Alternative and Complementary Approach to Pain Management Therapies

Alternative and Complementary Approach to Pain Management Therapies

The integrative approach to pain management at Patients Medical combines traditional therapeutic methods of pain treatment with alternative and complementary treatments, taking a holistic view of the patient and the causes for their pain. At times considered anecdotal and poorly substantiated by the mainstream medical community, alternative and complementary treatments are rapidly gaining ground, largely through the numbers of people turning to alternative methods when Western medical treatment alone falls short of their needs.

Simultaneously, a sound scientific footing for alternative medicine is accumulating through careful review of case studies, clinical trials, and the available literature that ancient therapies, along with more recently developed improvements of ancient techniques, show effectiveness in pain management and provide lasting relief in many patients. The mainstream medical community has been slow to recognize the data and move beyond the biomedical model offered in allopathic medicine. Integrative medical practitioners, however, are not suggesting a substitution or adversarial tact in prescribing alternative methods, but rather offer complementary techniques used effectively as adjuncts to traditional therapeutic methods.

Mind-Body-Spirit and Pain Perception

What are these methods? Rather loosely falling under the banner of the mind-body-spirit connection, many have been practiced for thousands of years, as is the case with acupuncture and acupressure (shiatsu) in Oriental medicine. Yoga and prana breathing techniques are foundational in Ayurvedic medical practice. Each in their own way focuses on harnessing energy flow in the body. Meditative practices and prayer can exert physiological benefits. Cognitive behavioral therapy involves reframing beliefs and behaviors, and guided imagery techniques use the capacities of visualization and imagination to evoke sensory or affective changes. Other holistically-oriented methods modify attitudes toward healthy diet and lifestyle choices, draw upon the time-honored practice of botanical medicine, utilize massage techniques, target shifts in body mechanics, and recondition the body using graduated exercises.

On their own or in combination, these alternative modalities can make a significant difference in pain levels and pain threshold. Taken together with conventional modalities, the holistic approach to the management of pain offers a viable, effective alternative that builds on traditional methods of therapy.

The mind-body-spirit connection is manifestly observed in the effects that calming techniques such as qi gong, yoga, or prana breathing have on blood pressure, stress response, and the subsequent effects of reduced stress on a disease state. Teaching these methods for use in concert with, say, traditional physical therapy, gentle exercise, or pharmacology when needed, is an example of an integrative treatment. Integrative practitioners take the view that an individual is a physical, psychological, social, and spiritual being and approach treatment by addressing the influence each component exerts on the whole person. We regularly use these techniques in the management of pain at Patients Medical.

The best strategy for pain relief usually involves a combination of techniques. In an integrative approach these therapies work in conjunction with traditional treatments and benefit a number of clinical conditions, not the least of which is pain management. Integrative medicine is not a system of care that simply addresses symptoms or predetermines a specific outcome as the only and best, but rather a system of care that approaches health management through the multiple aspects of the whole person—mind-body-spirit.

Pain Management

Pain is often a patient's first and chief complaint, the one motivating factor compelling someone to seek out a physician. Short-lived, sudden pain may be the body's self protecting protest that a movement or injury requires immediate corrective action. Acute pain is short-lived, frequently sudden, and often elicits the proper response even without conscious thought. The hand that wanders too close to the hot burner or steaming tea-kettle may suffer a burn, but reflexively jumps to safety even before the cause is consciously registered. Acute pain from a strain or minor injury, such as this, may persist for a few days but with time, minor analgesics, and natural healing subsides completely.

Chronic pain, however, the pain described as persisting for three months or longer, is a different experience altogether, and one that can leave a person depressed, distracted, unproductive, unfulfilled, and exhausted. Chronic pain is experienced by at least 10% to 15% of Americans 20 years of age and older–30 to 50 million people–a prevalence eliciting an enormous effort on the part of the pharmaceuticals industry to bring to market effective drugs for treatment. Though certainly a welcomed component in a physician's kit for the treatment of pain, a single-line pharmaceutical therapy, frequently involving addictive or poorly tolerated drugs, may not offer the only, or even the right solution to address the causes of chronic pain. If pain is the symptom, then treating the source of the pain, if possible, is more logical than simply masking the symptom.

The source of all this pain in millions of people varies widely. As bodies age, strains and injuries heal more slowly or poorly. Repetitive-motion strains and stresses accumulate and are the source of numerous job-related injuries resulting in chronic pain. Disease-related pain afflicts those with cancer, diabetes, arthritis, and many other human maladies. Chronic pain can result from major trauma in accidents or as a result of surgery, persisting long after the initial injuries or conditions have been treated and are ostensibly healed.

Pain in some people is an elusive phantom impossible to ignore but whose source is just as difficult to track down, identify, and effectively treat. Pain can beget pain, meaning the stress from suffering chronic pain can be a factor in how well one's pain is managed within him or herself.  Emotional pain, another potent stressor, can add to the suffering, causing physiological changes in the body that contribute to the inflammation, neurobiological, or metabolic mechanisms involved in one's pain. Chronic pain syndrome has been described in some long-term pain sufferers as a complex overlap of the pain suffered and the anxiety felt concerning one's health, one's identity living with pain, and attitudes towards one's life situations.

The role of practitioners at Patient's Medical has long been to approach each patient who comes to the center with chronic pain through an integrative program that carefully identifies the sources of pain and prescribes a comprehensive course of action. After careful listening and examination of a patient's complaints, symptoms, their medical history, and current physical condition, a combination of therapies will be suggested working from one or more of the four main components likely to contribute to one's pain:

  • physical/structural
  • metabolic/biochemical/immunologic
  • neurological/electromagnetic
  • mind-body-spirit

Approaching pain in this integrative, multilevel way has proven a successful strategy for addressing our patients' needs.

Assessing the Contributors to Chronic Pain

Physical/Structural

The physical/structural assessment examines the physical and structural aspects of the body, evaluating the status of muscles, joints, ligaments, bones and connective tissues, together with postural aspects and the physics of the body. Physical/structural therapies may include chiropractic or physical therapy, osteopathic manual therapy, exercise and fitness training, or neural therapy if appropriate. In some cases structural manipulation of the cranial bones and the thin layer of connective tissues surrounding muscles, the fascia, can reset the neuromuscular interface in the area of pain in such a way that it is no longer necessary for the mind/body to generate a pain message. Massage therapy has been shown to yield lasting pain reduction in results of a small study that rated pain at pre-treatment, post-treatment, and in a three-month follow up. Poultices using plants and oils, like castor oil, have a long history of being invaluable in various types of pain syndromes. Depression, anxiety, and mood measured in the study likewise showed improvements in the massage therapy group.

Metabolic/Biochemical/Immunologic

The metabolic/biochemical/immunological component evaluates the potential need for biochemical supplementation to address potential metabolic or immunologic contributions to the pain the patient is suffering. The therapies that address deficiencies or imbalances in metabolism or immune response cover a fairly wide range of possibly latent problems.

Through a careful evaluation of the patient's diet and lifestyle, modifications may be prescribed with the addition of specific dietary supplements or suggestions for healthy changes in lifestyle preferences. Healthy changes in diet can have broad metabolic effects, improving energy, reducing inflammation, and modifying general outlook toward both one's pain and one's life. Dietary and lifestyle changes often result in improvements in weight and body image, improving the patient's outlook in managing their pain if not directly aiding to diminish it. For many patients the acid-base balance in the body, particularly in the tissues affected, is too acidic and with proper supplementation and an emphasis on a diet that favors alkalinity this situation can be remedied.

Reducing exposure to environmental toxins, smoking, or excessive alcohol are additional lifestyle changes that support general health. Exposure to chemical toxins in cleaning or industrial products may not manifest obvious health risks; but tens of thousands of chemical ingredients are un-tested. Minimizing one's exposure may be a common sense rule of thumb to avoid unknown consequences. Limited alcohol consumption is shown to have a positive effect in some people's health; however, alcohol can be a self-prescribed treatment for people living with chronic pain that tends toward abuse and addiction. Federal drug authorities report that prescription pain medications, particularly prescription opioids, the class of drugs that includes oxycodone, hydrocodone and meperidine, while effective painkillers, through addiction and abuse cause more overdose deaths than heroine and cocaine overdose combined. Treating the addiction may become a necessary component of the overall strategy to relieve one's chronic suffering.

Rehabilitation of damaged membranes and tissues may be addressed through the addition of supplements such as high-grade fish oils, coconut oils, or phosphatidylcholine, the antioxidant found in lecithin. Inflammation in soft tissues and joints is a common source of discomfort, and a number of natural and pharmaceutical therapies are effective in addressing this inappropriate immune response. Triggered by injury or dysfunctional immunity, inflammation is mediated by many messenger chemicals in the body. Supplements or adjunct treatments can target both the localized inflammation resulting from injury or disease, while reducing the systemic chemical signaling that mediates the response.

Pain management may additionally integrate IV therapies that address serious nutritional or inflammatory conditions based on a thorough assessment of one's needs. Oxygen therapy is another integrative modality used to successfully reduce inflammation, promote healing of tissue and bone, and improve oxygenation of oxygen-starved tissues hindering natural healing metabolic processes. In our experience hyperbaric oxygen therapy has been useful in dealing with the pain associated with metastatic bone lesions from various cancers.

Hormonal therapies addressing adrenal or thyroid function may be prescribed, lending support to neuroendocrine disturbances of the hypothalamic-pituitary-adrenal (HPA) or hypothalamic-pituitary-thyroid (HPT) axes in association with pain syndromes.

An evaluation of a patient's chief neurotransmitters—serotonin, dopamine, epinephrine, and norepinephrine—can reveal either deficiencies or hyperactivity that contribute to insomnia, anxiety, depression, and other mood disturbances. Neurotransmitters are required for proper brain and nervous system function. Imbalances are shown to correlate with many conditions associated with pain, such as fibromyalgia syndrome, chronic fatigue syndrome, myofascial pain syndrome, complex regional pain syndrome, and other neuropathic pain syndromes. The transmission of pain neurotransmitters helps convey the electric signal coursing through the nervous system to the brain, triggering a cascade of responses by the body including those supporting inflammation and immunity. These syndromes—and the depression, anxiety, and insomnia that often accompany them—may respond well to integrative treatments and result in better coping strategies to manage one's pain.

Dysregulation of blood sugar levels, such as occurs with hyper- and hypoglycemia, is another source of discomfort, low energy, depression, and anxiety in those with pain conditions. Each of these factors can affect one's outlook toward managing their pain. An evaluation of blood sugar and insulin levels may reveal imbalances resulting from insulin resistance or hypoglycemia. Changes in diet, supplements, or medication can be prescribed to address the potential role in pain management.

Neurological/Electro-Magnetic

This component focuses on autonomic nervous function, the system responsible for involuntary responses, as well as the functional nervous system regulation of biochemical reactions involving cells and the physical structures of the body. Acupuncture is an ancient therapy that derives from an analysis of autonomic nervous function, and the flow of energy through the body. Electro-acupuncture and laser acupuncture are more recently developed variants of acupuncture that address the flow of energy through the sympathetic and parasympathetic nervous systems. Other forms of electrotherapies in this component, such as iontophoresis, transcutaneous electrical nerve stimulation (TENS), electronic muscle stimulation (EMS), and pulsed electromagnetic field (PEMF), may be included, where appropriate, as part of the integrative approach to pain management. Acupuncturists have long known that treating points along meridians that bear relationship to the area of the pain, but yet are in other regions of the body, are capable of balancing the energetic matrix of the body so that blockages causing the pain can be removed.

Mind-Body-Spirit

This last component is represented by therapies that focus on the mind-body-spirit connection in healing and pain management, integrating emotional, spiritual, calming, and stress reduction techniques in the individual's pain-coping strategies. Meditation, yoga and prana breathing are ancient relaxation techniques that assist in focusing and calming the mind. Cognitive behavioral therapy is a process whereby relearning how to think about pain, and your relationship to your body and pain, offers ways to enhance one's coping strategies.

Integrative practitioners understand that the root of the pain may not be in the biochemical or mechanical body.  Observing neuromuscular responses to different cues provided with muscle testing allows the practitioners to explore the mind-body-spirit interface. Diagnostics in applied kinesiology can help to pinpoint emotions and past experiences that are contributing to the perpetuation of pain as well as identifying techniques to release the emotions and reset the body's perception of pain.

Mind-body-spirit therapies for healing and positive outcomes for a variety of medical conditions have shown demonstrated efficacy, and are included in advice developed by consensus panels as effective and worthwhile. Several studies have examined the efficacy of mind-body-spirit therapies in the reduction of chronic pain, and found such techniques as yoga, t'ai chi, qi gong, hypnosis, progressive muscle relaxation techniques, biofeedback, meditation, and guided imagery both safe and effective.

Integrating Pain Management—Putting it all Together

No single drug or pain management technique will resolve a patient's chronic pain. Likewise, developing a course of action to help patients with chronic pain may not incorporate therapies from all of the above components. Each patient requires an individually tailored strategy that depends on many individual factors. A thorough, holistic knowledge of the patient informs us as to which components likely contribute to a patient's pain, and is critical to finding the integrative interventions that offer the most effective amelioration and management of their chronic pain condition.

Begin Your Journey to Wellness with Patients Medical

The effects of chronic pain can range from simple annoyance to debilitating and life-changing. Regardless of where you might find yourself on this spectrum of pain, the practitioners at Patients Medical offer a broad range of pain management therapies derived from modern and ancient traditions in the healing arts. Our integrative approach tackles your pain problem holistically, addressing the mind-body-spirit components of pain to help you manage your pain and live a full, satisfying life.

Begin Your Healing with Patients Medical

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