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ACOG Committee on Obstetric Practice Addresses Pain Management – F4CP Responds

On May 17, 2018, The American College of Obstetricians and Gynecologists’ (ACOG) Committee on Obstetric Practice released an important and timely committee opinion addressing postpartum pain management.

The advice of the ACOG Obstetrics Practice Committee is consistent with federal guidelines and recommendations seeking to increase the use of non-pharmacologic approaches to pain management and a minimization and elimination of the use of opioid containing products whenever possible, according the Foundation for Chiropractic Progress (F4CP).

“Pain and fatigue are the most common problems reported by women in the early postpartum period. Pain can interfere with a woman’s ability to care for herself and her infant,” notes the nation’s OBGYN community. In addition to interfering with the ability of a mother to care for her child, the use of opioids puts infants at risk. In April 2017, the U.S. Food and Drug Administration (FDA) announced labeling revisions advising “breastfeeding is not recommended while using medicines that contain codeine or tramadol because of the potential for serious adverse effects in the infant due to opioid overdose.”

ACOG carefully explores the impact of non-steroidal anti-inflammatory medications (NSAIDS) and codeine (opioid) containing products. Unfortunately, the ACOG opinion statement does not offer any guidance to obstetricians or mothers about available non-pharmacologic approaches to pain management.

For advice and recommendations relative to the non-pharmacologic management of postpartum pain, the Foundation for Chiropractic Progress consulted the clinicians involved in a ground-breaking interprofessional collaboration involving Life University’s Vital Life Health Center (VLHC) and Atlanta Birth Center (ABC) located in downtown/midtown, Atlanta, Georgia.

“As a chiropractor at the Vital Life Health Center I collaborate daily with the midwives and staff of Atlanta Birth Center providing chiropractic care throughout the pregnancy of many ABC clients,” comments Bryna Waters, D.C. “The most gratifying clinical opportunity for me is to adjust a mom-to-be, and see her go onto complete a normal delivery much faster than her progress had been up to that point.”

“Chiropractic is helpful at all stages of a pregnancy. It accrues to a safe and typically expedited labor and delivery,” according to Dr. Waters. The relationship is equally exciting from the perspective of the midwives responsible for the management of the pregnancy, labor and birth process at Atlanta Birth Center. “It is clear to us that our moms and babies benefit from chiropractic care in pregnancy, birth and postpartum. We have seen shorter, easier labor periods, less pushing times, overall increased likelihood of vaginal births and more successfully established breastfeeding relationships when they have the advantage of chiropractic care,” notes ABC Director and midwife, Anjli Hinman.

The interaction and cooperation involving chiropractic care and midwifery care does not stop at the birth of the newborn as chiropractic care is an essential part of the postpartum period for many clients of Atlanta Birth Center. Ms. Hinman stated, “We agree with ACOG that pain and fatigue are amongst the most common problems reported by women in the early postpartum period for many new mothers. We work with our chiropractic colleagues, massage therapists, physical therapists, cranio-sacral therapists, lactation consultants, maternal mental health therapists and our naturopathic care provider to bring as many resources, skills and clinical interventions as possible to our mothers and newborns to avoid the use of medications whenever and wherever possible. It is an approach we find our clients are looking for and interventions that work.”

“If more mothers had access to the range of care services we are able to provide our patients at the Vital Life Health Center and Atlanta Birth Center, the childbirth process (and developmental stages following) would be easier, safer, cheaper and more satisfying for everyone involved,” Dr. Waters offered.

Vital Life Health Center is an Atlanta-based, Life University affiliated collaboration providing chiropractic, functional neurology, and personal injury care. The Vital Life Health Center is a specialty clinic bringing unique assessment competencies and clinical skills together in a patient-centered neurologically-focused care environment.

Atlanta Birth Center is based on the birth center model of care, we believe pregnancy and birth are normal life events and should be women-centered. This model includes prenatal care, mind, body, spirit and social well-being, postpartum support, and much more to women in the Atlanta metro area. This birth center model of care cannot be duplicated by a local area hospital. We invite you to use our community of providers to learn more about the importance of a birth center care.

Foundation for Chiropractic Progress is a not-for-profit organization, providing information and education regarding the value of chiropractic care and its role in drug-free pain management. Visit www.f4cp.com; call 866-901-F4CP (3427). Social media: Facebook, Twitter, LinkedIn, Pinterest, YouTube.

F4CP Implements National Billboard Advertising

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Foundation for Chiropractic Progress Implements National Billboard Advertising

In honor of National Drug-Free Pain Management Awareness Month in September, the Foundation for Chiropractic Progress, along with six of its Group Member State Associations, are placing billboards throughout the U.S.

The billboards will support the Foundation’s goal to position chiropractic care as a safe, effective and drug-free first-line approach to manage back pain prior to utilization of drugs and surgery.

The placements are expected to reach nearly 8 million consumers.

Butte, MT
February 2019 – April 2019
Montana W/L N/O Train Depot #1 F/S

Great Falls, MT
February 2019 – April 2019
6th Sw E/L 35′ S/O Rr Trax F/S #2

Helena, MT
February 2019 – April 2019
Euclid S/L @ Glendale #1 F/E

Kalispell, MT
February 2019 – April 2019
US 2 E W/L 250′ N/O Tri-Cty Wrckng #1 f/S

Billings, MT
February 2019 – April 2019
Main St E/L .3 MI N/O Wicks #2 F/S

Bozeman, MT
February 2019 – April 2019
US 85 E/L 500′ N/O Laura Louise LN

Missoula, MT
February 2019 – April 2019
South Ave @ Stephens #1 F/W

Orlando, Florida
August 6 – September 2, 2018
SR 528 NS 100ft W/O Sand Lake Rd
Facing South West

Los Angeles, California
September 3 – 30, 2018
SUNLAND BL WL
600ft S/O SAN FERNANDO RD
Facing South

Des Moines, Iowa
September 3 – 30, 2018
SE 14TH ST WS  100ft N/O PARK AV
Facing North

Detroit, Michigan
September 3 – 30, 2018
N/S I-96, .4 MWO SOUTHFIELD 
Facing West
Nashville, Tennessee
September 3 – 30, 2018
S/S I-40E @ 906 2ND AV S
Facing North East
Austin, Texas
September 3 – 30, 2018 
I-35 S W/S 1000ft S/O LOOP 4
Facing South
Minot, North Dakota
November 1, 2018 – November 30, 2018
1500 South Broadway (US Highway 83)
Facing Northbound traffic

Mandan, North Dakota
November 1, 2018 – November 30, 2018
Corner of Century & Centennial Road
Facing Westbound traffic

Fargo, North Dakota
November 1, 2018 – November 30, 2018
4301 Main Avenue
Facing Eastbound traffic

Grand Forks, North Dakota
October 15, 2018  – November 15, 2018
DeMers W/O 20th
Facing Westbound traffic

Jamestown, North Dakota
October 15, 2018  – November 15, 2018
10th St SE Between 9th & 10th Ave
Facing Westbound traffic

For more information or to view each billboard placement design, email Marketing Director alexis@f4cp.com. 

Too high a price

Too high a price

Why, months before our “Drug-Free Pain Management Awareness” campaign in September, are we choosing to bring up the opioid epidemic? To answer this question, we point to a Centers for Disease Control and Prevention (CDC) release about the toll it took in 2016, when more people died from drug overdoses in a single year than in the Vietnam and Iraq wars combined.

It is no surprise that the CDC says synthetic and classic opioids today account for six of every 10 drug overdose deaths, given that another CDC study found that one out of every four Americans prescribed long-term opioid painkillers struggle with addiction. It’s a national tragedy that deserves our continuous attention.

As doctors of chiropractic join with other healthcare providers to explore the intricacies of chronic pain and the combination of treatment options, beginning with drug-free, non-invasive chiropractic care, a myriad of pain-related issues continue to surface. Deserving careful consideration are the risks of over-the-counter pain relievers such as nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen.

  • Managing the pain with NSAIDs and acetaminophen is like constantly replacing the tires on your car instead of getting the alignment that’s causing them to wear out in the first place. It is far better managed through the first-line option of spinal manipulation – eight out of 10 who seek chiropractic care for pain say they experience significant relief – and, if needed, subsequent physical therapies and medical procedures to address the cause of the pain. Yet 70 percent of new neck and back pain sufferers say they relied on NSAIDs such as Advil, aspirin and Aleve and 45 percent took acetaminophens, such as Tylenol in the first year, according to the 2017 Gallup-Palmer College of Chiropractic annual report.
  • A U.S. experiment recently reported in Journal of the American Medical Association (JAMA) found that NSAIDs and acetaminophen are better at easing the intensity of chronic pain in the back, knees and hips than prescribed opioid painkillers, but they still come with risks. While NSAIDs are not addictive, they can cause internal bleeding and kidney damage. There is also a well-established link between their use and heart hazards, according to Harvard Health Publications. Acetaminophen is generally considered safer, said the Mayo Clinic, but taking more than the recommended dose or mixing it with alcohol increases the risk of kidney damage or liver failure. These risks increase with age and additional health issues.
  • If you must take NSAIDs or acetaminophen, take the lowest recommended dose and only increase it if necessary for pain, recommended Harvard Health Publications. Make sure you’re monitored for possible side effects, and stop taking them when your pain subsides to the point where you can find comfort with hot baths or cold packs. Remember, too, that you have options in treating your pain. Stay as active as possible and watch what you eat. Talk to your team of health providers, including your doctor of chiropractic, about what treatments are available.

If there is one common thread in all of this, it’s that we’re paying too high a price for the hope of stopping the pain. Maybe by raising consciousness now and during our “Drug-Free Pain Management Awareness” campaign in September, we can make a difference.

STAND TALL

Stand Tall

By definition, chiropractic care encourages your body to heal itself by bringing it back into alignment. And by doing your part, you can make the lifestyle changes that prevent the conditions that brought you to the doctor of chiropractic in the first place.
posture

Eat better. Become more active. And, in keeping with the Foundation for Chiropractic Progress’ theme for May, practice good posture.

In olden days, proper young ladies would walk for hours balancing books on their heads, perfecting their posture. But times change and, with technology keeping us hunched over our laptop for hours on end and continually checking our mobile devices, we’ve lost our natural curve.

Whether you call it tech neck or millennial hunchback or a pain in the neck, doctors of chiropractic are seeing it show up on younger people these days, and it raises more than aesthetic concerns.

Poor posture leading to postural kyphosis can bring on back and neck pain, poor circulation, shallow breathing, fatigue, muscle tension, headaches and premature aging of the spine. Among the middle-aged and elderly, studies show it increases the risk of falling. But here’s the good news; chiropractic care, including spinal manipulation, can improve your posture and so much more:

• By allowing more room for your lungs and diaphragm to expand, you can optimize your breathing and circulation.
• Keeping your bones and joints in correct alignment allows your muscles to be used as they were meant to be, properly and efficiently. It also reduces the abnormal wearing of joint surfaces – think knees – that can lead to degenerative diseases.
• You’ll decrease stress on soft tissues, too, giving ligaments, muscles, tendons and discs a welcome break. Additionally, your spine won’t become fixed in an abnormal position.
• Finally, it boosts your mental well-being, boosting your mood and simply making you feel good about yourself.
What can you do to help? Here are a few ideas:
• Get rid of the slouch. Use the 90/90 rule when sitting in a chair, keeping your elbows and knees at 90-degree angles. Hold your mobile devices at eye level when checking your messages. And whether you’re working at your desk or watching television from the couch, take a few minutes each hour to limber up.
• Scrap the high heels or at least reserve them for special occasions. The same with heavy handbags and over-filled backpacks, notorious for pulling your body in unhealthy directions.
• When sitting at your desk, keep your head and neck aligned above your shoulders. Put your feet flat on the floor and your back against the back of the chair.

As a study proved, the best results come from a collaborative effort. In this particular case, 30 women between the ages of 20 and 39 were divided into three groups and each was taught how to sit and stand correctly. The first group received spinal manipulative therapy on restricted thoracic spine segments; the second, the therapy as well as stretch and strengthening exercises and the third, stretch and strengthening exercises alone.
All improved their posture, but the second group saw the best results and decreased their curvature of the spine. Where do you stand? It’s up to you!

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CHIROPRACTIC CARE FOR VETERANS: WHY DOCTORS OF CHIROPRACTIC SHOULD BE ON THE FRONT LINES OF THE INTEGRATED CARE TEAM

Military life requires many physical challenges. The physical stresses of carrying heavy loads, running with body armor and jumping out of planes can often have a long-term impact on a person’s body. It shouldn’t come as a surprise that many Veterans suffer from chronic pain from the lingering effects of active duty.

Of the millions of patients served annually in the Department of Veterans Affairs (VA) facilities, more than half experience chronic pain. Much of the chronic pain reported by Veterans is musculoskeletal pain, with around 25 percent consistently reporting low back pain (LBP). The prevalence of severe pain is more common in Veterans with LBP than in non-Veterans. Chiropractic care – a safe, effective and non-pharmacological approach to manage pain, as well as general health and wellness – should be an increased part of the integrated care that Veterans receive for LBP.

Luckily there is hope. A Department of Veterans Affairs policy enforces that Veterans have access to chiropractic care, but this service is dependent on the availability of doctors of chiropractic (DC) on staff at VA facilities. The VA now provides chiropractic care at approximately 75 major VA treatment facilities within the U.S. Unfortunately, most of America’s Veterans still do not have access to chiropractic care because the VA has yet to provide DCs at a vast number of its medical facilities. The Veterans Health Administration is the largest integrated health care system in the United States, providing care at 1,243 health care facilities, including 170 VA Medical Centers and 1,063 outpatient sites of care of varying complexity (VHA outpatient clinics), serving more than 9 million enrolled Veterans each year.

There is currently an effort to require the VA to provide chiropractic care to all its medical treatment centers by the end of 2020. Efforts to expand chiropractic care to Veterans has recently gained new steam as ranking members of the Veterans Subcommittee on Health have thrown their support behind H.R. 103, the Chiropractic Care Available to All Veterans Act. The bill would require chiropractic services to be offered at all VA medical centers and include chiropractic care as a standard benefit for Veterans using the VA. Companion legislation is in the Senate.

Furthermore, chiropractic care in the VA is expanding beyond just spinal manipulation. Recently, President Trump signed into law the Job for Our Heroes Act, which includes a provision allowing DCs working within the VA to perform physical exams on Veterans needing a medical certificate to operate a commercial motor vehicle. Prior to the legislation, only 25 medical doctors within the entire VA healthcare system were qualified to perform the Department of Transportation (DOT) physical exams. Providers in the National Registry of Certified Medical Examiners—including more than 3,500 DCs—were excluded from providing the exams to truck drivers who receive their care through the VA health care system. Consequently, the drivers were burdened with limited access and were forced to look outside the VA for eligible health professionals to perform the required physical.

As additional proof that chiropractic care is vital to Veterans, a consensus-based, integrated care pathway was recently designed for DCs, primary care providers and mental health professionals who manage Veterans with LBP within VA healthcare facilities. The purpose of this chiropractic integrated care pathway was to define the parameters of an appropriate approach incorporating mental health and chiropractic considerations in the primary management of patients with LBP. Since mental health conditions are common among VA patients, DCs, while providing LBP care, may identify changes in a patient’s mental health status that could require additional follow-up. Although this care pathway focuses on LBP management, it also includes an overview of common mental health issues that a patient may present while receiving chiropractic care.
Through providing treatment for LBP, physical exams and as another touchpoint for mental health, DCs are in a perfect position to help Veterans and should be included as part of the integrated care team.
Doctors of chiropractic, who receive a minimum of seven years of higher level education, are specifically trained to diagnose, evaluate and provide non-pharmaceutical care and rehabilitation to individuals suffering from acute and chronic back, low back and neck pain, headaches, neuro-musculoskeletal and other related conditions

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CHIROPRACTIC CARE FOR OUR MILITARY: MAKING PROGRESS IN DEFEATING CHRONIC PAIN

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Those who serve in the U.S. military are heroes, dedicating their lives to ensure the safety of our country. Military life requires many physical challenges, and for the troops to be in optimal shape they must undergo rigorous training. Common tasks include carrying heavy loads, running with body armor, jumping out of planes and much more. These types of activities can have a long-term impact on a person’s body, so it shouldn’t come as a surprise that many of our military suffer from chronic pain.

For many active duty military, chiropractic care is not easily accessible while they are serving. It could be difficult to see a doctor of chiropractic, leading many active duty members to simply deal with the pain. Unfortunately, too few military bases have a doctor of chiropractic (DC) onsite. According to a 2005 Government Accountability Office report, while there is a DC at 60 military bases around the country, only 54 percent of servicemen and women eligible for chiropractic care can reasonably access the benefit. Could better access to chiropractic care be the answer to getting military personnel on the road to living a pain-free life?

Care for Back and Neck Pain
Back pain can make life miserable and it’s common in the military. According to the 2016 National Health Interview Survey, more that 43% of veterans deal with joint pain. Over 30% deal with back pain and another 16% with neck pain. Randomized trials have found that spinal manipulation can be effective for lower back pain. One 2013 studyspecifically evaluated chiropractic care with general medical care in military personnel, 18-35 years old. The results suggest reduced pain and improved physical well-being and function under chiropractic care, as compared to patients who received only standard medical care.

These studies confirm the well-established fact that most individuals with back pain find relief with chiropractic care. The U.S. is not the only country utilizing chiropractic care for military back pain either. The Canadian Armed Forces also offer chiropractic services, and a survey among their military personnel found that more than 90 percent were satisfied with their own chiropractic services.

The Need for Safer Pain Management Approaches
The words “chronic pain” can be tough to come to terms with – after all, no one wants to live their life unable to do tasks they once enjoyed. Chiropractic care opens a new world for military personnel to live better, take back their quality of life and enhance their readiness for service.

Active-duty military personnel embrace chiropractic care and report that it enhances health and well-being while reducing stress. Surveys indicate military personnel take advantage of chiropractic services up to 7 times more often than civilians.  

Now that care is accessible to active duty personnel through Tricare, we need to promote awareness and use among active duty members. And as people become more aware of the benefits of chiropractic care, it is our hope that those who have given so much to our country have easier access to chiropractic services.

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HOW CHIROPRACTIC CARE CAN KEEP HEADACHES FROM BEING SUCH A PAIN IN THE NECK!

Nine out of 10 Americans suffer from headaches. Some are occasional, some frequent, some are dull and throbbing, and some cause debilitating pain and nausea.

What do you do when you suffer from a pounding headache? Pop a pill and hope the pain goes away? When taken in higher doses than recommended, commonly used over-the-counter pain relievers can increase the risk of serious health conditions such as ulcers, stomach bleeding, kidney and liver damage and even death. But there is a better option.

Doctors of chiropractic (DCs), who receive seven years of higher level education, are well positioned to diagnose and manage headaches. Research shows that spinal manipulation – most often performed by a DC – may be an effective option for managing specific types of headaches.

What causes headaches? 
Headaches have many causes, or “triggers.” These may include foods, environmental stimuli (noises, lights, stress) and/or behaviors (insomnia, dehydration, excessive exercise, blood sugar changes). About five percent of all headaches are warning signals caused by physical problems. The remaining 95 percent of headaches are primary headaches, such as tension, migraine or cervicogenic headaches. These types of headaches are not caused by disease; the headache itself is the primary concern.

Three Kinds of Primary Headaches

  • Contrary to popular belief, a migraine is not just a bad headache. It is an extremely incapacitating collection of neurological symptoms that usually includes a severe throbbing recurring pain on one side of the head and is often accompanied by nausea, vomiting and extreme sensitivity to light and sound.
  • Tension-type headaches are the most common form of headache, occurring in about three quarters of the general population. Tension headaches are usually described as a pain that feels like a tight band around your head or a weight on top of it. Your neck or shoulder muscles may hurt along with this type of headache.
  • A cervicogenic headache starts in the cervical spine – your neck. Sometimes these headaches mimic migraine headache symptoms. Initially pain may begin intermittently, spread to one side of the head, and become almost continuous. Pain can be exacerbated by neck movement or a particular neck position.

Headaches are a pain in the neck!
Most headaches are associated with muscle tension in the neck. Today, Americans engage in more sedentary activities than in the past, and more hours are spent in one fixed position or posture (such as sitting in front of a computer), that can increase joint irritation and muscle tension in the neck, upper back and scalp, causing your head to ache.

What can you do to help head-off a headache?

  • If you spend a large amount of time in one fixed position, such as in front of a computer, typing or reading, take a break and stretch every 30 minutes to one hour. The stretches should take your head and neck through a comfortable range of motion.
  • Low-impact exercise may help relieve the pain associated with primary headaches. However, if you are prone to dull, throbbing headaches, avoid heavy exercise. Engage in such activities as walking and low-impact aerobics.
  • Avoid teeth clenching. The upper teeth should never touch the lowers, except when swallowing. This results in stress at the temporomandibular joints (TMJ) – the two joints that connect your jaw to your skull – leading to TMJ irritation and a form of tension headaches.
  • Drink at least eight 8-ounce glasses of water a day to help avoid dehydration, which can lead to headaches.

Headaches and chiropractic care go hand-in-hand. While chiropractic care is not necessarily an option for treating allof these types of headaches, it is a great option for preventing future headaches. With regular adjustments, chiropractic patients can maintain proper spinal health and slow or stagnate the buildup of muscle tension. In addition to spinal manipulation, doctors of chiropractic can provide patients with exercises and nutritional advice that they can benefit from as well as tips to practice better overall posture.

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