BACKGROUND:Literature describing visceral mimicry dysfunctions have primarily been limited to referred pain patterns that are commonly related to viscera such as left shoulder pain arising from somatic versus cardiac etiology; right shoulder pain arising from somatic versus gallbladder etiology; and low back pain arising from somatic versus uterine/menstrual cycle etiology. Typical angina manifests as chest pain or discomfort and is believed to occur when heart muscle receives an inadequate supply of blood. Angina may present subjectively as a pressure-like or a squeezing pain in the chest. This pain may also occur in the shoulders, arms, neck, jaw, or back and occasionally resemble symptoms related to indigestion.
COLLABORATIVE MODEL:The issue of visceral mimicry syndrome represents opportunities for collaborative treatment options with chiropractors and allopathic physicians. Considering the reported prevalence of angina of somatic etiology, in the case of a patient presenting with myofascial indications of angina, in the presence of a negative history for cardiac red flags, normal vital signs and other normal screening tests, it would be reasonable to have the chiropractor evaluate possible musculoskeletal involvement. A trial of chiropractic treatment could serve as a diagnostic test to help differentially diagnose this type of mimicry syndrome. Even while the patient is receiving their battery of cardiac tests, one method of assessment could be a brief chiropractic assessment and trial of therapy of one week. The patient would follow up with the cardiologist to assess any changes in pain or dysfunction. Very close collaboration between a cardiologist and a chiropractor, even possibly offering chiropractic treatment within the cardiologist’s office, would insure the avoidance of unnecessary repeat testing as well as avoidance in delay of appropriate referral in both directions.
DISCUSSION:In chiropractic there are various methods that have attempted to incorporate viscerosomatic and somatovisceral interrelationships. Sacro-occipital technique is one such ‘technique system’ which includes both reflex and direct somatic treatment components. The sacro occipital technique system includes a model that addresses the relationships between myofascial dysfunction and mimicry visceral dysfunction syndromes called chiropractic manipulative reflex technique. Chiropractic manipulative reflex technique aims to diagnose visceral referred pain patterns and suggest possible spinal manipulative and reflex treatments to aid a patient suffering from visceral mimicry or somatovisceral syndromes.
This paper has attempted to highlight the potential gap in delivering more effective patient care for mimicry syndromes, specifically those that produce angina-like symptoms, and offer a model of collaborative care based upon both practical, conceptual and patient-centered concepts. Bridging communication and collaboration between conventional and alternative practitioners will only serve to improve patient outcomes and perhaps reduce the need for repeat extensive diagnostic testing. Other opportunities to demonstrate further effects of chiropractic care on the organic component of cardiac disease might potentially grow from these interdisciplinary collaborations. In the presence of a fractious delivery system, that does not foster integration between conventional and alternative care providers, it is very likely that the majority of these types of mimicry syndromes, which could potentially respond to somatically directed care, will continue to be go unrecognized and untreated.
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