Chiropractic and Pain Management
Options for easing pain and restoring function
The current trend in the shifting landscape of health care is the increasing use of Best Practices; essentially, what is the most effective treatment available at the greatest monetary value and with the least number of adverse effects? As patients, we are better informed about health care than we once were, and we have greater access to information and resources than ever. For chiropractors and pain management specialists, this is all very good news.
“As people are becoming much more proactive in their health care—rather than waiting to become ill before they seek help, or waiting before things become so bad they can’t function—chiropractic fits really nicely into that, because we are drugless and non-surgical,” says Dr. Jeffrey Mackey of Luedtke-Storm-Mackey Chiropractic Clinic. “There are very few spinal emergencies, and so in most cases trying the most conservative approach first makes the most sense.”
Mackey is very familiar with the old tension between physicians and chiropractors. When he started practicing in 1980, they “rarely even spoke to one another, let alone referred patients back and forth,” he says. Now LSM’s thirteen clinics are closely partnered with two of Madison’s major HMOs, and one LSM clinic is actually located inside the downtown Dean St. Mary’s Spine Center.
“We are in the clinic with the neurosurgeon, the orthopedist, the occupational med doctors. We function as a trans-disciplinary team,” says Mackey. “That way, we try to find the most effective care for each particular patient. And I think that’s going to be a trend of the future, where you’re able to see the physical therapist, the chiropractor, the family doc, all in the same building, and draw on the strengths of each profession.”
Going beyond the pain
Having unprecedented access to a vast spectrum of providers, disciplines and schools of thought might be comforting to one patient and overwhelming to another. Information and access are important to every patient, though, because people are so different from one another.
“Even if I see the same type of diagnosis several times a day, each case is unique,” says Dr. Jared Greenberg, an interventional spine specialist with Meriter Medical Group. “There are many variables that can affect treatment outcome, not just the anatomical source of the pain. Other factors include the chronicity of pain, the patient’s occupation or hobbies, their other medical conditions, pain-coping ability, life or social stressors, patients’ expectations of treatment, what treatments they’ve had previously, or what treatment experiences their friends and family have had—with or without success. Based on these and other factors, you can make the exact same diagnosis in two different patients, and create a completely different care plan or treatment algorithm for each of them.”
That’s essentially Greenberg’s job: to determine the anatomical basis for a patient’s pain, establish the diagnosis or diagnoses, and develop a comprehensive treatment plan that utilizes a range of rehabilitative tools, which can include physical therapy and diagnostic and therapeutic injections.
As a result, Greenberg doesn’t seek simply to manage pain, he involves understanding and managing the source of pain.
“In addition to improving pain, the goal is improve function as well,” he explains. “Patients with low back pain, especially chronic low back pain, have weakened back and core muscles, as well as mechanical imbalances due to this. Things don’t just snap back into place once the pain is improved.
It takes rehabilitation, healthy lifestyle choices and an active role by the patient to achieve an optimal treatment outcome.”
Digging deep to determine the cause of pain is also at the core of Dr. Maher Fattouh’s philosophy, as is harnessing any treatment modalities appropriate for individual patients.
“We want to find and address the root cause of your pain problem, not just cover it up with a pill,” says Fattouh, board-certified anesthesiologist and pain medicine specialist at Advanced Pain Management, which has eight locations in and around Madison. “We discuss all treatment options with the patient before doing anything, and these options aren’t necessarily even ones we offer here. Chiropractic, physical therapy and nutritionists would all be considered.”
In a phrase, Fattouh characterizes this approach as “primary care for pain.” After a thorough evaluation, Fattouh and his colleagues at APM present a variety of treatments beyond prescription medications; typically these are minimally invasive, outpatient procedures with a relatively short recovery time. They might include both traditional and leading-edge services such as Epidural Steroid Injection (ESI), neurostimulation, nerve blocks, and radio frequency ablation. Additionally, Fattouh takes a holistic and complex approach to treating pain that often comes as a surprise to patients who have tried many different treatments without success.
“Many of us spend our whole lives running from feeling, with the mistaken belief that you cannot bear the pain. But you have already borne the pain,” says Fattouh. “What you have not done is feel all you are beyond the pain.”
Whether pain is minimal, chronic or debilitating, APM doctors will see patients without a referral.
“If you say you are in pain, says Fattouh, “we believe you.”
Unwinding new procedures
Dr. Stacy Shropshire is the owner of Evolution Body Transformation, and a practitioner of a recently developed chiropractic procedure called Advanced Biostructural Correction. This procedure is often called Unwinding and was developed by Dr. Jesse Jutkowitz. It’s a natural, non-surgical adjustment protocol focused on correcting posture that Shropshire says has worked wonders for her patients—and herself.
“I’ve been a chiropractic patient my whole life and, of course, it’s also my career. This technique has really changed everything for me,” says Shropshire. “I feel much more stable, and my posture has improved greatly.”
Unwinding is based on the idea that, while our bodies self-correct in many ways, there are certain ways they do not and, as a result, become structurally misaligned. Chiropractic treatment is used to correct that, by helping to properly align bones; muscles then relax and the body is free to continue self-correcting—until it encounters, once again, a road block that can only be fixed by a chiropractor. Shropshire makes the adjustment, the patient goes on his or her way, and the pattern continues as the body aligns, until the process is complete and the patient’s natural posture is better than ever before.
“You shouldn’t have to work so hard at sitting up straight—if you’re in proper alignment, your shoulders should just naturally stay back with no effort,” says Shropshire. “When a person goes through this protocol, you can actually see their posture improve and their pain diminishes at the same time.”