What is Integrative Medicine Pain Management?

If you look up the definition of pain, you will come across synonyms such as suffering, agony, discomfort, ache, hurt, and affliction - words and feelings we would all avoid if we could. In the medical and wellness world, pain most often refers to the physical suffering or discomfort triggered by illness, injuries, dormant and underlying viruses and infections, prolonged inflammation, nerve damage, and even psychological and emotional stress (1, 2).

It is estimated that nearly 50.2 million U.S. adults (or 20.5%) experience chronic pain on most days, and 11.2% of adults suffer from chronic pain daily, with the most common pain locations being the back, hip, knee, or foot. Chronic pain is described as pain lasting longer than 3-6 months. The lingering and systemic effects of experiencing pain can impact the quality of daily life, medical costs, mental and emotional state, and social activity (3, 4, 5).

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What are The Benefits of Using Integrative Medicine Pain Management?

An integrative approach to pain management can help those suffering chronically or acutely find alternative ways to improve their quality of life, play an active role in their healing journey, and better cope with their pain.

As individuals become more aware of different healing modalities, their options for creating a more compliant and enjoyable protocol may broaden and enhance current treatment models. Incorporating these integrative modalities allows both the practitioner and patient to approach pain management with a more holistic lens (6).

Many pharmacologic approaches are used to alleviate or manage chronic pain, such as using opioids, corticosteroids, muscle relaxers, and Nonsteroidal anti-inflammatory drugs (NSAIDs). However, the use of complementary and integrative therapies has greatly increased, with roughly 33% of adults reportedly using complementary health approaches (7, 8).

What are Some Subspecialties Within Integrative Medicine Pain Management?

It is important to note that creating a pain management program is highly individual. The protocol must consider factors such as pain type, duration, cause(s), or contributing factors (if known). It is also essential to discuss overall health, age, history of previous injuries/infections, current medications, treatment plans, and other lifestyle factors (such as sleep, exercise, stress level, support system, etc.) (8).

Below are some common alternative subspecialties that take an integrative approach to pain management.

Acupuncture

While all of the mechanisms of acupuncture are not fully understood, the use of acupuncture for pain management is well documented since it can cause changes in inflammatory cytokines. Research suggests that acupuncture achieves its pain-relieving effects by stimulating nerves in the muscle, which relay the signal to the spinal cord, midbrain, and hypothalamus-pituitary system, triggering the release of neurotransmitters and hormones, like endorphins (9).

Some acupuncturists will also include cupping and gua sha treatment during or after your acupuncture session, which may help reduce inflammation associated with chronic pain. Gua sha is a Chinese healing technique that involves "scraping" your skin with the gua sha massage tool that helps improve and stimulate soft tissue circulation and increase blood flow (12).

Cupping therapy is commonly used in traditional Chinese medicine in which a therapist puts special cups on your skin for a few minutes to create suction and release the fascia from the muscle layer. Many studies have been done on cupping therapy as a form of pain management with positive results.

Auricular acupuncture is commonly used in practice where licensed Acupuncture Physicians place tiny needles or ear seeds on specific ear points that correlate with different areas of the body. Auricular acupuncture was originally "invented" by Dr. Paul Nogier. Dr. Nogier discovered ear somatotopy, a representation of the whole person in the shape of an inverted fetus on the ear. Since his discovery of these points, many variations have been used for pain management with great success, including the army's version of "battlefield acupuncture," which is currently taught to Army medics.

Needle-free acupuncture has been found to be as effective as conventional needle injection acupuncture. So if you're afraid of needles, this is the treatment for you. A 2010 study found that patients treated with needle-free acupuncture for myofascial shoulder pain reported less anxiety, less discomfort, and fewer adverse events (10).

Chiropractic

Chiropractic care involves the manipulation of the spine. It has been shown to decrease chronic pain, correct your body's alignment, and support how your body can function physically. A chiropractic adjustment affects both the nervous and the musculoskeletal systems. It can benefit those experiencing pain related to stress, overexertion, and tension, as well as lower back pain, neck pain, muscle pain, and headaches. Chiropractic care can include adjustments helping to realign joints, decrease pain, and increase range of motion. It can also include soft tissue therapy, which helps to relax tight muscles associated with pain and release tension in the fascia or connective tissues surrounding each muscle (11).

Yoga & Tai Chi

Mind-body exercises such as Yoga and Tai Chi have been used to reduce pain. These techniques increase mobility, induce the parasympathetic response, and reduce stress. They help calm pain signals and relax the body, as chronic pain is associated with reduced sympathetic nervous system reactivity. Tai Chi and Yoga both involve meditation, controlled breathing, and slow and controlled movement (13, 14, 15).

Individuals practicing tai chi have experienced improvements in pain, stiffness, physical function (such as walking, standing, rising from a bed, and getting in and out of a car), and balance. A systematic review looked at 14 randomized controlled trials and found that yoga was associated with lower pain scores. A 2019 meta-analysis of 10 randomized controlled trials involving 686 participants concluded that yoga might relieve neck pain intensity, improve pain-related function disability, increase cervical range of motion, and improve quality of life.

Physical Therapy

Physical therapy aims to reduce pain over time, not necessarily to be used as a quick and temporary method of pain management. A physical therapist can help evaluate and assess how your body is moving and what may be contributing to your overall pain. During physical therapy treatments, individuals can learn stretching and strengthening techniques that can be done at home to help continue their active pain management program. Many of these exercises include addressing poor posture and weak core muscles and strengthening muscles surrounding painful joints. Physical therapy has been successfully used for pain conditions such as lower back pain, joint pain, knee pain, sciatica, and even surgery recovery (16).

Massage

Massage therapy can be particularly beneficial for musculoskeletal pain, helping to relieve the pain of muscle strains or acute or chronic pain that affects the nerves, ligaments, and tendons. There are many massage techniques, including Swedish, deep tissue, sports, and chair massages, and all can differ in duration and intensity. Therapeutic massage may relieve pain by several mechanisms. For example, it can help relax painful muscles, tendons, and joints, helping to reduce stress. Also, massages can help stimulate competing nerve fibers by impeding pain messages to and from the brain (17, 18).

A study published in Annals of Family Medicine in 2014 found that getting a 60-minute massage session two-three times per week for four weeks relieved chronic neck pain. Massage has also been shown to benefit sleep and promote feelings of relaxation (19).

What are Some Specialty Labs to Use with Integrative Medicine Pain Management?

When assessing systemic pain in the body, it is paramount to look at all contributing factors and interconnected systems that can contribute to the manifestation of pain. Factors such as over-reaction of the immune system, dormant viruses, hidden infections, and markers of inflammation such as antibodies and white blood cells can give more insight into the pathogenesis of pain and help to create a more individualized pain management protocol.

Awareness of these various markers is helpful as they can increase and decrease depending on how much inflammation is in the body. Testing helps the practitioner and patient see where to focus their attention with integrative approaches and can help assess treatment progress.

Various labs can be used to assess factors that play a role in pain throughout the body, such as systemic inflammation and inflammatory markers such as C-Reactive Protein. Other labs can check for dormant viruses and other infections, particularly those impacting the immune system, such as Epstein-Barr, Tickborne viruses, and HIV, as well as autoimmunity.

Summary

Chronic pain can affect nearly every aspect of your life and last for months or years. It is possible to experience chronic and acute pain. Managing all types of pain can initially feel daunting to many, so addressing pain from a holistic perspective is important. This can look like creating an integrative pain management program that includes functional labs and incorporates complementary and alternative healing modalities such as acupuncture, yoga, chiropractic care, physical therapy, and massage.