Seminars in Integrative Medicine最新文献

Failed back surgery syndrome (FBSS) represents a distinct subpopulation of patients with refractory and disabling pain symptoms. Traditional treatment options of drugs and surgery have limited success. Constant application of permanent static magnets with 20-mm penetration has statistically reduced neuropathic pain in carpal tunnel syndrome and diabetic peripheral neuropathy. The aim of this study was to determine the efficacy of simultaneous permanent magnetic exposure to the back and feet (350 gauss and 450 gauss, respectively) over a 2-month period for the treatment of neuropathic pain compared to similar sham devices. This was a randomized, placebo-controlled trial of 17 patients with FBSS at two sites. Etiology for FBSS included herniated disks, spinal stenosis, epidural fibrosis, spinal instability, spondylolisthesis, and fusion failure. Baseline Visual Analog Scores (VAS 0-10) of neuropathic pain and sleep disturbance were compared at 1- and 2-month intervals for statistical changes. Sixteen patients completed this 2-month study. One patient dropped out during the first month. There was no statistical reduction in VAS scores for neuropathic pain or sleep. There were no safety issues. Simultaneous and constant exposure of weak, permanent magnets to the feet and back were ineffective in reducing neuropathic pain. Static magnetic fields need to penetrate 5 to 7 cm to address neuropathic pain from FBSS. Unfortunately, information regarding field decay from the surface of the magnet is rarely supplied by the vendors of such devices.

Researchers often use the term “sensitivity ” when theorizing that certain persons may be more readily affected by various influences than others. Through a review of the literature, it is argued that some individuals are disposed toward a range of sensitivities that, in novelty as well as intensity, distinguish them from the general population. The author cites evidence indicating that such persons exhibit greater susceptibility to a range of environmental factors including allergies, migraine headache, chronic pain, and chronic fatigue. Their immediate family members appear to be similarly affected. Additionally, these “sensitive” individuals report a high degree of anomalous perception. While no single factor in a person’s background is likely to distinguish him/her as sensitive, eight demographic or personality factors are found to be significant.

Coding for integrative medical services has a profound impact on serving the clients and constituencies that seek these services. Gaps in the Current Procedural Terminology (CPT) code set for complementary and alternative medicine (CAM) procedures are of significant concern. The comprehensive coverage and precision required for accurate communication of the provider/patient encounter is not available under the current CPT system. Lack of representation by certain licensed CAM professions on CPT panels and committees has been a factor. The ABC code set for CAM procedures developed by Alternative Link, Inc (“AltLink”), while an important effort to address this identified need, introduced a new set of concerns, including uncertain effects from coding integrative services through a separate code set. (1) There are significant gaps in available code sets that hinder the proper reporting, and indeed practice, of integrative and CAM therapies. (2) Difficulties in coding arise not merely from an absence of codes for many CAM procedures but from the guidelines, structure, and application of codes to health information infrastructure such as the determination of Relative Value Unit scales. (3) The development of codes that properly describe CAM services therefore requires representation by the professional associations whose members deliver this care.