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51. Legal and Ethical Issues in Integrative Pain Management.

Author

Richeimer, Steven, Audette, Joseph F., Bailey, Allison, and Cohen, Michael H.

Abstract

Use of complementary and alternative medical (CAM) therapies (such as acupuncture and traditional oriental medicine, chiropractic, herbal medicine, massage therapy, and mind-body therapies such as hypnotherapy and guided imagery) may be more common in pain management as compared with other clinical specialties, because of medical recognition that pain has psychological (and perhaps even spiritual) and physical dimensions. Nonetheless, the integration of CAM therapies into pain management raises legal issues for clinicians who may be initiating delivery of CAM therapies, referring patients to CAM providers, or simply responding to patient requests concerning specific CAM modalities. This review addresses some of the key legal issues and liability risk management strategies that may be helpful in integrative pain management. [ABSTRACT FROM AUTHOR]

Published
2008
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54. Hypothalamus and amygdala response to acupuncture stimuli in carpal tunnel syndrome

Author

Napadow, Vitaly J., Kettner, N., Liu, J., Li, M., Kwong, Kenneth Kin Man, Vangel, Mark G., Makris, Nikolaos, Audette, Joseph F., and Hui, K. K.S.

Abstract

Brain processing of acupuncture stimuli in chronic neuropathic pain patients may underlie its beneficial effects. We used fMRI to evaluate verum and sham acupuncture stimulation at acupoint LI-4 in Carpal Tunnel Syndrome (CTS) patients and healthy controls (HC). CTS patients were retested after 5 weeks of acupuncture therapy. Thus, we investigated both the short-term brain response to acupuncture stimulation, as well as the influence of longer-term acupuncture therapy effects on this short-term response. CTS patients responded to verum acupuncture with greater activation in the hypothalamus and deactivation in the amygdala as compared to HC, controlling for the non-specific effects of sham acupuncture. A similar difference was found between CTS patients at baseline and after acupuncture therapy. For baseline CTS patients responding to verum acupuncture, functional connectivity was found between the hypothalamus and amygdala – the less deactivation in the amygdala, the greater the activation in the hypothalamus, and vice versa. Furthermore, hypothalamic response correlated positively with the degree of maladaptive cortical plasticity in CTS patients (inter-digit separation distance). This is the first evidence suggesting that chronic pain patients respond to acupuncture differently than HC, through a coordinated limbic network including the hypothalamus and amygdala.

Published
2007
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77. List of Contributors

Author

Alleyne, Julia, Amy, Eduardo, Audette, Joseph F., Bachl, Norbert, Bailey, Allison, Baron, Ramon, Bergfeld, Deborah A., Borg-Stein, Joanne, Burry, Andrea, Cantu, Robert C., Cantu, Robert V., Chan, Kai-Ming, Chang, David S., Chang, Joseph Jeremy Hsi-Tse, Corrado, Gian, Correa, José, Crandell, David M., Derman, Wayne E., De Rose, Eduardo H., d'Hemecourt, Pierre A., Dugan, Sheila A., Earp, Brandon E., Ergen, Emin, Fagnani, Federica, Fields, Karl B., Frontera, Walter R., Gerbino, Peter, Giombini, Arrigo, Herring, Stanley A., Hyman, Jeff, Kennedy, Robert, Kibler, W. Ben, Kocher, Mininder S., Krabak, Brian J., Lennard, Ted A., Mandelbaum, Bert R., Martinez-Silvestrini, Julio A., Micheli, Lyle J., Micheo, William, Nielson, Jason H., Parisi, Attilio, Pigozzi, Fabio, Press, Joel M., Proctor, Mark R., Rizzo, Thomas D., Jr, Shephard, Roy J., Silver, Julie K., Simons, Stephen M., Smekal, Gerhard, Solomon, Jennifer L., Standaert, Christopher J., Tucker, Rachael, Ulkar, Bülent, Waite, Brandee, Walker, Katherine M., Waters, Peter M., Weiss, Jennifer M., Wicker, Anton, Wong, Fiona Chui-Yan, Zetaruk, Merrilee, and Zimmerman, Jerrad

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