5 Potentially Deadly Pains You Should Never Ignore

by All American Healthcare Comments Off on 5 Potentially Deadly Pains You Should Never Ignore

Nearly everyone experiences a headache or leg cramp on occasion.  Typically, these and other seemingly minor pains are waited out or treated with over-the-counter medicine. But when do these aches warrant a visit to the doctor’s office, or even hospital?

March 24, 2015 – Article TODAY Health by Kyung Kim

Emergency room physician Leigh Vinocur paid TODAY a visit on Thursday to explain five different pains that could be symptoms of serious conditions, and when they require immediate medical attention.  A good rule of thumb? “Trust your gut,” Vinocur said. “People have a sense that this isn’t the usual ache and pains.”

1. Leg or calf pain

Could be: Deep vein thrombosis, a blood clot in a leg vein

People at risk for Deep Vein Thrombosis, or DVT, include recent surgery patients, anyone on bed rest or women on birth control. The condition is sometimes called “economy class syndrome” because it affects car or plane travelers who have been sitting long hours in cramped spaces.

If you have a pain in your leg that feels different than a cramp, “get to the emergency room,” Vinocur said. “They will do ultrasounds. If it’s positive, they’ll give you blood thinners because we don’t want the clot to travel to your lungs and cause pulmonary embolism.”

2. Severe upper back pain

Could be: Aortic dissection, a tiny tear in the aorta that allows the blood to create a false passage

“People will describe it as a ‘tearing pain’ and they’re incapacitated,” Vinocur said of the severe pain that may be a sign of aortic dissection, or a small tear in the aorta.

People at risk for aortic dissection include those who already suffer from high blood pressure or connective tissue disease like Marfan’s syndrome. An aortic dissection can close off branching arteries, and may cause a stroke, paralysis or kidney failure.

3. Severe abdominal pain

Could be: Ruptured ectopic pregnancy

An ectopic pregnancy is one that has settled outside of the womb. If it ruptures, it can cause severe bleeding in the abdomen. Women at risk include for a ruptured ectopic pregnancy include those on birth control, individuals with tube scarring from sexual transmitted diseases, and those under going fertility treatments.

“No birth control is 100 percent,” Vinocur said. That’s why any woman of child bearing age who comes into the emergency room with abdominal pain will get a pregnancy test, she said.

4. Severe dental pain

Could be: Ludwig’s angina, a tooth abscess that has traveled down your neck.

Severe pain that spreads from your mouth to your neck could be the sign of Ludwig’s angina, an infection on the floor of your mouth that spreads down your neck. “You notice your neck is getting swollen, the skin looks red, your voice sounds funny, you’re drooling because you can’t swallow your own saliva, it can actually track down to your airway and cause airway obstruction” Vinocur said, adding: “Don’t let a tooth ache get that bad.”

5. Severe headache

Could be: A bleeding stroke

A headache that could indicate a bleeding stroke, Vinocur said, will be a “thunderclap headache,” or a headache that is both sudden and severe, reaching maximum intensity within seconds or minutes. “Suddenly people know something is wrong,” she said. “They’re grabbing their head, rolling on the ground. They can be unconscious.”

Typically, there is a family history of bleeding strokes. But other conditions including severe high blood pressure can also lead to the condition.

 

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All American Healthcare5 Potentially Deadly Pains You Should Never Ignore

Conservative Care First: Spinal Manipulation, Not Medication

by All American Healthcare Comments Off on Conservative Care First: Spinal Manipulation, Not Medication
Medical staff at All American Healthcare holding clipboard and making notes in patient file

All American Healthcare Doctor Holding Clipboard

Article by Christina Acampora in ACA News.  CHRONIC LOWER-BACK PAIN. For chiropractors it’s an area in which our services shine and that contributes to our strong rates of patient satisfaction. Chronic lower-back pain is one condition that can open doors for chiropractic physicians within the medical community, as it is lacking conservative care treatment options.

Guidelines have been established to manage nonspecific chronic back pain with a focus on medication as a first choice option.1,2 Some of these guidelines are based on traditional standards of care and reasonableness, concluding that they may have an impact on pain for the better, but often lack scientific evidence to support this claim. The recent Lancet study on the lack of efficacy of paracetamol, discussed below, provides a perfect example.

While chiropractic manipulation is commonly listed as a reasonable course of care and suggested in the Journal of the American Medical Association’s (JAMA) patient handout as a valid treatment option,3 it is still highly underutilized. Most MDs continue to focus on prescription medications as the starting point of pain management, with limited consideration of chiropractic referrals.

In an effort to help increase patient access to chiropractic services and improve understanding of where chiropractic can be utilized alongside of, or in place of medication, the following review provides some talking points for your next conversation with an MD.

Common Pharmaceutical Interventions PARACETAMOL: The most recently published data for paracetamol considered acute back pain, finding that paracetamol made no impact on pain, disability and several other outcomes compared with placebo.4 Thus, the authors have called into question the reasonableness of prescribing paracetamol for acute back pain. Findings are scarce for paracetamol use on its own to treat chronic pain.

NSAIDS: A 2008 Cochrane systematic review of nonsteroidal anti-inflammatory drugs (NSAIDs) for back pain indicated that NSAIDs performed only marginally better than paracetamol for controlling back pain but had significantly more side effects.5 In 2007, the American Heart Association published a scientific statement warning against chronic use of NSAIDs for pain in patients with, or at risk of, cardiovascular conditions.6 A 2010 Danish study supported these findings,7 and this warning has now encompassed over-the-counter versions as well. Thus, limiting the reliance on these medications is of clinical concern.

Studies that compared manipulation with NSAIDs or featured NSAIDs and manipulation as primary treatments often show a benefit in favor of manipulation without the risk of adverse symptoms. Manipulation instead of, or alongside, NSAIDs could help limit the need and reliance upon NSAIDs.

MUSCLE RELAXANTS: A 2007 systematic review of medications found muscle relaxants useful for acute lower-back pain in the short term.8 A 2003 Cochrane review concluded: “Muscle relaxants are effective in the management of nonspecific low-back pain, but the adverse effects require that they be used with caution.”9 There are multiple chiropractic therapies and strategies for managing the muscular aspects of back pain.

OPIOIDS: It’s postulated that restrictions in health care benefits, the FDA’s 2007 decision to deny marketing approval for the COX-2 inhibitor etoricoxib and reduced access for non-pharmacological treatments helped contribute to an alarming rise in opioid prescriptions. The growing documentation in lawsuits against the pharmaceutical companies marketing these medications argue the benefits have been overstated, while serious risks have been minimized, and that opioids are not approved for general pain management for common non-cancer chronic pain like back pain, arthritis and headaches.10,11 Specialists conclude that because much pain management takes place in MDs’ primary care offices where a significant rise in opioid prescriptions has been noted, more education is needed to properly advise these physicians on the safety and proper use of opioids.12

Simply stated, opioids are not conservative care. It would make sense to provide a short-term trial of manipulation prior to opioid prescriptions.

Looking Ahead

Conversing with MDs on safety and the side effects of medications will likely lead to a similar discussion on manipulation. The American Pain Society’s Clinical Guideline for the Evaluation and Management of Low Back Pain states that for manipulation, “including data from observational studies, the estimated risk for serious adverse events was lower than one per 1 million patient visits.”13

Finally, many surgical specialists remark that a majority of presenting patients are not surgical candidates nor have they had adequate courses of conservative care. It’s interesting to note that health plans such as the one for the University of Pittsburgh Medical School now mandate a course of manipulation for back pain prior to the authorization of surgical intervention.14

The causes of back pain are multifactorial, and there are opportunities to pursue other approaches as shown in a Cochrane review on low-back pain,15 but chiropractors are certainly a sensible starting point for conservative care. It will take proper collaboration and sound clinical advances among conservative care algorithms that must include spinal manipulation if we wish to see a positive change in the outcomes associated with nonspecific back pain.

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All American HealthcareConservative Care First: Spinal Manipulation, Not Medication