COMMENTARY PROFESSIONAL IDENTITY Chiropractic and chronic pain W Perspective on the evolving identity of the profession BY LE GROUPE AXIS hat chiropractic used to be might be quite different from what it has become and these changes may not necessarily be in the best interest of patients. Spanning over a century, chiropractic history was originally rooted in the observation that the spine and the related nervous system were somewhat in-volved in the health and well-being of the individual. It is said that this science was discovered when a deaf man re-covered his hearing following the reduction (adjustment) of a bump on his spine. While trying to explain this outcome with the knowledge of the time, an understanding would emerge where the nervous system was recognized as the mediator between the mind, the body and the environment. Interferences within this mediation could result in a less than optimal expression of health: a “dis-eased” state. According to the 19th century perspective, the nerves were thought to carry nerve impulses, from the brain to the body. They were largely responsible for the cellular and organic expression of life. This notion was related to vital-ism. Therefore, the chiropractor was to analyse the spine so as to localise spinal misalignments that could signifi-cantly interfere with nerve transmission. The primary goal was to correct these interferences in order to restore or improve health. This basic understanding, as well as the outcomes asso-ciated with this new application would, in the next century, elevate the chiropractic profession to one of the top three primary health-care professions in the world. This expo-nential growth came essentially via word-of-mouth. The profession was never bankrolled by outside industries. It stood on its own merit. Its success has been self-evident throughout its history. The effectiveness of spinal manip-ulation could no longer be questioned. At the same time, the rationale as to its mechanism of action did and will evolve as we gain a better understanding of the physiolog-ical processes behind its associated and diversified outcomes. The principle was simple, if your condition were any-where related to spinal misalignment (vertebral LE GROUPE AXIS is a think-tank focused on the future and practice of the chiropractic profession. The council brings together six chiropractic practitioners combining more than 200 years of clinical experience: Dr. Charles Allyson (PCC); Dr. Daniel Charland (PCC); Dr. André Lajoie (PCC); Dr. Richard Morency (CMCC); Dr. Louis-Philippe Morin (PCC); Dr. Pierre Paillé (PCC). Email them at [email protected]. 24 Canadian Chiropractor September 2017 subluxation), we could likely make you better. This “bet-ter” was not only related to the reduction of pain but, above all, to the improvement of nerve transmission and the ensuing enhancement in tissue, organ or cellular functions. Hence, the chiropractor was not treating pain but correct-ing spinal misalignment. Chiropractic patients are often afflicted with conditions that have evolved through time. Most present themselves with chronic conditions, which have been lasting or recur-ring for over three months. An essential distinction has to be made here. Pain from a chronic condition is distinct from, what is defined today as “chronic pain.” “Chronic pain can be a disease in itself. Chronic pain has a distinct pathology, causing changes throughout the nervous system that often worsen over time. It has signif-icant psychological and cognitive correlates and can con-stitute a serious, separate disease entity,” according to the U.S. National Academy of Medicine. One definitive characteristic of chronic pain is the per-sistence of pain despite healing of the injury and in some cases, without an initial injury. Chronic pain is a diagnosis as opposed to pain, the symptom. People afflicted with chronic pain do not represent the typical profile of those seeking chiropractic care. This distinction is fundamental and seems to escape some chiropractic institutions. Some of our fellow students are being taught an insidious paradigm where patients suffering from a chronic condition and those afflicted by chronic pain are presented as one of the same. Conven-iently, this perspective uses chronic pain’s scientific litera-ture in an attempt to dismiss the consistent and consider-able benefit of conventional chiropractic care. This behaviour is utterly irresponsible and is driving a potentially lethal blow to the profession. The pain symptom has become the main motive for intervention as opposed to a motive for consultation. We have moved from a well-ness professional to pain neutralizer therapist. This new goal is being promoted by the application of a 1 to 10 scale to objectify pain as the foremost measure of therapeutic efficiency. Pain is no longer a purely virtual signal. It is like marketing a new smoke detector with a volume control, as if the noise, not the fire, is the problem or nuisance. In this pain scenario, we are invited to co-manage the patient with all those who share, in this new age of enlight-enment, the new paradigm: “pain as nuisance”. ‘Therapeutic teams” shall do their mutual best to disrupt the pain signal, blinded to its cause and to the lasting and disturbing consequences of their actions on the patient’s www.canadianchiropractor.ca
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