Panama Chiropractic Continuing Education

Hour 1

• Define interventional pain management and how it can be applied to help solve acute and chronic pain.
• Outline and critique different pain theories.
• Outline the Biopsychosocial model of chronic pain and explain why this model is the most comprehensive for acute and chronic pain management.
• Summarize how to integrate interventional pain management with conservative care for acute and chronic pain.

Hour 2:

• Describe common interventional pain management procedures and how to integrate them into a comprehensive plan of care.
• List the most utilized injections and when they are considered.
• Identify when a spinal cord stimulator may be considered and how it can aid conservative management.
• Explain the use of endoscopic procedures and when they may be utilized to treat acute and chronic pain.

• Explore chiropractic patients’ perceptions of discomfort, pain, and stiffness to determine if and how they differentiate among the concepts 
• Describe the relationship between the presence of an audible pop during spinal manipulative therapy and pain outcomes
• Evaluate the effect of spinal manipulation on pressure pain thresholds in a real-world clinical setting 
• Assess whether a 10-second one legged stance test can independently predict survival in middle and older aged men and women 
• Illustrate the relationship between physical activity levels and pain

• Relate the different neurophysiologic mechanisms to the development of chronic pain states. 
• Draw the pathways specific to Lamina I versus Lamina V sensory pathways.
• Discuss basic science research that supports the main theories of chronic/central pain syndromes.  
• Apply basic neurorehabilitation techniques to modulate chronic pain circuits.
• Develop treatment plans for chronic pin patients consistent with current pain models.

• This contains all courses with the educational objectives listed from Pain 116 through Pain 121

• Relate the effects of interoceptive dysfunction to the development of chronic pain.
• Draw the pathways specific to Lamina I versus Lamina V sensory pathways.
• Discuss how the interoceptive nervous system may relate to Functional Neurologic Symptom Disorder.
• Apply knowledge of how interoceptive dysfunction may negatively affect higher cortical functions.
• Design and utilize strategies that normalize interoception to improve intractable patient symptoms.

• Relate the effects of cold sensory deficit to chronic central pain states.
• Map the pathways specific to Lamina I versus Lamina V sensory afferents.
• Discuss basic science research that links C-Fiber subpopulations with hyper-excitability of sensory neurons.
• Apply techniques to gate pain processing through the Dorsal Insula/Anterior Cingulate pain switch.
• Utilize relationship between cold pathways and pain pathways to gate chronic pain.

• Identify the relationship between the ANS and chronic pain.
• Explore the cause of sympathetic maintained pain.
• Discuss the emerging role of the brain and spinal cord in CRPS.
• Apply non-invasive neuromodulation techniques for pain control.
• Formulate an effective treatment plan based on current knowledge.

• Relate the effects of failure within the DNIC to the development of chronic pain.
• Draw the pathways specific to ascending sensory and descending pain modulatory circuits.
• Apply knowledge of the DNIC, as it relates to chronic lower back pain.
• Discuss basic science research that links the PAG with the phenomena of offset analgesia and conditioned pain modulation.
• Formulate and apply treatment plans based on stimulation of the DNIC utilizing spinal cord stimulation, motor cortex activation and heterotopic noxious conditioning stimulation.

• Relate the effects of cingulate cortex activation on chronic pain suppression.
• Draw and identify regions of the cingulate cortex pertinent to pain and suppression.
• Discuss basic science research that links area’s 32, 24 and 25 with pain and its relief.
• Apply specific techniques to modulate cortical areas 32, 24, and 25 for pain suppression.
• Formulate and implement a treatment plan based on the M1-ACC pain model.

• Determine why communication is imperative in clinical encounters
• Classify rights and responsibilities of the patient -provider partnership
• Recognize barriers and benefits regarding improved communication
• Apply numerous strategies to improve and solidify patient interactions
• Summarize how to fix the system so providers will provide better quality visits

• Identify the ways your conscious or unconscious bias toward patient characteristics may enter the clinical relationship
• Outline ways to improve your clinical communication with patients who are elderly, poor or ethnic minorities.
• Distinguish male and female patient communication styles and plan what to do when your patient wants a different gender provider
• Compare the way Jewish, Irish, Italian, and other cultures present differently as patients and prepare your communication style appropriately
• Internalize the seven ideal interpersonal traits patients want in their health care providers

• Recognize deceptive behaviors from other people and integrate these skills
• Use tips garnered from former CIA officers to separate truth from lies
• Determine motivations for patients to lie to health care providers
• Strategize ways to avoid being lied to by your patients and staff
• Assess the consequences of lying and how it compromises clinical relationships

• Explain the Four Habits of Highly Effective Clinicians
• Show the payoffs for each of the habits and provide examples
• Demonstrate how to avoid “Door Knob Concerns” and uncover hidden problems
• Specify barriers to patient communication and how to overcome them
• Describe action steps to incorporate better communication habits into practice immediately

• Modify explanations about risks, harms and benefits to avoid miscommunication to patients
• Apply research concepts such as sensitivity and specificity to outcomes communications
• Identify weak spots in clinical trials with regard to benefits and harms
• Implement the best practitioner action to build trust in patients
• Discover strategies for better communicating with low functional health literacy patients

• Describe and utilize an effective but non-invasive treatment for warts
• Understand the risk versus benefit of diagnostic imaging radiation in children
• Recognize patterns of pain in children that might actually indicate malignancies
• Develop an understanding of pediatric atlantooccipital dislocation
• Be able to perform 5 minute infant physical examination to detect congenital anomalies of the musculoskeletal system

Hour 1

• Discover what primitive reflexes are and why we have them
• Understand the various possible causes of retained primitive reflexes in a child
• Outline common questions that would suggest retention of primitive reflexes
• Identify and assess eight primitive reflexes that can be easily evaluated by a doctor of chiropractic, specifically the Moro, Grasp, Spinal Galant, Rooting, Asymmetrical Tonic Neck, Symmetrical Tonic Neck, Tonic Labyrinthine, and the Landau reflexes.

Hour 2

• Further identify and assess the remaining of the eight primitive reflexes not covered in the first hour
• Detect the presence or absence of specific primitive reflexes
• Recognize the need for intervention when a retained primitive reflex is demonstrated by a patient
• Prescribe a specific course of treatment for each of the eight primitive reflexes if they are determined to be retained

• Construct examination/radiographic criteria for Osteochondritis Dissecans
• Dissect the elbow as it relates to lateral epicondylitis
• Develop a diagnostic and treatment approach for adhesive capsulitis
• Review possible causes of Intervertebral Disc Degeneration
• Create a list of differential diagnoses of foot pain

• Develop an understanding of shoulder anatomy and motion as they pertain to diagnosis and treatment of the injured shoulder
• Review examination techniques relative to diagnosis of injury in the overhead athlete
• Review the characteristics and diagnosis of shoulder injuries common to overhead athletes
• Understand the functional anatomy of joint and the classification of traumatic injuries of the acromioclavicular joint
• Develop understanding of the mechanisms, examination, diagnosis, radiography and treatment of common acromioclavicular joint injuries

• Identify common causes of patellofemoral syndrome
• Understand knee mechanics relative to patellofemoral syndrome
• Differentially diagnose patellofemoral syndrome from other knee conditions
• Define an appropriate treatment program for patellofemoral syndrome

• Identify common causes of shoulder syndrome
• Understand functional mechanics of the shoulder relative to impingement syndrome
• Differentially diagnose shoulder impingement from other shoulder conditions
• Define an appropriate treatment program for impingement syndrome.

• Identify common risk factors and causes for CTS
• Define tests and examination procedures to diagnose CTS
• List the common conditions important in the differential diagnosis of CTS
• Develop a chiropractic treatment plan for CTS

• Understand the use of plain film and advanced imaging for patients with Rheumatoid Arthritis
• Identify conservative treatments for Rheumatoid Arthritis
• Discuss supplements relative to alleviating Rheumatoid Arthritis symptoms as well as other treatment additions to the patient's drug regimen
• Provide an overview of the rheumatoid arthritis diagnosis and traditional treatments

• Understand the general features of congestive heart failure, a condition which currently affects 4.9 million Americans
• Determine physical examination and diagnostic imaging findings in patients with congestive heart failure
• Discuss treatment, including conservative management, for congestive heart failure patients
• Discuss conditions commonly associated with congestive heart failure

• Define the classifications of Breast cancer and compare the stage
• List some of the major risk factors for Breast Cancer
• List some of the screening techniques for the detection of Breast Cancer
• Discuss some main options in evaluating breast cancer
• List some of the treatment options that are available for women with a genetic predisposition for Breast Cancer

• List some of the risk factors for low back injuries in the work place
• List the classes of low back etiologies and describe some of the spinal diseases that may cause low back syndrome exacerbation
• List some of the protocols for documenting and managing repetitive stress type injuries and low back pain and describe some of the factors to consider when documenting
• List some of the clinical manifestations of pain
• Describe some of the orthopedic tests that may be utilized in the examination for low back pain
• List some treatment options for Low back injuries

• Relate relatively common but sometimes challenging patient cases
• Explain diagnostic and therapeutic considerations in thyroid disease
• Give examples of diagnostic and therapeutic considerations in drug toxicity
• Describe diagnostic and therapeutic considerations in diabetic neuropathy
• Demonstrate diagnostic and therapeutic considerations in vitamin deficiency

• Summarize premenstrual syndrome, its diagnosis, causes and natural therapies
• Understand premenstrual dysphoric disorder, its diagnosis, causes and natural therapies
• Outline polycystic ovarian syndrome, its diagnosis, causes and natural therapies
• Illustrate menopause, its diagnosis, causes and natural therapies
• Discuss nutritional support for womens health

• Differentiate between premenstrual disorder, menopause and perimenopause
• Identify the causes of Estrogen Dominance in the typical patient for patient education
• Assess hormone levels and diagnosis with saliva and blood spot testing with reputable labs listed
• Observe recorded changes in actual patient histories with treatments and results
• Apply products listed by Brand Names to use for treatments, with suggested dosages

• Diagnose Fibromyalgia and Discuss the modern research that contradicts older ideas about the syndrome, separating myth from fact
• Obtain an accurate diagnosis and differentiate from other syndromes
• Recognize prescription medication side effects
• Apply appropriate movement and exercise therapy
• Select the best alternative and holistic treatments and design a treatment plan
• Treat using integrated care, including physical, emotional and spiritual support as needed