Purpose of Courses: Chronic pain has presented an enormous impact on individual patients, and in turn has generated an emergent evidence base regarding the diagnosis, treatment and management of painful conditions. Based on known and established anatomical, physiological, and medical principles, Needling Therapy (Acupuncture) has an evidence base that is consistent with the historic foundations and present understanding of Western and Chinese/oriental medicine. The Acupuncture Medical Treatment Guidelines, (§ 9792.21. (2)), supersede the “American College of Occupational and Environmental Medicine (ACOEM)” Guidelines, 2nd Edition (2004) relating to acupuncture, except for shoulder complaints, and address acupuncture treatment were not discussed in the ACOEM Practice Guidelines.

Pain is subjective. It cannot be readily validated or objectively measured (p 566 AMA Guides). Subjective reports of pain severity may not correlate well with its functional impact. Thus, it is essential to understand the extent that pain creates impaired function, while assessment of function represents a useful way to assess pain (p 578 AMA Guides).

During the period of the Zhao dynasty (1128-220 BCE) orthopedics was formalized in China from 600 to 200 BCE. Obstructive “bi” Syndrome that includes restricted blood flow to the musculoskeletal system as well as “wei” syndrome referring to flaccid conditions will be described. This course provides training in pain mechanisms, which can be broadly categorized as nociceptive or neuropathic as well as Needling Therapy (Acupuncture) mechanisms explained in physiologic terms. This course further provides training in permanent impairment rating analysis and disability evaluations for patients that have reached their maximum medical improvement (MMI), which has remained stable for 12 months or more. Learning to utilize the information obtained in orthopedic assessment of important parameters such as range-of-motion (ROM) and diagnosis-related estimates (DRE) from which impairment ratings are derived is paramount to this process. This is covered in the last three weeks of this course. Most important of the process is learning to conduct a thorough and systematic review of patient’s medical records and reports. This includes gathering and evaluating all of the documentation pertinent to any given case. Report writing skills are addressed to summarize this information to satisfy requirements for documenting Workers’ compensation cases as well as Personal Injury, HMO and PPO reporting requirements, consistent with appropriate state requirements. Report writing is covered in the second, third and forth weeks of this course.

Specific Objectives: Recent investigation, utilizing functional neuro-imaging techniques, has demonstrated that many neuropathic and other chronic pain conditions may have a large centralized component. These conditions include chronic low back pain (CLBP), fibromyalgia, irritable bowel syndrome, and Complex Regional Pain Syndrome (CRPS)/Reflex Sympathetic Dystrophy (RSD) (Mackey and Maeda 2004).This course allows students to utilize knowledge gained in orthopedics courses with respect to performing reliable assessment of orthopedic conditions, while explaining them in physiologic terms, while developing a replicable treatment strategy. This course provides the students with the means to evaluate possible permanent impairment and subsequent disability using assessment skills previously developed in conjunction with the AMA Guides.