The Inside Scoop on Applying for
Disability Benefits

By Kristen Lavoie

Whether you’re a patient, caregiver, or
physician who wants to learn more about
disability benefits—you’ll want to read this.

A helpful tool is the residual functional capacity (RFC) evaluation process: When applying for disability, the following may serve as helpful information for both the applicant and their treating physicians, either past or present.

In order to improve an applicant’s chances of getting disability benefits from the Social Security Administration, one particularly helpful tip involves making sure your physician has the most effective, proper documentation in your medical records.

Although this process isn’t mentioned on the official Social Security website, it may serve as a vital tool in making sure your disability claim is adequate enough to warrant you the benefits you need.

An important responsibility of both the applicant AND their medical team is to prove what potential occupational activities the patient is capable of performing and what his or her limitations are. When a claims examiner contacts the physicians listed on the patient’s disability application, those physicians must be able to provide very specific documentation about their patient’s limitations. (Note: It is most helpful for a patient to list physicians on their disability application who have regularly and most recently treated them; and for those physicians to prepare and compile specific documentation—verses a physician who saw the applicant once years ago).

A physician can help significantly to ensure that a patient acquires disability benefits by conducting a residual functional capacity (RFC) assessment. You can read more about the RFC assessment here. A patient’s RFC refers to a patient’s remaining abilities despite any limitations from his or her impairment. The RFC evaluation assesses a patient’s capacity to do work-related physical and mental tasks on a regular and continuing basis—which means eight hours a day, five days a week.
Read More The Inside Scoop on Applying for Disability Benefits

Why Patient Care Needs To Get Personal

By David L. Katz, MD; Chief Medical Officer of the Community Pain Center

Patient-centered care is an important concept, but may not take the matter far enough—because a “patient” is still generic.

Truly good medical care must be, in a word: personal. Not about a patient in general, but when you are the patient, all about you.

This is, superficially, a very obvious contention—of course the care you receive should be about you. And my experience suggests that most clinicians not only embrace this perspective, but doubt there is an alternative.

My vantage point for this observation? For a span of eight years, I was the Director of Medical Studies in Public Health at the Yale School of Medicine. Basically, this meant I had responsibility for teaching public health and related subjects to Yale medical students.

The students’ interest in public health was generally tepid at best (as was that of most of my colleagues in practice), largely because they didn’t come to medical school to learn how to care for the public; they came to learn how to care for patients, one at a time. Individualized care was what mattered.

Or so they thought. In fact, focusing care on individuals is difficult at best, and at worst, downright impossible. If it were otherwise, care that’s all about individuals might actually prevail.

Exercise: How a Little Goes a Long Way

By David L. Katz, MD; Chief Medical Officer of the Community Pain Center

Mechanistically, exercise is entirely dependent on action potentials, while its incredible benefits may be characterized as the potential of action to enhance our lives. Ironically, perhaps, the luminous potential of action to promote our health is in a very fundamental way the exact opposite of the action potentials from which it derives.

I imagine that may be about as clear as the way through a Tough Mudder. No worries; I’ve got Windex.

An action potential refers to the mechanism that underlies the firing of our nerve cells, or neurons.

Famously, action potentials are “all or nothing.”

At rest, there is a slight electrical gradient maintained across the cell membrane of a neuron. That slight charge is energy dependent, requiring the constant work of ion channels that traverse the cell membrane, shuttling positively and negatively charged ions in opposite directions. When we talk about “resting energy expenditure,” or “basal metabolism,” these are the kinds of functions represented; our cells are always working even when we are not.

That electrical gradient is, quite literally, an “action potential,” because it primes the cell to take the one action it owns: depolarizing. When a stimulus reaches a neuron, if it is strong enough, it reverses the electrical charge at the site of contact. That reversal of charge, or depolarization, then courses along the length of that nerve cell, rather like a fast moving wave.

If the nerve cell in question is a sensory neuron, the result of that wave is that we feel or perceive something—a caress, a color, a shiver, or a symphony.

If it is a motor neuron, it ends at a muscle cell, which in turn is stimulated to contract. When a whole lot of muscle cells contract in unison, we have the familiar command over our moving body parts; such as my fingers, currently dancing over this keyboard.

We could, of course, go much deeper into the weeds, but that’s the relevant gist. What matters for today’s story is that the depolarization of every neuron, or muscle cell (myocyte) for that matter, is all or nothing. The stimulus reaching it is either enough to excite full depolarization, or it is not. There are no partial responses; there is no dose response curve.

Holistic Medicine: How to Define It

By David L. Katz, MD; Chief Medical Officer of the Community Pain Center

We are probably all familiar with things that are tough to define, but that we recognize when we see them. No, I’m not planning on talking about that one…

The term I have in mind is: holistic.

I practice holistic medicine. Specifically, for the past decade, I have directed a rather unique clinic that provides what we call ‘evidence-based integrative care.’ We have published and presented details of the model.

People tend to have a strong sense of what holistic means, whether or not they can actually define it. Detractors see it as an indication of quackery–without looking past the label. Proponents embrace it as an emblem of virtuous humanism. Holistic is good, and all else … less so.

But if that is really true — if holistic care is better (I’m among those who believes it is) — then a workable definition is important. First, so that people who want to sign up for holistic care — to give it, or receive it — know what they are signing up for, exactly. And second, and more importantly, because you can’t practice what you can’t define. Unless we can say just what holistic care is, it can’t be taught, tested, replicated, or improved.

The medical version of TheFreeDictionary tells us that

Holistic care is: “a system of comprehensive or total patient care that considers the
physical, emotional, social, economic, and
spiritual needs of the person; his or her
response to illness; and the effect of the illness on the ability to meet self-care needs.”

I am comfortable with this in theory, but not in practice. In practice, it begs the question: how, exactly, do you do that? What does considering ‘physical, emotional, social, economic, and spiritual needs’ look like in a doctor/patient encounter? What is a clinician actually supposed to do in a room with a patient so that the care that transpires between them is holistically concordant with this definition?

Let’s acknowledge that platitudes don’t really help. Of course, a holistic practitioner looks beyond a battered body part to the whole body; looks beyond the body to the mind and spirit; looks beyond the individual to the body politic of which they are an intimate part; and, if responsible, looks at the body of pertinent scientific evidence as well.
Read More Holistic Medicine: How to Define It

Massage Therapy for Osteoarthritis of the Knee: A Randomized Controlled Trial

Adam I. Perlman, MD, MPH; Alyse Sabina, MD; Anna-Leila Williams, PA-C, MPH; Valentine Yanchou Njike, MD;
David L. Katz, MD, MPH

Author Affiliations: Institute for Complementary and Alternative Medicine, University of Medicine and Dentistry of New Jersey, Newark (Dr Perlman); Yale Prevention Research Center, Yale University School of Medicine, Derby, Conn (Drs Sabina, Njike, and Katz and Ms Williams).

Arch Intern Med. 2006;166(22):2533-2538. doi:10.1001/archinte.166.22.2533.

Background Massage therapy is an attractive treatment option for osteoarthritis (OA), but its efficacy is uncertain. We conducted a randomized, controlled trial of massage therapy for OA of the knee.

Methods Sixty-eight adults with radiographically confirmed OA of the knee were assigned either to treatment (twice-weekly sessions of standard Swedish massage in weeks 1-4 and once-weekly sessions in weeks 5-8) or to control (delayed intervention). Primary outcomes were changes in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and functional scores and the visual analog scale of pain assessment. The sample provided 80% statistical power to detect a 20-point difference between groups in the change from baseline on the WOMAC and visual analog scale, with a 2-tailed α of .05.

Results The group receiving massage therapy demonstrated significant improvements in the mean (SD) WOMAC global scores (−17.44 [23.61] mm; P<.001), pain (−18.36 [23.28]; P<.001), stiffness (−16.63 [28.82] mm; P<.001), and physical function domains (−17.27 [24.36] mm; P <.001) and in the visual analog scale of pain assessment (−19.38 [28.16] mm; P<.001), range of motion in degrees (3.57 [13.61]; P = .03), and time to walk 50 ft (15 m) in seconds (−1.77 [2.73]; P<.01). Findings were unchanged in multivariable models controlling for demographic factors.

Conclusions Massage therapy seems to be efficacious in the treatment of OA of the knee. Further study of cost effectiveness and duration of treatment effect is clearly warranted.

Trial Registration clinicaltrials.gov Identifier: NCT00322244

Chronic Pain and Poor Sleep: A Vicious Cycle

By Gerard J. Meskill, MD

Chronic pain is extremely common in America, and it can affect sleep quality. According to the 2015 Sleep in America^™ Poll⁽¹⁾,
21 percent of Americans experience chronic pain, while another 36 percent have experienced acute pain in the past week.

Most people with chronic pain find their symptoms worse while lying in bed trying to sleep, when the external stimuli of the world are no longer providing distraction from their ailments.

Poor sleep can make pain syndromes worse, and worsening of the pain syndrome can feed into perpetuation of poor sleep quality.

Sleep deprivation is an enormous problem in this country as it is. One in three individuals without pain report in the past week that they don’t always or often get a good night’s sleep, the sleep they need to feel their best, or have had trouble falling or staying asleep. In the sub-population of those suffering with pain, it is even worse. According to the National Sleep Foundation⁽²⁾, people with chronic pain average 42 minutes of sleep debt nightly. Furthermore, only 45 percent of those with acute pain and 37 percent of those with chronic pain report good or very good sleep quality. More than half of those individuals with sleep difficulties and pain report that their poor sleep interfered with their work. This can jeopardize employment and further deteriorate quality of life.

CHRONIC PAIN IMPAIRS SLEEP QUALITY

There are many reasons why chronic pain can impair sleep quality. The obvious one is that dealing with pain while trying to fall asleep makes sleep initiation more difficult. Once sleep finally is achieved, any arousal out of sleep allow for perception of the pain phenomenon again, thus prolonging the time it takes to fall back asleep. Since sleeping lowers our overall sleep drive, it is more difficult to fall back asleep with each awakening. As this pattern continues, the way the brain perceives the bed and sleep changes. Much like the Russian psychologist Pavlov taught his dog to associate the sound of a bell with food, the brain starts to anticipate difficulty sleeping every time an individual suffering from insomnia gets into bed. This leads to increased adrenaline levels (“The Fight or Flight” response), which makes it even harder to fall asleep.
Read More Chronic Pain and Poor Sleep: A Vicious Cycle

A Holistic View of Evidence-Based Medicine

By David L. Katz, MD; Chief Medical Officer of the Community Pain Center

On April 29, 2014, I was on the Katie Couric Show to discuss Integrative Medicine. Somewhat ironically, I returned from Manhattan that same day to a waiting email from a colleague, forwarding me a rather excoriating critique of integrative medicine on The Health Care Blog, and asking me for my opinion. The juxtaposition, it turns out, was something other than happenstance. The Cleveland Clinic has recently introduced the use of herbal medicines as an option for its patients, generating considerable media attention. Some of it, as in the case of the Katie Couric Show, is of the kinder, gentler variety. Some, like The Health Care Blog—is rather less so. Which is the right response? One might argue, from the perspective of evidence-based medicine, that harsh treatment is warranted for everything operating under the banner of “alternative” medicine, or any of the nomenclature alternative to “alternative”—such as complementary, holistic, traditional, or integrative.

One might argue, conversely, for a warm embrace from the perspective of patient-centered care, in which patient preference is a primary driver.

I tend to argue both ways, and land in the middle. I’ll elaborate.

First, I am a card-carrying member (well, I would be if they issued cards) of the evidence-based medicine club. I am a conventionally trained Internist, and run a federally funded clinical research laboratory. I have taught biostatistics, evidence-based medicine, and clinical epidemiology to Yale medical students over a span of nearly a decade. I have authored a textbook on evidence-based medicine.

But on the other hand, I practice Integrative Medicine, and have done so for nearly 15 years. And I represent Yale on the steering committee of the Consortium of Academic Health Centers for Integrative Medicine.
Read More A Holistic View of Evidence-Based Medicine

Animal-Assisted Therapy for People with Chronic Pain

By Kristen Counts, MOT, OT/L

This notion of animals as having a healing
effect on humans is almost intuitive,
considering our history in seeking
their companionship.

Background Information

Humans have been in close partnership with animals throughout most of recorded history. We have depended on their working with us for our survival as they have tended livestock, guarded our homes, and hunted for game, among other types of work. Evidence of animals as companions has also been traced to the very beginnings of human history. The symbiotic relationship continues today and is gaining recognition as a therapeutic modality. This notion of animals as having a healing effect on humans is almost intuitive, considering our history in seeking their companionship. When looking at the therapeutic value of the human-animal bond in alleviating pain and associated symptoms, research is in its initial stages.

Animal-assisted therapy (AAT) is the term most often used when animals are utilized as a therapeutic modality. AAT is used in a variety of settings by nurses, occupational therapists, physical therapists, speech and language pathologists, and psychologists, along with additional health professionals. It is utilized for a variety of conditions in children, adults, and older adults.

Environmental Therapy:
An Important Step in Pain Reduction

By Teresa Emerick, D.M.

Environmental therapy is important for most chronic pain patients, especially those suffering with fibromyalgia, migraines, lupus, severe allergies, and most autoimmune illnesses. These patients develop a heightened sensitivity that demands they become aware of their surroundings at all times in order to minimize symptoms. Most Western physicians are not familiar with environmental therapy and what an essential tool it can be for their chronic pain patients. However, many alternative therapists that specialize in energy therapies such as Reiki, massage, EFT, acupuncture, music therapy, and reflexology understand the importance of energy flow in a patient’s surrounding environment to promote healing.

The very minute that we are born,
we start to die.

Every cell in the body goes through a process of birth, transformation, and death. These cells are all connected and react to their surrounding environment. What we see, hear, feel, smell, and even think, all create a ripple effect that causes a cellular reaction within our body. A bigger issue can be the things we do not see, hear, feel, or smell, but are still there causing problems, such as energy.

Energy is what makes everything happen. There are two types: potential energy, which is stored energy, and kinetic energy, which is moving energy. Energy can be emitted in many forms, such as chemical energy within molecules, the radiant energy of light, thermal energy transferred as heat, or energy transferred between electrical fields. One form of energy can be transferred to another form. The laws of thermodynamics determine why and how energy is transferred.
Read More Environmental Therapy: An Important Step in Pain Reduction