Posts by: Patrick van Dun

Chronic pain is common and has a substantial impact on individuals’ lives and the society in which they live. However, current strategies for managing chronic pain have low to moderate efficacy. We present a complexity informed model of managing chronic pain.

The authors propose that the biological, psychological and social factors influencing the experience of chronic pain can be framed as elements of a complex system (when ‘system’ is understood as a mental model of a set of relationships in the world) and discuss the advantages of this approach.

The ‘Learning Cycles’ framework of Human Learning Systems is suggested as an appropriate approach to managing chronic pain. There are five elements of the Learning Cycle; ‘understanding the system’, ‘co-design’, ‘experimentation exploration’, ‘embedding and influencing’ and ‘system stewardship’. The authors describe how this could be implemented in osteopathic practice.

The implications of a complexity approach with respect to evidence-informed as opposed to evidence-based practice is briefly discussed. Further, the opportunity for osteopathy to be at the vanguard of broader movement for change in public service and healthcare is highlighted.

Applying Learning Cycles to the context of managing chronic pain requires further research to explore its utility. Learning Cycles provide an action-research model that would supply the rich data by which to understand the efficacy of chronic pain management … ABSTRACT

Osteopathic Manipulative Treatment (OMT) is a therapeutic whole-body approach mainly focused on correcting somatic dysfunctions. The aim of this scoping review is to systematically map the literature regarding the documented biological effects observed following OMT … MORE

The sphenopalatine (pterygopalatine) ganglion (SPG) is the most superficial ganglia to manipulate from the oral cavity. It has parasympathetic and sensory fibers directly affecting the paranasal sinuses as well as the palatine, nasal, pharyngeal, and lacrimal glands. The SPG can be manipulated intraorally by students and physicians utilizing osteopathic manipulative treatment (OMT) to relieve congestion associated with sinusitis, allergies, headaches, and upper respiratory infections. Within osteopathic medical education programs, students have anecdotally had difficulty identifying this ganglion due to its deep anatomic location and lack of direct visualization. In this article, we discuss that cadaveric dissection with a superficial to deep approach to the SPG has the ability to allow medical students and physicians to better understand the three-dimensional location and osteopathic clinical relevance of this ganglion … MORE

Reports on autonomic responses to transcutaneous auricular vagus nerve stimulation (taVNS) and osteopathic manipulative techniques have been equivocal, partly due to inconsistent interpretation of heart rate variability (HRV). We developed a mechanistic framework for the interpretation of HRV based on a model of sinus node automaticity that considers autonomic effects on Phase 3 repolarization and Phase 4 depolarization of the sinoatrial action potential. The model was applied to HRV parameters calculated from ECG recordings (healthy adult humans, both genders) before (30 min), during (15 min), and after (30 min) a time control intervention (rest, n = 23), taVNS (10 Hz, 300 μs, 1–2 mA, cymba concha, left ear, n = 12), or occipitoatlantal decompression (OA‐D, n = 14). The experimental protocol was repeated on 3 consecutive days. The model simulation revealed that low frequency (LF) HRV best predicts sympathetic tone when calculated from heart rate time series, while high frequency (HF) HRV best predicts parasympathetic tone when calculated from heart period time series. Applying our model to the HRV responses to taVNS and OA‐D, revealed that taVNS increases cardiac parasympathetic tone, while OA‐D elicits a mild decrease in cardiac sympathetic tone … MORE

Chronic low back pain (CLBP) has long plagued mankind, but little progress has been made in finding a rational and effective treatment, let alone a common cause. This study is an attempt to fill that void by measuring short- and long-term effects of osteopathic manipulative treatment (OMT), including psychosocial and pain reduction in CLBP patients. The objectives of this study were to investigate the effectiveness of neuromusculoskeletal medicine/osteopathic manipulative medicine (OMM) in treating CLBP, with a focus on biopsychosocial (pain sensitivity questionnaire [PSQ]) and pain control in chronic conditions … MORE

The objective of this prospective study is to evaluate the maternal-fetal hemodynamic effects after osteopathic manipulative treatment by measuring vital signs and Doppler velocimetry in third-trimester pregnant women … MORE