Friday, July 28, 2006

Osteopathic Manipulation Helps Children with Ear Infections

Osteopathic manipulation helps children who have had multiple ear infections by reducing the frequency of infections and preventing the need for surgery, according to a new study published in the Archives of Pediatric and Adolescent Medicine (2003;157:861–6).

Acute otitis media (AOM, inflammation of the middle ear) is one of the leading causes of physician visits for children. Research has shown that antibiotic therapy has limited effectiveness and poses a potential danger by contributing to the development of antibiotic-resistant bacterial strains. Current recommendations discourage the use of antibiotics but offer few alternatives. Surgery is often used to treat children who have recurrent episodes of AOM. This surgery involves rupturing the eardrum and inserting a tube to allow better drainage and possibly to prevent the growth of colonies of infectious bacteria. Some osteopathic physicians have suggested that manipulative techniques might be effective in correcting structural causes of restricted drainage, thereby reducing the infection rate and the need for surgery. Preliminary studies have suggested that osteopathic manipulation might improve functioning of the eardrum in children with a history of recurrent AOM.

Fifty-seven children, ranging in age from six months to six years, participated in the current study. All of the children had experienced at least three acute ear infections in the previous six months, or at least four in the previous year. They were randomly divided into two groups: one group received routine pediatric care and the other received routine care plus nine osteopathic manipulation treatments over the study period of six months.

The treatments used were gentle techniques to open areas of restriction identified by the osteopathic physicians. These included applying pressure to joints, ligaments, tendons, and muscles in any areas of restriction in the body, with special attention to the head and neck. No high-velocity "popping" techniques were used. The children receiving osteopathic manipulation treatments had significantly fewer episodes of AOM and fewer surgeries during the study period than the children receiving standard care. Furthermore, scores on eardrum function testing improved in significantly more children in the group receiving osteopathic manipulation than in the group receiving standard care.

The results of this study demonstrate that osteopathic manipulation may be beneficial as part of a treatment program for children with recurrent AOM. Including osteopathic manipulation in the treatment of recurrent AOM, as well as other complementary approaches such as identifying and eliminating reactive foods and using herbal eardrops for pain relief, may prevent antibiotic overuse and reduce the need for ear surgery. Further studies are needed to confirm the findings of this study and to determine the optimal number and frequency of treatment sessions.

Monday, July 10, 2006

Pain is treatable, not always curable

Pain is treatable, not always curable,1249,640193153,00.html
By Lois M. Collins
Deseret Morning News

Low back pain is high on the list of reasons people go to the doctor. If you figure the price of disability, time off and other related expenses, it costs about $100 billion in the United States every year.
Add in the cost associated with all the other types of pains — headaches, misery that accompanies some cancers, the post-surgery pain that won't leave — and it's daunting, says Dr. Christopher Caldwell, who completed an Anesthesia Pain Medicine Fellowship and is board-certified in neuromusculoskeletal medicine and osteopathic manipulative medicine.
Scott G. Winterton, Deseret Morning NewsClaudia Campbell, clinical director of the Intermountain Pain Center, will field Health Hotline calls with Dr. Christopher Caldwell today. Although it's not always curable, pain is treatable, if patient and health-care provider can work together.
Pain is the subject of today's Deseret Morning News/Intermountain Healthcare Hotline from 10 a.m. to noon. Caldwell and Claudia Campbell, clinical director of the Intermountain Pain Center at Cottonwood Hospital, where both work, will answer phoned-in questions. All calls are confidential.
One of the challenges with treating low back pain is that so many different things may cause it. It can result from arthritis or muscle pain, for instance.
Pain often comes in layers. "There's almost never a single cause with a simple solution," Caldwell says, so it "requires a willingness to look for and find all the different contributing factors, and then we must try to address each of them appropriately."
Some doctors simply don't have the time or the expertise to peel away the layers.
"We need to do better," Caldwell says. "Physicians are folks who've given their lives to be in a position where they can help. Pain is a very humbling thing to treat. Often we can't make it go away completely. We can manage it with exercise and by increasing our understanding of the options . . . but it's often a very frustrating thing for physicians who really want to offer lasting relief and help. Pain eludes even the specialists in finding that cure in many cases."
Often, though, it responds very well to treatment, he and Campbell agree.
The center doesn't offer surgery but will make a referral. As a profession, Caldwell says, they "don't understand very well who will and who won't benefit from surgery. We take our best shot at it, and we're getting better, but there's still a mystery to that."
Several classes of medications help treat pain, and which one is used depends on where the pain is, what's causing it and what's keeping it alive. While most people think first of strong opioid medications, they offer only limited benefits for chronic pain. It's much better for acute, short-term pain such as a broken arm or after surgery.
Medications that work on nerves make them less likely to send a pain message to the brain, often used to treat neuropathic pain. Pain itself can change how the body signals, which is why pain sometimes persists when the root cause is gone.
Anti-inflammatory medications are often helpful. So are exercise and osteopathic manipulative treatment. There are a dozen different procedures that can be done under X-ray guidance to apply medication or technology in the body, including placing steroids deep in the lower back by the spinal cord. Radiofrequency neuroablation, spinal cord stimulators and nerve blocks are part of the arsenal.
Backs don't get better without physical rehabilitation, "with enough (pain) relief to accomplish it. There's no way through it other than through it," Caldwell says, so patients must be willing to do their part.
Cancer pain unleashes a "very different philosophy right out of the gate," he adds. For those with limited life expectancy, the goal is better quality of life and pain control, not rehabilitation. With less concern about the long-term implications of what treatment is chosen (addiction, for instance, is a moot point), there are more options in terms of pain relief.
Campbell points out that being addicted does not mean pain is not real. But it adds another challenge to treatment.
Intractable pain that lingers after surgery is comparatively uncommon and may be unrelated to a surgical problem. Sometimes, the body and mind have a difficult time after surgery and specialists work to create a window where they can get ahead of the pain. "For most people, that pretty well works." Such treatment is usually of short duration, he says.

WWW This blog