1. Complimentary and Alternative Medicine for Veterans Pain Management Class One: Acupuncture, Chiropractic care, Massage therapy August 15, 2015 By Heather Díamani

2. Hello, I’m Heather, a 6 year Army Veteran. Deployed twice to Iraq. Injured in an IED Blast in 2007. “We cannot always control everything that happens to us in life, but we can control how we respond.” –L. Lionel Kendrick

3. Complementary and Alternative Medicine (CAM)  Complimentary and alternative medicine can be defined as: “a category of medicine that includes a variety of treatment approaches that fall outside the realm of conventional medicine” (Everyday Health, 2015).

4. Examples of Complimentary and Alternative Medicine (CAM)  Acupuncture  Aromatherapy  Ayurveda  Biofeedback  Chiropractic care  Herbalism  Homeopathy  Hypnosis  Massage Therapy  Meditation  Naturopathy Nutrition Therapy Osteopathic manipulative therapy (OMT) Qi Gong Reflexology Reiki Spiritual healing Tai Chi Traditional Chinese Medicine (TCM) Yoga

5. Acupuncture  Acupuncture uses hair-thin needles that are inserted in the skin at specific points in the body to correct imbalances in the flow of energy (Qi).  Qi (pronounced Chi) is the life energy force which flows around the body via meridians.  Helpful for pain (muscle, joint, head, other), nausea or other digestive issues, insomnia, anxiety or depression, infertility, other gynecological issues, sinus or other respiratory disorders, stress and immunity

6. Meridians in the Body

7. Getting Acupuncture: What to Expect Tranquility Acupuncture should bring you peace and relaxation.

8. Clinical Studies for Acupuncture Study One  17, 922 participants with chronic neck, shoulder, back, headache, joint, or osteoarthritis pain  Randomized groups, 8 week study  Result= Acupuncture is effective for the treatment of chronic pain (Vickers, 2012)- JAMA Study Two  298 patients with chronic lower back pain.  Randomized groups, 12 30-minute sessions during 8 week study  Result= Acupuncture was more effective in improving pain than no acupuncture treatment in patients with chronic low back pain (Brinkhaus, 2006). JAMA

9. Chiropractic care Chiropractic care deals with the diagnosis, treatment, and prevention of mechanical disorders of the musculoskeletal system and the effects of these disorders on the function of the nervous system and general health (World Federation of Chiropractic, 2001).

10. Chiropractic Care Benefits  Improved Nerve Communication in the Body  Improved Joint Motion and Coordination  Improved Physical Function and Performance  Improved Posture  Relief from Back and Neck Pain  Relief from Leg, Knee, Foot and Ankle Pain  Relief from Arm, Wrist, Shoulders or Elbow Pain  Relief from Stress and Tension Disorders  Relief from Joint Discomfort  Relief from Bursitis  Relief from Arthritis  Relief from Chronic Injuries (The Joint, 2015)

11. How it Works

12. Clinical Studies for Chiropractic Care  523 acute pain patients, 293 chronic pain patients treated weekly and assessed at one week, one month, and 3 months.  Both acute and chronic patients improved with chiropractic care. (Peterson, 2012)  Low back pain in 18-35 year old Active Duty Military Personnel  4 week duration study. Comparison of standard medical care (SMC) versus chiropractic manipulative therapy (CMT)  Results showed CMT had significant advantage when combined with SMC in decreasing pain (Goertz,2013) Study One: Acute & Chronic Lower Back Pain Study Two: Standard vs Chiropractic Care for Military Personnel

13. Receiving Chiropractic Care: What to Expect Fill out forms, identify areas of pain, sometimes even rate the pain.

14. 15 minute BREAK! Get up, move around, stretch, use the bathroom, get a drink, make a phone call… do what you need to do but don’t leave just yet!

15. Massage Therapy  Massage therapy is defined as manipulation of soft body tissues (muscle, connective tissue, tendons and ligaments) to enhance a person's health and well- being.

16. Types of Massage  Swedish Massage (relaxation)  Hot Stone (relaxation)  Chair Massage (relaxation)  Reflexology (relaxation)  Trigger point (rehabilitative)  Deep Tissue (rehabilitative)  Neuromuscular therapy (rehabilitative)  Cranial Sacral (rehabilitative)  Sports Massage (overall health)  Thai Massage (overall health)  Shiatsu (overall health)  Geriatric Massage (overall health)

17. Benefits of Massage Stress relief, pain relief, relaxation, improved circulation, increased mobility, better sleep at night, mood improvement and an overall better well-being.

18. Clinical Studies for Massage  24 Adult participants (12 men, 12 women).  Duration: 30-minutes massages twice per week over 5 weeks  Outcome: Massage therapy is effective in reducing pain, stress hormones and symptoms associated with chronic low back pain. (Hernandez-Reif, 2015) International Journal of Neuroscience  228 male and female participants with chronic neck pain.  4 week duration, 5 split groups receiving either 30 minute massage 1-2 times weekly, 60-minutes massages 1, 2, or 3 times per week. Assessed by week 5.  Outcome: the group that received 2 or more 60-minute massages weekly had the most significant improvements (Sherman, 2014) Study One: Reduced Lower Back Pain with Massage Study Two: Therapeutic Massage for Chronic Neck Pain

19. Getting a Massage: What to Expect  Dim lit room, comfortable setting.  Lotion or oil (non- clogging)  30, 60, or 90 minute session Relax

20. Handout: Self-Assessment 1. How much is pain affecting your life? 2. Which method of CAM interests you the most? 3. Are You Stressed? “True compassion means not only feeling another’s pain but also being moved to help relieve it” –Daniel Goleman

21. Resources for Affordable Care  Hope For Heroes (The Samaritan Center)  AOMA Graduate School of Integrative Medicine ($15 Acupuncture for Veterans!)  Texas Health and Science University ($28 Acupuncture by student)  The Joint (No insurance needed. Certified professionals. $19 introductory, plans available)  Active Life Healing Center (Free x-ray & exam, 50% off treatment/adjustment)  The Lauterstein-Conway Massage School ($35 one hour massage by student)  Academy for Massage Therapy Training ($46 for deep tissue massage by student)

22. Brinkhaus, B. (2006). “Acupuncture in Patients With Chronic Low Back Pain”. JAMA Internal Medicine. Retrieved from: http://archinte.jamanetwork.com/article.aspx?articleid=409858 Peterson, C. (2012). “Predictors of Improvement in Patients With Acute and Chronic Low Back Pain Undergoing Chiropractic Treatment”. Journal of Manipulative and Physiological Therapeutics. Retrieved from: http://www.sciencedirect.com/science/article/pii/S0161475412001169 Sherman, K. (2014). Five-week outcomes from a dosing trial of therapeutic massage for chronic neck pain. Annals Of Family Medicine, 12(2), 112-120. doi:10.1370/afm.1602 The Joint (2012). “Health Benefits of Chiropractic”. Retrieved from: http://www.thejoint.com/health-benefits Vickers, A. (2012). “Acupuncture for Chronic Pain”. JAMA Internal Medicine. Retrieved from: http://archinte.jamanetwork.com/article.aspx?articleid=1357513#COMME NT World Federation of Chiropractic (2001). Definitions of Chiropractic. Retrieved from: https://www.wfc.org/website/index.php?option=com_content&view=articl e&id=90&Itemid=110 References

23. References Continued Dunn, A. (2011). “Chiropractic Management for Veterans with Neck Pain: A Retrospective Study of Clinical Outcomes”. Journal of Manipulative and Physiological Therapeutics. Retrieved from: http://www.sciencedirect.com/science/article/pii/S0161475411001916 Goertz, C. (2013). “Adding Chiropractic Manipulative Therapy to Standard Medical Care for Patients With Acute Low Back Pain”. Retrieved from: http://journals.lww.com/spinejournal/abstract/2013/04150/adding_chiropracti c_manipulative_therapy_to.2.aspx Hernandex-Reif, M. (2015). “Lower Back Pain is Reduced and Range of Motion Increased After Massage Therapy”. Retrieved from: http://www.tandfonline.com/doi/abs/10.3109/00207450109149744#.Vco9D2CF I3h Northwestern Health Sciences University (2015). “What is massage therapy?” Retrieved from: https://www.nwhealth.edu/school-of-massage- therapy/massage-therapy-definition/ Pinola, M. (2014). “What’s the difference between all these types of massage?” LifeHacker. Retrieved from: http://lifehacker.com/whats-the- difference-between-all-these-types-of-massag-1522088430 Massage Envy (2015). “Types of massage”. Retrieved from: http://www.massageenvy.com/types-of-massage.aspx

24. Anymore Questions? See You Next Week!