Chronic Pain Management: Exploring Integrative Therapy

 

Chronic pain is by far the biggest economic burden and cause of disability in our country. Current prescription drug abuse epidemic is just one of the symptoms of this huge problem killing more people than road accidents and gun related deaths. It is ironic that American consumes more opioids than rest of the world combined but still has the largest number of untreated pain patients. All of this indicates the failure of traditional western medicine in managing this problem and calls for integration of additional modalities including complementary and alternative therapies.

In many countries, opioids are only used as a last resort and largely in terminally ill cases for pain management. Complementary and alternative medicine are a routine course of treatment in these countries. China, Thailand, India are good examples of the successful use of these integrative modalities. Some of the commonly used modalities are yoga, acupuncture, meditation and breathing exercises. These modalities not only treat the specific conditions but also improves the overall health and well-being of the patient. These approaches often represent a shift from the idea of cure to the concept of the healing process. These modalities are also not associated with side effects commonly associated with western traditional medicine.

 

Complementary and Alternative Modalities Commonly Used in Pain Management

Yoga, an ancient Indian technique is popular worldwide for keeping a sound mind and body for all age groups. There are specific yoga exercises for various conditions including back and neck pain, migraines, and pelvic pain. Yoga​ is as good as ​any physical therapy​ in reducing chronic ​low back pain​, the most common pain​ problem in the United States is shown by a 2016 research by Robert B. Saper, MD, director of integrative medicine at Boston Medical Center.

There is compelling evidence from studies conducted at NIH/NCCIH and other sites that mind-body techniques, such as yoga and meditation, can change the brain. Studies show that yoga practitioners have more gray matter than controls in multiple brain regions, including those involved in pain modulation. Assessing the impact of brain anatomy on pain reduction, gray matter changes in the insula or internal structures of the cerebral cortex are most significant for pain tolerance. Brain anatomy changes may contribute to mood disorders and other effective and cognitive comorbidities of chronic pain. The encouraging news for people with chronic pain is mind-body practices seem to exert a protective effect on brain gray matter that counteracts the neuroanatomical effects of chronic pain.

Acupuncture

Acupuncture is an ancient therapy that continues to play a role in today’s medicine. Experts believe that inserting needles into acupuncture points stimulates the release of chemicals in the muscles, spinal cord, and brain. This flow of natural chemicals may promote healing, improve your sense of energy and well-being, and relieve pain. Acupuncture has the ability to provide desensitization to areas suffering with chronic pain. Some people also choose acupuncture as a way to prevent illness or to treat specific health problems. It is known that acupuncture can alter levels of specific chemical compounds in the brain (especially hormones and neurotransmitters) including Substance P, endorphins, and ACTH. In summary, there is a significant role of complementary and alternative medicine techniques in treating chronic pain. Many of these modalities can ultimately reduce the use of opioids in treating these chronic conditions. Although several studies are available in published literature, there is further need for insurance companies to provide better payment coverage for these alternative modalities. As a result, this will also hopefully lead to the integration of these techniques in standard practice by medical practitioners.

 

Dr. Kavita Gupta is a director at Advocare Pain Institute in Voorhees, NJ.

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