Conventional medicine and Complementary and Alternative Medicine (CAM) may appear unlikely friends on the surface, but the push for integrative care has brought them together. Their unique strengths and weaknesses could change how we treat pain.
As you already know, musculoskeletal pain often involves significant trial and error to mask the symptoms, with no cure in sight.
The usual course of care is a laundry-list of prescription or over the counter drugs including:
- NSAIDS
- DMARDS
- salicylates
- antispasmodics and antispastics
- anticonvulsants
- steroids
- antidepressants
- opioids
- and in some regions, medical marijuana.
However, these drugs present the risk for a myriad of unwanted side-effects, cognitive impairment, and/or the potential for abuse and addiction with chronic use, or when combined with other medications.
That said, internal medications can provide a better quality of life in moderation in times of extreme pain. Still, the toll they can take on the body and/or mind with long-term use has caused concern from patients and clinicians alike.
But there is a silver lining.
The search for safer and more effective options has prompted an uptake in complementary and alternative medicine (CAM) use. In fact, John Hopkins Arthritis Center, the number 1 ranking rheumatology resource, has noted that “…arthritis and joint pain are within the top five reasons people seek out complementary and alternative medicine.”
A growing body of scientific evidence now supports effective alternative approaches to pain relief. But it does not mean we need to throw “the baby out with the bathwater.” Conventional medication still has its place in pain treatment. However, natural approaches can reduce dependence on these medications, and even help omit them as pain levels subside.
This is your chance to expand your practice by honing your networking skills with professionals outside your expertise.
Read on to consider options on how to expand your practice with integrative adjunctive modalities you provide or a guest can offer from your network.Integrative Medicine Takes Center Stage With the World Health Organization
The World Health Organization (WHO) is a long-standing authority on healthcare and world health emergencies. When they prioritize research and policies, the public and clinicians alike listen.
WHO noted that the health challenges of the 21st century have created a revival in traditional and complementary medicine (T&CM) adoption.
In fact, Tedros Adhanom Ghebreyesus, Director-General of WHO has said, “Countries aiming to integrate the best of T&CM and conventional medicine would do well to look not only at the many differences between the two systems, but also at areas where both converge to help tackle the unique health challenges of the 21st century. In an ideal world, traditional medicine would be an option offered by a well-functioning, people-centred [sic] health system that balances curative services with preventive care.”
To support this assumption, the WHO evaluated TC&M policies around the world between 2005-2018.
In the America’s alone, they noted “The region lagged slightly behind the global scenario for all indicators, but it is anticipated that T&CM will be steadily recognized as a valuable contributor to health care.”
Meanwhile, The National Center for Health Statistics (NCHS) conducted research on patient use of T&CM between 2012 to 2017.
In 2012, the NCHS found
- 17. 7% of adults used natural products
- 3.0% adults adopted specialized diets
Between 2012 to 2017, there was a
- 9.5 to 14.3% growth in yoga practice
- 4.1% to 14.2% growth in meditation practice
- 9.1 to 10.3% growth in chiropractic use
Post COVID-19 research could show even higher statistics in TC&M use. All of this reveals the vast potential of integrative practices.
5 Types of Traditional and Complementary Practices for Pain Management
1. Mindfulness meditation in pain management
Meditation is an ancient discipline practically as old as humanity itself. While its roots are spiritual, both religious and non-religious people alike have adopted the practice of mindfulness meditation to address physical and emotional health by relaxing the mind and training awareness.
The use of meditation in Western clinical settings for pain began with Jon Kabat-Zinn, a world-renowned meditation expert and professor emeritus of medicine. In his 1985 study on 90 chronic pain patients: “The clinical use of mindfulness meditation for the self-regulation of chronic pain,” he found that symptom improvements from the study were maintained up to 15-months aside from “present-moment pain.”
Since then, numerous studies on mindfulness have validated Zinn’s findings. In fact, some medical doctors offer suggested mindfulness practices for rheumatologists so they can have guidance on how to incorporate mindfulness into treatment plans.
Fast forward to 2022, mindfulness has made its way to new technologies including telehealth, virtual reality (VR), and smartphone health and wellness apps. You can use these technologies in your practice, to network with guests, or even to “prescribe” meditation YouTube episodes.
2. Yoga for pain management
Yoga is an ancient mind, body, and spirit practice first described in Indian Vedic scriptures. It involves breathwork, body movement, and a set of beliefs to help maintain physical and mental strength. While it was initially designed to be part of an Eastern spiritual practice, Westerners primarily use it for nonstrenuous exercise, posture correction and maintenance, flexibility, endurance, and tranquility.
Studies have shown that yoga helps significantly reduce musculoskeletal pain. For instance, a 2019 study found that there was a significant improvement in multiple measures after practice, including improved brief pain inventory (BPI) scores.
It has been found so effective that it is commonly recommended by pain and orthopedic specialists as an important part of self-care.
You can encourage your patients to participate in a yoga class in your area, invite a yoga instructor to your practice, or provide YouTube videos specifically for pain relief and posture correction.
3. Acupuncture for pain treatment
Acupuncture is an ancient Traditional Chinese Medicine (TCM) modality using thin needles to stimulate meridians or energy channels–which can be paralleled to the central nervous system.
TCM believes that disruption of the qi or energy flow causes disease and acupuncture unblocks the channels to promote overall health. Similarly, allopathic medical research has shown that acupuncture releases chemicals into the muscles, spinal cord, and brain; which cause biochemical changes in the body to promote well-being.
It has gained increasing popularity in both holistic and conventional medical settings.
The most reliable data on acupuncture use in the United States, conducted by the National Health Interview Survey, showed a 50% increase in acupuncture use between 2002 to 2012 alone.
Acupuncture has been widely studied for acute and chronic pain treatment.
- A 2017 study on chronic pain showed that acupuncture was an effective treatment with lasting results.
- The American College of Physicians (ACP) included acupuncture in non-invasive treatment recommendations for lower back pain.
- A review of 27 trials on acupuncture for neck pain treatment concluded that acupuncture is more effective than inactive treatment.
The results have been so promising that acupuncture is now available in many United States hospitals and clinics for pain treatment.
In summary, acupuncture could be an excellent addition to your patient’s treatment repertoire.
4. Cognitive behavioral therapy (CBT) for pain management
Cognitive behavioral therapy (CBT) was developed by Aaron Beck in the 1960’s, when many experimental philosophies and psychological treatments were at their zenith. It was initially conceptualized to address cognitive distortions in depression. Since then, it has been used as a behavioral modification tool for a range of psychiatric and non-psychiatric conditions including managing chronic pain.
In essence, CBT addresses
- Automatic thoughts
- Cognitive distortions
- Underlying beliefs or schemas
Its effectivity has been explained through the concept of neuroplasticity, the term used to describe the brain’s malleability. The brain has an amazing capacity to redirect and form healthy new neural networks as people learn new skills and behaviors. CBT has proven to be particularly helpful in a patient’s pain-catastrophizing behavior.
With so much promising research, CBT has become popular in public clinics and hospitals because it is generally a short-term, evidence-based therapy.
CBT typically lasts between 5 to 20 sessions for average populations.
A typical CBT session involves:
- Reviewing homework from the previous session
- Evaluating thoughts, perceptions, and behavior surrounding a current concern
- Practicing new skills
- Assigning homework
You can collaborate with a CBT professional or direct your client to the range of CBT-inspired apps.
5. Art therapy for pain management
The use of the arts as therapy is innate to humanity. However, its formal Western use traces back to art with World War II refugees. Artists such as Edith Kramer noted that making art could help alleviate trauma.
Fast forward to the present, it is now used for a variety of needs from psychiatric concerns to pain. In fact, it is often provided for hospice patients and children experiencing chronic disease or terminal illness. Moreover, it has shown promise in a handful of studies on pain relief.
It can not only help reduce pain duration and frequency, but it can also mitigate the psychological symptoms associated with long-term pain.
- A 2018 study published in The Arts for Psychotherapy concluded that art therapy may reduce pain and improve mood and anxiety when offered at the bedside during acute hospital treatment.
- A 2019 paper published in The Journal of Applied Arts and Health demonstrated how interdisciplinary pain treatment clinicians and arts professionals can collaborate to help address the biopsychosocial aspects of pain through art making.
- A 2021 study on art therapy drawing protocols for chronic pain published in The Arts for Psychotherapy concluded that pain scores, levels of depression and anxiety, relationships, and feelings of helplessness improved after using art therapy.
While the studies are limited regarding arts in pain management, they show promise in helping improve the quality of life for patients living with pain.
This is your chance to collaborate with art therapists or even museums to extend your range of services for pain patients while having fun in the process.
MYCO CLINIC™ Topicals Intersect Conventional and Holistic Medicine
MYCO CLINIC embraces both traditional medicine and conventional medicine. That’s why we feature FDA listed pharmaceutical ingredients, menthol and camphor, which have both been scientifically proven to induce hot and cold sensations when applied to the skin.
Similar to art therapy, CBT, and mindfulness meditation; these ingredients distract the pain signals to the brain to temporarily offer relief.
These powerful naturally derived extracts combine synergistically with age-old botanical extracts, seed oils, and functional mushrooms to provide a safe and effective ointment, cream, stick, or oil to enhance any treatment or modality you offer.
Integrative Medicine Takeaway
The possibilities for integrating TC & M with conventional pain treatment are endless.
“Despite the fact that a wide range of mind-body therapies has been shown to be effective for the treatment of chronic pain and the inclusion of these interventions into comprehensive treatment plans has been recommended by consensus panels, only 20% of patients with chronic pain report the use of such adjunctive therapies.”
This missing piece is your education and authority to help guide patients to self-care beyond your office.
Mindfulness meditation, yoga, acupuncture, CBT, and art therapy are just a few of the practices that can be employed with patients seeking pain relief. Dietary changes and supplements, massage therapy, hypnosis, Pilates, chiropractic care, and many other holistic approaches have shown benefits.
So, get out there and start networking or create your own additional services.
References
Acupuncture. Acupuncture | Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/wellness-and-prevention/acupuncture#:~:text=Acupuncture%20points%20are%20believed%20to,physical%20and%20emotional%20well%2Dbeing. Accessed October 31, 2022.
Acupuncture: What you need to know. National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/health/acupuncture-what-you-need-to-know. Accessed October 31, 2022.
Chand SP, Kuckel DP, Huecker MR. Cognitive Behavior Therapy. [Updated 2022 Sep 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Accessed October 31, 2022. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470241/
Craighead DH, Alexander LM. Topical menthol increases cutaneous blood flow. Microvasc Res. 2016;107:39-45. doi:10.1016/j.mvr.2016.04.010
Hass-Cohen N, Bokoch R, Goodman K, Conover KJ. Art therapy drawing protocols for chronic pain: Quantitative results from a mixed method pilot study. The Arts in Psychotherapy. https://www.sciencedirect.com/science/article/abs/pii/S0197455620301222. Published December 25, 2020. Accessed October 31, 2022.
Haaz, S. Rheumatoid arthritis: Complementary and alternative medicine options. Johns Hopkins Arthritis Center. https://www.hopkinsarthritis.org/patient-corner/disease-management/ra-complementary-alternative-medicine/. Published December 19, 2008. Accessed October 16, 2022.
Kabat-Zinn, J., Lipworth, L. & Burney, R. The clinical use of mindfulness meditation for the self-regulation of chronic pain. J Behav Med 8, 163–190 (1985). https://doi.org/10.1007/BF00845519
Junge, M.B. A history of art therapy. In: Gussak DE, Rosal ML., eds. The Wiley Handbook of Art Therapy, 1st ed. John Wiley & Sons, Ltd; 2016:7-16. https://catalogimages.wiley.com/images/db/pdf/9781118306598.excerpt.pdf. Accessed December 15, 2022.
Koebner I. A(n)esthetics: The Intersection of Art and Pain Management Practices, Tuft University, Boston, Massachusetts, USA, 12 September 2018. J Appl Arts Health. 2019;10(3):396-400.
Kotaka T, Kimura S, Kashiwayanagi M, Iwamoto J. Camphor induces cold and warm sensations with increases in skin and muscle blood flow in human. Biol Pharm Bull. 2014;37(12):1913-1918. doi:10.1248/bpb.b14-00442
Lim JA, Choi SH, Lee WJ, et al. Cognitive-behavioral therapy for patients with chronic pain: Implications of gender differences in empathy. Medicine (Baltimore). 2018;97(23):e10867. doi:10.1097/MD.0000000000010867
Qaseem A, Wilt TJ, McLean RM, et al. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Annals of Internal Medicine. 2017;166(7):514-530. Accessed October 31, 2022.
Schmid AA, Fruhauf CA, Sharp JL, Van Puymbroeck M, Bair MJ, Portz JD. Yoga for People With Chronic Pain in a Community-Based Setting: A Feasibility and Pilot RCT. J Evid Based Integr Med. 2019;24:2515690X19863763. doi:10.1177/2515690X19863763
Seminowicz DA, Shpaner M, Keaser ML, et al. Cognitive-behavioral therapy increases prefrontal cortex gray matter in patients with chronic pain. J Pain. 2013;14(12):1573-1584. doi:10.1016/j.jpain.2013.07.020
Shella TA. Art therapy improves mood, and reduces pain and anxiety when offered at bedside during acute hospital treatment. The Arts in Psychotherapy. https://www.sciencedirect.com/science/article/abs/pii/S0197455617301053. Published October 7, 2017. Accessed October 31, 2022.
Statistics on complementary and integrative health approaches. National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/research/statistics-on-complementary-and-integrative-health-approaches. Accessed October 30, 2022.
Trinh K, Graham N, Irnich D, Cameron ID, Forget M. Acupuncture for neck disorders. Cochrane Database Syst Rev. 2016;(5):CD004870. Published 2016 May 4. Accessed October 31, 2022. doi:10.1002/14651858.CD004870.pub4
Vickers AJ, Vertosick EA, Lewith G, MacPherson H, Foster NE, Sherman KJ, Irnich D, Witt CM, Linde K; Acupuncture Trialists’ Collaboration. Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis. J Pain. 2018 May;19(5):455-474. doi: 10.1016/j.jpain.2017.11.005. Epub 2017 Dec 2. PMID: 29198932; PMCID: PMC5927830.
World Health Organization. (2019). WHO global report on traditional and complementary medicine 2019. World Health Organization. https://apps.who.int/iris/handle/10665/312342. License: CC BY-NC-SA 3.0 IGO
Young LA. Mindfulness meditation: a primer for rheumatologists. Rheum Dis Clin North Am. 2011 Feb;37(1):63-75. Accessed October 30, 2022. doi: 10.1016/j.rdc.2010.11.010. PMID: 21220086; PMCID: PMC3045754.
