functional capacity

[Guest guest]

, " alon marcus " <alonmarcus@w...>

wrote:

if we are to study painful

> > disorders than i would like to see functional capacity studied as it is more

> > objective. For example, if we can show a higher return to work in work

comp

> > population that is an objective parameter and very significant finding.

 

this is a very important point. So I would turn Brian's question around. If a

patient reports decreased pain, but no gain in function, then what has changed.

I think Brian assumed I was talking about some blood level one could measure

for pain. While it is vital that the patient perceive less pain, I think if two

patients report less pain, it is more accurate to assess orthopedic tests, ROM

tests, medication changes and return to normal activities. Verbal reports of

changes in pain, whether scaled or not, are completely inaccurate. A visual

analog scale is better and a questionnaire better still. But functional

assessments supposedly have the highest correlation with successful long

term recovery. I do not know what type of assessments were used in the

german study, but something gave me the impression they were pain

questionnaires. but Alon is right. Even under the best of circumstances, the

subjective study of pain is not where we want to stake our claims.

 

I think it would be valuable to measure some kind of changes that occur during

pain treatment such as on an fMRI and see if the same changes occur with

differing or sham treatments. Early fMRI work seems to show some

specificity in point function. In other words, some points activate particular

parts of the brain and not others. The areas of activation seem to relate

known point functions with known areas of brain control. In other words, the

visual cortex becomes active when stimulating points for the eyes. See

neuroacupuncture from qpuncture.com for more details (nice book, BTW).

 

If this is true, one wonders whether the sham points were any body points or

were they close to the actual body points used in the " real " group. It may be

that acupuncture function is specific to general areas, if not precise points.

In other words, not much difference between HT 5,6,7, but a big difference

between HT 5 and SP2, for example. That is a lot different than a total sham.

Especially with pain, often needling anywhere on the affected channel will

have affects, whether an actual point or not.

 

Also by tracking the treatments with fMRI's, we can see if one generalized

thing is going on or different pathways are leading to the same overall effect

on physiology. For example, it is hard to believe that a strongly local TCM

style treatment elicits the same brain response as a japanese five phase

treatment that uses only distal points with light stimulation. If acupuncture

is a placebo, then the fMRI should be the same in all patients with the same

disease regardless of points chosen.

 

But let's say that a local treatment works by improving local circulation,

relaxing local spasm and reducing local inflammation. Let's say the distal

treatment works on higher level neuroendocrine control mechanisms. At the

end of the treatment, I could see how both sets of pathways could lead to a

decreased perception of pain. The fMRI would show that the needles had

activated different parts of the brain. And perhaps a sham acupuncture

treatment would show a third difference. This would prove real physiological

changes occur that can explain sx relief. And while sham tx may get equal

short term relief, we ened to do long trm followup and see what holds. I

suspect " real " treatments have lasting effects.