Effect of Suboccipital Release on Pain Perception and Autonomic Reflex Responses to Ischemic and Cold Pain.

OBJECTIVE/SUBJECTS: To determine the autonomic effects of suboccipital release (SOR) during experimentally induced pain, 16 healthy subjects (eight women, eight men) experienced ischemic (forearm postexercise muscle ischemia [PEMI]) and cold (cold pressor test [CPT]) pain. DESIGN: Beat-to-beat heart rate (electrocardiogram), mean arterial blood pressure (finger photoplethysmography), baroreflex sensitivity (transfer function analysis), and pain perception were measured. SOR or a sham (modified yaw; 30 cycles/min) was performed in minute 2 of pain. RESULTS: PEMI increased blood pressure by 23 ± 2 and 20 ± 2 mmHg; no differences occurred between SOR or yaw. PEMI modestly elevated heart rate during ischemia, followed by significant reduction from baseline with SOR (-3 ± 2 bpm) and yaw (-4 ± 2 bpm); no differences were observed between treatments. CPT increased blood pressure (SOR = 11 ± 1, yaw = 9 ± 2 mmHg) and heart rate (SOR = 10 ± 2, yaw = 8 ± 3 bpm) before SOR and yaw. Neither treatment nor sham blunted blood pressure increases (SOR = 25 ± 2, yaw = 22 ± 2 mmHg) during CPT; both decreased heart rate (SOR = -3 ± 2, yaw = -2 ± 2 bpm) from baseline. PEMI and CPT caused increased pain without treatment modulation. Following pain and manual intervention, SOR increased baroreflex sensitivity in the 0.15-0.35 Hz range and decreased R-R interval power spectral density in the 0.03-0.5 Hz range compared with yaw. To probe potential mechanisms and interactions between manual treatment and a prototypic analgesic, oral aspirin (967 mg) was given 60 minutes before testing to reduce prostaglandin synthesis. Aspirin slightly attenuated pain but neither altered cardiovascular changes to PEMI nor interacted with SOR or yaw. CONCLUSIONS: SOR has the capacity to modulate pain-induced autonomic control and regulation.

A call to promote healthcare justice: A summary of integrated outpatient clinics exemplifying principles of Catholic social teaching.

There is an urgent need to promote healthcare justice for patients as well as members of the healthcare team including physicians. In this article, we explain how principles of Catholic social teaching (i.e., dignity of the individual, common good, destination of goods, solidarity, and subsidiarity) are applied to health care, by featuring various types of outpatient clinics including free, charitable-direct primary care, hybrid, federally qualified health center, and rural health clinic. We describe how attempts have been made to improve the quality and access of health care by creating new medical schools (i.e., Marian University College of Osteopathic Medicine) and training programs as well as allocating government funding to alleviate the cost of training new healthcare providers through the National Health Service Corps. Finally, we suggest a few approaches (i.e., adopting new clinic models to include volunteer healthcare professionals and cross-training members of the healthcare team) to fill in current gaps in health care. Summary : There is a need to promote justice in healthcare. In this article, we explain how principles of Catholic social teaching are applied to health care. To illustrate this, we feature various types of outpatient clinics. We also describe how attempts have been made to improve the quality and access of health care. Finally, we suggest further ways to improve healthcare reform based upon Catholic social teaching.