patients may receive several adjustments over multiple chiropractic visits. In addition to chiropractic adjustments, the care plan may also include massage and functional restoration exercises.</p>]]></content>
- </subject>
- <subject>
- <banner image="http://awdfiles.myrayhawk.com/images/banners/8.jpg" color="light" height="360"><![CDATA[http://awdfiles.myrayhawk.com/images/banners/8.jpg]]></banner>
- <icon><![CDATA[http://awdfiles.myrayhawk.com/images/icons/6.png]]></icon>
- <title><![CDATA[Massage Treatment]]></title>
- <path><![CDATA[48]]></path>
- <content><![CDATA[<p>If you are looking for an effective way to relax, re-align, and rejuvenate then you may want to consider massage. Massage can relax muscles, sooth your aches, and restore your body's balance. It rejuvenates and makes us better able to handle all the challenges that come with life. Our experienced, professional therapists believe that each client deserves a great revitalizing experience, exceptional care, and a customized treatment that addresses individual needs. These therapists know most of us have hectic lifestyles, and they want to help relieve the tension associated with our daily stressors.</p> <p> Today many Americans rely on massage to provide relaxation and help achieve a balanced lifestyle. So schedule an appointment and find out how amazing it feels to be pampered by a professional massage therapist.</p>]]></content>
- </subject>
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- <banner image="http://awdfiles.myrayhawk.com/images/banners/7.jpg" color="light" height="360"><![CDATA[http://awdfiles.myrayhawk.com/images/banners/7.jpg]]></banner>
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- <title><![CDATA[Nutrition & Fitness]]></title>
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- <page>
- <title><![CDATA[Low Back Pain Fact Sheet]]></title>
- <subject><![CDATA[Back / Back Pain]]></subject>
- <type><![CDATA[General Information]]></type>
- <banner>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/banners/banner_low_back_facts.jpg]]></image>
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- <section>
- <title><![CDATA[Introduction]]></title>
- <anchor><![CDATA[8]]></anchor>
- <keywords></keywords>
- <content><![CDATA[<p>If you have lower back pain, you are not alone. Nearly everyone at some point has back pain that interferes with work, routine daily activities, or recreation. Americans spend at least $50 billion each year on low back pain, the most common cause of job-related disability and a leading contributor to missed work. Back pain is the second most common neurological ailment in the United States - only headache is more common. Fortunately, most occurrences of low back pain go away within a few days. Others take much longer to resolve or lead to more serious conditions.</p>
- <p><i>Acute</i> or short-term low back pain generally lasts from a few days to a few weeks. Most acute back pain is mechanical in nature - the result of trauma to the lower back or a disorder such as arthritis. Pain from trauma may be caused by a sports injury, work around the house or in the garden, or a sudden jolt such as a car accident or other stress on spinal bones and tissues. Symptoms may range from muscle ache to shooting or stabbing pain, limited flexibility and/or range of motion, or an inability to stand straight. Occasionally, pain felt in one part of the body may "radiate" from a disorder or injury elsewhere in the body. Some acute pain syndromes can become more serious if left untreated.</p>
- <p><i>Chronic</i> back pain is measured by duration - pain that persists for more than 3 months is considered chronic. It is often progressive and the cause can be difficult to determine.</p>]]></content>
- </section>
- <section>
- <title><![CDATA[What Structures Make Up the Back?]]></title>
- <anchor><![CDATA[9]]></anchor>
- <keywords><![CDATA[structures]]></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/structures.jpg]]></image>
- <content><![CDATA[<p>The back is an intricate structure of bones, muscles, and other tissues that form the posterior part of the body's trunk, from the neck to the pelvis. The centerpiece is the spinal column, which not only supports the upper body's weight but houses and protects the spinal cord - the delicate nervous system structure that carries signals that control the body's movements and convey its sensations. Stacked on top of one another are more than 30 bones - the vertebrae - that form the spinal column, also known as the spine. Each of these bones contains a roundish hole that, when stacked in register with all the others, creates a channel that surrounds the spinal cord. The spinal cord descends from the base of the brain and extends in the adult to just below the rib cage. Small nerves (&quot;roots&quot;) enter and emerge from the spinal cord through spaces between the vertebrae. Because the bones of the spinal column continue growing long after the spinal cord reaches its full length in early childhood, the nerve roots to the lower back and legs extend many inches down the spinal column before exiting. This large bundle of nerve roots was dubbed by early anatomists as the cauda equina, or horse's tail. The spaces between the vertebrae are maintained by round, spongy pads of cartilage called intervertebral discs that allow for flexibility in the lower back and act much like shock absorbers throughout the spinal column to cushion the bones as the body moves. Bands of tissue known as ligaments and tendons hold the vertebrae in place and attach the muscles to the spinal column.</p>
- <p>Starting at the top, the spine has four regions:</p>
- <ul>
- <li>The seven cervical or neck vertebrae (labeled C1-C7);</li>
- <li>The 12 thoracic or upper back vertebrae (labeled T1-T12);</li>
- <li>The five lumbar vertebrae (labeled L1-L5), which we know as the lower back;</li>
- <li>The sacrum and coccyx, a group of bones fused together at the base of the spine.</li>
- </ul>
- <p>The lumbar region of the back, where most back pain is felt, supports the weight of the upper body.</p>]]></content>
- </section>
- <section>
- <title><![CDATA[What Causes Lower Back Pain?]]></title>
- <anchor><![CDATA[10]]></anchor>
- <keywords><![CDATA[causes]]></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/causes.jpg]]></image>
- <content><![CDATA[<p>As people age, bone strength and muscle elasticity and tone tend to decrease. The discs begin to lose fluid and flexibility, which decreases their ability to cushion the vertebrae.</p>
- <p>Pain can occur when, for example, someone lifts something too heavy or overstretches, causing a sprain, strain, or spasm in one of the muscles or ligaments in the back. If the spine becomes overly strained or compressed, a disc may rupture or bulge outward. This rupture may put pressure on one of the more than 50 nerves rooted to the spinal cord that control body movements and transmit signals from the body to the brain. When these nerve roots become compressed or irritated, back pain results.</p>
- <p>Low back pain may reflect nerve or muscle irritation or bone lesions. Most low back pain follows injury or trauma to the back, but pain may also be caused by degenerative conditions such as arthritis or disc disease, osteoporosis or other bone diseases, viral infections, irritation to joints and discs, or congenital abnormalities in the spine. Obesity, smoking, weight gain during pregnancy, stress, poor physical condition, posture inappropriate for the activity being performed, and poor sleeping position also may contribute to low back pain. Additionally, scar tissue created when the injured back heals itself does not have the strength or flexibility of normal tissue. Buildup of scar tissue from repeated injuries eventually weakens the back and can lead to more serious injury.</p>
- <p>Occasionally, low back pain may indicate a more serious medical problem. Pain accompanied by fever or loss of bowel or bladder control, pain when coughing, and progressive weakness in the legs may indicate a pinched nerve or other serious condition. People with diabetes may have severe back pain or pain radiating down the leg related to neuropathy. People with these symptoms should contact a doctor immediately to help prevent permanent damage.</p>]]></content>
- </section>
- <section>
- <title><![CDATA[Who is Most Likely To Develop Low Back Pain?]]></title>
- <anchor><![CDATA[11]]></anchor>
- <keywords><![CDATA[develop]]></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/develop.jpg]]></image>
- <content><![CDATA[<p>Nearly everyone has low back pain sometime. Men and women are equally affected. It occurs most often between ages 30 and 50, due in part to the aging process but also as a result of sedentary life styles with too little (sometimes punctuated by too much) exercise. The risk of experiencing low back pain from disc disease or spinal degeneration increases with age.</p>
- <p>Low back pain unrelated to injury or other known cause is unusual in pre-teen children. However, a backpack overloaded with schoolbooks and supplies can quickly strain the back and cause muscle fatigue. The U.S. Consumer Product Safety Commission estimates that more than 13,260 injuries related to backpacks were treated at doctors' offices, clinics, and emergency rooms in the year 2000. To avoid back strain, children carrying backpacks should bend both knees when lifting heavy packs, visit their locker or desk between classes to lighten loads or replace books, or purchase a backpack or airline tote on wheels.</p>]]></content>
- </section>
- <section>
- <title><![CDATA[Conditions Associated With Low Back Pain]]></title>
- <anchor><![CDATA[12]]></anchor>
- <keywords><![CDATA[conditions]]></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/conditions.jpg]]></image>
- <content><![CDATA[<p>Conditions that may cause low back pain and require treatment by a physician or other health specialist include:</p>
- <p><i>Bulging disc (also called protruding, herniated, or ruptured disc)</i>. The intervertebral discs are under constant pressure. As discs degenerate and weaken, cartilage can bulge or be pushed into the space containing the spinal cord or a nerve root, causing pain. Studies have shown that most herniated discs occur in the lower, lumbar portion of the spinal column.</p>
- <p>A much more serious complication of a ruptured disc is <i>cauda equina syndrome</i>, which occurs when disc material is pushed into the spinal canal and compresses the bundle of lumbar and sacral nerve roots. Permanent neurological damage may result if this syndrome is left untreated.</p>
- <p><i>Sciatica</i> is a condition in which a herniated or ruptured disc presses on the sciatic nerve, the large nerve that extends down the spinal column to its exit point in the pelvis and carries nerve fibers to the leg. This compression causes shock-like or burning low back pain combined with pain through the buttocks and down one leg to below the knee, occasionally reaching the foot. In the most extreme cases, when the nerve is pinched between the disc and an adjacent bone, the symptoms involve not pain but numbness and some loss of motor control over the leg due to interruption of nerve signaling. The condition may also be caused by a tumor, cyst, metastatic disease, or degeneration of the sciatic nerve root.</p>
- <p><i>Spinal degeneration</i> from disc wear and tear can lead to a narrowing of the spinal canal. A person with spinal degeneration may experience stiffness in the back upon awakening or may feel pain after walking or standing for a long time.</p>
- <p><i>Spinal stenosis</i> related to congenital narrowing of the bony canal predisposes some people to pain related to disc disease.</p>
- <p><i>Osteoporosis</i> is a metabolic bone disease marked by progressive decrease in bone density and strength. Fracture of brittle, porous bones in the spine and hips results when the body fails to produce new bone and/or absorbs too much existing bone. Women are four times more likely than men to develop <i>osteoporosis</i>. Caucasian women of northern European heritage are at the highest risk of developing the condition.</p>
- <p><i>Skeletal irregularities</i> produce strain on the vertebrae and supporting muscles, tendons, ligaments, and tissues supported by spinal column. These irregularities include <i>scoliosis</i>, a curving of the spine to the side; <i>kyphosis</i>, in which the normal curve of the upper back is severely rounded; <i>lordosis</i>, an abnormally accentuated arch in the lower back; <i>back extension</i>, a bending backward of the spine; and <i>back flexion</i>, in which the spine bends forward.</p>
- <p><i>Fibromyalgia</i> is a chronic disorder characterized by widespread musculoskeletal pain, fatigue, and multiple &quot;tender points&quot;, particularly in the neck, spine, shoulders, and hips. Additional symptoms may include sleep disturbances, morning stiffness, and anxiety.</p>
- <p><i>Spondylitis</i> refers to chronic back pain and stiffness caused by a severe infection to or inflammation of the spinal joints. Other painful inflammations in the lower back include <i>osteomyelitis</i> (infection in the bones of the spine) and <i>sacroiliitis</i> (inflammation in the sacroiliac joints).</p>]]></content>
- </section>
- <section>
- <title><![CDATA[How is Low Back Pain Diagnosed?]]></title>
- <anchor><![CDATA[13]]></anchor>
- <keywords><![CDATA[diagnosed, diagnosis]]></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/how_diagnosed.jpg]]></image>
- <content><![CDATA[<p>A thorough medical history and physical exam can usually identify any dangerous conditions or family history that may be associated with the pain. The patient describes the onset, site, and severity of the pain; duration of symptoms and any limitations in movement; and history of previous episodes or any health conditions that might be related to the pain. The physician will examine the back and conduct neurologic tests to determine the cause of pain and appropriate treatment. Blood tests may also be ordered. Imaging tests may be necessary to diagnose tumors or other possible sources of the pain.</p>
- <p>A variety of diagnostic methods are available to confirm the cause of low back pain:</p>
- <p><i>X-ray imaging</i> includes conventional and enhanced methods that can help diagnose the cause and site of back pain. A <i>conventional x-ray</i>, often the first imaging technique used, looks for broken bones or an injured vertebra. A technician passes a concentrated beam of low-dose ionized radiation through the back and takes pictures that, within minutes, clearly show the bony structure and any vertebral misalignment or fractures. Tissue masses such as injured muscles and ligaments or painful conditions such as a bulging disc are not visible on conventional x-rays. This fast, noninvasive, painless procedure is usually performed in a doctor's office or at a clinic.</p>
- <p><i>Discography</i> involves the injection of a special contrast dye into a spinal disc thought to be causing low back pain. The dye outlines the damaged areas on x-rays taken following the injection. This procedure is often suggested for patients who are considering lumbar surgery or whose pain has not responded to conventional treatments. <i>Myelograms</i> also enhance the diagnostic imaging of an x-ray. In this procedure, the contrast dye is injected into the spinal canal, allowing spinal cord and nerve compression caused by herniated discs or fractures to be seen on an x-ray.</p>
- <p><i>Computerized tomography (CT)</i> is a quick and painless process used when disc rupture, spinal stenosis, or damage to vertebrae is suspected as a cause of low back pain. X-rays are passed through the body at various angles and are detected by a computerized scanner to produce two-dimensional slices (1 mm each) of internal structures of the back. This diagnostic exam is generally conducted at an imaging center or hospital.</p>
- <p><i>Magnetic resonance imaging (MRI)</i> is used to evaluate the lumbar region for bone degeneration or injury or disease in tissues and nerves, muscles, ligaments, and blood vessels. MRI scanning equipment creates a magnetic field around the body strong enough to temporarily realign water molecules in the tissues. Radio waves are then passed through the body to detect the &quot;relaxation&quot; of the molecules back to a random alignment and trigger a resonance signal at different angles within the body. A computer processes this resonance into either a three-dimensional picture or a two-dimensional &quot;slice&quot; of the tissue being scanned, and differentiates between bone, soft tissues and fluid-filled spaces by their water content and structural properties. This noninvasive procedure is often used to identify a condition requiring prompt surgical treatment.</p>
- <p><i>Electrodiagnostic procedures</i> include electromyography (EMG), nerve conduction studies, and evoked potential (EP) studies. EMG assesses the electrical activity in a nerve and can detect if muscle weakness results from injury or a problem with the nerves that control the muscles. Very fine needles are inserted in muscles to measure electrical activity transmitted from the brain or spinal cord to a particular area of the body. With nerve conduction studies the doctor uses two sets of electrodes (similar to those used during an electrocardiogram) that are placed on the skin over the muscles. The first set gives the patient a mild shock to stimulate the nerve that runs to a particular muscle. The second set of electrodes is used to make a recording of the nerve's electrical signals, and from this information the doctor can determine if there is nerve damage. EP tests also involve two sets of electrodes - one set to stimulate a sensory nerve and the other set on the scalp to record the speed of nerve signal transmissions to the brain.</p>
- <p><i>Bone scans</i> are used to diagnose and monitor infection, fracture, or disorders in the bone. A small amount of radioactive material is injected into the bloodstream and will collect in the bones, particularly in areas with some abnormality. Scanner-generated images are sent to a computer to identify specific areas of irregular bone metabolism or abnormal blood flow, as well as to measure levels of joint disease.</p>
- <p><i>Thermography</i> involves the use of infrared sensing devices to measure small temperature changes between the two sides of the body or the temperature of a specific organ. Thermography may be used to detect the presence or absence of nerve root compression.</p>
- <p><i>Ultrasound imaging</i>, also called ultrasound scanning or sonography, uses high-frequency sound waves to obtain images inside the body. The sound wave echoes are recorded and displayed as a real-time visual image. Ultrasound imaging can show tears in ligaments, muscles, tendons, and other soft tissue masses in the back.</p>]]></content>
- </section>
- <section>
- <title><![CDATA[How is Back Pain Treated?]]></title>
- <anchor><![CDATA[14]]></anchor>
- <keywords><![CDATA[treatment]]></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/how_treated.jpg]]></image>
- <content><![CDATA[<p>Most low back pain can be treated without surgery. Treatment involves using analgesics, reducing inflammation, restoring proper function and strength to the back, and preventing recurrence of the injury. Most patients with back pain recover without residual functional loss. Patients should contact a doctor if there is not a noticeable reduction in pain and inflammation after 72 hours of self-care.</p>
- <p>Although <i>ice and heat</i> (the use of cold and hot compresses) have never been scientifically proven to quickly resolve low back injury, compresses may help reduce pain and inflammation and allow greater mobility for some individuals. As soon as possible following trauma, patients should apply a cold pack or a cold compress (such as a bag of ice or bag of frozen vegetables wrapped in a towel) to the tender spot several times a day for up to 20 minutes. After 2 to 3 days of cold treatment, they should then apply heat (such as a heating lamp or hot pad) for brief periods to relax muscles and increase blood flow. Warm baths may also help relax muscles. Patients should avoid sleeping on a heating pad, which can cause burns and lead to additional tissue damage.</p>
- <p><i>Bed rest</i> - 1-2 days at most. A 1996 Finnish study found that persons who continued their activities without bed rest following onset of low back pain appeared to have better back flexibility than those who rested in bed for a week. Other studies suggest that bed rest alone may make back pain worse and can lead to secondary complications such as depression, decreased muscle tone, and blood clots in the legs. Patients should resume activities as soon as possible. At night or during rest, patients should lie on one side, with a pillow between the knees (some doctors suggest resting on the back and putting a pillow beneath the knees).</p>
- <p><i>Exercise</i> may be the most effective way to speed recovery from low back pain and help strengthen back and abdominal muscles. Maintaining and building muscle strength is particularly important for persons with skeletal irregularities. Doctors and physical therapists can provide a list of gentle exercises that help keep muscles moving and speed the recovery process. A routine of back-healthy activities may include stretching exercises, swimming, walking, and movement therapy to improve coordination and develop proper posture and muscle balance. Yoga is another way to gently stretch muscles and ease pain. Any mild discomfort felt at the start of these exercises should disappear as muscles become stronger. But if pain is more than mild and lasts more than 15 minutes during exercise, patients should stop exercising and contact a doctor.</p>
- <p><i>Medications</i> are often used to treat acute and chronic low back pain. Effective pain relief may involve a combination of prescription drugs and over-the-counter remedies. Patients should always check with a doctor before taking drugs for pain relief. Certain medicines, even those sold over the counter, are unsafe during pregnancy, may conflict with other medications, may cause side effects including drowsiness, or may lead to liver damage.</p>
- <ul>
- <li><i>Over-the-counter analgesics</i>, including nonsteroidal anti-inflammatory drugs (aspirin, naproxen, and ibuprofen), are taken orally to reduce stiffness, swelling, and inflammation and to ease mild to moderate low back pain. <i>Counter-irritants</i> applied topically to the skin as a cream or spray stimulate the nerve endings in the skin to provide feelings of warmth or cold and dull the sense of pain. Topical analgesics can also reduce inflammation and stimulate blood flow. Many of these compounds contain salicylates, the same ingredient found in oral pain medications containing aspirin.</li>
- <li><i>Anticonvulsants</i> - drugs primarily used to treat seizures - may be useful in treating certain types of nerve pain and may also be prescribed with analgesics.</li>
- <li>Some <i>antidepressants</i>, particularly tricyclic antidepressants such as amitriptyline and desipramine, have been shown to relieve pain (independent of their effect on depression) and assist with sleep. Antidepressants alter levels of brain chemicals to elevate mood and dull pain signals. Many of the new antidepressants, such as the selective serotonin reuptake inhibitors, are being studied for their effectiveness in pain relief.</li>
- <li><i>Opioids</i> such as codeine, oxycodone, hydrocodone, and morphine are often prescribed to manage severe acute and chronic back pain but should be used only for a short period of time and under a physician's supervision. Side effects can include drowsiness, decreased reaction time, impaired judgment, and potential for addiction. Many specialists are convinced that chronic use of these drugs is detrimental to the back pain patient, adding to depression and even increasing pain.</li>
- </ul>
- <p><i>Spinal manipulation</i> is literally a &quot;hands-on&quot; approach in which professionally licensed specialists (doctors of chiropractic care) use leverage and a series of exercises to adjust spinal structures and restore back mobility.</p>
- <p>When back pain does not respond to more conventional approaches, patients may consider the following options:</p>
- <p><i>Acupuncture</i> involves the insertion of needles the width of a human hair along precise points throughout the body. Practitioners believe this process triggers the release of naturally occurring painkilling molecules called peptides and keeps the body's normal flow of energy unblocked. Clinical studies are measuring the effectiveness of acupuncture in comparison to more conventional procedures in the treatment of acute low back pain.</p>
- <p><i>Biofeedback</i> is used to treat many acute pain problems, most notably back pain and headache. Using a special electronic machine, the patient is trained to become aware of, to follow, and to gain control over certain bodily functions, including muscle tension, heart rate, and skin temperature (by controlling local blood flow patterns). The patient can then learn to effect a change in his or her response to pain, for example, by using relaxation techniques. Biofeedback is often used in combination with other treatment methods, generally without side effects.</p>
- <p><i>Interventional therapy</i> can ease chronic pain by blocking nerve conduction between specific areas of the body and the brain. Approaches range from injections of local anesthetics, steroids, or narcotics into affected soft tissues, joints, or nerve roots to more complex nerve blocks and spinal cord stimulation. When extreme pain is involved, low doses of drugs may be administered by catheter directly into the spinal cord. Chronic use of steroid injections may lead to increased functional impairment.</p>
- <p><i>Traction</i> involves the use of weights to apply constant or intermittent force to gradually &quot;pull&quot; the skeletal structure into better alignment. Traction is not recommended for treating acute low back symptoms.</p>
- <p><i>Transcutaneous electrical nerve stimulation (TENS)</i> is administered by a battery-powered device that sends mild electric pulses along nerve fibers to block pain signals to the brain. Small electrodes placed on the skin at or near the site of pain generate nerve impulses that block incoming pain signals from the peripheral nerves. TENS may also help stimulate the brain's production of endorphins (chemicals that have pain-relieving properties).</p>
- <p><i>Ultrasound</i> is a noninvasive therapy used to warm the body's internal tissues, which causes muscles to relax. Sound waves pass through the skin and into the injured muscles and other soft tissues.</p>
- <p>Minimally invasive outpatient treatments to seal fractures of the vertebrae caused by osteoporosis include <i>vertebroplasty</i> and <i>kyphoplasty</i>. Vertebroplasty uses three-dimensional imaging to help a doctor guide a fine needle into the vertebral body. A glue-like epoxy is injected, which quickly hardens to stabilize and strengthen the bone and provide immediate pain relief. In kyphoplasty, prior to injecting the epoxy, a special balloon is inserted and gently inflated to restore height to the bone and reduce spinal deformity.</p>
- <p>In the most serious cases, when the condition does not respond to other therapies, surgery may relieve pain caused by back problems or serious musculoskeletal injuries. Some surgical procedures may be performed in a doctor's office under local anesthesia, while others require hospitalization. It may be months following surgery before the patient is fully healed, and he or she may suffer permanent loss of flexibility. Since invasive back surgery is not always successful, it should be performed only in patients with progressive neurologic disease or damage to the peripheral nerves.</p>
- <ul>
- <li><i>Discectomy</i> is one of the more common ways to remove pressure on a nerve root from a bulging disc or bone spur. During the procedure the surgeon takes out a small piece of the lamina (the arched bony roof of the spinal canal) to remove the obstruction below.</li>
- <li><i>Foraminotomy</i> is an operation that &quot;cleans out&quot; or enlarges the bony hole (foramen) where a nerve root exits the spinal canal. Bulging discs or joints thickened with age can cause narrowing of the space through which the spinal nerve exits and can press on the nerve, resulting in pain, numbness, and weakness in an arm or leg. Small pieces of bone over the nerve are removed through a small slit, allowing the surgeon to cut away the blockage and relieve the pressure on the nerve.</li>
- <li><i>IntraDiscal Electrothermal Therapy (IDET)</i> uses thermal energy to treat pain resulting from a cracked or bulging spinal disc. A special needle is inserted via a catheter into the disc and heated to a high temperature for up to 20 minutes. The heat thickens and seals the disc wall and reduces inner disc bulge and irritation of the spinal nerve.</li>
- <li><i>Nucleoplasty</i> uses radiofrequency energy to treat patients with low back pain from contained, or mildly herniated, discs. Guided by x-ray imaging, a wand-like instrument is inserted through a needle into the disc to create a channel that allows inner disc material to be removed. The wand then heats and shrinks the tissue, sealing the disc wall. Several channels are made depending on how much disc material needs to be removed.</li>
- <li><i>Radiofrequency lesioning</i> is a procedure using electrical impulses to interrupt nerve conduction (including the conduction of pain signals) for 6 to 12 months. Using x-ray guidance, a special needle is inserted into nerve tissue in the affected area. Tissue surrounding the needle tip is heated for 90-120 seconds, resulting in localized destruction of the nerves.</li>
- <li><i>Spinal fusion</i> is used to strengthen the spine and prevent painful movements. The spinal disc(s) between two or more vertebrae is removed and the adjacent vertebrae are "fused" by bone grafts and/or metal devices secured by screws. Spinal fusion may result in some loss of flexibility in the spine and requires a long recovery period to allow the bone grafts to grow and fuse the vertebrae together.</li>
- <li><i>Spinal laminectomy</i> (also known as spinal decompression) involves the removal of the lamina (usually both sides) to increase the size of the spinal canal and relieve pressure on the spinal cord and nerve roots.</li>
- </ul>
- <p>Other surgical procedures to relieve severe chronic pain include <i>rhizotomy</i>, in which the nerve root close to where it enters the spinal cord is cut to block nerve transmission and all senses from the area of the body experiencing pain; <i>cordotomy</i>, where bundles of nerve fibers on one or both sides of the spinal cord are intentionally severed to stop the transmission of pain signals to the brain; and <i>dorsal root entry zone operation, or DREZ</i>, in which spinal neurons transmitting the patient's pain are destroyed surgically.</p>]]></content>
- </section>
- <section>
- <title><![CDATA[Can Back Pain Be Prevented?]]></title>
- <anchor><![CDATA[15]]></anchor>
- <keywords><![CDATA[prevention]]></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/prevented.jpg]]></image>
- <content><![CDATA[<p>Recurring back pain resulting from improper body mechanics or other nontraumatic causes is often preventable. A combination of exercises that don't jolt or strain the back, maintaining correct posture, and lifting objects properly can help prevent injuries.</p>
- <p>Many work-related injuries are caused or aggravated by stressors such as heavy lifting, contact stress (repeated or constant contact between soft body tissue and a hard or sharp object, such as resting a wrist against the edge of a hard desk or repeated tasks using a hammering motion), vibration, repetitive motion, and awkward posture. Applying ergonomic principles - designing furniture and tools to protect the body from injury - at home and in the workplace can greatly reduce the risk of back injury and help maintain a healthy back. More companies and homebuilders are promoting ergonomically designed tools, products, workstations, and living space to reduce the risk of musculoskeletal injury and pain.</p>
- <p>The use of wide elastic belts that can be tightened to &quot;pull in&quot; lumbar and abdominal muscles to prevent low back pain remains controversial. A landmark study of the use of lumbar support or abdominal support belts worn by persons who lift or move merchandise found no evidence that the belts reduce back injury or back pain. The 2-year study, reported by the National Institute for Occupational Safety and Health (NIOSH) in December 2000, found no statistically significant difference in either the incidence of workers' compensation claims for job-related back injuries or the incidence of self-reported pain among workers who reported they wore back belts daily compared to those workers who reported never using back belts or reported using them only once or twice a month.</p>
- <p>Although there have been anecdotal case reports of injury reduction among workers using back belts, many companies that have back belt programs also have training and ergonomic awareness programs. The reported injury reduction may be related to a combination of these or other factors.</p>]]></content>
- </section>
- <section>
- <title><![CDATA[Quick Tips To A Healthier Back]]></title>
- <anchor><![CDATA[16]]></anchor>
- <keywords><![CDATA[healthy]]></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/quick_tips.jpg]]></image>
- <content><![CDATA[<p>Following any period of prolonged inactivity, begin a program of regular low-impact exercises. Speed walking, swimming, or stationary bike riding 30 minutes a day can increase muscle strength and flexibility. Yoga can also help stretch and strengthen muscles and improve posture. Ask your physician or orthopedist for a list of low-impact exercises appropriate for your age and designed to strengthen lower back and abdominal muscles.</p>
- <ul>
- <li>Always stretch before exercise or other strenuous physical activity.</li>
- <li>Don't slouch when standing or sitting. When standing, keep your weight balanced on your feet. Your back supports weight most easily when curvature is reduced.</li>
- <li>At home or work, make sure your work surface is at a comfortable height for you.</li>
- <li>Sit in a chair with good lumbar support and proper position and height for the task. Keep your shoulders back. Switch sitting positions often and periodically walk around the office or gently stretch muscles to relieve tension. A pillow or rolled-up towel placed behind the small of your back can provide some lumbar support. If you must sit for a long period of time, rest your feet on a low stool or a stack of books.</li>
- <li>Wear comfortable, low-heeled shoes.</li>
- <li>Sleep on your side to reduce any curve in your spine. Always sleep on a firm surface.</li>
- <li>Ask for help when transferring an ill or injured family member from a reclining to a sitting position or when moving the patient from a chair to a bed.</li>
- <li>Don't try to lift objects too heavy for you. Lift with your knees, pull in your stomach muscles, and keep your head down and in line with your straight back. Keep the object close to your body. Do not twist when lifting.</li>
- <li>Maintain proper nutrition and diet to reduce and prevent excessive weight, especially weight around the waistline that taxes lower back muscles. A diet with sufficient daily intake of calcium, phosphorus, and vitamin D helps to promote new bone growth.</li>
- <li>If you smoke, quit. Smoking reduces blood flow to the lower spine and causes the spinal discs to degenerate.</li>
- </ul>]]></content>
- </section>
- <section>
- <title><![CDATA[What Research is Being Done?]]></title>
- <anchor><![CDATA[17]]></anchor>
- <keywords><![CDATA[research]]></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/research.jpg]]></image>
- <content><![CDATA[<p>The National Institute of Neurological Disorders and Stroke, a component of the National Institutes of Health (NIH) within the U.S. Department of Health and Human Services, is the nation's leading federal funder of research on disorders of the brain and nervous system and one of the primary NIH components that supports research on pain and pain mechanisms. Other institutes at NIH that support pain research include the National Institute of Dental and Craniofacial Research, the National Cancer Institute, the National Institute on Drug Abuse, the National Institute of Mental Health, the National Center for Complementary and Alternative Medicine, and the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Additionally, other federal organizations, such as the Department of Veterans Affairs and the Centers for Disease Control and Prevention, conduct studies on low back pain.</p>
- <p>Scientists are examining the use of different drugs to effectively treat back pain, in particular daily pain that has lasted at least 6 months. Other studies are comparing different health care approaches to the management of acute low back pain (standard care versus chiropractic, acupuncture, or massage therapy). These studies are measuring symptom relief, restoration of function, and patient satisfaction. Other research is comparing standard surgical treatments to the most commonly used standard nonsurgical treatments to measure changes in health-related quality of life among patients suffering from spinal stenosis. NIH-funded research at the Consortial Center for Chiropractic Research encourages the development of high-quality chiropractic projects. The Center also encourages collaboration between basic and clinical scientists and between the conventional and chiropractic medical communities.</p>
- <p>Other researchers are studying whether low-dose radiation can decrease scarring around the spinal cord and improve the results of surgery. Still others are exploring why spinal cord injury and other neurological changes lead to an increased sensitivity to pain or a decreased pain threshold (where normally non-painful sensations are perceived as painful, a class of symptoms called <i>neuropathic pain</i>), and how fractures of the spine and their repair affect the spinal canal and intervertebral foramena (openings around the spinal roots).</p>
- <p>Also under study for patients with degenerative disc disease is artificial spinal disc replacement surgery. The damaged disc is removed and a metal and plastic disc about the size of a quarter is inserted into the spine. Ideal candidates for disc replacement surgery are persons between the ages of 20 and 60 who have only one degenerating disc, do not have a systemic bone disease such as osteoporosis, have not had previous back surgery, and have failed to respond to other forms of nonsurgical treatment. Compared to other forms of back surgery, recovery from this form of surgery appears to be shorter and the procedure has fewer complications.</p>]]></content>
- </section>
- <section>
- <title><![CDATA[Where Can I Get More Information?]]></title>
- <anchor><![CDATA[18]]></anchor>
- <keywords><![CDATA[information]]></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/more_info.jpg]]></image>
- <content><![CDATA[<p>For more information on neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institute's Brain Resources and Information Network (BRAIN) at:</p>
- <h4>BRAIN</h4>
- <p>P.O. Box 5801<br />
- Bethesda, MD 20824<br />
- (800)352-9424<br />
- <a href="http://www.ninds.nih.gov">http://www.ninds.nih.gov</a></p>
- <p>Information also is available from the following organizations:</p>
- <h4>American Chronic Pain Association (ACPA)</h4>
- <p>P.O. Box 850<br />
- Rocklin, CA 95677-0850<br />
- <a href="mailto: ACPA@pacbell.net">ACPA@pacbell.net</a><br />
- <a href="http://www.theacpa.org">http://www.theacpa.org</a><br />
- Tel: 916-632-0922 / 800-533-3231<br />
- Fax: 916-652-8190<br /></p>
- <h4>American Pain Foundation</h4>
- <p>201 North Charles Street<br />
- Suite 710<br />
- Baltimore, MD 21201-4111<br />
- <a href="mailto: info@painfoundation.org">info@painfoundation.org</a><br />
- <a href="http://www.painfoundation.org">http://www.painfoundation.org</a><br />
- Tel: 888-615-PAIN (7246)<br />
- Fax: 410-385-1832<br /></p>
- <h4>National Institute of Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse</h4>
- <p>1 AMS Circle<br />
- Bethesda, MD 20892-3675<br />
- <a href="mailto: NIAMSinfo@mail.nih.gov">NIAMSinfo@mail.nih.gov</a><br />
- <a href="http://www.niams.nih.gov">http://www.niams.nih.gov</a><br />
- Tel: 877-22-NIAMS (226-4267) / 301-565-2966 (TTY)<br />
- Fax: 301-718-6366<br /></p>
- <h4>American Association of Neurological Surgeons</h4>
- <p>5550 Meadowbrook Drive<br />
- Rolling Meadows, IL 60008-3852<br />
- <a href="mailto: info@aans.org">info@aans.org</a><br />
- <a href="http://www.aans.org">http://www.aans.org</a><br />
- Tel: 847-378-0500 / 888-566-AANS (2267)<br />
- Fax: 847-378-0600<br /></p>
- <h4>American Academy of Orthopaedic Surgeons/ American Association of Orthopaedic Surgeons</h4>
- <p>6300 North River Road<br />
- Rosemont, IL 60018<br />
- <a href="mailto: hackett@aaos.org">hackett@aaos.org</a><br />
- <a href="http://www.aaos.org">http://www.aaos.org</a><br />
- Tel: 847-823-7186<br />
- Fax: 847-823-8125<br /></p>
- <h4>American Academy of Family Physicians</h4>
- <p>11400 Tomahawk Creek Parkway<br />
- Suite 440<br />
- Leawood, KS 66211-2672<br />
- <a href="mailto: fp@aafp.org">fp@aafp.org</a><br />
- <a href="http://www.aafp.org">http://www.aafp.org</a><br />
- Tel: 913-906-6000 / 800-274-2237<br />
- Fax: 913-906-6095<br /></p>
- <h4>Alzheimer's Association</h4>
- <p>225 North Michigan Avenue<br />
- 17th Floor<br />
- Chicago, IL 60601-7633<br />
- <a href="mailto: info@alz.org">info@alz.org</a><br />
- <a href="http://www.alz.org">http://www.alz.org</a><br />
- Tel: 312-335-8700 / 1-800-272-3900 (24-hour helpline)<br />
- TDD: 312-335-5886<br />
- Fax: 866-699-1246<br /></p>
- <h4>American Academy of Neurological and Orthopaedic Surgeons</h4>
- <p>10 Cascade Creek Lane<br />
- Las Vegas, NV 89113<br />
- <a href="mailto: aanos@aanos.org">aanos@aanos.org</a><br />
- <a href="http://www.aanos.org">http://www.aanos.org</a><br />
- Tel: 702-388-7390<br />
- Fax: 702-871-4728<br /></p>
- <h4>American Academy of Physical Medicine &amp; Rehabilitation</h4>
- <p>330 North Wabash Ave.<br />
- Suite 2500<br />
- Chicago, IL 60611-7617<br />
- <a href="mailto: info@aapmr.org">info@aapmr.org</a><br />
- <a href="http://www.aapmr.org">http://www.aapmr.org</a><br />
- Tel: 312-464-9700<br />
- Fax: 312-464-0227<br /></p>]]></content>
- </section>
- </page>
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- <page>
- <title><![CDATA[Spanish Low Back Pain]]></title>
- <subject><![CDATA[Back / Back Pain]]></subject>
- <type><![CDATA[General Information]]></type>
- <banner>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/banners/banner_low_back_facts.jpg]]></image>
- <color><![CDATA[light]]></color>
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- <section>
- <title><![CDATA[Spanish Low Back Pain Intro]]></title>
- <anchor><![CDATA[179]]></anchor>
- <keywords></keywords>
- <content><![CDATA[<p>Spanish content for low back pain intro</p>]]></content>
- </section>
- </page>
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- <page>
- <title><![CDATA[Chiropractic: An Introduction]]></title>
- <subject><![CDATA[Chiropractic]]></subject>
- <type><![CDATA[General Information]]></type>
- <banner>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/banners/banner_chiro_an_intro.jpg]]></image>
- <color><![CDATA[light]]></color>
- <height><![CDATA[360]]></height>
- </banner>
- <section>
- <title><![CDATA[Introduction]]></title>
- <anchor><![CDATA[19]]></anchor>
- <keywords></keywords>
- <content><![CDATA[<p>Chiropractic is a health care approach that focuses on the relationship between the body's structure - mainly the spine - and its functioning. Although practitioners may use a variety of treatment approaches, they primarily perform adjustments to the spine or other parts of the body with the goal of correcting alignment problems and supporting the body's natural ability to heal itself.</p>]]></content>
- </section>
- <section>
- <title><![CDATA[Key Points]]></title>
- <anchor><![CDATA[20]]></anchor>
- <keywords></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/key_points.jpg]]></image>
- <content><![CDATA[<ul><li>People seek chiropractic care primarily for pain conditions such as back pain, neck pain, and headache.</li>
- <li>Side effects and risks depend on the type of chiropractic treatment used.</li>
- <li>Chiropractic practitioners in the United States are required to earn a Doctor of Chiropractic degree from properly accredited colleges.</li>
- <li>Ongoing research is looking at effects of chiropractic treatment approaches, how they might work, and diseases and conditions for which they may be most helpful.</li>
- <li>Tell your health care providers about any complementary and alternative practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.</li>
- </ul>]]></content>
- </section>
- <section>
- <title><![CDATA[Overview and History]]></title>
- <anchor><![CDATA[21]]></anchor>
- <keywords><![CDATA[overview, history]]></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/overview_history.jpg]]></image>
- <content><![CDATA[<p>The term &quot;chiropractic&quot; combines the Greek words cheir (hand) and praxis (action) to describe a treatment done by hand. Hands-on therapy - especially adjustment of the spine - is central to chiropractic care. Chiropractic, which in the United States is considered part of complementary and alternative medicine (CAM), is based on these key concepts:</p>
- <ul>
- <li>The body has a powerful self-healing ability;</li>
- <li>The body's structure (primarily that of the spine) and its function are closely related, and this relationship affects health;</li>
- <li>Therapy aims to normalize this relationship between structure and function and assist the body as it heals.</li>
- </ul>
- <p>While some procedures associated with chiropractic care can be traced back to ancient times, the modern profession of chiropractic was founded by Daniel David Palmer in 1895 in Davenport, Iowa. Palmer, a self-taught healer, believed that the body has a natural healing ability. Misalignments of the spine can interfere with the flow of energy needed to support health, Palmer theorized, and the key to health is to normalize the function of the nervous system, especially the spinal cord.</p>]]></content>
- </section>
- <section>
- <title><![CDATA[Patterns of Use]]></title>
- <anchor><![CDATA[22]]></anchor>
- <keywords><![CDATA[patterns]]></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/patterns_use.jpg]]></image>
- <content><![CDATA[<p>According to the 2007 National Health Interview Survey, which included a comprehensive survey of CAM use by Americans, about 8 percent of American adults and nearly 3 percent of children had received chiropractic or osteopathic manipulation in the past 12 months. Adjusted to nationally representative numbers, these percentages mean that more than 18 million adults and 2 million children received chiropractic or osteopathic manipulation in the previous year.</p>
- <p>Many people who seek chiropractic care have chronic, pain-related health conditions. Low-back pain, neck pain, and headache are common conditions for which people seek chiropractic treatment.</p>]]></content>
- </section>
- <section>
- <title><![CDATA[What To Expect From Chiropractic Visits]]></title>
- <anchor><![CDATA[23]]></anchor>
- <keywords><![CDATA[visit]]></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/chiro_visits.jpg]]></image>
- <content><![CDATA[<p>During the initial visit, chiropractors typically take a health history and perform a physical examination, with a special emphasis on the spine. Other examinations or tests such as x-rays may also be performed. If chiropractic treatment is considered appropriate, a treatment plan will be developed.</p>
- <p>During followup visits, practitioners may perform one or more of the many different types of adjustments used in chiropractic care. Given mainly to the spine, a chiropractic adjustment (sometimes referred to as a manipulation) involves using the hands or a device to apply a controlled, sudden force to a joint, moving it beyond its passive range of motion. The goal is to increase the range and quality of motion in the area being treated and to aid in restoring health. Other hands-on therapies such as mobilization (movement of a joint within its usual range of motion) also may be used.</p>
- <p>Chiropractors may combine the use of spinal adjustments with several other treatments and approaches such as:</p>
- <ul>
- <li>Heat and ice;</li>
- <li>Electrical stimulation;</li>
- <li>Rest;</li>
- <li>Rehabilitative;</li>
- <li>Counseling about diet, weight loss, and other lifestyle factors;</li>
- <li>Dietary supplements.</li>
- </ul>]]></content>
- </section>
- <section>
- <title><![CDATA[Side Effects and Risks]]></title>
- <anchor><![CDATA[24]]></anchor>
- <keywords><![CDATA[side effect, risk]]></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/effects_risks.jpg]]></image>
- <content><![CDATA[<p>Side effects and risks depend on the specific type of chiropractic treatment used. For example, side effects from chiropractic adjustments can include temporary headaches, tiredness, or discomfort in parts of the body that were treated. The likelihood of serious complications, such as stroke, appears to be extremely low and related to the type of adjustment performed and the part of the body treated.</p>
- <p>If dietary supplements are a part of the chiropractic treatment plan, they may interact with medicines and cause side effects. It is important that people inform their chiropractors of all medicines (whether prescription or over-the-counter) and supplements they are taking.</p>]]></content>
- </section>
- <section>
- <title><![CDATA[Qualifications To Practice]]></title>
- <anchor><![CDATA[25]]></anchor>
- <keywords><![CDATA[qualifications]]></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/qualifications.jpg]]></image>
- <content><![CDATA[<p>To practice chiropractic care in the United States, a practitioner must earn a Doctor of Chiropractic (D.C.) degree from a college accredited by the Council on Chiropractic Education (CCE). CCE is the agency certified by the U.S. Department of Education to accredit chiropractic colleges in the United States. Admission to a chiropractic college requires a minimum of 90 semester hour credits (approximately 3 years) of undergraduate study, mostly in the sciences.</p>
- <p>Chiropractic training is a 4-year academic program that includes both classroom work and direct experience caring for patients. Coursework typically includes instruction in the biomedical sciences, as well as in public health and research methods. Some chiropractors pursue a 2- to 3-year residency for training in specialized fields.</p>]]></content>
- </section>
- <section>
- <title><![CDATA[Regulation]]></title>
- <anchor><![CDATA[26]]></anchor>
- <keywords><![CDATA[regulation]]></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/regulation.jpg]]></image>
- <content><![CDATA[<p>Chiropractic is regulated individually by each state and the District of Columbia. Board examinations are required for licensing and include a mock patient encounter. Most states require chiropractors to earn annual continuing education credits to maintain their licenses. Chiropractors' scope of practice varies by state in areas such as laboratory tests or diagnostic procedures, the dispensing or selling of dietary supplements, and the use of other CAM therapies such as acupuncture or homeopathy.</p>]]></content>
- </section>
- <section>
- <title><![CDATA[Insurance Coverage]]></title>
- <anchor><![CDATA[27]]></anchor>
- <keywords><![CDATA[insurance]]></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/insurance.jpg]]></image>
- <content><![CDATA[<p>Compared with other CAM therapies, insurance coverage for chiropractic services is extensive. Many HMOs (health maintenance organizations) and private health care plans cover chiropractic treatment, as do all state workers' compensation systems. Chiropractors can bill Medicare, and many states cover chiropractic treatment under Medicaid. If you have health insurance, check whether chiropractic services are covered before you seek treatment.</p>]]></content>
- </section>
- <section>
- <title><![CDATA[Other Points To Consider]]></title>
- <anchor><![CDATA[28]]></anchor>
- <keywords></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/other_points.jpg]]></image>
- <content><![CDATA[<ul><li>Research to expand the scientific understanding of chiropractic treatment is ongoing.</li>
- <li>If you decide to seek chiropractic care, talk to your chiropractor about:
- <ul>
- <li>His education, training, and licensing;</li>
- <li>Whether he has experience treating the health conditions for which you are seeking care;</li>
- <li>Any special medical concerns you have and any medicines or dietary supplements you are taking.</li>
- </ul>
- </li>
- <li>Tell all of your health care providers about any complementary and alternative practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.</li>
- </ul>]]></content>
- </section>
- <section>
- <title><![CDATA[NCCAM - Funded Research]]></title>
- <anchor><![CDATA[29]]></anchor>
- <keywords><![CDATA[research]]></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/research.jpg]]></image>
- <content><![CDATA[<p>Recent research projects on chiropractic care supported by the National Center for Complementary and Alternative Medicine (NCCAM) have focused on the:</p>
- <ul>
- <li>Effectiveness of chiropractic treatments for back pain, neck pain, and headache, as well as for other health conditions such as temporomandibular disorders;</li>
- <li>Development of a curriculum to increase the number of chiropractors involved in research;</li>
- <li>Influence of people's satisfaction with chiropractic care on their response to treatment.</li>
- </ul>]]></content>
- </section>
- <section>
- <title><![CDATA[References]]></title>
- <anchor><![CDATA[30]]></anchor>
- <keywords></keywords>
- <content><![CDATA[<ol><li>Agency for Health Care Policy and Research. Chiropractic in the United States: Training, Practice, and Research. Rockville, MD: Agency for Health Care Policy and Research; 1997. AHCPR publication no. 98-N002.</li>
- <li>Meeker WC, Haldeman S. <a href="http://www.ncbi.nlm.nih.gov/sites/entrez?orig_db=PubMed&amp;db=PubMed&amp;cmd=Search&amp;term=136%5Bvolume%5D%20AND%203%5Bissue%5D%20AND%20216%5Bpage%5D%20AND%202002%5Bpdat%5D">Chiropractic: a profession at the crossroads of mainstream and alternative medicine</a>. Annals of Internal Medicine. 2002;136(3):216-227.</li>
- <li>Barnes PM, Powell-Griner E, McFann K, Nahin RL. Complementary and alternative medicine use among adults: United States, 2002. CDC Advance Data Report #343. 2004.</li>
- <li>Coulter ID, Hurwitz EL, Adams AH, et al. <a href="http://www.ncbi.nlm.nih.gov/sites/entrez?Db=PubMed&amp;Cmd=ShowDetailView&amp;TermToSearch=11805694&amp;ordinalpos=2&amp;itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum">Patients using chiropractors in North America: who are they, and why are they in chiropractic care?</a> Spine. 2002;27(3):291-296.</li>
- <li>The Council on Chiropractic Education. Standards for Doctor of Chiropractic Programs and Requirements for Institutional Status January 2007. The Council on Chiropractic Education Web site. Accessed on June 28, 2007.</li>
- <li>Dagenais S, Haldeman S. Chiropractic. Primary Care. 2002;29(2):419-437.</li>
- <li>Eisenberg DM, Cohen MH, Hrbek A, et al. <a href="http://www.ncbi.nlm.nih.gov/sites/entrez?orig_db=PubMed&amp;db=PubMed&amp;cmd=Search&amp;term=137%5Bvolume%5D%20AND%2012%5Bissue%5D%20AND%20965%5Bpage%5D%20AND%202002%5Bpdat%5D">Credentialing complementary and alternative medical providers</a>. Annals of Internal Medicine. 2002;137(12):965-973.</li>
- <li>Ernst, E, Pittler, MH, Wider, B, eds. The Desktop Guide to Complementary and Alternative Medicine: An Evidence-Based Approach. 2nd ed. St. Louis, MO: Mosby Elsevier; 2006.</li>
- <li>Kaptchuk TJ, Eisenberg DM. <a href="http://www.ncbi.nlm.nih.gov/sites/entrez?orig_db=PubMed&amp;db=PubMed&amp;cmd=Search&amp;term=158%5Bvolume%5D%20AND%2020%5Bissue%5D%20AND%202215%5Bpage%5D%20AND%201998%5Bpdat%5D">Chiropractic: origins, controversies, and contributions</a>. Archives of Internal Medicine. 1998;158(20):2215-2224.</li>
- <li>Senstad O, Leboeuf-Yde C, Borchgrevink C.<a href="http://www.ncbi.nlm.nih.gov/sites/entrez?orig_db=PubMed&amp;db=PubMed&amp;cmd=Search&amp;term=22%5Bvolume%5D%20AND%204%5Bissue%5D%20AND%20435%5Bpage%5D%20AND%201997%5Bpdat%5D">Frequency and characteristics of side effects of spinal manipulative therapy</a>. Spine. 1997;22(4):435-440.</li>
- <li>The National Center for Complementary and Alternative Medicine (NCCAM) in association with the National Institutes of Health (NIH) and the U.S. Department of Health and Human Services (HHS). </li>
- </ol>]]></content>
- </section>
- <section>
- <title><![CDATA[For More Information]]></title>
- <anchor><![CDATA[31]]></anchor>
- <keywords></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/more_info.jpg]]></image>
- <content><![CDATA[<h4>NCCAM Clearinghouse</h4>
- <p>The NCCAM Clearinghouse provides information on CAM and NCCAM, including publications and searches of Federal databases of scientific and medical literature. The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners.</p>
- <p>Toll-free in the U.S.: 1-888-644-6226<br />
- TTY (for deaf and hard-of-hearing callers): 1-866-464-3615<br />
- Web site: <a href="http://nccam.nih.gov">nccam.nih.gov</a><br />
- E-mail: <a href="mailto: info@nccam.nih.gov">info@nccam.nih.gov</a></p>
- <h4>PubMed&amp;reg;</h4>
- <p>A service of the National Library of Medicine (NLM), PubMed contains publication information and (in most cases) brief summaries of articles from scientific and medical journals. CAM on PubMed, developed jointly by NCCAM and NLM, is a subset of the PubMed system and focuses on the topic of CAM.</p>
- <p>Web site: <a href="http://www.ncbi.nlm.nih.gov/sites/entrez">www.ncbi.nlm.nih.gov/sites/entrez</a><br />
- CAM on PubMed: <a href="http://nccam.nih.gov/camonpubmed/">nccam.nih.gov/camonpubmed/</a></p>
- <h4>ClinicalTrials.gov</h4>
- <p>ClinicalTrials.gov is a database of information on federally and privately supported clinical trials (research studies in people) for a wide range of diseases and conditions. It is sponsored by the National Institutes of Health and the U.S. Food and Drug Administration.</p>
- <p>Web site: <a href="http://www.clinicaltrials.gov">www.clinicaltrials.gov</a></p>
- <h4>CRISP (Computer Retrieval of Information on Scientific Projects)</h4>
- <p>CRISP is a database of information on federally funded scientific and medical research projects being conducted at research institutions.</p>
- <p>Web site: <a href="http://report.nih.gov/crisp/">report.nih.gov/crisp/</a></p>]]></content>
- </section>
- </page>
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- <page>
- <title><![CDATA[Spinal Manipulation for Low Back Pain]]></title>
- <subject><![CDATA[Chiropractic]]></subject>
- <type><![CDATA[General Information]]></type>
- <banner>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/banners/banner_low_back_pain.jpg]]></image>
- <color><![CDATA[light]]></color>
- <height><![CDATA[265]]></height>
- </banner>
- <section>
- <title><![CDATA[Introduction]]></title>
- <anchor><![CDATA[32]]></anchor>
- <keywords></keywords>
- <content><![CDATA[<p>Low-back pain is a common condition that can be difficult to treat. Spinal manipulation is among the treatment options used by people with low-back pain in attempts to relieve pain and improve functioning. It is performed by chiropractors and other health care professionals such as physical therapists, osteopaths, and some conventional medical doctors. This fact sheet summarizes the current scientific knowledge about the effects of spinal manipulation on low-back pain.</p>]]></content>
- </section>
- <section>
- <title><![CDATA[Key Points]]></title>
- <anchor><![CDATA[33]]></anchor>
- <keywords></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/key_points.jpg]]></image>
- <content><![CDATA[<ul><li>Evidence indicates that spinal manipulation can provide mild-to-moderate relief from low-back pain. It appears to be as effective as conventional treatments, and recent guidelines for health care practitioners include it as a treatment option for pain that does not improve with self-care.</li>
- <li>Spinal manipulation is generally a safe treatment for low-back pain. The most common side effects (e.g., discomfort in the treated area) are minor and go away within 1 to 2 days. Serious complications are very rare.</li>
- <li>Recent research into spinal manipulation for low-back pain has begun to look at the effects of different forms of manipulation, as well as treatment duration and frequency.</li>
- <li>Tell your health care providers about any complementary and alternative practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.</li>
- </ul>]]></content>
- </section>
- <section>
- <title><![CDATA[About Low-Back Pain]]></title>
- <anchor><![CDATA[34]]></anchor>
- <keywords></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/about_low_back.jpg]]></image>
- <content><![CDATA[<p>Each year, up to one-quarter of U.S. adults experience low-back pain. Most people have significant back pain at least once in their lives; often, the cause is unknown. Back pain varies widely. For many people, it lasts only a few weeks, no matter what treatment is used. But for others, the pain can become chronic and even debilitating. Low-back pain is a challenging condition to diagnose, treat, and study.</p>]]></content>
- </section>
- <section>
- <title><![CDATA[Spinal Manipulation and Low-Back Pain]]></title>
- <anchor><![CDATA[35]]></anchor>
- <keywords><![CDATA[spinal manipulation]]></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/spinal.jpg]]></image>
- <content><![CDATA[<p>Spinal manipulation - sometimes called &amp;quot;spinal manipulative therapy&amp;quot; - is practiced by health care professionals such as chiropractors, physical therapists, osteopaths, and some conventional medical doctors. Practitioners perform spinal manipulation by using their hands or a device to apply a controlled force to a joint of the spine, moving it beyond its passive range of motion. The amount of force applied depends on the form of manipulation used. The goal of the treatment is to relieve pain and improve physical functioning.</p>
- <p>In the United States, spinal manipulation is often performed as part of chiropractic care. Chiropractic is a health care approach that focuses on the relationship between the body's structure-mainly the spine-and its functioning. In chiropractic, spinal manipulation is sometimes called &amp;quot;adjustment.&amp;quot; Back problems are the most common reason people seek chiropractic care. (For background information on chiropractic, see <a href="chiro_intro.html">Chiropractic: An Introduction</a>.)</p>]]></content>
- </section>
- <section>
- <title><![CDATA[What the Science Says]]></title>
- <anchor><![CDATA[36]]></anchor>
- <keywords><![CDATA[science]]></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/science_says.jpg]]></image>
- <content><![CDATA[<h4>Study Findings to Date</h4>
- <p>Overall, studies have shown that spinal manipulation can provide mild-to-moderate relief from low-back pain and appears to be as effective as conventional medical treatments. In 2007 guidelines, the American College of Physicians and the American Pain Society include spinal manipulation as one of several treatment options for practitioners to consider using when pain does not improve with self-care.</p>
- <p>Research is under way to determine whether the effects of spinal manipulation depend on the duration and frequency of treatment. Recent studies have found that spinal manipulation provides relief from low-back pain at least over the short term (i.e., up to 3 months), and that pain-relieving effects may continue for up to 1 year. In one study funded by the National Center for Complementary and Alternative Medicine (NCCAM) that examines long-term effects in more than 600 people with low-back pain, results to date suggest that chiropractic care involving spinal manipulation is at least as effective as conventional medical care for up to 18 months. However, less than 20 percent of participants in this study were pain free at 18 months, regardless of the type of treatment used.</p>
- <h4>Challenges Facing Researchers</h4>
- <p>When considering the evidence on spinal manipulation for low-back pain, it is important to know about the research behind the evidence. Although many clinical trials have been conducted, earlier trials tended to be small and poorly designed, making their findings less reliable. Moreover, studies have differed in focus (the specific type of back pain treated and form of manipulation used) and design (comparisons with other treatments vs. placebos). It can be difficult to clearly interpret findings when what is being measured varies widely from one study to the next. Recent research has begun to address these issues.</p>]]></content>
- </section>
- <section>
- <title><![CDATA[Side Effects and Risks]]></title>
- <anchor><![CDATA[37]]></anchor>
- <keywords><![CDATA[side effects, risks]]></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/effects_risks.jpg]]></image>
- <content><![CDATA[<h4>Common Side Effects</h4>
- <p>Reviews have concluded that spinal manipulation is relatively safe when performed by a trained and licensed practitioner. The most common side effects are generally minor and include temporary discomfort in the treated area, headache, or tiredness. These effects usually go away in 1 to 2 days.</p>
- <h4>Serious Complications</h4>
- <p>The rate of serious complications from spinal manipulation, although not definitely known, appears to be very low overall. A potential complication from low-back manipulation is cauda equina syndrome, a condition in which nerves in the lower part of the spinal cord become compressed, resulting in pain, weakness, and loss of feeling in one or both legs. Other functions-such as bowel or bladder control-may also be affected. Reports indicate that cauda equina syndrome is an extremely rare complication. In people whose pain is caused by a herniated disc, manipulation of the low back also appears to have a very low chance of either causing or worsening cauda equina syndrome.</p>]]></content>
- </section>
- <section>
- <title><![CDATA[NCCAM - Funded Research]]></title>
- <anchor><![CDATA[38]]></anchor>
- <keywords><![CDATA[research]]></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/research.jpg]]></image>
- <content><![CDATA[<p>Projects supported by NCCAM to study spinal manipulation for low-back pain include studies of:</p>
- <ul>
- <li>The optimal number and frequency of treatments, and the duration of care;</li>
- <li>Estimated use, costs, and outcomes of chiropractic care for recurrent back pain;</li>
- <li>What happens in the body during manipulation of the low back.</li>
- </ul>]]></content>
- </section>
- <section>
- <title><![CDATA[References]]></title>
- <anchor><![CDATA[39]]></anchor>
- <keywords></keywords>
- <content><![CDATA[<ol><li>Assendelft WJ, Morton SC, Yu EI, et al. Spinal manipulative therapy for low back pain. Annals of Internal Medicine. 2003;138(11):871-881.</li>
- <li>Barnes PM, Powell-Griner E, McFann K, Nahin RL. Complementary and alternative medicine use among adults: United States, 2002. CDC Advance Data Report #343. 2004.</li>
- <li>Bronfort G, Haas M, Evans R, et al. Evidence-informed management of chronic low back pain with spinal manipulation and mobilization. Spine Journal. 2008;8(1):213-225.</li>
- <li>Bronfort G, Haas M, Evans RL, et al. Efficacy of spinal manipulation and mobilization for low back pain and neck pain: a systematic review and best evidence synthesis. Spine Journal. 2004;4(3):335-356.</li>
- <li>Cagnie B, Vinck E, Beernaert A, et al. How common are side effects of spinal manipulation and can these side effects be predicted? Manual Therapy. 2004;9(3):151-156.</li>
- <li>Cambron JA, Gudavalli MR, Hedeker D, et al. One-year follow-up of a randomized clinical trial comparing flexion distraction with an exercise program for chronic low-back pain. Journal of Alternative and Complementary Medicine. 2006;12(7):659-668.</li>
- <li>Centers for Disease Control and Prevention. Health, United States, 2006. Hyattsville, MD: Centers for Disease Control and Prevention; 2006. Publication no. 2007-1232. Accessed on March 27, 2008.</li>
- <li>Cherkin DC, Sherman KJ, Deyo RA, et al. A review of the evidence for the effectiveness, safety, and cost of acupuncture, massage therapy, and spinal manipulation for back pain. Annals of Internal Medicine. 2003;138(11):898-906.</li>
- <li>Chou R, Huffman LH. Nonpharmacologic therapies for acute and chronic low-back pain: a review of the evidence for and American Pain Society/American College of Physicians clinical practice guideline. Annals of Internal Medicine. 2007;147(7):492-504. Kaptchuk TJ, Eisenberg DM. Chiropractic: origins, controversies, and contributions. Archives of Internal Medicine. 1998;158(20):2215-2224.</li>
- <li>Chou R, Qaseem A, Snow V, et al. Diagnosis and treatment of low-back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Annals of Internal Medicine. 2007;147(7):478-491.</li>
- <li>Coulter ID, Hurwitz EL, Adams AH, et al. Patients using chiropractors in North America: who are they, and why are they in chiropractic care? Spine. 2002;27(3):291-296.</li>
- <li>Ferreira ML, Ferreira PH, Latimer J, et al. Comparison of general exercise, motor control exercise and spinal manipulative therapy for chronic low back pain: a randomized trial. Pain. 2007;131(1-2):31-37.</li>
- <li>Ferreira ML, Ferreira PH, Latimer J, et al. Efficacy of spinal manipulative therapy for low back pain of less than 3 months' duration. Journal of Manipulative and Physiological Therapeutics. 2003;26(9):593-601.</li>
- <li>Gudavalli MR, Cambron JA, McGregor M, et al. A randomized clinical trial and subgroup analysis to compare flexion-distraction with active exercise for chronic low back pain. European Spine Journal. 2006;15(7):1070-1082.</li>
- <li>Haldeman S, Kohlbeck FJ, McGregor M. Stroke, cerebral artery dissection, and cervical spine manipulation therapy. Journal of Neurology. 2002;249(8):1098-1104.</li>
- <li>Hoiriis KT, Pfleger B, McDuffie FC, et al. A randomized clinical trial comparing chiropractic adjustments to muscle relaxants for subacute low back pain. Journal of Manipulative and Physiological Therapeutics. 2004;27(6):388-398.</li>
- <li>Hurwitz EL, Morgenstern H, Kominski GF, et al. A randomized trial of chiropractic and medical care for patients with low back pain: eighteen-month follow-up outcomes from the UCLA low back pain study. Spine. 2006;31(6):611-621.</li>
- <li>Kaptchuk TJ, Eisenberg DM. Chiropractic: origins, controversies, and contributions. Archives of Internal Medicine. 1998;158(20):2215-2224.</li>
- <li>Kinkade S. Evaluation and treatment of acute low back pain. American Family Physician. 2007;75(8):1181-1188.</li>
- <li>National Institute of Arthritis and Musculoskeletal and Skin Disorders. Handout on Health: Back Pain. Bethesda, MD: National Institute of Arthritis and Musculoskeletal and Skin Disorders; 2005. NIH publication no. 05-5282. Accessed on March 27, 2008.</li>
- <li>Oliphant D. Safety of spinal manipulation in the treatment of lumbar disk herniations: a systematic review and risk assessment. Journal of Manipulative and Physiological Therapeutics. 2004;27(3):197-210.</li>
- <li>Santilli V, Beghi E, Finucci S. Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations. The Spine Journal. 2006;6(2):131-137.</li>
- <li>Senstad O, Leboeuf-Yde C, Borchgrevink C. Frequency and characteristics of side effects of spinal manipulative therapy. Spine. 1997;22(4):435-440.</li>
- <li>Tindle HA, Davis RB, Phillips RS, and Eisenberg DM. Trends in use of complementary and alternative medicine by US adults: 1997-2002. Alternative Therapies in Health and Medicine. 2005;11(1):42-49.</li>
- <li>van Tulder MW, Koes B, Malmivaara A. Outcome of non-invasive treatment modalities on back pain: an evidence-based review. European Spine Journal. 2006;15(suppl 1):S64-S81.</li>
- <li>The National Center for Complementary and Alternative Medicine (NCCAM) in association with the National Institutes of Health (NIH) and the U.S. Department of Health and Human Services (HHS). </li>
- </ol>]]></content>
- </section>
- <section>
- <title><![CDATA[For More Information]]></title>
- <anchor><![CDATA[40]]></anchor>
- <keywords></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/more_info.jpg]]></image>
- <content><![CDATA[<h4>NCCAM Clearinghouse</h4>
- <p>The NCCAM Clearinghouse provides information on CAM and NCCAM, including publications and searches of Federal databases of scientific and medical literature. The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners.</p>
- <p>Toll-free in the U.S.: 1-888-644-6226<br />
- TTY (for deaf and hard-of-hearing callers): 1-866-464-3615<br />
- Web site: <a href="http://nccam.nih.gov">nccam.nih.gov</a><br />
- E-mail: <a href="mailto: info@nccam.nih.gov">info@nccam.nih.gov</a></p>
- <h4>PubMed&amp;reg;</h4>
- <p>A service of the National Library of Medicine (NLM), PubMed contains publication information and (in most cases) brief summaries of articles from scientific and medical journals. CAM on PubMed, developed jointly by NCCAM and NLM, is a subset of the PubMed system and focuses on the topic of CAM.</p>
- <p>Web site: <a href="http://www.ncbi.nlm.nih.gov/sites/entrez">www.ncbi.nlm.nih.gov/sites/entrez</a><br />
- CAM on PubMed: <a href="http://nccam.nih.gov/camonpubmed/">nccam.nih.gov/camonpubmed/</a></p>
- <h4>ClinicalTrials.gov</h4>
- <p>ClinicalTrials.gov is a database of information on federally and privately supported clinical trials (research studies in people) for a wide range of diseases and conditions. It is sponsored by the National Institutes of Health and the U.S. Food and Drug Administration.</p>
- <p>Web site: <a href="http://www.clinicaltrials.gov">www.clinicaltrials.gov</a></p>
- <h4>CRISP (Computer Retrieval of Information on Scientific Projects)</h4>
- <p>CRISP is a database of information on federally funded scientific and medical research projects being conducted at research institutions.</p>
- <p>Web site: <a href="http://report.nih.gov/crisp/">report.nih.gov/crisp/</a></p>]]></content>
- </section>
- </page>
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- <page>
- <title><![CDATA[Massage Therapy May Ease Pain &amp; Improve Mood in Advanced Cancer Patients]]></title>
- <subject><![CDATA[Massage Therapy]]></subject>
- <type><![CDATA[Articles]]></type>
- <section>
- <title><![CDATA[Overview]]></title>
- <anchor><![CDATA[41]]></anchor>
- <keywords></keywords>
- <content><![CDATA[<p>People with advanced cancer often experience pain that causes physical and emotional distress, which leads to a decrease in functional ability and quality of life. Symptom relief is an important part of end-of-life care, and small studies have suggested that massage therapy may benefit people with advanced cancer.</p>
- <p>In a study funded in part by NCCAM, researchers investigated the benefits of massage versus simple touch therapy (placing both hands on specific body sites) in patients with advanced cancer. This multisite study - conducted at 15 U.S. hospices in the Population-based Palliative Care Research Network - included 380 participants with advanced cancer who were experiencing moderate-to-severe pain. Participants were randomly assigned to receive six 30-minute treatment sessions of either massage or simple touch therapy over a 2-week period.</p>
- <p>Results of the study showed that both groups experienced statistically significant improvements in pain relief, physical and emotional distress, and quality of life. Immediate improvement in pain and mood was greater with massage than with simple touch; however, sustained effects of these therapies were not observed.</p>
- <p>The researchers concluded that massage therapy may provide some immediate relief for patients with advanced cancer. They also suggest that simple touch, which can be provided by family members and volunteers, may benefit these patients.</p>]]></content>
- </section>
- <section>
- <title><![CDATA[References]]></title>
- <anchor><![CDATA[42]]></anchor>
- <keywords></keywords>
- <content><![CDATA[<ol> <li>Kutner J, Smith M, Corbin S, et al. Massage therapy versus simple touch to improve pain and mood in patients with advanced cancer: a randomized trial. Annals of Internal Medicine. 2008; 149(6): 369 - 379.</li>
- <li>The National Center for Complementary and Alternative Medicine (NCCAM) in association with the National Institutes of Health (NIH) and the U.S. Department of Health and Human Services (HHS).</li>
- </ol>]]></content>
- </section>
- </page>
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- <page>
- <title><![CDATA[Study Finds Benefits of Therapeutic Massage for Chronic Neck Pain]]></title>
- <subject><![CDATA[Massage Therapy]]></subject>
- <type><![CDATA[Articles]]></type>
- <section>
- <title><![CDATA[Overview]]></title>
- <anchor><![CDATA[43]]></anchor>
- <keywords></keywords>
- <content><![CDATA[<p>Neck pain is a common health problem in the United States. People suffering from neck pain often turn to complementary and alternative medicine (CAM) therapies. Although therapeutic massage is one of the most popular CAM therapies for neck pain, little is known about its effectiveness for this condition.</p>
- <p>In an NCCAM-funded study conducted at the Group Health Center in Seattle, 64 adults with neck pain persisting for at least 12 weeks were randomly assigned to receive either massage or a self-care book. The massage group had up to 10 treatments over a 10-week period, provided by licensed practitioners who used a variety of common Swedish and clinical massage techniques and also made typical self-care suggestions. After 4, 10, and 26 weeks, the researchers interviewed participants to assess function (Neck Disability Index), symptom bothersomeness, and other measures.</p>
- <p>After 10 weeks, the massage group was more likely than the self-care-book group to have clinically significant improvement in function and symptoms. At 26 weeks, the massage group tended to be more likely to report improvement in function but not in specific symptoms. For both function and symptoms, mean differences between the two groups were strongest at 4 weeks and not evident by 26 weeks. At all followup points, the massage group was more likely than the self-care-book group to report global improvement ratings of "better" or "much better." At 26 weeks, medication use had increased 14 percent for the self-care-book group but had not changed for the massage group. There were no serious adverse experiences reported.</p>
- <p>The researchers concluded that therapeutic massage is safe and may have benefits for treating chronic neck pain, at least in the short term. They recommended studies to determine optimal massage treatment, as well as larger, more comprehensive studies to follow patients for at least 1 year.</p>]]></content>
- </section>
- <section>
- <title><![CDATA[References]]></title>
- <anchor><![CDATA[44]]></anchor>
- <keywords></keywords>
- <content><![CDATA[<ol><li>Sherman KJ, Cherkin DC, Hawkes RJ, et al. Randomized trial of therapeutic massage for chronic neck pain. Clinical Journal of Pain. 2009; 25(3): 233 - 238.</li>
- <li>The National Center for Complementary and Alternative Medicine (NCCAM) in association with the National Institutes of Health (NIH) and the U.S. Department of Health and Human Services (HHS).</li>
- </ol>]]></content>
- </section>
- </page>
- <!--
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- http://www.rayhawkweb.com
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- <page>
- <title><![CDATA[Massage Therapy: An Introduction]]></title>
- <subject><![CDATA[Massage Therapy]]></subject>
- <type><![CDATA[General Information]]></type>
- <banner>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/banners/banner_massage_an_intro.jpg]]></image>
- <color><![CDATA[dark]]></color>
- <height><![CDATA[360]]></height>
- </banner>
- <section>
- <title><![CDATA[Introduction]]></title>
- <anchor><![CDATA[45]]></anchor>
- <keywords></keywords>
- <content><![CDATA[<p>Massage therapy has a long history in cultures around the world. Today, people use many different types of massage therapy for a variety of health-related purposes. In the United States, massage therapy is often considered part of complementary and alternative medicine (CAM), although it does have some conventional uses. This fact sheet provides a general overview of massage therapy and suggests sources for additional information.</p>]]></content>
- </section>
- <section>
- <title><![CDATA[Key Points]]></title>
- <anchor><![CDATA[46]]></anchor>
- <keywords></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/key_points-0.jpg]]></image>
- <content><![CDATA[<ul>
- <li>Scientific evidence on massage therapy is limited. Scientists are not yet certain what changes occur in the body during massage, whether they influence health, and, if so, how. The National Center for Complementary and Alternative Medicine (NCCAM) is sponsoring studies to answer these questions and identify the purposes for which massage may be most helpful.</li>
- <li>Massage therapy appears to have few serious risks if it is used appropriately and provided by a trained massage professional.</li>
- <li>Tell your health care providers about any complementary and alternative practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.
- </li>
- </ul>]]></content>
- </section>
- <section>
- <title><![CDATA[History of Massage]]></title>
- <anchor><![CDATA[47]]></anchor>
- <keywords><![CDATA[history of massage]]></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/history_massage.jpg]]></image>
- <content><![CDATA[<p>Massage therapy dates back thousands of years. References to massage appear in writings from ancient China, Japan, India, Arabic nations, Egypt, Greece (Hippocrates defined medicine as "the art of rubbing"), and Rome.</p>
- <p>Massage became widely used in Europe during the Renaissance. In the 1850s, two American physicians who had studied in Sweden introduced massage therapy in the United States, where it became popular and was promoted for a variety of health purposes. With scientific and technological advances in medical treatment during the 1930s and 1940s, massage fell out of favor in the United States. Interest in massage revived in the 1970s, especially among athletes.</p>]]></content>
- </section>
- <section>
- <title><![CDATA[Use of Massage Therapy in the United States]]></title>
- <anchor><![CDATA[48]]></anchor>
- <keywords><![CDATA[massage use]]></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/use_massage.jpg]]></image>
- <content><![CDATA[<p>According to the 2007 National Health Interview Survey, which included a comprehensive survey of CAM use by Americans, an estimated 18 million U.S. adults and 700,000 children had received massage therapy in the previous year.</p>
- <p>People use massage for a variety of health-related purposes, including to relieve pain, rehabilitate sports injuries, reduce stress, increase relaxation, address anxiety and depression, and aid general wellness.</p>]]></content>
- </section>
- <section>
- <title><![CDATA[Defining Massage Therapy]]></title>
- <anchor><![CDATA[49]]></anchor>
- <keywords><![CDATA[massage therapy]]></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/defining_massage.jpg]]></image>
- <content><![CDATA[<p>The term "massage therapy" encompasses many different techniques. In general, therapists press, rub, and otherwise manipulate the muscles and other soft tissues of the body. They most often use their hands and fingers, but may use their forearms, elbows, or feet.</p>
- <h4 class="margin15">Types of Massage Therapy: A Few Examples</h4>
- <p>In Swedish massage, the therapist uses long strokes, kneading, deep circular movements, vibration, and tapping. Sports massage is similar to Swedish massage, adapted specifically to the needs of athletes. Among the many other examples are deep tissue massage; trigger point massage, which focuses on myofascial trigger points - muscle "knots" that are painful when pressed and can cause symptoms elsewhere in the body; and reflexology, which applies pressure to the feet (or sometimes the hands or ears), to promote relaxation or healing in other parts of the body.</p>]]></content>
- </section>
- <section>
- <title><![CDATA[The Practice of Massage Therapy]]></title>
- <anchor><![CDATA[50]]></anchor>
- <keywords><![CDATA[practice]]></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/practice_massage.jpg]]></image>
- <content><![CDATA[<p>Massage therapists work in a variety of settings, including private offices, hospitals, nursing homes, studios, and sport and fitness facilities. Some also travel to patients' homes or workplaces. They usually try to provide a calm, soothing environment.</p>
- <p>Therapists usually ask new patients about symptoms, medical history, and desired results. They may also perform an evaluation through touch, to locate painful or tense areas and determine how much pressure to apply.</p>
- <p>Typically, the patient lies on a table, either in loose-fitting clothing or undressed (covered with a sheet, except for the area being massaged). The therapist may use oil or lotion to reduce friction on the skin. Sometimes, people receive massage therapy while sitting in a chair. A massage session may be fairly brief, but may also last an hour or even longer.</p>]]></content>
- </section>
- <section>
- <title><![CDATA[Research Status]]></title>
- <anchor><![CDATA[51]]></anchor>
- <keywords><![CDATA[research]]></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/research_status.jpg]]></image>
- <content><![CDATA[<p>Although scientific research on massage therapy - whether it works and, if so, how - is limited, there is evidence that massage may benefit some patients. Conclusions generally cannot yet be drawn about its effectiveness for specific health conditions.</p>
- <p>According to one analysis, however, research supports the general conclusion that massage therapy is effective. The studies included in the analysis suggest that a single session of massage therapy can reduce "state anxiety" (a reaction to a particular situation), blood pressure, and heart rate, and multiple sessions can reduce "trait anxiety" (general anxiety-proneness), depression, and pain. In addition, recent studies suggest that massage may benefit certain conditions, for example:</p>
- <ul>
- <li>A 2008 review of 13 clinical trials found evidence that massage might be useful for chronic low-back pain. Clinical practice guidelines issued in 2007 by the American Pain Society and the American College of Physicians recommend that physicians consider using certain CAM therapies, including massage (as well as acupuncture, chiropractic, progressive relaxation, and yoga), when patients with chronic low-back pain do not respond to conventional treatment.</li>
- <li>A multisite study of more than 300 hospice patients with advanced cancer concluded that massage may help to relieve pain and improve mood for these patients.</li>
- <li>A study of 64 patients with chronic neck pain found that therapeutic massage was more beneficial than a self-care book, in terms of improving function and relieving symptoms.</li>
- </ul>
- <p>There are numerous theories about how massage therapy may affect the body. For example, the "gate control theory" suggests that massage may provide stimulation that helps to block pain signals sent to the brain. Other examples include theories suggesting that massage might stimulate the release of certain chemicals in the body, such as serotonin or endorphins, or cause beneficial mechanical changes in the body. However, additional studies are needed to test the various theories.</p>]]></content>
- </section>
- <section>
- <title><![CDATA[Safety]]></title>
- <anchor><![CDATA[52]]></anchor>
- <keywords><![CDATA[safety]]></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/safety.jpg]]></image>
- <content><![CDATA[<p>Massage therapy appears to have few serious risks - if it is performed by a properly trained therapist and if appropriate cautions are followed. The number of serious injuries reported is very small. Side effects of massage therapy may include temporary pain or discomfort, bruising, swelling, and a sensitivity or allergy to massage oils.</p>
- <p>Cautions about massage therapy include the following:</p>
- <ul>
- <li>Vigorous massage should be avoided by people with bleeding disorders or low blood platelet counts, and by people taking blood-thinning medications such as warfarin.</li>
- <li>Massage should not be done in any area of the body with blood clots, fractures, open or healing wounds, skin infections, or weakened bones (such as from osteoporosis or cancer), or where there has been a recent surgery.</li>
- <li>Although massage therapy appears to be generally safe for cancer patients, they should consult their oncologist before having a massage that involves deep or intense pressure. Any direct pressure over a tumor usually is discouraged. Cancer patients should discuss any concerns about massage therapy with their oncologist.</li>
- <li>Pregnant women should consult their health care provider before using massage therapy.</li>
- </ul>]]></content>
- </section>
- <section>
- <title><![CDATA[Training, Licensing and Certification]]></title>
- <anchor><![CDATA[53]]></anchor>
- <keywords><![CDATA[training, licensing, certification]]></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/training.jpg]]></image>
- <content><![CDATA[<p>There are approximately 1,500 massage therapy schools and training programs in the United States. In addition to hands-on practice of massage techniques, students generally learn about the body and how it works, business practices, and ethics. Massage training programs generally are approved by a state board. Some may also be accredited by an independent agency, such as the Commission on Massage Therapy Accreditation (COMTA).</p>
- <p>As of 2007, 38 states and the District of Columbia had laws regulating massage therapy. In some states, regulation is by town ordinance.</p><p>The National Certification Board for Therapeutic Massage and Bodywork (NCBTMB) certifies practitioners who pass a national examination. Increasingly, states that license massage therapists require them to have a minimum of 500 hours of training at an accredited institution, pass the NCBTMB exam, meet specific continuing education requirements, and carry malpractice insurance.</p>
- <p>In addition to massage therapists, health care providers such as chiropractors and physical therapists may have training in massage.</p>
- <h4 class="margin15">Licenses and Vertifications</h4>
- <p>Some common licenses or certifications for massage therapists include:</p>
- <table>
- <tr>
- <td>LMT</td>
- <td>Licensed Massage Therapist</td>
- </tr>
- <tr>
- <td>LMP</td>
- <td>Licensed Massage Practitioner</td>
- </tr>
- <tr>
- <td>CMT</td>
- <td>Certified Massage Therapist</td>
- </tr>
- <tr>
- <td>NCTMB</td>
- <td>Has met the credentialing requirements (including passing an exam) of the National Certification Board for Therapeutic Massage and Bodywork, for practicing therapeutic massage and bodywork</td>
- </tr>
- <tr>
- <td>NCTM</td>
- <td>Has met the credentialing requirements (including passing an exam) of the National Certification Board for Therapeutic Massage and Bodywork, for practicing therapeutic massage</td>
- </tr>
- </table>]]></content>
- </section>
- <section>
- <title><![CDATA[If You Are Thinking About Using Massage Therapy]]></title>
- <anchor><![CDATA[54]]></anchor>
- <keywords></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/thinking_about.jpg]]></image>
- <content><![CDATA[<ul>
- <li>Do not use massage therapy to replace your regular medical care or as a reason to postpone seeing a health care provider about a medical problem.</li>
- <li>If you have a medical condition and are unsure whether massage therapy would be appropriate for you, discuss your concerns with your health care provider. Your health care provider may also be able to help you select a massage therapist. You might also look for published research articles on massage therapy for your condition.</li>
- <li>Before deciding to begin massage therapy, ask about the therapist's training, experience, and credentials. Also ask about the number of treatments that might be needed, the cost, and insurance coverage.</li>
- <li>If a massage therapist suggests using other CAM practices (for example, herbs or other supplements, or a special diet), discuss it first with your regular health care provider.</li>
- <li>Tell your health care providers about any complementary and alternative practices you use. Give them a full picture of what you do to manage your health. This will ensure coordinated and safe care.</li>
- </ul>]]></content>
- </section>
- <section>
- <title><![CDATA[NCCAM Funded Research on Massage Therapy]]></title>
- <anchor><![CDATA[55]]></anchor>
- <keywords><![CDATA[research]]></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/research.jpg]]></image>
- <content><![CDATA[<ul>
- <li>The effects of massage on chronic neck pain and low-back pain.</li>
- <li>Massage to treat anxiety disorder, alleviate depression in patients with advanced AIDS, and promote recovery in women who were victims of sexual abuse as children.</li>
- <li>Massage to relieve fatigue in cancer patients undergoing chemotherapy, reduce treatment-related swelling of the arms in breast cancer patients, and alleviate pain and distress in cancer patients at the end of life.</li>
- <li>Whether massage improves weight gain and immune system function in preterm infants.</li>
- <li>Whether massage given at home by a trained family member helps reduce pain from sickle cell anemia.</li>
- </ul>]]></content>
- </section>
- <section>
- <title><![CDATA[References]]></title>
- <anchor><![CDATA[56]]></anchor>
- <keywords></keywords>
- <content><![CDATA[<ol>
- <li>Barnes PM, Bloom B, Nahin RL. Complementary and alternative medicine use among adults and children: United States, 2007. <i>CDC National Health Statistics Report #12.</i> 2008.</li>
- <li>Bureau of Labor Statistics, U.S. Department of Labor. <i>Occupational Outlook Handbook, 2008 - 09 Edition: Massage Therapists.</i> Accessed at <a href="../www.bls.gov/oco/ocos295.htm">www.bls.gov/oco/ocos295.htm</a> on August 6, 2008.</li>
- <li>Cherkin DC, Sherman KJ, Deyo RA, et al. A review of the evidence for the effectiveness, safety, and cost of acupuncture, massage therapy, and spinal manipulation for back pain. <i>Annals of Internal Medicine.</i> 2003; 138(11): 898 - 907.</li>
- <li>Chou R, Qaseem A, Snow V, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. <i>Annals of Internal Medicine.</i> 2007; 147(7): 478 - 491.</li>
- <li>Corbin L. Safety and efficacy of massage therapy for patients with cancer. <i>Cancer Control: Journal of the Moffitt Cancer Center.</i> 2005; 12(3): 158 - 164.</li>
- <li>Eisenberg DM, Cohen MH, Hrbek A, et al. Credentialing complementary and alternative medical providers. <i>Annals of Internal Medicine.</i> 2002; 137(12): 965 - 973.</li>
- <li>Ernst E. The safety of massage therapy. <i>Rheumatology.</i> 2003; 42(9):1101 - 1106.</li>
- <li>Ezzo J. What can be learned from Cochrane systematic reviews of massage that can guide future research? <i>Journal of Alternative and Complementary Medicine.</i> 2007; 13(2): 291 - 295.</li>
- <li>Field T. Massage therapy effects. <i>American Psychologist.</i> 1998; 53(12):1270 - 1281.</li>
- <li>Furlan AD, Imamura M, Dryden T, et al. Massage for low-back pain. <i>Cochrane Database of Systematic Reviews.</i> 2008; (4): CD001929. Accessed on November 25, 2008.</li>
- <li>Goldstone LA. Massage as an orthodox medical treatment past and future. <i>Complementary Therapies in Nursing and Midwifery.</i> 2000; 6(4): 169 - 175.</li>
- <li>Kutner JS, Smith MC, Corbin L, et al. Massage therapy versus simple touch to improve pain and mood in patients with advanced cancer: a randomized trial. <i>Annals of Internal Medicine.</i> 2008; 149(6): 369 - 379.</li>
- <li>Massage: Bottom Line Monograph. Natural Standard Web site. Accessed on July 25, 2008.</li>
- <li>Moyer CA, Rounds J, Hannum JW. A meta-analysis of massage therapy research. <i>Psychological Bulletin.</i> 2004; 130(1): 3 - 18.</li>
- <li>Sherman KJ, Cherkin DC, Hawkes RJ, et al. Randomized trial of therapeutic massage for chronic neck pain. <i>Clinical Journal of Pain.</i> 2009; 25(3): 233 - 238.</li>
- </ol>]]></content>
- </section>
- <section>
- <title><![CDATA[For More Information]]></title>
- <anchor><![CDATA[57]]></anchor>
- <keywords></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/more_info.jpg]]></image>
- <content><![CDATA[<h4 class="margin15">NCCAM Clearinghouse</h4>
- <p>The NCCAM Clearinghouse provides information on CAM and NCCAM, including publications and searches of Federal databases of scientific and medical literature. The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners.</p>
- <p>Toll-free in the U.S.: 1-888-644-6226<br />
- TTY (for deaf and hard-of-hearing callers): 1-866-464-3615<br />
- Web site: <a href="http:/nccam.nih.gov/">nccam.nih.gov</a><br />
- E-mail: <a href="mailto: info@nccam.nih.gov">info@nccam.nih.gov</a><br /></p>
- <h4 class="margin15">PubMed&amp;reg;</h4>
- <p>A service of the National Library of Medicine (NLM), PubMed contains publication information and (in most cases) brief summaries of articles from scientific and medical journals. CAM on PubMed, developed jointly by NCCAM and NLM, is a subset of the PubMed system and focuses on the topic of CAM.</p>
- <p>Web site: <a href="http://www.ncbi.nlm.nih.gov/sites/entrez">www.ncbi.nlm.nih.gov/sites/entrez</a><br />
- CAM on PubMed: <a href="http://www.ncbi.nlm.nih.gov/sites/entrez">nccam.nih.gov/camonpubmed/</a></p>]]></content>
- </section>
- </page>
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- <page>
- <title><![CDATA[Pain: Hope Through Research]]></title>
- <subject><![CDATA[Pain / Pain Management]]></subject>
- <type><![CDATA[General Information]]></type>
- <banner>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/banners/banner_pain_hope_research.jpg]]></image>
- <color><![CDATA[dark]]></color>
- <height><![CDATA[440]]></height>
- </banner>
- <section>
- <title><![CDATA[Introduction: The Universal Disorder]]></title>
- <anchor><![CDATA[58]]></anchor>
- <keywords></keywords>
- <content><![CDATA[<p>You know it at once. It may be the fiery sensation of a burn moments after your finger touches the stove. Or it's a dull ache above your brow after a day of stress and tension. Or you may recognize it as a sharp pierce in your back after you lift something heavy.</p>
- <p>It is pain. In its most benign form, it warns us that something isn't quite right, that we should take medicine or see a doctor. At its worst, however, pain robs us of our productivity, our well-being, and, for many of us suffering from extended illness, our very lives. Pain is a complex perception that differs enormously among individual patients, even those who appear to have identical injuries or illnesses.</p>
- <p>In 1931, the French medical missionary Dr. Albert Schweitzer wrote, &quot;Pain is a more terrible lord of mankind than even death itself.&quot; Today, pain has become the universal disorder, a serious and costly public health issue, and a challenge for family, friends, and health care providers who must give support to the individual suffering from the physical as well as the emotional consequences of pain.</p>]]></content>
- <subsection>
- <title><![CDATA[A Brief History of Pain]]></title>
- <anchor><![CDATA[58-1]]></anchor>
- <keywords><![CDATA[history of pain]]></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/introduction_history.jpg]]></image>
- <content><![CDATA[<p>Ancient civilizations recorded on stone tablets accounts of pain and the treatments used: pressure, heat, water, and sun. Early humans related pain to evil, magic, and demons. Relief of pain was the responsibility of sorcerers, shamans, priests, and priestesses, who used herbs, rites, and ceremonies as their treatments.</p>
- <p>The Greeks and Romans were the first to advance a theory of sensation, the idea that the brain and nervous system have a role in producing the perception of pain. But it was not until the Middle Ages and well into the Renaissance - the 1400s and 1500s - that evidence began to accumulate in support of these theories. Leonardo da Vinci and his contemporaries came to believe that the brain was the central organ responsible for sensation. Da Vinci also developed the idea that the spinal cord transmits sensations to the brain.</p>
- <p>In the 17th and 18th centuries, the study of the body - and the senses - continued to be a source of wonder for the world's philosophers. In 1664, the French philosopher René Descartes described what to this day is still called a "pain pathway". Descartes illustrated how particles of fire, in contact with the foot, travel to the brain and he compared pain sensation to the ringing of a bell.</p>
- <p>In the 19th century, pain came to dwell under a new domain-science-paving the way for advances in pain therapy. Physician-scientists discovered that opium, morphine, codeine, and cocaine could be used to treat pain. These drugs led to the development of aspirin, to this day the most commonly used pain reliever. Before long, anesthesia - both general and regional - was refined and applied during surgery.</p>
- <p>"It has no future but itself", wrote the 19th century American poet Emily Dickinson, speaking about pain. As the 21st century unfolds, however, advances in pain research are creating a less grim future than that portrayed in Dickinson's verse, a future that includes a better understanding of pain, along with greatly improved treatments to keep it in check.</p>]]></content>
- </subsection>
- <subsection>
- <title><![CDATA[The Two Faces of Pain: Acute and Chronic]]></title>
- <anchor><![CDATA[58-2]]></anchor>
- <keywords><![CDATA[acute pain, chronic pain]]></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/introduction_faces.jpg]]></image>
- <content><![CDATA[<p>What is pain? The International Association for the Study of Pain defines it as: <i>An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.</i></p>
- <p>It is useful to distinguish between two basic types of pain, acute and chronic, and they differ greatly.</p>
- <ul>
- <li><b>Acute pain</b>, for the most part, results from disease, inflammation, or injury to tissues. This type of pain generally comes on suddenly, for example, after trauma or surgery, and may be accompanied by anxiety or emotional distress. The cause of acute pain can usually be diagnosed and treated, and the pain is self-limiting, that is, it is confined to a given period of time and severity. In some rare instances, it can become chronic.</li>
- <li><b>Chronic pain</b> is widely believed to represent disease itself. It can be made much worse by environmental and psychological factors. Chronic pain persists over a longer period of time than acute pain and is resistant to most medical treatments. It can - and often does - cause severe problems for patients.</li>
- </ul>]]></content>
- </subsection>
- <subsection>
- <title><![CDATA[The A to Z of Pain]]></title>
- <anchor><![CDATA[58-3]]></anchor>
- <keywords></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/introduction_a_z.jpg]]></image>
- <content><![CDATA[<p>Hundreds of pain syndromes or disorders make up the spectrum of pain. There are the most benign, fleeting sensations of pain, such as a pin prick. There is the pain of childbirth, the pain of a heart attack, and the pain that sometimes follows amputation of a limb. There is also pain accompanying cancer and the pain that follows severe trauma, such as that associated with head and spinal cord injuries. A sampling of common pain syndromes follows, listed alphabetically.</p>
- <p><b>Arachnoiditis</b> is a condition in which one of the three membranes covering the brain and spinal cord, called the arachnoid membrane, becomes inflamed. A number of causes, including infection or trauma, can result in inflammation of this membrane. Arachnoiditis can produce disabling, progressive, and even permanent pain.</p>
- <p><b>Arthritis</b>: millions of Americans suffer from arthritic conditions such as osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, and gout. These disorders are characterized by joint pain in the extremities. Many other inflammatory diseases affect the body's soft tissues, including tendonitis and bursitis.</p>
- <p><b>Back pain</b> has become the high price paid by our modern lifestyle and is a startlingly common cause of disability for many Americans, including both active and inactive people. Back pain that spreads to the leg is called sciatica and is a very common condition (see below). Another common type of back pain is associated with the discs of the spine, the soft, spongy padding between the vertebrae (bones) that form the spine. Discs protect the spine by absorbing shock, but they tend to degenerate over time and may sometimes rupture. <b>Spondylolisthesis</b> is a back condition that occurs when one vertebra extends over another, causing pressure on nerves and therefore pain. Also, damage to nerve roots (see <a href="#appendix_spine_basics">Spine Basics</a> in the Appendix) is a serious condition, called <b>radiculopathy</b>, that can be extremely painful. Treatment for a damaged disc includes drugs such as painkillers, muscle relaxants, and steroids; exercise or rest, depending on the patient's condition; adequate support, such as a brace or better mattress and physical therapy. In some cases, surgery may be required to remove the damaged portion of the disc and return it to its previous condition, especially when it is pressing a nerve root. Surgical procedures include discectomy, laminectomy, or spinal fusion (see section on surgery in <a href="#treated">How is Pain Treated?</a> for more information on these treatments).</p>
- <p><b>Burn pain</b> can be profound and poses an extreme challenge to the medical community. First-degree burns are the least severe; with third-degree burns, the skin is lost. Depending on the injury, pain accompanying burns can be excruciating, and even after the wound has healed patients may have chronic pain at the burn site.</p>
- <p><b>Central pain syndrome</b> - see "<a href="#introduction_a_z_trauma">Trauma</a>" below.</p>
- <p><b>Cancer pain</b> can accompany the growth of a tumor, the treatment of cancer, or chronic problems related to cancer's permanent effects on the body. Fortunately, most cancer pain can be treated to help minimize discomfort and stress to the patient.</p>
- <p><b>Headaches</b> affect millions of Americans. The three most common types of chronic headache are migraines, cluster headaches, and tension headaches. Each comes with its own telltale brand of pain.</p>
- <ul>
- <li><b>Headaches</b> affect millions of Americans. The three most common types of chronic headache are migraines, cluster headaches, and tension headaches. Each comes with its own telltale brand of pain.</li>
- <li><b>Cluster</b> headaches are characterized by excruciating, piercing pain on one side of the head; they occur more frequently in men than women.</li>
- <li><b>Tension headaches</b> are often described as a tight band around the head.</li>
- </ul>
- <p><b>Head and facial pain</b> can be agonizing, whether it results from dental problems or from disorders such as cranial neuralgia, in which one of the nerves in the face, head, or neck is inflamed. Another condition, <b>trigeminal neuralgia</b> (also called <i>tic douloureux</i>), affects the largest of the cranial nerves (see <a href="#appendix_nervous_systems">The Nervous Systems</a> in the Appendix) and is characterized by a stabbing, shooting pain.</p>
- <p><b>Muscle pain</b> can range from an aching muscle, spasm, or strain, to the severe spasticity that accompanies paralysis. Another disabling syndrome is <b>fibromyalgia</b>, a disorder characterized by fatigue, stiffness, joint tenderness, and widespread muscle pain. <b>Polymyositis</b>, <b>dermatomyositis</b>, and <b>inclusion body myositis</b> are painful disorders characterized by muscle inflammation. They may be caused by infection or autoimmune dysfunction and are sometimes associated with connective tissue disorders, such as lupus and rheumatoid arthritis.</p>
- <p><b>Myofascial pain syndromes</b> affect sensitive areas known as trigger points, located within the body's muscles. Myofascial pain syndromes are sometimes misdiagnosed and can be debilitating. <b>Fibromyalgia</b> is a type of myofascial pain syndrome.</p>
- <p><b>Neuropathic pain</b> is a type of pain that can result from injury to nerves, either in the peripheral or central nervous system (see <a href="#appendix_nervous_systems">The Nervous Systems</a> in the Appendix). Neuropathic pain can occur in any part of the body and is frequently described as a hot, burning sensation, which can be devastating to the affected individual. It can result from diseases that affect nerves (such as diabetes) or from trauma, or, because chemotherapy drugs can affect nerves, it can be a consequence of cancer treatment. Among the many neuropathic pain conditions are <b>diabetic neuropathy</b> (which results from nerve damage secondary to vascular problems that occur with diabetes); <b>reflex sympathetic dystrophy syndrome</b> (see below), which can follow injury; <b>phantom limb</b> and <b>post-amputation pain</b> (see <a href="#appendix_phantom_pain">Phantom Pain</a> in the Appendix), which can result from the surgical removal of a limb; <b>postherpetic neuralgia</b>, which can occur after an outbreak of shingles; and <b>central pain syndrome</b>, which can result from trauma to the brain or spinal cord.</p>
- <p><b>Reflex sympathetic dystrophy syndrome</b>, or RSDS, is accompanied by burning pain and hypersensitivity to temperature. Often triggered by trauma or nerve damage, RSDS causes the skin of the affected area to become characteristically shiny. In recent years, RSDS has come to be called <b>complex regional pain syndrome</b> (CRPS); in the past it was often called <b>causalgia</b>.</p>
- <p>Repetitive stress injuries are muscular conditions that result from repeated motions performed in the course of normal work or other daily activities. They include:</p>
- <ul>
- <li>Writer's cramp, which affects musicians and writers and others;</li>
- <li>Compression or entrapment neuropathies, including carpal tunnel syndrome, caused by chronic overextension of the wrist;</li>
- <li>Tendonitis or tenosynovitis, affecting one or more tendons.</li>
- </ul>
- <p><b>Sciatica</b> is a painful condition caused by pressure on the sciatic nerve, the main nerve that branches off the spinal cord and continues down into the thighs, legs, ankles, and feet. Sciatica is characterized by pain in the buttocks and can be caused by a number of factors. Exertion, obesity, and poor posture can all cause pressure on the sciatic nerve. One common cause of sciatica is a herniated disc (see <a href="#appendix_spine_basics">Spine Basics</a> in the Appendix).</p>
- <p><b>Shingles and other painful disorders</b> affect the skin. Pain is a common symptom of many skin disorders, even the most common rashes. One of the most vexing neurological disorders is shingles or herpes zoster, an infection that often causes agonizing pain resistant to treatment. Prompt treatment with antiviral agents is important to arrest the infection, which if prolonged can result in an associated condition known as <b>postherpetic neuralgia</b>. Other painful disorders affecting the skin include:</p>
- <ul>
- <li><b>Vasculitis</b>, or inflammation of blood vessels;</li>
- <li>Other infections, including <b>herpes simplex</b>;</li>
- <li>Skin <b>tumors</b> and <b>cysts</b>;</li>
- <li>Tumors associated with <b>neurofibromatosis</b>, a neurogenetic disorder.</li>
- </ul>
- <p><b>Sports injuries</b> are common. Sprains, strains, bruises, dislocations, and fractures are all well-known words in the language of sports. Pain is another. In extreme cases, sports injuries can take the form of costly and painful spinal cord and head injuries, which cause severe suffering and disability.</p>
- <p><b>Spinal stenosis</b> refers to a narrowing of the canal surrounding the spinal cord. The condition occurs naturally with aging. Spinal stenosis causes weakness in the legs and leg pain usually felt while the person is standing up and often relieved by sitting down.</p>
- <p><b>Surgical pain</b> may require regional or general anesthesia during the procedure and medications to control discomfort following the operation. Control of pain associated with surgery includes presurgical preparation and careful monitoring of the patient during and after the procedure.</p>
- <p><b>Temporomandibular disorders</b> are conditions in which the temporomandibular joint (the jaw) is damaged and/or the muscles used for chewing and talking become stressed, causing pain. The condition may be the result of a number of factors, such as an injury to the jaw or joint misalignment, and may give rise to a variety of symptoms, most commonly pain in the jaw, face, and/or neck muscles. Physicians reach a diagnosis by listening to the patient's description of the symptoms and by performing a simple examination of the facial muscles and the temporomandibular joint.</p>
- <p><a name="introduction_a_z_trauma"></a><b>Trauma</b> can occur after injuries in the home, at the workplace, during sports activities, or on the road. Any of these injuries can result in severe disability and pain. Some patients who have had an injury to the spinal cord experience intense pain ranging from tingling to burning and, commonly, both. Such patients are sensitive to hot and cold temperatures and touch. For these individuals, a touch can be perceived as intense burning, indicating abnormal signals relayed to and from the brain. This condition is called <b>central pain syndrome</b> or, if the damage is in the thalamus (the brain's center for processing bodily sensations), <b>thalamic pain syndrome</b>. It affects as many as 100,000 Americans with multiple sclerosis, Parkinson's disease, amputated limbs, spinal cord injuries, and stroke. Their pain is severe and is extremely difficult to treat effectively. A variety of medications, including analgesics, antidepressants, anticonvulsants, and electrical stimulation, are options available to central pain patients.</p>
- <p><b>Vascular disease or injury</b>-such as vasculitis or inflammation of blood vessels, coronary artery disease, and circulatory problems-all have the potential to cause pain. Vascular pain affects millions of Americans and occurs when communication between blood vessels and nerves is interrupted. Ruptures, spasms, constriction, or obstruction of blood vessels, as well as a condition called ischemia in which blood supply to organs, tissues, or limbs is cut off, can also result in pain.</p>]]></content>
- </subsection>
- </section>
- <section>
- <title><![CDATA[How is Pain Diagnosed?]]></title>
- <anchor><![CDATA[59]]></anchor>
- <keywords><![CDATA[pain diagnosis]]></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/diagnosed.jpg]]></image>
- <content><![CDATA[<p>There is no way to tell how much pain a person has. No test can measure the intensity of pain, no imaging device can show pain, and no instrument can locate pain precisely. Sometimes, as in the case of headaches, physicians find that the best aid to diagnosis is the patient's own description of the type, duration, and location of pain. Defining pain as sharp or dull, constant or intermittent, burning or aching may give the best clues to the cause of pain. These descriptions are part of what is called the pain history, taken by the physician during the preliminary examination of a patient with pain.</p>
- <p>Physicians, however, do have a number of technologies they use to find the cause of pain. Primarily these include:</p>
- <ul>
- <li><b>Electrodiagnostic procedures</b> include <b>electromyography (EMG)</b>, <b>nerve conduction studies</b>, and <b>evoked potential (EP) studies</b>. Information from <b>EMG</b> can help physicians tell precisely which muscles or nerves are affected by weakness or pain. Thin needles are inserted in muscles and a physician can see or listen to electrical signals displayed on an EMG machine. With <b>nerve conduction studies</b> the doctor uses two sets of electrodes (similar to those used during an electrocardiogram) that are placed on the skin over the muscles. The first set gives the patient a mild shock that stimulates the nerve that runs to that muscle. The second set of electrodes is used to make a recording of the nerve's electrical signals, and from this information the doctor can determine if there is nerve damage. <b>EP tests</b> also involve two sets of electrodes - one set for stimulating a nerve (these electrodes are attached to a limb) and another set on the scalp for recording the speed of nerve signal transmission to the brain.</li>
- <li>Imaging, especially <b>magnetic resonance imaging</b> or <b>MRI</b>, provides physicians with pictures of the body's structures and tissues. MRI uses magnetic fields and radio waves to differentiate between healthy and diseased tissue.</li>
- <li>A <b>neurological examination</b> in which the physician tests movement, reflexes, sensation, balance, and coordination.</li>
- <li><b>X-rays</b> produce pictures of the body's structures, such as bones and joints.</li>
- </ul>]]></content>
- </section>
- <section>
- <title><![CDATA[How is Pain Treated?]]></title>
- <anchor><![CDATA[60]]></anchor>
- <keywords><![CDATA[pain treatment]]></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/treated_1.jpg]]></image>
- <content><![CDATA[<p>The goal of pain management is to improve function, enabling individuals to work, attend school, or participate in other day-to-day activities. Patients and their physicians have a number of options for the treatment of pain; some are more effective than others. Sometimes, relaxation and the use of imagery as a distraction provide relief. These methods can be powerful and effective, according to those who advocate their use. Whatever the treatment regime, it is important to remember that pain is <b>treatable</b>. The following treatments are among the most common.</p>
- <p><b>Acetaminophen</b> is the basic ingredient found in Tylenol&amp;reg; and its many generic equivalents. It is sold over the counter, in a prescription-strength preparation, and in combination with codeine (also by prescription).</p>
- <p><b>Acupuncture</b> dates back 2,500 years and involves the application of needles to precise points on the body. It is part of a general category of healing called traditional Chinese or Oriental medicine. Acupuncture remains controversial but is quite popular and may one day prove to be useful for a variety of conditions as it continues to be explored by practitioners, patients, and investigators.</p>
- <p><b>Analgesic</b> refers to the class of drugs that includes most painkillers, such as aspirin, acetaminophen, and ibuprofen. The word analgesic is derived from ancient Greek and means to reduce or stop pain. Nonprescription or over-the-counter pain relievers are generally used for mild to moderate pain. Prescription pain relievers, sold through a pharmacy under the direction of a physician, are used for more moderate to severe pain.</p>
- <p><b>Anticonvulsants</b> are used for the treatment of seizure disorders but are also sometimes prescribed for the treatment of pain. Carbamazepine in particular is used to treat a number of painful conditions, including trigeminal neuralgia. Another antiepileptic drug, gabapentin, is being studied for its pain-relieving properties, especially as a treatment for neuropathic pain.</p>
- <p><b>Antidepressants</b> are sometimes used for the treatment of pain and, along with neuroleptics and lithium, belong to a category of drugs called psychotropic drugs. In addition, anti-anxiety drugs called benzodiazepines also act as muscle relaxants and are sometimes used as pain relievers. Physicians usually try to treat the condition with analgesics before prescribing these drugs.</p>
- <p><b>Antimigraine</b> drugs include the triptans - sumatriptan (Imitrex&amp;reg;), naratriptan (Amerge&amp;reg;), and zolmitriptan (Zomig&amp;reg;) - and are used specifically for migraine headaches. They can have serious side effects in some people and therefore, as with all prescription medicines, should be used only under a doctor's care.</p>
- <p><b>Aspirin</b> may be the most widely used pain-relief agent and has been sold over the counter since 1905 as a treatment for fever, headache, and muscle soreness.</p>
- <p><b>Biofeedback</b> is used for the treatment of many common pain problems, most notably headache and back pain. Using a special electronic machine, the patient is trained to become aware of, to follow, and to gain control over certain bodily functions, including muscle tension, heart rate, and skin temperature. The individual can then learn to effect a change in his or her responses to pain, for example, by using relaxation techniques. Biofeedback is often used in combination with other treatment methods, generally without side effects. Similarly, the use of relaxation techniques in the treatment of pain can increase the patient's feeling of well-being.</p>
- <p><b>Capsaicin</b> is a chemical found in chili peppers that is also a primary ingredient in pain-relieving creams (see <a href="#appendix_peppers_capsaicin">Chili Peppers, Capsaicin, and Pain</a> in the Appendix).</p>
- <p><b>Chemonucleolysis</b> is a treatment in which an enzyme, chymopapain, is injected directly into a herniated lumbar disc (see <a href="#appendix_spine_basics">Spine Basics</a> in the Appendix) in an effort to dissolve material around the disc, thus reducing pressure and pain. The procedure's use is extremely limited, in part because some patients may have a life-threatening allergic reaction to chymopapain.</p>
- <p><b>Chiropractic</b> care may ease back pain, neck pain, headaches, and musculoskeletal conditions. It involves &quot;hands-on&quot; therapy designed to adjust the relationship between the body's structure (mainly the spine) and its functioning. Chiropractic spinal manipulation includes the adjustment and manipulation of the joints and adjacent tissues. Such care may also involve therapeutic and rehabilitative exercises.</p>
- <p><b>Cognitive-behavioral therapy</b> involves a wide variety of coping skills and relaxation methods to help prepare for and cope with pain. It is used for postoperative pain, cancer pain, and the pain of childbirth.</p>
- <p><b>Counseling</b> can give a patient suffering from pain much needed support, whether it is derived from family, group, or individual counseling. Support groups can provide an important adjunct to drug or surgical treatment. Psychological treatment can also help patients learn about the physiological changes produced by pain.</p>
- <p><b>COX-2 inhibitors</b> may be effective for individuals with arthritis. For many years scientists have wanted to develop a drug that works as well as morphine but without its negative side effects. Nonsteroidal anti-inflammatory drugs (NSAIDs) work by blocking two enzymes, cyclooxygenase-1 and cyclooxygenase-2, both of which promote production of hormones called prostaglandins, which in turn cause inflammation, fever, and pain. The newer COX-2 inhibitors primarily block cyclooxygenase-2 and are less likely to have the gastrointestinal side effects sometimes produced by NSAIDs.</p>
- <p>In 1999, the Food and Drug Administration approved a COX-2 inhibitor - celecoxib - for use in cases of chronic pain. The long-term effects of all COX-2 inhibitors are still being evaluated, especially in light of new information suggesting that these drugs may increase the risk of heart attack and stroke. Patients taking any of the COX-2 inhibitors should review their drug treatment with their doctors.</p>
- <p><b>Electrical stimulation</b>, including transcutaneous electrical stimulation (TENS), implanted electric nerve stimulation, and deep brain or spinal cord stimulation, is the modern-day extension of age-old practices in which the nerves of muscles are subjected to a variety of stimuli, including heat or massage. Electrical stimulation, no matter what form, involves a major surgical procedure and is not for everyone, nor is it 100 percent effective. The following techniques each require specialized equipment and personnel trained in the specific procedure being used:</p>
- <ul>
- <li><b>TENS</b> uses tiny electrical pulses, delivered through the skin to nerve fibers, to cause changes in muscles, such as numbness or contractions. This in turn produces temporary pain relief. There is also evidence that TENS can activate subsets of peripheral nerve fibers that can block pain transmission at the spinal cord level, in much the same way that shaking your hand can reduce pain.</li>
- <li><b>Peripheral nerve stimulation</b> uses electrodes placed surgically on a carefully selected area of the body. The patient is then able to deliver an electrical current as needed to the affected area, using an antenna and transmitter.</li>
- <li><b>Spinal cord stimulation</b> uses electrodes surgically inserted within the epidural space of the spinal cord. The patient is able to deliver a pulse of electricity to the spinal cord using a small box-like receiver and an antenna taped to the skin.</li>
- <li><b>Deep brain or intracerebral stimulation</b> is considered an extreme treatment and involves surgical stimulation of the brain, usually the thalamus. It is used for a limited number of conditions, including severe pain, central pain syndrome, cancer pain, phantom limb pain, and other neuropathic pains.</li>
- </ul>]]></content>
- <subsection>
- <title><![CDATA[Exercise]]></title>
- <anchor><![CDATA[60-4]]></anchor>
- <keywords><![CDATA[exercise]]></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/treated_2.jpg]]></image>
- <content><![CDATA[<p><b>Exercise</b> has come to be a prescribed part of some doctors' treatment regimes for patients with pain. Because there is a known link between many types of chronic pain and tense, weak muscles, exercise-even light to moderate exercise such as walking or swimming-can contribute to an overall sense of well-being by improving blood and oxygen flow to muscles. Just as we know that stress contributes to pain, we also know that exercise, sleep, and relaxation can all help reduce stress, thereby helping to alleviate pain. Exercise has been proven to help many people with low back pain. It is important, however, that patients carefully follow the routine laid out by their physicians.</p>
- <p><b>Hypnosis</b>, first approved for medical use by the American Medical Association in 1958, continues to grow in popularity, especially as an adjunct to pain medication. In general, hypnosis is used to control physical function or response, that is, the amount of pain an individual can withstand. How hypnosis works is not fully understood. Some believe that hypnosis delivers the patient into a trance-like state, while others feel that the individual is simply better able to concentrate and relax or is more responsive to suggestion. Hypnosis may result in relief of pain by acting on chemicals in the nervous system, slowing impulses. Whether and how hypnosis works involves greater insight - and research - into the mechanisms underlying human consciousness.</p>
- <p><b>Ibuprofen</b> is a member of the aspirin family of analgesics, the so-called <a href="#treated_nonsteroidal_drugs">nonsteroidal anti-inflammatory drugs</a> (see below). It is sold over the counter and also comes in prescription-strength preparations.</p>
- <p><b>Low-power lasers</b> have been used occasionally by some physical therapists as a treatment for pain, but like many other treatments, this method is not without controversy.</p>
- <p><b>Magnets</b> are increasingly popular with athletes who swear by their effectiveness for the control of sports-related pain and other painful conditions. Usually worn as a collar or wristwatch, the use of magnets as a treatment dates back to the ancient Egyptians and Greeks. While it is often dismissed as quackery and pseudoscience by skeptics, proponents offer the theory that magnets may effect changes in cells or body chemistry, thus producing pain relief.</p>
- <p><b>Narcotics</b> (see <a href="#treated_opioids">Opioids</a>, below).</p>
- <p><b>Nerve blocks</b> employ the use of drugs, chemical agents, or surgical techniques to interrupt the relay of pain messages between specific areas of the body and the brain. There are many different names for the procedure, depending on the technique or agent used. Types of surgical nerve blocks include neurectomy; spinal dorsal, cranial, and trigeminal rhizotomy; and sympathectomy, also called sympathetic blockade (see <a href="#appendix_nerve_blocks">Nerve Blocks</a> in the Appendix).</p>
- <p><a name="treated_nonsteroidal_drugs"></a><b>Nonsteroidal anti-inflammatory drugs (NSAIDs)</b> (including aspirin and ibuprofen) are widely prescribed and sometimes called non-narcotic or non-opioid analgesics. They work by reducing inflammatory responses in tissues. Many of these drugs irritate the stomach and for that reason are usually taken with food. Although acetaminophen may have some anti-inflammatory effects, it is generally distinguished from the traditional NSAIDs.</p>
- <p><a name="treated_opioids"></a><b>Opioids</b> are derived from the poppy plant and are among the oldest drugs known to humankind. They include codeine and perhaps the most well-known narcotic of all, <b>morphine</b>. Morphine can be administered in a variety of forms, including a pump for patient self-administration. Opioids have a narcotic effect, that is, they induce sedation as well as pain relief, and some patients may become physically dependent upon them. For these reasons, patients given opioids should be monitored carefully; in some cases stimulants may be prescribed to counteract the sedative side effects. In addition to drowsiness, other common side effects include constipation, nausea, and vomiting.</p>
- <p><b>Physical therapy and rehabilitation</b> date back to the ancient practice of using physical techniques and methods, such as heat, cold, exercise, massage, and manipulation, in the treatment of certain conditions. These may be applied to increase function, control pain, and speed the patient toward full recovery.</p>
- <p><b>Placebos</b> offer some individuals pain relief although whether and how they have an effect is mysterious and somewhat controversial. Placebos are inactive substances, such as sugar pills, or harmless procedures, such as saline injections or sham surgeries, generally used in clinical studies as control factors to help determine the efficacy of active treatments. Although placebos have no direct effect on the underlying causes of pain, evidence from clinical studies suggests that many pain conditions such as migraine headache, back pain, post-surgical pain, rheumatoid arthritis, angina, and depression sometimes respond well to them. This positive response is known as the placebo effect, which is defined as the observable or measurable change that can occur in patients after administration of a placebo. Some experts believe the effect is psychological and that placebos work because the patients believe or expect them to work. Others say placebos relieve pain by stimulating the brain's own analgesics and setting the body's self-healing forces in motion. A third theory suggests that the act of taking placebos relieves stress and anxiety-which are known to aggravate some painful conditions-and, thus, cause the patients to feel better. Still, placebos are considered controversial because by definition they are inactive and have no actual curative value.</p>
- <p><b>R.I.C.E.</b> - <b>R</b>est, <b>I</b>ce, <b>C</b>ompression, and <b>E</b>levation-are four components prescribed by many orthopedists, coaches, trainers, nurses, and other professionals for temporary muscle or joint conditions, such as sprains or strains. While many common orthopedic problems can be controlled with these four simple steps, especially when combined with over-the-counter pain relievers, more serious conditions may require surgery or physical therapy, including exercise, joint movement or manipulation, and stimulation of muscles.</p>
- <p><b>Surgery</b>, although not always an option, may be required to relieve pain, especially pain caused by back problems or serious musculoskeletal injuries. Surgery may take the form of a nerve block (see <a href="#appendix_nerve_blocks">Nerve Blocks</a> in the Appendix) or it may involve an operation to relieve pain from a ruptured disc. Surgical procedures for back problems include <b>discectomy</b> or, when microsurgical techniques are used, <b>microdiscectomy</b>, in which the entire disc is removed; <b>laminectomy</b>, a procedure in which a surgeon removes only a disc fragment, gaining access by entering through the arched portion of a vertebra; and <b>spinal fusion</b>, a procedure where the entire disc is removed and replaced with a bone graft. In a spinal fusion, the two vertebrae are then fused together. Although the operation can cause the spine to stiffen, resulting in lost flexibility, the procedure serves one critical purpose: protection of the spinal cord. Other operations for pain include <b>rhizotomy</b>, in which a nerve close to the spinal cord is cut, and <b>cordotomy</b>, where bundles of nerves within the spinal cord are severed. Cordotomy is generally used only for the pain of terminal cancer that does not respond to other therapies. Another operation for pain is the <b>dorsal root entry zone operation</b>, or DREZ, in which spinal neurons corresponding to the patient's pain are destroyed surgically. Because surgery can result in scar tissue formation that may cause additional problems, patients are well advised to seek a second opinion before proceeding. Occasionally, surgery is carried out with electrodes that selectively damage neurons in a targeted area of the brain. These procedures rarely result in long-term pain relief, but both physician and patient may decide that the surgical procedure will be effective enough that it justifies the expense and risk. In some cases, the results of an operation are remarkable. For example, many individuals suffering from trigeminal neuralgia who are not responsive to drug treatment have had great success with a procedure called microvascular decompression, in which tiny blood vessels are surgically separated from surrounding nerves.</p>]]></content>
- </subsection>
- </section>
- <section>
- <title><![CDATA[What is the Role of Age and Gender in Pain?]]></title>
- <anchor><![CDATA[61]]></anchor>
- <keywords><![CDATA[age, gender]]></keywords>
- <content></content>
- <subsection>
- <title><![CDATA[Gender and Pain]]></title>
- <anchor><![CDATA[61-6]]></anchor>
- <keywords><![CDATA[gender, pain]]></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/gender_gender.jpg]]></image>
- <content><![CDATA[<p>It is now widely believed that pain affects men and women differently. While the sex hormones estrogen and testosterone certainly play a role in this phenomenon, psychology and culture, too, may account at least in part for differences in how men and women receive pain signals. For example, young children may learn to respond to pain based on how they are treated when they experience pain. Some children may be cuddled and comforted, while others may be encouraged to tough it out and to dismiss their pain.</p>
- <p>Many investigators are turning their attention to the study of gender differences and pain. Women, many experts now agree, recover more quickly from pain, seek help more quickly for their pain, and are less likely to allow pain to control their lives. They also are more likely to marshal a variety of resources-coping skills, support, and distraction - with which to deal with their pain.</p>
- <p>Research in this area is yielding fascinating results. For example, male experimental animals injected with estrogen, a female sex hormone, appear to have a lower tolerance for pain-that is, the addition of estrogen appears to lower the pain threshold. Similarly, the presence of testosterone, a male hormone, appears to elevate tolerance for pain in female mice: the animals are simply able to withstand pain better. Female mice deprived of estrogen during experiments react to stress similarly to male animals. Estrogen, therefore, may act as a sort of pain switch, turning on the ability to recognize pain.</p>
- <p>Investigators know that males and females both have strong natural pain-killing systems, but these systems operate differently. For example, a class of painkillers called kappa-opioids is named after one of several opioid receptors to which they bind, the kappa-opioid receptor, and they include the compounds <i>nalbuphine</i> (Nubain&amp;reg;) and <i>butorphanol</i> (Stadol&amp;reg;). Research suggests that kappa-opioids provide better pain relief in women.</p>
- <p>Though not prescribed widely, kappa-opioids are currently used for relief of labor pain and in general work best for short-term pain. Investigators are not certain why kappa-opioids work better in women than men. Is it because a woman's estrogen makes them work, or because a man's testosterone prevents them from working? Or is there another explanation, such as differences between men and women in their perception of pain? Continued research may result in a better understanding of how pain affects women differently from men, enabling new and better pain medications to be designed with gender in mind.</p>]]></content>
- </subsection>
- <subsection>
- <title><![CDATA[Pain in Aging and Pediatric Populations: Special Needs and Concerns]]></title>
- <anchor><![CDATA[61-7]]></anchor>
- <keywords><![CDATA[special needs]]></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/gender_age.jpg]]></image>
- <content><![CDATA[<p>Pain is the number one complaint of older Americans, and one in five older Americans takes a painkiller regularly. In 1998, the American Geriatrics Society (AGS) issued guidelines<em>*</em> for the management of pain in older people. The AGS panel addressed the incorporation of several non-drug approaches in patients' treatment plans, including exercise. AGS panel members recommend that, whenever possible, patients use alternatives to aspirin, ibuprofen, and other NSAIDs because of the drugs' side effects, including stomach irritation and gastrointestinal bleeding. For older adults, acetaminophen is the first-line treatment for mild-to-moderate pain, according to the guidelines. More serious chronic pain conditions may require opioid drugs (narcotics), including codeine or morphine, for relief of pain.</p>
- <p>Pain in younger patients also requires special attention, particularly because young children are not always able to describe the degree of pain they are experiencing. Although treating pain in pediatric patients poses a special challenge to physicians and parents alike, pediatric patients should never be undertreated. Recently, special tools for measuring pain in children have been developed that, when combined with cues used by parents, help physicians select the most effective treatments.</p>
- <p>Nonsteroidal agents, and especially acetaminophen, are most often prescribed for control of pain in children. In the case of severe pain or pain following surgery, acetaminophen may be combined with codeine.</p>
- <p><em>* Journal of the American Geriatrics Society (1998; 46:635-651).</em></p>]]></content>
- </subsection>
- </section>
- <section>
- <title><![CDATA[A Pain Primer: What Do We Know About Pain?]]></title>
- <anchor><![CDATA[62]]></anchor>
- <keywords></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/primer.jpg]]></image>
- <content><![CDATA[<p>We may experience pain as a prick, tingle, sting, burn, or ache. Receptors on the skin trigger a series of events, beginning with an electrical impulse that travels from the skin to the spinal cord. The spinal cord acts as a sort of relay center where the pain signal can be blocked, enhanced, or otherwise modified before it is relayed to the brain. One area of the spinal cord in particular, called the <i>dorsal horn</i> (see section on <a href="#appendix_spine_basics">Spine Basics</a> in the Appendix), is important in the reception of pain signals.</p>
- <p>The most common destination in the brain for pain signals is the thalamus and from there to the cortex, the headquarters for complex thoughts. The thalamus also serves as the brain's storage area for images of the body and plays a key role in relaying messages between the brain and various parts of the body. In people who undergo an amputation, the representation of the amputated limb is stored in the thalamus. (For a discussion of the thalamus and its role in this phenomenon, called phantom pain, see section on <a href="#appendix_phantom_pain">Phantom Pain</a> in the Appendix.)</p>
- <p>Pain is a complicated process that involves an intricate interplay between a number of important chemicals found naturally in the brain and spinal cord. In general, these chemicals, called <i>neurotransmitters</i>, transmit nerve impulses from one cell to another.</p>
- <p>There are many different neurotransmitters in the human body; some play a role in human disease and, in the case of pain, act in various combinations to produce painful sensations in the body. Some chemicals govern mild pain sensations; others control intense or severe pain.</p>
- <p>The body's chemicals act in the transmission of pain messages by stimulating <i>neurotransmitter receptors</i> found on the surface of cells; each receptor has a corresponding neurotransmitter. Receptors function much like gates or ports and enable pain messages to pass through and on to neighboring cells. One brain chemical of special interest to neuroscientists is <i>glutamate</i>. During experiments, mice with blocked glutamate receptors show a reduction in their responses to pain. Other important receptors in pain transmission are opiate-like receptors. Morphine and other opioid drugs work by locking on to these opioid receptors, switching on pain-inhibiting pathways or circuits, and thereby blocking pain.</p>
- <p>Another type of receptor that responds to painful stimuli is called a <i>nociceptor</i>. Nociceptors are thin nerve fibers in the skin, muscle, and other body tissues, that, when stimulated, carry pain signals to the spinal cord and brain. Normally, nociceptors only respond to strong stimuli such as a pinch. However, when tissues become injured or inflamed, as with a sunburn or infection, they release chemicals that make nociceptors much more sensitive and cause them to transmit pain signals in response to even gentle stimuli such as breeze or a caress. This condition is called <i>allodynia</i> - a state in which pain is produced by innocuous stimuli.</p>
- <p>The body's natural painkillers may yet prove to be the most promising pain relievers, pointing to one of the most important new avenues in drug development. The brain may signal the release of painkillers found in the spinal cord, including serotonin, norepinephrine, and opioid-like chemicals. Many pharmaceutical companies are working to synthesize these substances in laboratories as future medications.</p>
- <p><i>Endorphins</i> and <i>enkephalins</i> are other natural painkillers. Endorphins may be responsible for the &quot;feel good&quot; effects experienced by many people after rigorous exercise; they are also implicated in the pleasurable effects of smoking.</p>
- <p>Similarly, <i>peptides</i>, compounds that make up proteins in the body, play a role in pain responses. Mice bred experimentally to lack a gene for two peptides called <i>tachykinins-neurokinin</i> A and substance P-have a reduced response to severe pain. When exposed to mild pain, these mice react in the same way as mice that carry the missing gene. But when exposed to more severe pain, the mice exhibit a reduced pain response. This suggests that the two peptides are involved in the production of pain sensations, especially moderate-to-severe pain. Continued research on tachykinins, conducted with support from the NINDS, may pave the way for drugs tailored to treat different severities of pain.</p>
- <p>Scientists are working to develop potent pain-killing drugs that act on receptors for the chemical <i>acetylcholine</i>. For example, a type of frog native to Ecuador has been found to have a chemical in its skin called epibatidine, derived from the frog's scientific name, <i>Epipedobates tricolor</i>. Although highly toxic, epibatidine is a potent analgesic and, surprisingly, resembles the chemical nicotine found in cigarettes. Also under development are other less toxic compounds that act on acetylcholine receptors and may prove to be more potent than morphine but without its addictive properties.</p>
- <p>The idea of using receptors as gateways for pain drugs is a novel idea, supported by experiments involving substance P. Investigators have been able to isolate a tiny population of neurons, located in the spinal cord, that together form a major portion of the pathway responsible for carrying persistent pain signals to the brain. When animals were given injections of a lethal cocktail containing substance P linked to the chemical saporin, this group of cells, whose sole function is to communicate pain, were killed. Receptors for substance P served as a portal or point of entry for the compound. Within days of the injections, the targeted neurons, located in the outer layer of the spinal cord along its entire length, absorbed the compound and were neutralized. The animals' behavior was completely normal; they no longer exhibited signs of pain following injury or had an exaggerated pain response. Importantly, the animals still responded to acute, that is, normal, pain. This is a critical finding as it is important to retain the body's ability to detect potentially injurious stimuli. The protective, early warning signal that pain provides is essential for normal functioning. If this work can be translated clinically, humans might be able to benefit from similar compounds introduced, for example, through lumbar (spinal) puncture.</p>
- <p>Another promising area of research using the body's natural pain-killing abilities is the transplantation of chromaffin cells into the spinal cords of animals bred experimentally to develop arthritis. Chromaffin cells produce several of the body's pain-killing substances and are part of the adrenal medulla, which sits on top of the kidney. Within a week or so, rats receiving these transplants cease to exhibit telltale signs of pain. Scientists, working with support from the NINDS, believe the transplants help the animals recover from pain-related cellular damage. Extensive animal studies will be required to learn if this technique might be of value to humans with severe pain.</p>
- <p>One way to control pain outside of the brain, that is, peripherally, is by inhibiting hormones called <i>prostaglandins</i>. Prostaglandins stimulate nerves at the site of injury and cause inflammation and fever. Certain drugs, including NSAIDs, act against such hormones by blocking the enzyme that is required for their synthesis.</p>
- <p>Blood vessel walls stretch or dilate during a migraine attack and it is thought that serotonin plays a complicated role in this process. For example, before a migraine headache, serotonin levels fall. Drugs for migraine include the triptans: <i>sumatriptan</i> (Imitrix&amp;reg;), <i>naratriptan</i> (Amerge&amp;reg;), and <i>zolmitriptan</i> (Zomig&amp;reg;). They are called <i>serotonin</i> agonists because they mimic the action of endogenous (natural) serotonin and bind to specific subtypes of serotonin receptors.</p>
- <p>Ongoing pain research, much of it supported by the NINDS, continues to reveal at an unprecedented pace fascinating insights into how genetics, the immune system, and the skin contribute to pain responses.</p>
- <p>The explosion of knowledge about human genetics is helping scientists who work in the field of drug development. We know, for example, that the pain-killing properties of codeine rely heavily on a liver enzyme, CYP2D6, which helps convert codeine into morphine. A small number of people genetically lack the enzyme CYP2D6; when given codeine, these individuals do not get pain relief. CYP2D6 also helps break down certain other drugs. People who genetically lack CYP2D6 may not be able to cleanse their systems of these drugs and may be vulnerable to drug toxicity. CYP2D6 is currently under investigation for its role in pain.</p>
- <p>In his research, the late John C. Liebeskind, a renowned pain expert and a professor of psychology at UCLA, found that pain can kill by delaying healing and causing cancer to spread. In his pioneering research on the immune system and pain, Dr. Liebeskind studied the effects of stress-such as surgery-on the immune system and in particular on cells called <i>natural killer</i> or <i>NK cells</i>. These cells are thought to help protect the body against tumors. In one study conducted with rats, Dr. Liebeskind found that, following experimental surgery, NK cell activity was suppressed, causing the cancer to spread more rapidly. When the animals were treated with morphine, however, they were able to avoid this reaction to stress.</p>
- <p>The link between the nervous and immune systems is an important one. Cytokines, a type of protein found in the nervous system, are also part of the body's immune system, the body's shield for fighting off disease. Cytokines can trigger pain by promoting inflammation, even in the absence of injury or damage. Certain types of cytokines have been linked to nervous system injury. After trauma, cytokine levels rise in the brain and spinal cord and at the site in the peripheral nervous system where the injury occurred. Improvements in our understanding of the precise role of cytokines in producing pain, especially pain resulting from injury, may lead to new classes of drugs that can block the action of these substances.</p>]]></content>
- </section>
- <section>
- <title><![CDATA[What is the Future of Pain Research?]]></title>
- <anchor><![CDATA[63]]></anchor>
- <keywords></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/future.jpg]]></image>
- <content><![CDATA[<p>In the forefront of pain research are scientists supported by the National Institutes of Health (NIH), including the NINDS. Other institutes at NIH that support pain research include the National Institute of Dental and Craniofacial Research, the National Cancer Institute, the National Institute of Nursing Research, the National Institute on Drug Abuse, and the National Institute of Mental Health. Developing better pain treatments is the primary goal of all pain research being conducted by these institutes.</p>
- <p>Some pain medications dull the patient's perception of pain. Morphine is one such drug. It works through the body's natural pain-killing machinery, preventing pain messages from reaching the brain. Scientists are working toward the development of a morphine-like drug that will have the pain-deadening qualities of morphine but without the drug's negative side effects, such as sedation and the potential for addiction. Patients receiving morphine also face the problem of morphine tolerance, meaning that over time they require higher doses of the drug to achieve the same pain relief. Studies have identified factors that contribute to the development of tolerance; continued progress in this line of research should eventually allow patients to take lower doses of morphine.</p>
- <p>One objective of investigators working to develop the future generation of pain medications is to take full advantage of the body's pain &quot;switching center&quot; by formulating compounds that will prevent pain signals from being amplified or stop them altogether. Blocking or interrupting pain signals, especially when there is no injury or trauma to tissue, is an important goal in the development of pain medications. An increased understanding of the basic mechanisms of pain will have profound implications for the development of future medicines. The following areas of research are bringing us closer to an ideal pain drug.</p>
- <p><i>Systems and Imaging</i>: The idea of mapping cognitive functions to precise areas of the brain dates back to phrenology, the now archaic practice of studying bumps on the head. Positron emission tomography (PET), functional magnetic resonance imaging (fMRI), and other imaging technologies offer a vivid picture of what is happening in the brain as it processes pain. Using imaging, investigators can now see that pain activates at least three or four key areas of the brain's cortex-the layer of tissue that covers the brain. Interestingly, when patients undergo hypnosis so that the unpleasantness of a painful stimulus is not experienced, activity in some, but not all, brain areas is reduced. This emphasizes that the experience of pain involves a strong emotional component as well as the sensory experience, namely the intensity of the stimulus.</p>
- <p><i>Channels</i>: The frontier in the search for new drug targets is represented by channels. Channels are gate-like passages found along the membranes of cells that allow electrically charged chemical particles called ions to pass into the cells. Ion channels are important for transmitting signals through the nerve's membrane. The possibility now exists for developing new classes of drugs, including pain cocktails that would act at the site of channel activity.</p>
- <p><i>Trophic Factors</i>: A class of &quot;rescuer&quot; or &quot;restorer&quot; drugs may emerge from our growing knowledge of trophic factors, natural chemical substances found in the human body that affect the survival and function of cells. Trophic factors also promote cell death, but little is known about how something beneficial can become harmful. Investigators have observed that an over-accumulation of certain trophic factors in the nerve cells of animals results in heightened pain sensitivity, and that some receptors found on cells respond to trophic factors and interact with each other. These receptors may provide targets for new pain therapies.</p>
- <p><i>Molecular Genetics</i>: Certain genetic mutations can change pain sensitivity and behavioral responses to pain. People born genetically insensate to pain-that is, individuals who cannot feel pain have a mutation in part of a gene that plays a role in cell survival. Using &quot;knockout&quot; animal models-animals genetically engineered to lack a certain gene-scientists are able to visualize how mutations in genes cause animals to become anxious, make noise, rear, freeze, or become hypervigilant. These genetic mutations cause a disruption or alteration in the processing of pain information as it leaves the spinal cord and travels to the brain. Knockout animals can be used to complement efforts aimed at developing new drugs.</p>
- <p><a name="research_plasticity"></a><i>Plasticity</i>: Following injury, the nervous system undergoes a tremendous reorganization. This phenomenon is known as plasticity. For example, the spinal cord is &quot;rewired&quot; following trauma as nerve cell axons make new contacts, a phenomenon known as &quot;sprouting&quot;. This in turn disrupts the cells' supply of trophic factors. Scientists can now identify and study the changes that occur during the processing of pain. For example, using a technique called polymerase chain reaction, abbreviated PCR, scientists can study the genes that are induced by injury and persistent pain. There is evidence that the proteins that are ultimately synthesized by these genes may be targets for new therapies. The dramatic changes that occur with injury and persistent pain underscore that chronic pain should be considered a disease of the nervous system, not just prolonged acute pain or a symptom of an injury. Thus, scientists hope that therapies directed at preventing the long-term changes that occur in the nervous system will prevent the development of chronic pain conditions.</p>
- <p><i>Neurotransmitters</i>: Just as mutations in genes may affect behavior, they may also affect a number of neurotransmitters involved in the control of pain. Using sophisticated imaging technologies, investigators can now visualize what is happening chemically in the spinal cord. From this work, new therapies may emerge, therapies that can help reduce or obliterate severe or chronic pain.</p>
- <h4>Hope for the Future</h4>
- <p>Thousands of years ago, ancient peoples attributed pain to spirits and treated it with mysticism and incantations. Over the centuries, science has provided us with a remarkable ability to understand and control pain with medications, surgery, and other treatments. Today, scientists understand a great deal about the causes and mechanisms of pain, and research has produced dramatic improvements in the diagnosis and treatment of a number of painful disorders. For people who fight every day against the limitations imposed by pain, the work of NINDS-supported scientists holds the promise of an even greater understanding of pain in the coming years. Their research offers a powerful weapon in the battle to prolong and improve the lives of people with pain: <i>hope</i>.</p>]]></content>
- </section>
- <section>
- <title><![CDATA[Where Can I Get More Information?]]></title>
- <anchor><![CDATA[64]]></anchor>
- <keywords></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/more_info.jpg]]></image>
- <content><![CDATA[<p>For more information on neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institute's Brain Resources and Information Network (BRAIN) at:</p>
- <h4>BRAIN</h4>
- <p>P.O. Box 5801<br />
- Bethesda, MD 20824<br />
- (800)352-9424<br />
- <a href="http://www.ninds.nih.gov">http://www.ninds.nih.gov</a></p>
- <p>Information also is available from the following organizations:</p>
- <h4>National Institute of Dental and Craniofacial Research (NIDCR)</h4>
- <p>National Institutes of Health, DHHS<br />
- 31 Center Drive, Room 5B-55<br />
- Bethesda, MD 20892<br />
- <a href="mailto: nidcrinfo@mail.nih.gov">nidcrinfo@mail.nih.gov</a><br />
- <a href="http://www.nidcr.nih.gov">http://www.nidcr.nih.gov</a><br />
- Tel: 301-496-4261</p>
- <h4>American Chronic Pain Association (ACPA)</h4>
- <p>P.O. Box 850<br />
- Rocklin, CA 95677-0850<br />
- <a href="mailto: ACPA@pacbell.net">ACPA@pacbell.net</a><br />
- <a href="http://www.theacpa.org">http://www.theacpa.org</a><br />
- Tel: 916-632-0922 / 800-533-3231<br />
- Fax: 916-652-8190<br />
- Provides self-help coping skills and peer support to people with chronic pain. Sponsors local support groups throughout the U.S. and provides assistance in starting and maintaining support groups.</p>
- <h4>American Headache Society Committee for Headache Education (ACHE)</h4>
- <p>19 Mantua Road<br />
- Mt. Royal, NJ 08061<br />
- <a href="mailto: achehq@talley.com">achehq@talley.com</a><br />
- <a href="http://www.achenet.org">http://www.achenet.org</a><br />
- Tel: 856-423-0043<br />
- Fax: 856-423-0082<br />
- The American Headache Society Committee on Headache Education (ACHE) is a nonprofit patient-health professional partnership dedicated to advancing the treatment and management of patients with headache.</p>
- <h4>National Headache Foundation</h4>
- <p>820 N. Orleans<br />
- Suite 217<br />
- Chicago, IL 60610-3132<br />
- <a href="mailto: info@headaches.org">info@headaches.org</a><br />
- <a href="http://www.headaches.org">http://www.headaches.org</a><br />
- Tel: 312-274-2650 / 888-NHF-5552 (643-5552)<br />
- Fax: 312-640-9049<br />
- Non-profit organization dedicated to service headache sufferers, their families, and the healthcare practitioners who treat them. Promotes research into headache causes and treatments and educates the public.</p>
- <h4>National Foundation for the Treatment of Pain</h4>
- <p>P.O. Box 70045<br />
- Houston, TX 77270<br />
- <a href="mailto: NFTPain@cwo.com">NFTPain@cwo.com</a><br />
- <a href="http://www.paincare.org">http://www.paincare.org</a><br />
- Tel: 713-862-9332<br />
- Fax: 713-862-9346<br />
- Not-for-profit organization dedicated to providing support for patients who are suffering from intractable pain, their families, friends and the physicians who treat them. Offers a patient forum, advocacy programs, information, support resources, and direct medical intervention.</p>
- <h4>Mayday Fund [For Pain Research]</h4>
- <p>c/o SPG<br />
- 136 West 21st Street, 6th Floor<br />
- New York, NY 10011<br />
- <a href="mailto: mayday@maydayfund.org">mayday@maydayfund.org</a><br />
- <a href="http://www.painandhealth.org">http://www.painandhealth.org</a><br />
- Tel: 212-366-6970<br />
- Fax: 212-366-6979<br />
- The Mayday Pain Project works to increase awareness and to provide objective information concerning the treatment of pain.</p>
- <h4>American Pain Foundation</h4>
- <p>201 North Charles Street<br />
- Suite 710<br />
- Baltimore, MD 21201-4111<br />
- <a href="mailto: info@painfoundation.org">info@painfoundation.org</a><br />
- <a href="http://www.painfoundation.org">http://www.painfoundation.org</a><br />
- Tel: 888-615-PAIN (7246)<br />
- Fax: 410-385-1832<br />
- Independent non-profit information, education, and advocacy organization serving people with pain. Works to improve the quality of life for people with pain by raising public awareness, providing practical information, promoting research, and advocating the removal of barriers and increased access to effective pain management.</p>
- <h4>Arthritis Foundation</h4>
- <p>1330 West Peachtree Street<br />
- Suite 100<br />
- Atlanta, GA 30309<br />
- <a href="mailto: help@arthritis.org">help@arthritis.org</a><br />
- <a href="http://www.arthritis.org">http://www.arthritis.org</a><br />
- Tel: 800-283-7800 / 404-872-7100 / 404-965-7888<br />
- Fax: 404-872-0457<br />
- Volunteer-driven organization that works to improve lives through leadership in the prevention, control, and cure of arthritis and related diseases. Offers free brochures on various types of <p>For more information on neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institute's Brain Resources and Information Network (BRAIN) at:</p>
- <h4>BRAIN</h4>
- <p>P.O. Box 5801<br />
- Bethesda, MD 20824<br />
- (800)352-9424<br />
- <a href="http://www.ninds.nih.gov">http://www.ninds.nih.gov</a></p>
- <p>Information also is available from the following organizations:</p>
- <h4>National Institute of Dental and Craniofacial Research (NIDCR)</h4>
- <p>National Institutes of Health, DHHS<br />
- 31 Center Drive, Room 5B-55<br />
- Bethesda, MD 20892<br />
- <a href="mailto: nidcrinfo@mail.nih.gov">nidcrinfo@mail.nih.gov</a><br />
- <a href="http://www.nidcr.nih.gov">http://www.nidcr.nih.gov</a><br />
- Tel: 301-496-4261</p>
- <h4>American Chronic Pain Association (ACPA)</h4>
- <p>P.O. Box 850<br />
- Rocklin, CA 95677-0850<br />
- <a href="mailto: ACPA@pacbell.net">ACPA@pacbell.net</a><br />
- <a href="http://www.theacpa.org">http://www.theacpa.org</a><br />
- Tel: 916-632-0922 / 800-533-3231<br />
- Fax: 916-652-8190<br />
- Provides self-help coping skills and peer support to people with chronic pain. Sponsors local support groups throughout the U.S. and provides assistance in starting and maintaining support groups.</p>
- <h4>American Headache Society Committee for Headache Education (ACHE)</h4>
- <p>19 Mantua Road<br />
- Mt. Royal, NJ 08061<br />
- <a href="mailto: achehq@talley.com">achehq@talley.com</a><br />
- <a href="http://www.achenet.org">http://www.achenet.org</a><br />
- Tel: 856-423-0043<br />
- Fax: 856-423-0082<br />
- The American Headache Society Committee on Headache Education (ACHE) is a nonprofit patient-health professional partnership dedicated to advancing the treatment and management of patients with headache.</p>
- <h4>National Headache Foundation</h4>
- <p>820 N. Orleans<br />
- Suite 217<br />
- Chicago, IL 60610-3132<br />
- <a href="mailto: info@headaches.org">info@headaches.org</a><br />
- <a href="http://www.headaches.org">http://www.headaches.org</a><br />
- Tel: 312-274-2650 / 888-NHF-5552 (643-5552)<br />
- Fax: 312-640-9049<br />
- Non-profit organization dedicated to service headache sufferers, their families, and the healthcare practitioners who treat them. Promotes research into headache causes and treatments and educates the public.</p>
- <h4>National Foundation for the Treatment of Pain</h4>
- <p>P.O. Box 70045<br />
- Houston, TX 77270<br />
- <a href="mailto: NFTPain@cwo.com">NFTPain@cwo.com</a><br />
- <a href="http://www.paincare.org">http://www.paincare.org</a><br />
- Tel: 713-862-9332<br />
- Fax: 713-862-9346<br />
- Not-for-profit organization dedicated to providing support for patients who are suffering from intractable pain, their families, friends and the physicians who treat them. Offers a patient forum, advocacy programs, information, support resources, and direct medical intervention.</p>
- <h4>Mayday Fund [For Pain Research]</h4>
- <p>c/o SPG<br />
- 136 West 21st Street, 6th Floor<br />
- New York, NY 10011<br />
- <a href="mailto: mayday@maydayfund.org">mayday@maydayfund.org</a><br />
- <a href="http://www.painandhealth.org">http://www.painandhealth.org</a><br />
- Tel: 212-366-6970<br />
- Fax: 212-366-6979<br />
- The Mayday Pain Project works to increase awareness and to provide objective information concerning the treatment of pain.</p>
- <h4>American Pain Foundation</h4>
- <p>201 North Charles Street<br />
- Suite 710<br />
- Baltimore, MD 21201-4111<br />
- <a href="mailto: info@painfoundation.org">info@painfoundation.org</a><br />
- <a href="http://www.painfoundation.org">http://www.painfoundation.org</a><br />
- Tel: 888-615-PAIN (7246)<br />
- Fax: 410-385-1832<br />
- Independent non-profit information, education, and advocacy organization serving people with pain. Works to improve the quality of life for people with pain by raising public awareness, providing practical information, promoting research, and advocating the removal of barriers and increased access to effective pain management.</p>
- <h4>Arthritis Foundation</h4>
- <p>1330 West Peachtree Street<br />
- Suite 100<br />
- Atlanta, GA 30309<br />
- <a href="mailto: help@arthritis.org">help@arthritis.org</a><br />
- <a href="http://www.arthritis.org">http://www.arthritis.org</a><br />
- Tel: 800-283-7800 / 404-872-7100 / 404-965-7888<br />
- Fax: 404-872-0457<br />
- Volunteer-driven organization that works to improve lives through leadership in the prevention, control, and cure of arthritis and related diseases. Offers free brochures on various types of arthritis, treatment options, and management of daily activities when affected.</p>arthritis, treatment options, and management of daily activities when affected.</p>]]></content>
- </section>
- <section>
- <title><![CDATA[Appendix]]></title>
- <anchor><![CDATA[65]]></anchor>
- <keywords></keywords>
- <content></content>
- <subsection>
- <title><![CDATA[Spine Basics: The Vertebrae, Discs, and Spinal Cord]]></title>
- <anchor><![CDATA[65-8]]></anchor>
- <keywords><![CDATA[spine, vertebrae, disc, spinal cord]]></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/appendix_spine_basics.jpg]]></image>
- <content><![CDATA[<p>Stacked on top of one another in the spine are more than 30 bones, the vertebrae, which together form the spine. They are divided into four regions:</p>
- <ul>
- <li>The seven cervical or neck vertebrae (labeled C1-C7);</li>
- <li>The 12 thoracic or upper back vertebrae (labeled T1-T12);</li>
- <li>The five lumbar vertebrae (labeled L1-L5), which we know as the lower back;</li>
- <li>The sacrum and coccyx, a group of bones fused together at the base of the spine.</li>
- </ul>
- <p>The vertebrae are linked by ligaments, tendons, and muscles. Back pain can occur when, for example, someone lifts something too heavy, causing a sprain, pull, strain, or spasm in one of these muscles or ligaments in the back.</p>
- <p>Between the vertebrae are round, spongy pads of cartilage called <i>discs</i> that act much like shock absorbers. In many cases, degeneration or pressure from overexertion can cause a disc to shift or protrude and bulge, causing pressure on a nerve and resultant pain. When this happens, the condition is called a slipped, bulging, herniated, or ruptured disc, and it sometimes results in permanent nerve damage.</p>
- <p>The column-like spinal cord is divided into segments similar to the corresponding vertebrae: cervical, thoracic, lumbar, sacral, and coccygeal. The cord also has nerve roots and rootlets which form branch-like appendages leading from its ventral side (that is, the front of the body) and from its dorsal side (that is, the back of the body). Along the dorsal root are the cells of the dorsal root ganglia, which are critical in the transmission of "pain" messages from the cord to the brain. It is here where injury, damage, and trauma become pain.</p>]]></content>
- </subsection>
- <subsection>
- <title><![CDATA[The Nervous Systems]]></title>
- <anchor><![CDATA[65-9]]></anchor>
- <keywords><![CDATA[nervous system]]></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/appendix_nervous_systems.jpg]]></image>
- <content><![CDATA[<p>The central nervous system (CNS) refers to the brain and spinal cord together. The peripheral nervous system refers to the cervical, thoracic, lumbar, and sacral nerve trunks leading away from the spine to the limbs. Messages related to function (such as movement) or dysfunction (such as pain) travel from the brain to the spinal cord and from there to other regions in the body and back to the brain again. The autonomic nervous system controls involuntary functions in the body, like perspiration, blood pressure, heart rate, or heart beat. It is divided into the sympathetic and parasympathetic nervous systems. The sympathetic and parasympathetic nervous systems have links to important organs and systems in the body; for example, the sympathetic nervous system controls the heart, blood vessels, and respiratory system, while the parasympathetic nervous system controls our ability to sleep, eat, and digest food.</p>
- <p>The peripheral nervous system also includes 12 pairs of cranial nerves located on the underside of the brain. Most relay messages of a sensory nature. They include the olfactory (I), optic (II), oculomotor (III), trochlear (IV), trigeminal (V), abducens (VI), facial (VII), vestibulocochlear (VIII), glossopharyngeal (IX), vagus (X), accessory (XI), and hypoglossal (XII) nerves. Neuralgia, as in trigeminal neuralgia, is a term that refers to pain that arises from abnormal activity of a nerve trunk or its branches. The type and severity of pain associated with neuralgia vary widely.</p>]]></content>
- </subsection>
- <subsection>
- <title><![CDATA[Phantom Pain: How Does the Brain Feel?]]></title>
- <anchor><![CDATA[65-10]]></anchor>
- <keywords><![CDATA[phantom pain]]></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/appendix_phantom_pain.jpg]]></image>
- <content><![CDATA[<p>Sometimes, when a limb is removed during an amputation, an individual will continue to have an internal sense of the lost limb. This phenomenon is known as phantom limb and accounts describing it date back to the 1800s. Similarly, many amputees are frequently aware of severe pain in the absent limb. Their pain is real and is often accompanied by other health problems, such as depression.</p>
- <p>What causes this phenomenon? Scientists believe that following amputation, nerve cells "rewire" themselves and continue to receive messages, resulting in a remapping of the brain's circuitry. The brain's ability to restructure itself, to change and adapt following injury, is called plasticity (see section on <a href="#research_plasticity">Plasticity</a>).</p>
- <p>Our understanding of phantom pain has improved tremendously in recent years. Investigators previously believed that brain cells affected by amputation simply died off. They attributed sensations of pain at the site of the amputation to irritation of nerves located near the limb stump. Now, using imaging techniques such as positron emission tomography (PET) and magnetic resonance imaging (MRI), scientists can actually visualize increased activity in the brain's cortex when an individual feels phantom pain. When study participants move the stump of an amputated limb, neurons in the brain remain dynamic and excitable. Surprisingly, the brain's cells can be stimulated by other body parts, often those located closest to the missing limb.</p>
- <p>Treatments for phantom pain may include analgesics, anticonvulsants, and other types of drugs; nerve blocks; electrical stimulation; psychological counseling, biofeedback, hypnosis, and acupuncture; and, in rare instances, surgery.</p>]]></content>
- </subsection>
- <subsection>
- <title><![CDATA[Chili Peppers, Capsaicin, and Pain]]></title>
- <anchor><![CDATA[65-11]]></anchor>
- <keywords></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/appendix_peppers_capsaicin.jpg]]></image>
- <content><![CDATA[<p>The hot feeling, red face, and watery eyes you experience when you bite into a red chili pepper may make you reach for a cold drink, but that reaction has also given scientists important information about pain. The chemical found in chili peppers that causes those feelings is <i>capsaicin</i> (pronounced cap-SAY-sin), and it works its unique magic by grabbing onto receptors scattered along the surface of sensitive nerve cells in the mouth.</p>
- <p>In 1997, scientists at the University of California at San Francisco discovered a gene for a capsaicin receptor, called the vanilloid receptor. Once in contact with capsaicin, vanilloid receptors open and pain signals are sent from the peripheral nociceptor and through central nervous system circuits to the brain. Investigators have also learned that this receptor plays a role in the burning type of pain commonly associated with heat, such as the kind you experience when you touch your finger to a hot stove. The vanilloid receptor functions as a sort of "ouch gateway", enabling us to detect burning hot pain, whether it originates from a 3-alarm habanera chili or from a stove burner.</p>
- <p>Capsaicin is currently available as a prescription or over-the-counter cream for the treatment of a number of pain conditions, such as shingles. It works by reducing the amount of substance P found in nerve endings and interferes with the transmission of pain signals to the brain. Individuals can become desensitized to the compound, however, perhaps because of long-term damage to nerve tissue. Some individuals find the burning sensation they experience when using capsaicin cream to be intolerable, especially when they are already suffering from a painful condition, such as postherpetic neuralgia. Soon, however, better treatments that relieve pain by blocking vanilloid receptors may arrive in drugstores.</p>]]></content>
- </subsection>
- <subsection>
- <title><![CDATA[Marijuana]]></title>
- <anchor><![CDATA[65-12]]></anchor>
- <keywords><![CDATA[marijuana]]></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/appendix_marijuana.jpg]]></image>
- <content><![CDATA[<p>As a painkiller, marijuana or, by its Latin name, <i>cannabis</i>, continues to remain highly controversial. In the eyes of many individuals campaigning on its behalf, marijuana rightfully belongs with other pain remedies. In fact, for many years, it was sold under highly controlled conditions in cigarette form by the Federal government for just that purpose.</p>
- <p>In 1997, the National Institutes of Health held a workshop to discuss research on the possible therapeutic uses for smoked marijuana. Panel members from a number of fields reviewed published research and heard presentations from pain experts. The panel members concluded that, because there are too few scientific studies to prove marijuana's therapeutic utility for certain conditions, additional research is needed. There is evidence, however, that receptors to which marijuana binds are found in many brain regions that process information that can produce pain.</p>]]></content>
- </subsection>
- <subsection>
- <title><![CDATA[Nerve Blocks]]></title>
- <anchor><![CDATA[65-13]]></anchor>
- <keywords><![CDATA[nerves, nerve blocks]]></keywords>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/appendix_nerve_blocks.jpg]]></image>
- <content><![CDATA[<p>Nerve blocks may involve local anesthesia, regional anesthesia or analgesia, or surgery; dentists routinely use them for traditional dental procedures. Nerve blocks can also be used to prevent or even diagnose pain.</p>
- <p>In the case of a local nerve block, any one of a number of local anesthetics may be used; the names of these compounds, such as lidocaine or novocaine, usually have an <i>aine</i> ending. Regional blocks affect a larger area of the body. Nerve blocks may also take the form of what is commonly called an epidural, in which a drug is administered into the space between the spine's protective covering (the dura) and the spinal column. This procedure is most well known for its use during childbirth. Morphine and methadone are opioid narcotics (such drugs end in ine or one) that are sometimes used for regional analgesia and are administered as an injection.</p>
- <p>Neurolytic blocks employ injection of chemical agents such as alcohol, phenol, or glycerol to block pain messages and are most often used to treat cancer pain or to block pain in the cranial nerves (see <a href="#appendix_nervous_systems">The Nervous Systems</a>). In some cases, a drug called guanethidine is administered intravenously in order to accomplish the block.</p>
- <p>Surgical blocks are performed on cranial, peripheral, or sympathetic nerves. They are most often done to relieve the pain of cancer and extreme facial pain, such as that experienced with trigeminal neuralgia. There are several different types of surgical nerve blocks and they are not without problems and complications. Nerve blocks can cause muscle paralysis and, in many cases, result in at least partial numbness. For that reason, the procedure should be reserved for a select group of patients and should only be performed by skilled surgeons. Types of surgical nerve blocks include:</p>
- <ul>
- <li><b>Neurectomy</b> (including peripheral neurectomy) in which a damaged peripheral nerve is destroyed.</li>
- <li><b>Spinal dorsal rhizotomy</b> in which the surgeon cuts the root or rootlets of one or more of the nerves radiating from the spine. Other rhizotomy procedures include <b>cranial rhizotomy</b> and <b>trigeminal rhizotomy</b>, performed as a treatment for extreme facial pain or for the pain of cancer.</li>
- <li><b>Sympathectomy</b>, also called <b>sympathetic blockade</b>, in which a drug or an agent such as guanethidine is used to eliminate pain in a specific area (a limb, for example). The procedure is also done for cardiac pain, vascular disease pain, the pain of reflex sympathetic dystrophy syndrome, and other conditions. The term takes its name from the sympathetic nervous system (see <a href="#appendix_nervous_systems">The Nervous Systems</a>) and may involve, for example, cutting a nerve that controls contraction of one or more arteries.</li>
- </ul>]]></content>
- </subsection>
- </section>
- </page>
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- <index>
- <title><![CDATA[Educational Content]]></title>
- <subject>
- <title><![CDATA[Back / Back Pain]]></title>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/icons/icon_back_pain.png]]></image>
- <type>
- <title><![CDATA[General Information]]></title>
- <page>
- <title><![CDATA[Low Back Pain Fact Sheet]]></title>
- <path><![CDATA[low_back_facts]]></path>
- <content><![CDATA[If you have lower back pain, you are not alone. Nearly everyone at some point has back pain that interferes with work, routine daily activities, or recreation. Americans spend at least $50 billion each year on low back pain, the most common cause of job-related disability and a leading contributor to missed work. Back pain is the second most common neurological ailment in the United States - only headache is more common. Fortunately, most occurrences of low back pain go away within a few days. Others take much longer to resolve or lead to more serious conditions.
- Acute or...]]></content>
- </page>
- </type>
- </subject>
- <subject>
- <title><![CDATA[Chiropractic]]></title>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/icons/5.png]]></image>
- <type>
- <title><![CDATA[General Information]]></title>
- <page>
- <title><![CDATA[Chiropractic: An Introduction]]></title>
- <path><![CDATA[chiro_intro]]></path>
- <content><![CDATA[Chiropractic is a health care approach that focuses on the relationship between the body's structure - mainly the spine - and its functioning. Although practitioners may use a variety of treatment approaches, they primarily perform adjustments to the spine or other parts of the body with the goal of correcting alignment problems and supporting the body's natural ability to heal itself.]]></content>
- </page>
- <page>
- <title><![CDATA[Spinal Manipulation for Low Back Pain]]></title>
- <path><![CDATA[spinal_manipulation]]></path>
- <content><![CDATA[Low-back pain is a common condition that can be difficult to treat. Spinal manipulation is among the treatment options used by people with low-back pain in attempts to relieve pain and improve functioning. It is performed by chiropractors and other health care professionals such as physical therapists, osteopaths, and some conventional medical doctors. This fact sheet summarizes the current scientific knowledge about the effects of spinal manipulation on low-back pain.]]></content>
- </page>
- </type>
- </subject>
- <subject>
- <title><![CDATA[Massage Therapy]]></title>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/icons/6.png]]></image>
- <type>
- <title><![CDATA[Articles]]></title>
- <page>
- <title><![CDATA[Massage Therapy May Ease Pain &amp; Improve Mood in Advanced Cancer Patients]]></title>
- <path><![CDATA[massage_cancer]]></path>
- <content><![CDATA[People with advanced cancer often experience pain that causes physical and emotional distress, which leads to a decrease in functional ability and quality of life. Symptom relief is an important part of end-of-life care, and small studies have suggested that massage therapy may benefit people with advanced cancer.
- In a study funded in part by NCCAM, researchers investigated the benefits of massage versus simple touch therapy (placing both hands on specific body sites) in patients with advanced cancer. This multisite study - conducted at 15 U.S. hospices in the Population-based Palliative Care Research Network - included 380 participants with...]]></content>
- </page>
- <page>
- <title><![CDATA[Study Finds Benefits of Therapeutic Massage for Chronic Neck Pain]]></title>
- <path><![CDATA[study_chronic]]></path>
- <content><![CDATA[Neck pain is a common health problem in the United States. People suffering from neck pain often turn to complementary and alternative medicine (CAM) therapies. Although therapeutic massage is one of the most popular CAM therapies for neck pain, little is known about its effectiveness for this condition.
- In an NCCAM-funded study conducted at the Group Health Center in Seattle, 64 adults with neck pain persisting for at least 12 weeks were randomly assigned to receive either massage or a self-care book. The massage group had up to 10 treatments over a 10-week period, provided by licensed practitioners who...]]></content>
- </page>
- </type>
- <type>
- <title><![CDATA[General Information]]></title>
- <page>
- <title><![CDATA[Massage Therapy: An Introduction]]></title>
- <path><![CDATA[massage_intro]]></path>
- <content><![CDATA[Massage therapy has a long history in cultures around the world. Today, people use many different types of massage therapy for a variety of health-related purposes. In the United States, massage therapy is often considered part of complementary and alternative medicine (CAM), although it does have some conventional uses. This fact sheet provides a general overview of massage therapy and suggests sources for additional information.]]></content>
- </page>
- </type>
- </subject>
- <subject>
- <title><![CDATA[Pain / Pain Management]]></title>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/icons/icon_pain_management.png]]></image>
- <type>
- <title><![CDATA[General Information]]></title>
- <page>
- <title><![CDATA[Pain: Hope Through Research]]></title>
- <path><![CDATA[pain_hope_research]]></path>
- <content><![CDATA[You know it at once. It may be the fiery sensation of a burn moments after your finger touches the stove. Or it's a dull ache above your brow after a day of stress and tension. Or you may recognize it as a sharp pierce in your back after you lift something heavy.
- It is pain. In its most benign form, it warns us that something isn't quite right, that we should take medicine or see a doctor. At its worst, however, pain robs us of our productivity, our well-being, and, for many of us suffering from extended illness,...]]></content>
- </page>
- </type>
- </subject>
- </index>
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- <page>
- <title><![CDATA[Chiropractic F.A.Q.]]></title>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/icons/5.png]]></image>
- <section>
- <title><![CDATA[What is Kinetic Chiropractic™?]]></title>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/images/logo_k_chiro.png]]></image>
- <keywords><![CDATA[kinetic chiropractic, k-chiro]]></keywords>
- <content><![CDATA[<p>&quot;Kinetic Chiropractic&trade;&quot; and its abbreviation &quot;K-CHIRO&trade;&quot; are proprietary marks which represents the upper echelon of advanced chiropractic care. The licensing body which governs the use of these marks requires chiropractors to make specific acknowledgments before being eligible to gain K-CHIRO&trade; membership. To be eligible for K-CHIRO&trade; membership a qualified Doctor of Chiropractic must acknowledge that:</p>
- <ol>
- <li>Each patient is unique and deserves a specialized treatment plan;</li>
- <li>Each patient may have specific concerns which should be addressed by a knowledgeable and compassionate chiropractor who is committed to educate the patient and make them comfortable with the proposed treatment plan; and</li>
- <li>Each patient should be offered the appropriate blend of skillfully executed techniques, chiropractic expertise, and state-of-the-art technology.</li>
- </ol>
- <p><em>If</em> granted K-CHIRO&trade; membership, the chiropractor may utilize the Kinetic Chiropractic&trade; and K-CHIRO&trade; marks to promote his or her practice.</p>]]></content>
- </section>
- <section>
- <title><![CDATA[How do I find a K-CHIRO™ member?]]></title>
- <keywords></keywords>
- <content><![CDATA[<p>You can locate a Kinetic Chiropractic&trade; member by using the Find a Doctor feature at www.kchiro.com.</p>]]></content>
- </section>
- <section>
- <title><![CDATA[What does a Chiropractor do?]]></title>
- <keywords></keywords>
- <content><![CDATA[<p>Doctors of Chiropractic - also known as chiropractors - provide their patients with a drug-free, hands-on approach to health and wellness. Chiropractors have broad capabilities which range from performing therapeutic physical adjustments of the spine and recommending rehabilitative exercises to providing nutritional and lifestyle counseling.</p>
- <p>One of the central treatments performed by chiropractors is a &quot;spinal manipulation&quot; or &quot;chiropractic adjustment&quot;. The purpose of the adjustment is to restore joint mobility by manually applying a controlled force. By restoring the mobility of the affected joints a chiropractic adjustment can alleviate pain, reduce muscle tightness, and promote tissue healing.</p>
- <p>With conditions such as low-back pain, chiropractic care may be the primary mode of treatment.</p>
- <p>Before performing a treatment, Doctors of Chiropractic often conduct a thorough evaluation of the patient to determine if chiropractic treatment is appropriate or not. If it is determined that the patient's specific condition is not suitable for chiropractic treatment or warrants co-management with other health care providers, then the patient is often referred to the appropriate health care provider.</p>]]></content>
- </section>
- <section>
- <title><![CDATA[What conditions do chiropractors treat?]]></title>
- <keywords><![CDATA[conditions]]></keywords>
- <content><![CDATA[<p>Chiropractors primarily treat disorders of the musculoskeletal system and the nervous system (including the effects of these disorders on general health). Chiropractic care focuses on addressing neuromusculoskeletal complaints, including, but not limited to: back pain, neck pain, pain in the joints of the arms or legs, and headaches.</p>]]></content>
- </section>
- <section>
- <title><![CDATA[Do I need a referral from a Medical Doctor to seek chiropractic treatment?]]></title>
- <keywords><![CDATA[referral]]></keywords>
- <content><![CDATA[<p>No, you do NOT need a referral by an M.D. to visit a Doctor of Chiropractic. Chiropractors are first contact doctors who are capable of arriving at a diagnosis under chiropractic care or referring the patient to the appropriate health care provider.</p>]]></content>
- </section>
- <section>
- <title><![CDATA[What side effects and risks are associated with chiropractic treatment?]]></title>
- <keywords><![CDATA[side effects, risks]]></keywords>
- <content><![CDATA[<p>Although chiropractic care is widely recognized as a relatively safe, non-invasive therapeutic modality, no treatment is completely free of potential adverse effects.</p>
- <h4>Common Side Effects</h4>
- <p>According to the National Institutes of Health: &quot;Reviews have concluded that spinal manipulation is relatively safe when performed by a trained and licensed practitioner. The most common side effects are generally minor and include temporary discomfort in the treated area, headache, or tiredness. These effects usually go away in 1 to 2 days.&quot;&sup1;</p>
- <h4>Serious Complications</h4>
- <p>The rate of serious complications from spinal manipulation, although not definitely known, appears to be very low overall and related to the type of adjustment performed and the part of the body treated.</p>
- <p><b>Low-back manipulation</b> - A potential complication from low-back manipulation is cauda equina syndrome, a condition in which nerves in the lower part of the spinal cord become compressed, resulting in pain, weakness, and loss of feeling in one or both legs. Other functions - such as bowel or bladder control - may also be affected. Reports indicate that cauda equina syndrome is an extremely rare complication. In people whose pain is caused by a herniated disc, manipulation of the low back also appears to have a very low chance of either causing or worsening cauda equina syndrome.</p>
- <p><b>Neck manipulation</b> - Some reports have linked upper high-velocity neck manipulation with a certain kind of stroke, or vertebral artery dissection, but a clear understanding of the relationship has proven to be hard to establish. While we may not know the actual incidence of stroke associated with high-velocity upper neck manipulation, the occurrence appears to be rare - 1 in 5.85 million manipulations.&sup2; To put this risk into perspective, if you drive more than a mile to go shopping, you are at greater risk of serious injury from a car accident than from your chiropractic treatment.</p>
- <p>It is also worth noting that other common treatments for musculoskeletal pain such as taking non-steroidal anti-inflammatory drugs (NSAIDS) may be associated with significantly greater risks than chiropractic manipulation. In fact, the American Journal of Gastroenterology estimated that 33% of all hospitalizations and deaths related to gastrointestinal bleeding can be attributed to the use of painkillers such as aspirin or NSAIDs (e.g. ibuprofen)&sup3;</p>
- <p>Furthermore, some patients elect to have invasive surgery for conditions that may also be helped by chiropractic manipulation. These surgical procedures may be associated with risk many times great than chiropractic treatment.</p>
- <ol class="footnote">
- <li><cite>National Center for Complementary and Alternative Medicine (NCCAM) Publication No. D409. Created April 2008.</cite></li>
- <li><cite>Haldeman S, et al. Arterial dissection following cervical manipulation: a chiropractic experience. Can Med Assoc J 2001;165(7):905-06.</cite></li>
- <li><cite>Lanas A, et al. A nationwide study of mortality associated with hospital admission due to severe gastrointestinal events and those associated with nonsteroidal anti-inflammatory drug use. Am J Gastroenterol 2005;100:1685-1693.</cite></li>
- </ol>]]></content>
- </section>
- </page>
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- <page>
- <title><![CDATA[Spanish Chiro FAQ]]></title>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/icons/5.png]]></image>
- <section>
- <title><![CDATA[spanish intro chiro faq]]></title>
- <keywords></keywords>
- <content><![CDATA[<p>content</p>]]></content>
- </section>
- </page>
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- <page>
- <title><![CDATA[Massage Therapy F.A.Q.]]></title>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/icons/6.png]]></image>
- <section>
- <title><![CDATA[What is Massage Therapy?]]></title>
- <keywords><![CDATA[massage therapy]]></keywords>
- <content><![CDATA[<p>Massage therapy is the application of specific manipulation techniques to human musculature and soft tissues. Massage therapy can help reduce stress, fatigue, pain, inflammation, and stiffness while improving circulation and flexibility.</p> <p>Massage therapy specifically excludes the adjustment, diagnosis, and/or treatment of the human skeletal structure, or any other service, procedure, or treatment which requires a license to practice orthopedics, physical therapy, podiatry, chiropractic, osteopathy, psychotherapy, acupuncture, or any other profession or branch of medicine.</p>]]></content>
- </section>
- <section>
- <title><![CDATA[What should I expect during a massage therapy session?]]></title>
- <keywords></keywords>
- <content><![CDATA[<p>Your massage therapy session should be a relaxing and healing experience. Before your first therapy session, you will fill out a form where you will provide any medical history, past/present injuries, and any other physical conditions your professional massage therapist should be made aware of. Your massage therapist may want to discuss your current physical condition and any specific anatomical areas which are causing pain or discomfort. This is your opportunity to discuss any issues you are hoping to address during your massage.</p> <p>Your massage will take place in a tranquil environment where you should be able to relax. You will be positioned on a comfortable massage table and meditative music or soothing sounds maybe playing softly in the background.</p> <p>During the session your therapist typically asks you to tell them if any technique or stroke being applied is painful or uncomfortable. You will receive either a customized full-body massage aimed at general physical and mental relaxation or a more focused session that targets specific areas of your body that are causing pain or discomfort.</p> <p>At the end of your massage session, you will be left alone to get dressed.</p>]]></content>
- </section>
- <section>
- <title><![CDATA[What is the treatment room like?]]></title>
- <keywords><![CDATA[treatment room]]></keywords>
- <content><![CDATA[<p>Your massage will be performed in a peaceful, quiet room. You will lie on a table especially designed for your comfort and fitted with clean sheets. Meditative music or soothing sounds may be played in the background to help create a tranquil atmosphere. The treatment room may also feature calming aromatherapy.</p>]]></content>
- </section>
- <section>
- <title><![CDATA[What are some of the benefits of massage therapy?]]></title>
- <keywords><![CDATA[benfits]]></keywords>
- <content><![CDATA[<p>Receiving massage therapy on a regular basis can help:</p> <ul> <li>Lower blood pressure</li> <li>Improve circulation and tissue oxygenation</li> <li>Reduce depression and anxiety</li> <li>Release endorphins (which are the body's natural painkillers</li> <li>Reduce headaches and provide migraine relief</li> <li>Enhance healing and injury rehabilitation</li> <li>Strengthen the immune system</li> <li>Stimulate lymphatic flow</li> <li>Increase joint flexibility and range of motion</li> <li>Decrease dependency on medications</li> <li>Reduce muscular tension and stiffness</li> <li>Enhance chronic pain management</li> <li>Alleviate low-back pain</li> <li>Improve posture</li> <li>Promote relaxation</li> <li>Relieve stress</li> </ul>]]></content>
- </section>
- <section>
- <title><![CDATA[How much time does it take to receive a massage?]]></title>
- <keywords></keywords>
- <content><![CDATA[<p>Typically a full-body massage or bodywork session takes approximately 1 hour to complete. Partial massages which target only specific parts of your body may be completed in 30 minutes. Generally a 60 to 90 minute session helps achieve ideal results and relaxation.</p>]]></content>
- </section>
- <section>
- <title><![CDATA[Must I be completely nude for the massage session?]]></title>
- <keywords></keywords>
- <content><![CDATA[<p>Most massages are performed with the client undressed; however, ultimately you should disrobe to your level of comfort. Some clients prefer to completely disrobe, while others remain partially clothed. Once disrobed, you will lie on the massage table, draped under a clean sheet or towel.</p>]]></content>
- </section>
- <section>
- <title><![CDATA[Will the therapist be in the treatment room when I undress?]]></title>
- <keywords></keywords>
- <content><![CDATA[<p>Your massage therapist should leave the room while you undress, lie on the table, and drape yourself with a clean sheet or towel. Your therapist should give you a few minutes to undress and should knock on the door to ask if you are ready before entering the room.</p>]]></content>
- </section>
- <section>
- <title><![CDATA[How exposed will I be during the massage?]]></title>
- <keywords></keywords>
- <content><![CDATA[<p>You should be appropriately draped with a clean sheet or towel throughout your massage session. The therapist will only expose the area of your body they are actively working on.</p>]]></content>
- </section>
- <section>
- <title><![CDATA[What areas of my body will be treated?]]></title>
- <keywords></keywords>
- <content><![CDATA[<p>Before starting the massage you and the therapist should discuss the goals of your session. This will determine which parts of your body will be focused on. A typical full body session will include work on your arms, back, feet, hands, head, legs, neck, and shoulders. The therapist should not touch you on or near your genitals (male or female) or breasts (female).</p>]]></content>
- </section>
- <section>
- <title><![CDATA[Are there different types of massage therapy?]]></title>
- <keywords></keywords>
- <content><![CDATA[<p>Yes. There are numerous techniques or types of massage that may be customized to meet needs of each individual. Each type employs different strokes, movements, and applications of pressure to achieve the goals of the therapy session.</p> <p>One of the most popular is the Swedish massage, which is characterized by broad, sweeping strokes that work to relax your nervous system and relieve muscle tension and stiffness.</p> <p>Deep tissue massage is another type of therapy which employs more intense movements and pressure than a Swedish massage. It targets deeper anatomy with the aim of releasing knots, relieving chronic muscle tension, and decreasing inflammation. The technique involves first relaxing the surface muscles which allows the therapist to reach and treat the deeper tissues.</p>]]></content>
- </section>
- <section>
- <title><![CDATA[How will I feel during the massage?]]></title>
- <keywords></keywords>
- <content><![CDATA[<p>During the massage you should relax. Some people just close their eyes and enjoy the tranquility while others prefer to converse with their therapist. You can use the opportunity to ask the therapist questions and learn more about the specific type of massage being provided to you.</p> <p>As you become relaxed, your therapist will be able to increase the pressure applied in an effort to relieve tension, stiffness, and stress. Often oil or lotion is applied to help your muscles relax and decrease the friction cause by the massage. These oils or lotions also help moisturize your skin.</p> <p>Your therapist's efforts will be much more effective if you and your body can relax during the massage. Accordingly, you should make the therapist aware of any discomfort or pain you experience during the session so that the techniques employed can be appropriately adjusted.</p>]]></content>
- </section>
- <section>
- <title><![CDATA[How will I feel after the massage?]]></title>
- <keywords></keywords>
- <content><![CDATA[<p>After an ideal session of massage therapy, you should feel relaxed and rejuvenated. Some people may also experience a decrease in the aches and pains associated with muscular tension. For days after the massage some people experience an increase in energy, level of alertness and productivity. To help "flush out" any toxins released by the massage session you should keep yourself adequately hydrated.</p>]]></content>
- </section>
- <section>
- <title><![CDATA[Are there situations when massage is not advisable?]]></title>
- <keywords></keywords>
- <content><![CDATA[<p>Yes. Unfortunately, not everyone will be an ideal candidate for massage therapy. Accordingly, it is vital that before seeking massage therapy you consult with your primary or regular healthcare provider and get a written recommendation to receive massage therapy or bodywork. In fact, your massage therapist may actually require that your healthcare provider approve or recommend massage therapy prior to your session.</p> <p>Furthermore, before the massage session you should provide your therapist details about any symptoms you are experiencing, your current physical condition, any past or present injuries you have sustained, your medical history, and any other relevant details about your health. Communicating such information to the massage therapist will help you receive coordinated and safe treatment.</p>]]></content>
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- <title><![CDATA[Does insurance pay for massage therapy?]]></title>
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- <content><![CDATA[<p>Massage and bodywork may be covered by health insurance when such therapy is provided as part of a treatment prescribed by a qualified healthcare provider.</p>]]></content>
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- <index>
- <title><![CDATA[Frequently Asked Questions (F.A.Q.)]]></title>
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- <title><![CDATA[Chiropractic F.A.Q.]]></title>
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- <content><![CDATA[<p>(6) questions and answers.</p>]]></content>
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- <title><![CDATA[Massage Therapy F.A.Q.]]></title>
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- <content><![CDATA[<p>(14) questions and answers.</p>]]></content>
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- http://www.rayhawkweb.com
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- <index>
- <title><![CDATA[An In-depth Look At Back Pain]]></title>
- <path><![CDATA[look_at_back_pain]]></path>
- <content><![CDATA[A detailed look at what really causes back pain and how you should go about treatment.]]></content>
- <length><![CDATA[3:42]]></length>
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- <youtube><![CDATA[4ZsiqqOyWx8]]></youtube>
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- <index>
- <title><![CDATA[Lower Back Pain Excersises]]></title>
- <path><![CDATA[lower_back_pain_excersises]]></path>
- <content><![CDATA[These lower back pain exercises may help back pain, relieve back pain, and even end back pain.]]></content>
- <length><![CDATA[2:29]]></length>
- <keywords></keywords>
- <youtube><![CDATA[T4ioJZHSBig]]></youtube>
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- <index>
- <title><![CDATA[Four Tricks To Relieve Back Pain]]></title>
- <path><![CDATA[tricks_to_relieve]]></path>
- <content><![CDATA[Four simple ways to relieve back pain at home and advice on how to stretch, sit and sleep with sore muscles.]]></content>
- <length><![CDATA[2:08]]></length>
- <keywords></keywords>
- <youtube><![CDATA[Bt57mcfbML4]]></youtube>
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- <index>
- <title><![CDATA[spanish lower back pain ex]]></title>
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- <index>
- <title><![CDATA[Educational Videos]]></title>
- <path><![CDATA[educational_videos]]></path>
- <page>
- <title><![CDATA[An In-depth Look At Back Pain]]></title>
- <path><![CDATA[look_at_back_pain]]></path>
- <content><![CDATA[A detailed look at what really causes back pain and how you should go about treatment.]]></content>
- <length><![CDATA[3:42]]></length>
- <keywords></keywords>
- <youtube><![CDATA[4ZsiqqOyWx8]]></youtube>
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- <title><![CDATA[Lower Back Pain Excersises]]></title>
- <path><![CDATA[lower_back_pain_excersises]]></path>
- <content><![CDATA[These lower back pain exercises may help back pain, relieve back pain, and even end back pain.]]></content>
- <length><![CDATA[2:29]]></length>
- <keywords></keywords>
- <youtube><![CDATA[T4ioJZHSBig]]></youtube>
- </page>
- <page>
- <title><![CDATA[Four Tricks To Relieve Back Pain]]></title>
- <path><![CDATA[tricks_to_relieve]]></path>
- <content><![CDATA[Four simple ways to relieve back pain at home and advice on how to stretch, sit and sleep with sore muscles.]]></content>
- <length><![CDATA[2:08]]></length>
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- </index>
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- <index>
- <title><![CDATA[Media]]></title>
- <subcategory>
- <title><![CDATA[Educational Videos]]></title>
- <path><![CDATA[educational_videos]]></path>
- <page>
- <title><![CDATA[An In-depth Look At Back Pain]]></title>
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- <content><![CDATA[A detailed look at what really causes back pain and how you should go about treatment.]]></content>
- <length><![CDATA[3:42]]></length>
- <keywords></keywords>
- <youtube><![CDATA[4ZsiqqOyWx8]]></youtube>
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- <page>
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- <path><![CDATA[lower_back_pain_excersises]]></path>
- <content><![CDATA[These lower back pain exercises may help back pain, relieve back pain, and even end back pain.]]></content>
- <length><![CDATA[2:29]]></length>
- <keywords></keywords>
- <youtube><![CDATA[T4ioJZHSBig]]></youtube>
- </page>
- <page>
- <title><![CDATA[Four Tricks To Relieve Back Pain]]></title>
- <path><![CDATA[tricks_to_relieve]]></path>
- <content><![CDATA[Four simple ways to relieve back pain at home and advice on how to stretch, sit and sleep with sore muscles.]]></content>
- <length><![CDATA[2:08]]></length>
- <keywords></keywords>
- <youtube><![CDATA[Bt57mcfbML4]]></youtube>
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- </subcategory>
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- <index>
- <title><![CDATA[Library]]></title>
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- <title><![CDATA[Educational Content]]></title>
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- <title><![CDATA[Frequently Asked Questions (F.A.Q.)]]></title>
- <notoc/>
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- <content><![CDATA[Frequently asked questions with corresponding answers.]]></content>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/icons/icon_faq.png]]></image>
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- <title><![CDATA[Media]]></title>
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- <path><![CDATA[media]]></path>
- <content><![CDATA[Educational, informational, and testimonial videos.]]></content>
- <image><![CDATA[http://awdfiles.myrayhawk.com/images/icons/icon_media.png]]></image>
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