b'CODING Update ComplianceLEGAL NUTRITION UpdateANJC News ANJC Leadership ANJC News! LEGAL EASE NUTRITION Member Scholarships REHAB Update CHIRO AssistExecutive Directors Update LEGAL Q&A2020 ANJC AWARDSINSURANCE Update INSURANCE Update Legislative UpdateTECHNIQUE Update Choosing a MedicareQ&AMedicare Update Documenting OUR HEALTHTopical Analgesic the Subluxation for By Dr. Richard C. HealyMedicare (Series 3 of 3)ANJC Medicare ConsultantSubsequent Visitn HistoryReview of chief complaint Changes since last visit System review, if relevant n Physical examination (P.A.R.T.)Assessment of change in patient condition since last visit Evaluation of treatment effectiveness n Documentation of presence or absence of subluxation for every visit n Treatment given on day of visit Include specific areas and levels of spine where manipulation was performedabsorption, only a local effect directly over the underlyingWhen using TAs start with single formulation before you nerves, joints and muscles.begin to stack therapies.This offers clinical control and CBD2 receptors are found in the upper stratum of the kerati- enables you to treat patients with specificity.Furthermore, nocytes and activation of these receptors is beneficial in painalways consider its penetration.The TA needs to penetrate control.The abundant distribution of cannabinoid receptorsdeep enough to affect the nociceptive receptors, not just sit on skin nerve fibers and mast cells provides implications foron the stratum corneum.an anti-inflammatory, anti-nociceptive action of cannabinoidTAs are simply another tool in our chiropractic pain manage-receptor activation.The challenge with CBD TAs is to getment kit.CMT, exercise, nutraceuticals, supports, taping, absorption through stratum corneum into the deeper layersand lifestyle management round out our holistic approach of the epidermis and dermis.Local transdermal CDB agentsto address the underlying cause of the pain.Be sure to use have the maximum absorption. them all.Lidocaine is a well-documented anesthetic and has beenREFERENCES:in use as an FDA approved 5% patch since the 1990s.TheAnand P, Bery T, Topical capsaicin for pain management: therapeutic potentialdosage is a maximum of three patches per day with anand mechanisms of action of the new high-concentration capsaicin 8% patch, British Journal of Anaesthesia 107 (4): 490502 (2011) on-off interval of 12 hours.The systemic effects of the patchChoi E,et al, Topical agents: a thoughtful choice for multimodal analgesia, Korean Jare minimal. Anesthesiol2020;73(5):384-393TAs are part of a multimodal approach to pain management. Craighead DH,Mechanisms and time course of menthol-induced cutaneous The topical you choose depends on the site, intention andVasodilation, Microvasc Res. 2017 March ; 110: 4347Sheena Derry S et al, Topical NSAIDs for acute musculoskeletal pain in adults, Cochrane therapeutic goal.As with any topical, apply first over aDatabase Syst Rev. Jun; 2015: 6small area to ensure the patient will not have an allergicSilva H, Current Knowledge on the Vascular effects of Menthol, Frontiers in Physiology, reaction to any of its ingredients.Capsaicin offers heat,April 2020Stander S, et al, Distribution of cannabinoid receptor 1 (CB1) and 2 (CB2) on sensory menthol/peppermint offers cooling, NSAIDs are Cox-2nerve fibers and adnexal structures in human skin, J Dermatol Sci. 2005 Jun;38(3):177-88 inhibitors, lidocaine is strictly analgesic, and CBD attacks the inflammatory cascade.In addition, counter-irritants are Donald DeFabio, DC, DACBSP, DACRB, DABCO, is in private not to be used over sensitive areas of the body (face, practice in Berkeley Heights where he hosts relevant rehab groin, etc.). study groups for doctors looking to workshop together. www.njchiropractors.com I 13'