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Vital Resource Vital Resource for Medical-Legal for Medical SOLUTIONS M EDICAL C ONSULTANTS October 2004 Volume 5, Issue 3 AURICULAR CONDUCTIVITY MEASUREMENTS FOR CHRONIC PAIN By Peter Chase, DDS; Paula Spaight, BS, RDH, L.AC.; K. Megan Scott, Ph. D; and Benedict Messana, MD pathology by detecting low skin resistance in corresponding INTRODUCTION somatotopic points in the ear. (2) The overall purpose of this study is to evaluate Auricu-lotherapy as a tool for clinical diagnosis in the setting of a Within the setting of the Chronic Orofacial Pain Clinic at the chronic orofacial pain referral center. Since auricular diagno- University of the Pacific (UOP) Dental School, we intend to sis and treatment are not yet mainstream clinical tools, we evaluate this methodology in a controlled manner. Our ap-evaluate our initial level of interobserver reliability using this proach to patient care requires that more than one examiner be skin conductivity measuring device (Stimflex 400A). capable of carrying out an auricular diagnostic protocol. There-fore, we intend to perform the study with two examiners carrying STUDY OBJECTIVE out all measurements on each study subject (see Materials & Part I: To determine how consistently two observers using Methods section). Since this adds an additional variable to the written guidelines obtain equivalent measurements from the data collection, we intend to perform the study in two parts. Part same ...

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• Publié par: Cipot
• Nombre de lectures: 85
• Langue: English

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M E D I C A L C O N S U L T A N T S

VitalResource forMedical-Legal SOLUTIONS

October 2004 Volume 5, Issue3

AURICULAR CONDUCTIVITY MEASUREMENTS FOR CHRONIC PAIN By Peter Chase, DDS;Paula Spaight, BS, RDH, L.AC.; K. Megan Scott, Ph. D; and Benedict Messana, MD

INTRODUCTION pathology by detecting low skin resistance in corresponding somatotopic points in the ear. (2) The overall purpose of this study is to evaluate Auricu lotherapy as a tool for clinical diagnosis in the setting of aWithin the setting of the Chronic Orofacial Pain Clinic at the chronic orofacial pain referral center.Since auricular diagnoUniversity of the Pacific (UOP) Dental School, we intend to sis and treatment are not yet mainstream clinical tools, weevaluate this methodology in a controlled manner.Our ap evaluate our initial level of interobserver reliability using thisproach to patient care requires that more than one examiner be skin conductivity measuring device (Stimflex 400A). capable of carrying out an auricular diagnostic protocol.There fore, we intend to perform the study with two examiners carrying STUDY OBJECTIVE out all measurements on each study subject (see Materials & Part I:determine how consistently two observers using To Methods section).Since this adds an additional variable to the written guidelines obtain equivalent measurements from the data collection, we intend to perform the study in two parts.Part same subjects, at the same time using one measuring de I will compare the findings of two different observers who will vice. Traditionalfull body acupuncture uses 14 different en take conductivity measurements from the same subjects at the ergy channels located from the top of the head to the tip of same time.Once a satisfactory level of interrater reliability can the toes in order to access the entire body and all of its var be established, Part II will examine diagnostic accuracy and ied systems.Auriculoacupuncture, considered to be a mi consistency of this method.Based on our findings, we may crosystem or subset within the overall realm of acupuncture, include auricular diagnostic techniques to our existing patient includes the disciplines of auricular diagnostics and thera evaluation approach.Any additional tool would be most wel peutics. Withinthis subsystem, the entire somatotopic map come in the clinical approach to chronic pain. of the body is represented by the image of an inverted fetus on each ear, in an “auricular homunculus” of sorts.Each MATERIALS & METHODS pinna is felt to contain all of the somatotopic contact points Thirtynine volunteer subjects were selected from the Chronic from the ipsilateral half of the body.Thus, the right handOrofacial Pain Clinic, from would be accessible through the right pinna, the left legthe dental student popula INSIDE THIS ISSUE: through the left pinna, etc.The location of these somation and from staff and totopic points upon the ear are reportedly consistent fromfaculty at UOP School of Consultant Pr one individual to the next.Dentistry. Subjectswere ofile 3 entered into the study as a Several prior studies have concluded that when there is convenience sample.Sub painful pathology in a specific part of the body, the corre We Feel Your Pain 3 ject ages ranged from 23 to sponding somatotopic ear point will exhibit lowered resis 57 and averaged 33 years. tance (increased conductivity) and is said to be “reactive” compared to the surrounding skin. (1)For example, a pa Bromley in Athens 3 There were 13 females and 26 males.All volunteers tient with traumatic left wrist pain would have increased skin provided signed statements conductivity at the corresponding wrist point in the left pinna. New Consultants 4 of informed consent. This would manifest as a low skin resistance measurement (< 4 meg ohm) and be considered a “reactive” auricularA standardized self point. This point may also exhibit localized tenderness in thereport questionnaire was Insert Affiliate Partners/ same patient.It is reported that by using this methodology incompleted by all subjects. Macro-Pro a double blinded fashion, an examiner can localize existingThe report indicated the specialistexperienceservices © 2004 All Rights Reserved

M E D I C A L C O N S U L T A N T S in the same locations (based on map) and with same technique AURICULAR CONDUCTIVITY ( CONT.) as the other.The subject‘s ear skin was pulled slightly taut and the point of greatest increase in skin conductivity, demon subject’s age, gender and the presence or absence of pain in strated by the greatest deflection in analog resistance meter. specific parts of the body.For the purposes of this study, six That point was numerically entered in subject record as a value areas of the body were considered: Thumb, Hand, Wrist, Fore between 0 – 9 meg ohm.A value between 0 – 4 meg ohm was arm, Elbow and Shoulder.These six (6) areas correspond to considered “reactive” (lowered resistance, increased conductiv the 6 somatotopic points in each ear that would subsequently ity) and a reading 5 – 9 considered “nonreactive”. Noelectri have electrical conductivity measurements taken by study ex cal stimulation was performed.The examiners were blinded to aminers. Inthis study, no medical history was taken other than clinical questionnaire information until after conductivity meas the questionnaire and no physical exam performed besides urements were taken.A complete set of data points was col auricular conductivity measurements. lected on 39 subjects, resulting in 468 total data points (12 x  Torecord data, a separate, 39). Toenable more meaningful two page form was used for each comparison, each observer’s nu subject, one for each examiner. merical reading was converted as Each page required entry of 12 follows: O – 4 = “reactive” or data points by each examiner, six “treatable”; 5– 9 = “nonreactive” points on each ear.With two or “nontreatable”.For each data examiners collecting data on point measured, the two observers each subject, there were 24 data either: agreed(both reactive or points taken for each of 39 sub both nonreactive), or disagreed jects in the project. (one reactive & one nonreactive). The emphasis in this Part RESULTS: Thetwo observers (one) of the study is placed on were in agreement for 304 of 468 interobserver reliability.We de data points.That is, in 64.9% or in liberately chose two observers approximately 2 out of every 3 data (PS & KMS) with different levels points measured, the two observers of experience in auricular acu agreedthe measurement was that puncture. Oneexaminer (PS) is either reactive or nonreactive (or, a licensed acupuncturist with 10+ nd treatable vs. nontreatable).In 1 out of every 3 data points years of experience.The 2(KMS) is a clinical psychologist measured, the two observersdisagreedRe: reactivevs. non and biofeedback therapist with minimal background in acu reactive. Inany given subject (with 12 data points), the level of puncture techniques. agreement between the two observers ranged from a low of  Theexact location of each auricular testing point was based 25% (1 subject)to a high of 100% (2 subjects). on somatotopic mapping illustrated in a study by Oleson, 1980. CONCLUSIONS: Usinga particular set of guidelines, the ob (1) (Figure 1). Auricularconductivity measurements were servers in this study fell short of an acceptable level of agree taken using the StimFlex 400A device by Electro Medical Inc. ment that would be expected of a measurement that is used for The device is similar to a galvanic skin resistance (GSR) bio clinical decision making.Based on our experience in this feedback instrument.The StimFlex consists of a metaltipped study, we have noted several aspects of the research protocol probe with a springloaded stylus, a source of constant 9V DC that could be modified in order to raise the interobserver reli current and an analog current meter.The metal stylus quanti ability to a clinicallyacceptable level.The possible changes to fied the amount of current flowing through ear point; it was protocol could include the following:1) develop a more regi springloaded to avoid pressureinduced changes in conductiv mented technique for measuring auricular conductivity;2) ity. Allsubjects had each of 12 data points (6 per ear) meas teach the modified technique to all clinical participants prior to ured by both observers during a single clinic visit.The subjects initiating a repeat study;3) standardize all the data collection were examined in a sitting position and had their auricular skin and recording methods; 4) study a patient population with more cleaned with alcohol prior to any measurements.Each ob pathology. server was blinded to the other’s measurements during the BIBLIOGRAPHY clinic visit.Each attempted to perform the measurements in the same locations (based on map) and with same technique 1 )Oleson, TD, et al.An experimental evaluation of auricular as the other.The subject‘s ear skin was pulled slightly taut and diagnosis: thesomatotopic mapping of musculoskeletal pain at the probe held perpendicular to the skin.A wooden tongue ear acupuncture points.Pain. 1980;8:217229. blade was placed behind the pinna for added stability.With the 2) Bergsmann,O, et al.Differences in electrical skin conduc springloaded probe compressed from 10 – 40% of spring tivity between acupuncture points and adjacent skin areas. travel distance, the probe was glided slowly over each desig American Journal of Acupuncture. 1973; 1: 2732. nated site to find blinded to the other’s measurements during the clinic visit.Each attempted to perform the measurements specialistexperienceservices

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M E D I C A L C O N S U L T A N T S C O N S U L T A N TP R O F I L E I R O P R A C T O RC H S E L E C T E DT O Eric Van Ostrand, M.D. T R E A TO L Y M P I A N SI NG R E E C E Neurologist Dr. Van Ostrand graduated with honors, Magna cum Laude from Haverford College in Pennsylocal chiropractor and consultant to Benchmark Medical and his doctorate in 1993 from thecine L  fromthe United States to treat and support participants vania with a Bachelor of Science deConsultants, Susan Bromley D.C., was selected by the gree in Chemistry and French in 1989,F.I.C.S. as one of only four doctors of chiropractic medi University of Rochester School ofduring the 2004 Olympic Games in Athens, Greece. Medicine in Rochester, New York.Dr.  Twelveto eighteen international chiropractic medicine doc Van Ostrand continued his post tors worked at the VISA World Olympian Reunion Center, lo graduate training at the University of cated at the Athens Lawn Tennis Center. The clinic provided Pennsylvania from 1993 through 1998. services to all past and present athletes, as well as the entire Following graduation he worked as an Olympic community, if needed. The selection of doctors for this Assistant Instructor in Neurology, an Instructor in Neurology, clinic is made by the International Federation of Sports Chiro followed by a Neurology Conference Coordinator at the Uni practic/ Fédération Internationale de Chiropratique du Sport versity of Pennsylvania.Dr. Van Ostrand earned his board (FICS). TheFICS is comprised of national chiropractic sports certification in Neurology in 1997 and is a certified member of councils worldwide, individual members, and has affiliations with the Acute Stroke Intervention team with participation in inves international organizations within the chiropractic profession and tigational drug trials.He is a current member of the American the world of sports. “To be chosen to work at this level is a great Academy of Neurology and the Sacramento Medical Society. honor and opportunity,” Bromley noted. Currently, Dr. Van Ostrand is in general practice with a spe  Olympicathletes face a lot of overuse injuries since they cialization in the Peripheral Nervous System and Neurodiag push themselves harder than the average person who works out nostic Evaluations.Dr. Van Ostrand is licensed to practice regularly. “Sports chiropractors are trained to treat specific inju medicine in the state of California.He has been performing ries of the muscle and tissue that cause pressure on connecting medicallegal evaluations since July 2000. joints and nerves that don’t allow a body an optimum perform ance,” said Bromley. By using chiropractic care as an alternative pain relief treatment, an athlete can reduce the risks associated P A I N …W EY O U RF E E L with narcotic pain control and or surgery. I N N O V A T IV ES O L U T IO N ST H R O U G HB E N C H M A R K  Dr.Bromley has an extensive background in sports medicine and athletics. She currently practices in Union City, California, Macro-Pro Affiliation and consults through  Benchmarkhas teamed up with MacroPro, a document Benchmark Medical Con retrieval and subpoena experts corporation.With just one sultants as an independ click of the mouse, you can request a second copy of medical ent consultant. Since records to be delivered to Benchmark for a consultant to re 1997, she has been a ProSport Chiropractic view. Sincetime and money are much too valuable to waste, participating doctor for you can now eliminate valuable time previously spent at the the Professional Rodeo copy machine or the expense of an extra set of records.Plus, Cowboys Association, as no more shipping!See insert for a stepbystep guide on how well as the International to use MacroPro’s website for transferring medical records to W o m e n ’ sF o o t b a l l Benchmark. League (IWFL). Brom ley’s experience also The Acropolis at Athens Resolving Disputes with Lien Holders includes working with Photo: Dr. Susan Bromley, D.C. Benchmark is now offering a unique service in conjunction high profile athletic and with our Bill Review Department.Our analyst can help settle sports teams, including: US American Fin Swimming Team, a dispute with lien holders who are noncompliant in providing American Basketball League, Women’s Professional Basketball, medical billing statements for the services rendered. Barnum and Bailey Circus, Winston Cup, Las Vegas Motor  Afterreviewing the records from the treating providers, our Speedway, Sears Point Raceway, and California Speedway. analyst will provide an itemized billing statement for the treat She attended University of California, Los Angeles and Los An ment provided to the patient.This valuable service is for in geles College of Chiropractic in Whittier,California where she surance cases involving uninsured motorist claims. graduated Cum Laude in 1994.  Formore information regarding this new service, please th  TheSummer Olympic Games were held from August 13 contact Karen Hagen at Benchmark Medical Consultants, th through 29, 2004 in Athens, Greece. 9169202272, ext. 538. specialistexperienceservices  1.800.458.1261www.BMCadmin.com ©2004 All Rights Reserved

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