East meets west for chronic pain management

Mixing Eastern and Western medicine in her Fort Wayne, IN, medical practice, Julie Y. Chao, MD, an anesthesiologist, specializes in pain medicine of both origins because she believes that "health is about balance."

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Mixing Eastern and Western medicine in her Fort Wayne, IN, medical practice, Julie Y. Chao, MD, an anesthesiologist, specializes in pain medicine of both origins because she believes that "health is about balance." While she can typically be found administering traditional pain-relieving methods to people with chronic pain, she also gives acupuncture and uses other Eastern methods, such as far-infrared (FIR) therapy, which involves waves of FIR light with wavelengths between 50 and 1000 μm moving in a figure-eight motion to elevate surface temperature, expanding capillaries to stimulate increased blood flow, regeneration, circulation, and oxygenation. Patients may receive FIR therapy as many times as they would like, says Dr. Chao, and after the initial therapy, patients with chronic pain–for instance, fibromyalgia and tendonitis–often need only periodic treatments.

Chronic pain leads to many complications, so some people find relief via external stimulation, such as a transcutaneous electrical nerve stimulation (TENS) unit, which sends a current of electricity to a targeted area, blocking transmission of pain messages to the brain to "stop the pain from going higher," says Dr. Chao. But she points out that while TENS unit is effective, most people who use it find they do not like the feeling 80% of the time.

Though acupuncture and FIR are being offered to patients by physicians, many insurers do not recognize their lower costs. Dr. Chao hopes hospitals will embrace use of acupuncture and FIR therapy, noting her frustration with the fact that patients who successfully use these treatments in the outpatient setting must forgo them if they are hospitalized.

For more information on treatment offered by Dr. Chao, visit www.askdrchao.com.

Laser liposuction: Effective, but don't believe the hype

Those who tout laser liposuction say that it involves less bruising and a quicker recovery time than traditional liposuction. And research presented at the recent annual meeting of the American Society for Aesthetic Plastic Surgery (ASAPS) in Washington, D.C., suggests that laser liposuction also results in the skin-tightening effect. But some dispute it, saying that it merely adds to the cost of traditional liposuction rather than the results, and increases the risk of side effects.

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The Smartlipo MPX provides 1064- and 1320-nm wavelengths, which gives the ability for two wavelengths to fire sequentially. (Image courtesy Cynosure)

Laser liposuction incorporates laser-assisted lipoplasty, in which a laser probe is inserted into the target area through a small incision and aimed at fatty tissue to rupture the fat cells. The laser, such as that of the Cynosure (Westford, MA) Smartlipo MPX (MultiPlex), which combines 1064- and 1320-nm wavelengths to disrupt fat tissue and tighten it through coagulation, is then directed toward the skin layer to stimulate the production of collagen and elastin, resulting in firmer, tighter and smoother skin. Lasers may also coagulate small blood vessels in the area to alleviate bruising. Finally, fat and disrupted tissue is suctioned out.

Laser-assisted lipoplasty is the second most popular surgical procedure in the U.S., with 283,735 performed in 2009, according to ASAPS statistics. But it has been subjected to debate since the first laser-assisted device, Cynosure's Smartlipo, received FDA clearance in late 2006. Cynosure then moved to innovate the device further, with the Smartlipo MPX in 2008 and the Smartlipo TriPlex in 2010, respectively, according to Cynosure.

"The past two decades have been highly technology-driven, with the introduction of many advanced liposuction-assisting devices," said Dr. DiSpaltro, a past president of ASAPS from West Orange, NJ. "Each new technology has spurred great interest and enthusiasm. It is our role to determine if it is hype or a useful tool."

But initial data showed that laser liposuction was no better than the traditional method. It could present some risks to the liver and kidneys by releasing fatty acids from the fat cells if the recommended concurrent liposuction step approved by the FDA and included in current teaching is not performed, as reported by ASAPS. A task force was assembled to investigate the technology, analyzing any safety issues and efficacy as compared to other devices, developing a teaching protocol, and educating 2,500 surgeons in how to effectively perform the procedure.

The bottom line: no tool on its own replaces the skill and experience of a board-certified plastic surgeon. Jeffrey M. Kenkel, MD, FACS, a Dallas, TX-based plastic surgeon, notes that "no device is a magic wand," and that "despite any hype generated by manufacturers, physicians, patients, or the media, results are ultimately practitioner-driven."

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