a physiological response that decreases sympathetic tone. Ba-sically, it’s when a patient walks into the doctor’s office, and instead of feeling nervous, they feel relaxed! This gives the therapist an advantage because the sympathetic nervous sys-tem, which is active during pain and times of anxiety, becomes submissive when actual relaxation occurs in the mind and body. For example, when a patient with post-traumatic stress disorder walks into my clinic and is greeted by Nitro, our nine-pound toy poodle therapy dog, a physiological transformation takes place within the patient’s body. Dr. David Neuman, MD, who studies the meaning response, says, “A neurohumoral reaction takes place in response to the patients’ surroundings when they perceive and infuse meaning in activities around them that impact their brain.” This neurohumoral reaction sees the release of endorphins flood pleasure centres in the brain. This causes a relaxation reflex in the arteries of the central and peripheral circulatory systems, which provide oxygen-rich blood to neuromusculo-skeletal tissues. Because this is a reflexive response, the patient subconsciously breaks the psychological and physiological cycle of pain – and this makes the body more receptive to the treatment they are about to receive. The following list was presented by Walach and Jonas in their paper, “Placebo research: The evidence base for harness-ing self-healing capacities”: safety, expectation and understand-ing; familiarity; and simplicity. These methods have been dem-onstrated in the medical literature as effective for enhancing healing responses to treament: Safety “The desire for safety stands against every great and noble enterprise.” – Tacitus Walach and Jonas feel that safety, in the presence of aid or the expression of care and concern, is the most fundamental ele-ment necessary for a positive meaning response. I try to in-corporate these elements through a variety of mandatory office protocols. I make it a point for my staff to contact every new patient the day after their first visit to my office. We provide a phone call asking the patient how they are doing, and reassur-ing them that having post-treatment soreness is not uncom-mon. Then we ask them if they have any questions for us. In addition, I often personally call patients at home in the eve-nings if earlier that day they presented with an acute injury. Patients appreciate these follow-up calls because it makes them feel special. Their busy chiropractor’s office is taking time out of their day to call them because they are concerned about their health. This promotes a feeling of safety, security and confi-dence in their decision to choose your clinic. Expectation and Understanding “The improvement of understanding is for two ends: first, our own increase of knowledge; secondly, to enable us to deliver that knowledge to others.” – John Locke Newman (2009) recommends that we provide experience-ori-ented interventions that allow patients to expect a resolution to 28 • CANADIAN CHIROPRACTOR | JUNE 2013 the problem, as they understand it. Basically, if our patients can see tangible changes in their condition, and if you can explain those changes in terms they understand, they will get better faster. For example, using a functional assessment approach that demonstrates muscle weakness or imbalance is something that lets patients see, feel, compare, and understand the difference in their own way. They are likely unable to interpret an EMG or an X-ray but they can sure tell if the gluteus maximus on the left is weaker than the one on the right. Then using an inter-vention to restore the muscle strength is a tangible result that provides a positive meaning response to the patient, validating their presence in your office and offering hope for the future. Familiarity “The familiar is by far the most beautiful.” – Marty Rubin In the past five years, hospitals and clinics in the United States that focus on treating heart disease have made it a priority to create a positive non-clinical surrounding called a milieu, which is the French word for environment. Applying therapies in a therapeutic setting where the milieu mirrors a comfort-able space, as opposed to in a traditional clinical setting, will elevate the meaning response (Walach 2004). I make an effort to do this from the moment patients walk in my door. The reception area is furnished with comfortable couches, lounge chairs and contemporary seating, which gives them the feel of their own living room as opposed to a doctor’s office. I make sure that no clocks are present so that they can focus on relax-ing as they watch a flat-screen TV play educational videos of my staff and me demonstrating all of the treatments offered at the clinic. This reduces their anxiety about acupuncture, manipulation and massage therapy. In addition to all this, our therapy dog, Nitro, greets patients in the reception area during their visit. Simplicity “If you can’t explain it simply, you don’t know it well enough.” – Albert Einstein Philips is a company that makes automated external defibrilla-tors (AEDs). In their promotional video they demonstrate how easy their product is to use by simply reading the directions to five-year-olds, who attach the leads to mannequins correctly – every time. At times, we are so wrapped up in our technical backgrounds that we do not learn to deliver explanations in terms others can understand. Making things simple is not always easy, but the better you can explain things to your patients, the better they will respond to your treatments (Jonas 2004). Chiropractors should get into the habit of explaining con-cepts such as degenerative arthritis, rotator cuff tears and disc bulges in a way that breaks down these concepts to a level that an eighth-grade student would understand. If a patient has a better idea regarding how the treatment works, they will have a greater neurohumoral response to the intervention (Walach, 2004). www.canadianchiropractor.ca
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