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July - August 2012 (PDF Version) - New York Chiropractic College

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Alumni Spotlight<br />

Chronic Pain among Veterans Presents Unique Challenges for<br />

<strong>Chiropractic</strong>: Andrew Dunn, DC (NYCC ’99) on Caring for Veterans<br />

Dr. Andrew Dunn, who treats injured veterans in his capacity as Staff Chiropractor at<br />

VA Western <strong>New</strong> <strong>York</strong> Healthcare System, shared some of his thoughts.<br />

Dr. Dunn finds musculoskeletal complaints<br />

to be common among veterans<br />

regardless of the recentness of their<br />

military service. “Not surprisingly,” he<br />

says, “the majority of our consult requests<br />

are for back pain.” Among more recent<br />

veterans, however, co-morbid conditions<br />

such as post-traumatic stress disorder<br />

(PTSD), traumatic brain injury (TBI), and<br />

depression may influence Dunn’s case<br />

management.<br />

Recognizing certain commonalities<br />

among patients whose response to treatment<br />

was limited, Dunn was curious<br />

to know the extent to which certain<br />

co-morbid conditions might influence<br />

clinical outcomes. “There are a number<br />

of well-founded theories that explain<br />

how chronic-pain complaints could be<br />

perpetuated or otherwise influenced by<br />

behavioral health issues,” he said. “We<br />

also noticed difficulties in managing patients<br />

who had issues with obesity, had<br />

reduced conditioning, and expressed<br />

fear-avoidance behaviors with regard to<br />

movement for fear of further injury.” It<br />

was important to convince the patient<br />

that he or she could begin moving and<br />

exercising with a focus on function over<br />

pain: “Providing pain management and<br />

instructions on self-care measures while<br />

validating the nature of their complaints<br />

and providing encouragement can be a<br />

powerful combination.”<br />

In an effort to better understand<br />

patient outcomes Dunn took part in a<br />

number of research studies. He was<br />

aware that although quality-assurance<br />

data was regularly tracked to assess clinic<br />

performance, the process for performing<br />

research within the VA was highly detailed<br />

and regulated, with proposals submitted<br />

to the Institutional Review Board<br />

for consideration, and then carried out<br />

based upon the requirements and rules<br />

of research within VA.<br />

Asked what his research revealed,<br />

Dunn responded, “The take-away message<br />

is that no one provider type can<br />

adequately address the diverse needs<br />

of chronic-pain patients with complex<br />

presentations. It is essential that chiropractors<br />

recognize the significance<br />

of co-morbid conditions and how they<br />

may influence clinical outcomes. Most<br />

importantly, develop a network of providers<br />

including specialists in behavioral<br />

health for referral or co-management as<br />

appropriate.”<br />

While the role of chiropractic in treat-<br />

Dr. Andrew Dunn (NYCC '99)<br />

ing men and women in the military and<br />

after their discharge has yet to be fully<br />

defined, Dunn believes that chiropractors<br />

who can appreciate the responsibilities of<br />

working within a larger healthcare system<br />

and find ways to add value to that system<br />

are well-suited to work within veterans’<br />

healthcare. “Value is defined not by the<br />

individual provider, but by the system;<br />

and those providers focused on making<br />

meaningful contributions to the mission<br />

of that system should be successful. “<br />

21

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