Chiropractic Medicine’s Role in Pain Management for Cancer Patients Jeff Sklar DC Chiropractic Services/ Director Eastern Region American Society for Pain Management Nursing Friday, September 9, 2016 Conflict of Interest Disclosure Authors Conflicts of Interest; – J. Sklar, No Conflict of Interest. Objectives • Attendee will become familiar with history of chiropractic integration into western medicine and applications of chiropractic care as it relates to pain associated with the side effects of cancer and cancer treatment • Attendee will be able to identify patients who are candidates for chiropractic care • Attendee will be able to recognize chiropractic modality or technique that will help address patient site of complaint • Attendee will be able to identify contraindications for chiropractic care as it related to cancer patients © 2015 Rising Tide 1 History of Chiropractic in Medical Settings • Chiropractic acceptance into the allopathic paradigm • Wilk vs. American Medical Association, 895 F.2d 352 (7th Cir. 1990) • Over 25 years of Medicare Coverage • Veterans Administration – at least 38 credentialed DCs nationwide in the VA system - serving in salaried staff positions in 66 VA facilities • American Academy of Hospital Chiropractors • Medical schools include Complementary and Alternative Medicine (CAM) • Barzansky B, Etzel SI. Educational programs in US Medical Schools, 2002-2003. JAMA. 2003;290:1190-1196 © 2015 Rising Tide Use of CAM by Cancer Patients On the Rise • How many cancer patients use complementary and alternative medicine: a systematic review and metaanalysis. Horneber M; Bueschel G; Dennert G; Less D; Ritter E; Zwahlen M. Integrative Cancer Therapies. 11(3):187-203, 2012 Sep. [Journal Article. Meta-Analysis. Research Support, Non-U.S. Gov't. Review] • The use of complementary and alternative medical providers by insured cancer patients in Washington state (Lafferty, Bellas, Corage, Tyree, Standish, Patterson) Cancer 2004; 100:1522-30. • Complementary/Alternative Medicine Use in a Comprehensive Cancer Center and the Implications for Oncology. Richardson MA, Sanders T, Palmer JL, et al. J Clin Oncol 2000 Jul;18(13):2505-14 © 2015 Rising Tide Literature Review • Adjustments may lower blood pressure short term • Increase in CD4 (T Cells) after adjustments • Effectiveness of Chiropractic Manipulation in the Treatment of Headaches – a review of literature • Exacerbations of chronic neck pain • Easing Physical tension and emotional stress • Autonomic Reflex Response • Sympathetic Relaxation and Pain Reduction • Chiropractic care for non-musculoskeletal conditions: a systematic review with implications for whole systems research • The chiropractor's role in pain management for oncology patients. Source – Schneider J, Gilford S. Naval Hospital Camp Pendleton, Camp Pendleton, CA, USA. [email protected] © 2015 Rising Tide 2 What the Literature Showed • When it comes to cancer related pain and chiropractic care, more research is needed © 2015 Rising Tide Art of Healing •“The art of healing comes from nature, not from the physician. Therefore the physician must start from nature, with an open mind.” • Philipus Aureolus Paracelsus © 2015 Rising Tide Passion for Cancer Patients © 2015 Rising Tide 3 Patient Centered Care and Pain Core Concepts • Dignity and Respect • Information Sharing • Participation • Collaboration © 2016 Rising Tide © 2015 Rising Tide Chiropractic’s Role • The Chiropractor’s Role in Pain Management for Oncology Patients (Schneider and Gilford (2001) Schneider J, Gilford S, Journal of Manipulative and Physiological Therapeutics, 2001; 24(1):52- 57 • “The chiropractor provides noninvasive and non- pharmacologic options for decreasing pain and improving function.” © 2015 Rising Tide 4 Chemotherapy Patients • (Schneider and Gilford 2001 cont.) • A possible side effect of certain chemical agents during chemotherapy is that of axonal neuropathy, potentially causing muscle weakness, leading to pronounced gait abnormalities. • Approximately 80% of studied patients with colon, lung, and prostate cancer have related problems with ambulation. • Weakness and deconditioning from fatigue, inactivity © 2015 Rising Tide Radiation Patients • (Schneider and Gilford 2001 cont.) • Radiation therapy on normal tissues can result in tissue fibrosis. Fibrosis potentially leads to a loss of mobility and/or painful movement. • Chiropractic techniques are often of benefit in instances in which joint contracture or adhesions occur. • Positioning necessities can cause musculoskeletal conditions to occur. © 2015 Rising Tide Significant Conclusions • Schneider and Gilford 2001(cont.) • Chiropractic care can enhance a cancer patient’s quality of life at any stage in the disease process by decreasing pain and improving function. • The chiropractor can assist in the treatment of the complications of prolonged bed rest, chronic pain related to radiation fibrosis, chemotherapy-related neuropathies and gait or functional abnormalities, thereby decreasing the patient's reliance on pain medication. • The addition of a chiropractor to the rehabilitation team can improve the physical and emotional well-being of a patient with cancer. © 2015 Rising Tide 5 Indications for Chiropractic • Neck pain and stiffness • Low back pain and stiffness • Shoulder, knee, hip pain or • Headaches stiffness • Sciatica • Upper or lower extremity radiculopathy • Neuropathy • Generalized stiffness and difficult • Some visceral disorders motion including hiatal hernia, • General wellness from de- hiccups, nausea stressing the musculoskeletal systems influence of the nervous system • Joint pain from prolonged bedrest © 2015 Rising Tide No Chiropractic • Primary bone cancer: no treatment within five spinal segments or to the affected extremity • Unstable bone metastases: no treatment available within five spinal segments • Cord compression from space occupying lesion • Do not treat any extremity with a thrombosis • Extreme low levels of platelet count (below 50k) • An essential part of chiropractic treatment of a cancer patient is access to the most recent records: PET, CT, MRI, X-ray, blood work, etc. © 2015 Rising Tide Case Study AM-ERMC 1 Integrative Cancer Treatment: Sleep Disrupted by Ostomy Complicated by Neck, Upper Back and Shoulder Pain Jeffrey A. Sklar, D.C., Cancer Treatment Centers of America® at Eastern Regional Medical Center © 2015 Rising Tide 6 Sleep Disrupted by Ostomy Complicated by Cervical Radiculopathy • Direct infusion for metastatic colon cancer • Extensive surgery of liver resection, omentectomy and cholicystectomy • Sleep became severely interrupted became sleep deprived due to discomfort • He developed radicular pain in the left side of his neck, radiating to scapula and deltoid • Receiving chiropractic treatment, the patient was able to sleep through the night without the radicular pain in his neck, upper back and shoulder, as well as sit more comfortably during his chemotherapy © 2015 Rising Tide Case Study CD-ERMC4 Integrative Cancer Treatment: Chemotherapy Induced Peripheral Neuropathy Jeffrey A. Sklar, D.C. Cancer Treatment Centers of America® at Eastern Regional Medical Center © 2015 Rising Tide Neuropathy (cont.) • The patient described her symptoms as a feeling of her toes being taped together • bottom of her feet feel like sandpaper when she walks • sensory deficit component led to balance issues for the patient • Chiropractic evaluation and treatment © 2015 Rising Tide 7 Techniques and Modalities © 2015 Rising Tide The Ultimate Adjusting Table © 2015 Rising Tide Activator Methods © 2015 Rising Tide 8 Impulse IQ © 2015 Rising Tide Rapid Release Technique © 2015 Rising Tide Sacro-Occipital Technique © 2015 Rising Tide 9 Hands On © 2015 Rising Tide Quality of Life • Every moment of every day counts for patients and their loved ones • Chiropractic has a role to keep people in motion with minimized pain and maximized function © 2015 Rising Tide © 2015 Rising Tide 10 References Barzansky B, Etzel SI. Educational programs in US Medical Schools, 2002-2003. JAMA. 2003;290:1190-1196 Horneber M; Bueschel G; Dennert G; Less D; Ritter E; Zwahlen M. Integrative Cancer Therapies. 11(3):187-203, 2012 Sep. [Journal Article. Meta-Analysis. Research Support, Non-U.S. Gov't. Review Lafferty, Bellas, Corage, Tyree, Standish, Patterson) Cancer 2004; 100:1522-30. Richardson MA, Sanders T, Palmer JL, et al. J Clin Oncol 2000 Jul;18(13):2505-14 Bakris G. Dickholtz M Sr. Meyer PM. Kravitz G. Avery E. Miller M. Brown J. Woodfield C. Bell B. Journal of Human Hypertension. 21(5):347-52, 2007 May Jeffrey L. Selano, Brett C. Hightower, Bruce Pfleger, Karen Freeley Collins, John D. Grostic Source: Chiropractic Research Journal : Volume 3, Number 1 Vernon HT. Journal of Manipulative & Physiological Therapeutics. 18(9):611-17, 1995 Nov-Dec. J Manipulative Physiol Ther. 2001 Jan;24(1):52-7.The chiropractor's role in pain management for oncology patients.Schneider J, Gilford S. Miller EB. Redmond P. Alternative Therapies in Health & Medicine. 5(2):102-4, 1999 Mar. Budgell BS. Journal of Manipulative & Physiological Therapeutics. 23(2):104-6, 2000 Feb. Tashiro M. Ogura T. Masud M. Watanuki S. Shibuya K. Yamaguchi K. Itoh M. Fukuda H. Yanai K.Alternative Therapies in Health & Medicine. 17(6):12-7, 2011 Nov-Dec. Hawk C. Khorsan R. Lisi AJ. Ferrance RJ. Evans MW. Journal of Alternative & Complementary Medicine. 13(5):491-512, 2007 Jun. © 2015 Rising Tide Contact Information Cancer Treatment Centers of America Eastern Regional Director Jeffrey Sklar, DC Email- jeff.sklar@ctca- hope.com Phone- 215-537-7168 © 2015 Rising Tide Thank You! © 2015 Rising Tide 11.