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Letters to the Editor  |   April 2011
Osteopathic Issues Raised by the September 2010 JAOA
Author Affiliations
  • David A. Patriquin, DO, FAAO
    West Dummerston, Vermont
Article Information
Pain Management/Palliative Care / Headache
Letters to the Editor   |   April 2011
Osteopathic Issues Raised by the September 2010 JAOA
The Journal of the American Osteopathic Association, April 2011, Vol. 111, 296-297. doi:10.7556/jaoa.2011.111.4.296
The Journal of the American Osteopathic Association, April 2011, Vol. 111, 296-297. doi:10.7556/jaoa.2011.111.4.296
To the Editor, 
I almost didn't read the September 2010 issue of JAOA—The Journal of the American Osteopathic Association because the table of contents suggested little in the way of osteopathic principles and practice, my main professional interest. However, I got trapped into reading the letters to the editor—especially those by Todd R. Fredricks, DO,1 and Zachary Comeaux, DO.2 These letters had been written in regard to an earlier letter by Eric E. Shore, DO, JD, MBA,3 who also wrote a response4 to the letters by Drs Fredricks1 and Comeaux.2 
We do not seem capable of resolving this ongoing controversy over the identity of the osteopathic medical profession vs the allopathic medical profession. This controversy has been wasting our energies since I entered the osteopathic medical profession in 1952 as a student, and we are no further ahead now than we were then in settling the matter. What would it take to agree to a moratorium on this debate? 
My attention having been captured by these letters, I moved on to the main articles in the JAOA that I was interested in. The original contribution on combat-related posttraumatic headache by CPT Matthew P. Kozminski, DO, MC, USA,5 struck a familiar note. 
I was an active-duty Marine during the Korean War, an active Marine Reservist for the next 14 years, and a Reserve Navy medical officer serving Marine Reservists for 19 years after that. While serving in these capacities, I saw, diagnosed, and treated many patients who had head and cervicothoracic distress. Although I identified several causes for the headaches, the most common etiologic factor by far was the wearing of military equipment, especially the World War II–type steel helmet. The cervicothoracic problems of many of my patients were also associated with the prolonged carrying of backpacks. 
I know that the protective equipment for military personnel has since been improved, both in terms of individual protection and “wearability.” However, I have learned recently from television news reports that it is common for soldiers in combat areas to carry a total weight of up to 80 pounds (36 kg) for extended missions of 8 hours or more. Wearing such heavy loads for such a long time, along with causing the obvious excessive fatigue, is clearly likely to induce sufficient stress in the cervical and upper thoracic areas to give rise to headache. Although our military personnel may not be able to avoid this trauma, osteopathic physicians should recognize the trauma as an important contributory factor to headache among these individuals and give it some priority in our diagnosis and treatment. 
Osteopathic physicians view occupational and “overuse” stresses and other recurrent stresses as important etiologic factors in a variety of musculoskeletal complaints of patients. The increased incidence of carpal tunnel syndrome since the widespread use of computers, as I have observed in my professional experience, has reinforced this clinical concept. 
Without considering behavioral contributors to musculoskeletal problems, how can an osteopathic physician treat “the whole patient”? Headache, even of a posttraumatic nature, is a symptom—the causes of which are often multiple, including a long history of contributory causes. 
I hope that the debate over the “osteopathic difference,” both in title and in practice, can be put aside in favor of directing our energies toward informing the public of the special and distinct forms of healthcare that osteopathic physicians offer. 
Fredricks TR. The anachronistic fight for osteopathic distinctiveness [letter]. J Am Osteopath Assoc. 2010;110(9):512 .
Comeaux Z. The anachronistic fight for osteopathic distinctiveness [letter]. J Am Osteopath Assoc. 2010;110(9):512-513,552.
Shore EE. The anachronistic fight for osteopathic distinctiveness [letter]. J Am Osteopath Assoc. 2010;110(5):299-300.
Shore EE. Response [letter]. J Am Osteopath Assoc. 2010;110(9):552-553.
Kozminski M. Combat-related posttraumatic headache: diagnosis, mechanisms of injury, and challenges to treatment. J Am Osteopath Assoc. 2010;110(9):514-519.