- Are you in pain and wanting to take better control of your health?
- Do you know someone with pain who is only using medications to control it?
- Have you ever talked to your doctor about what else you could be doing to support your pain management?
Pain is common, complex, and often costly to manage. It can range from daily headaches to low back pain to fibromyalgia to post-operative aches and soreness.
The Institute of Medicine reports that more Americans deal with pain than any other chronic condition (including diabetes, cancer, and cardiovascular disease), and that pain is an “expensive” condition to treat due to its collateral effects on health and life, such as depression, loss of work, and reduced productivity,1 not to mention the devastating effects of opioid addiction.2
The good news is that research supporting the use of integrative solutions to support pain management have shown improvements in the quality of life of those with pain.
The following questions are to ask your pain management doctor or health-care provider to make certain he/she is aware of these cutting-edge pain support solutions:
- Regarding prescription pain medications: Seek out a practitioner who follows the new guidelines that came out in May 2016 from the National Institutes of Health’s National Pain Strategy, which recommended, “Supporting the development of a system of patient-centered integrated pain management practices based on a biopsychosocial model of care that enables providers and patients to access the full spectrum of pain treatment options.” Look for practitioners who use or recommend integrative therapies in combination with conventional medical care, especially if you have low back pain, as this approach is “…more effective than select single therapies alone for treating low back pain.”3
- When it comes to over-the-counter pain medications and daily chronic pain management: Although they are widely utilized, chronic use of over-the-counter pain medications (such as aspirin, acetaminophen, and ibuprofen) carries risks, including gastrointestinal bleeding and kidney and liver damage. An integrative approach to pain can reduce the need for daily over-the-counter pain medications.4
- When it comes to surgery: Look for a surgical team who, in addition to the surgical procedure, offers a comprehensive evaluation and treatment plan. In addition to routine labs, a number of key metabolic and laboratory markers should be considered including weight, BMI, vitamin D, albumin, blood sugar, and hs-CRP levels. Deficiencies are not uncommon, with a recent survey finding that 67 percent of those preparing for elective orthopedic surgery were deficient in vitamin D. This is despite 44 percent of them having received some form of vitamin D supplementation.5 These deficiencies have direct implications on surgical outcomes. For example, a recent review of 31 studies found low pre-operative vitamin D was associated with:
- 3-4 times greater risk for hospital-acquired and surgical site infection
- Increased pain scores
- Decreased post-operative knee strength and walking ability6
Similarly, low albumin (<3.5 g/dL) has been shown in two recent UCLA and Yale studies to be associated with a greater than 3-fold increase in surgical complications.7,8
Unfortunately, as a recent JAMA study points out, in opioid-naive patients, a number of common surgical procedures are associated with an increased risk of requiring long-term opioid medications. Focusing on improving metabolic status as early as possible not only reduces post-operative pain and complications, but likely reduces the need for long-term pain medications, as well as improving recovery and function.
- When it comes to integrative care options: Ask whether your practitioner is open to discussing the use of integrative options, including nutritional supplements, acupuncture, and mind-body therapies (such as guided imagery and mindfulness meditation), all of which have been shown to reduce pain. Using these techniques, in addition to standard care recommendations (medications and physical therapy) to help support your overall health, as well as your aches and soreness, will help provide the most long-term relief.
Did you know that the documented benefits of mind-body practices in the surgical setting include:1
- Less anxiety and stress
- Less post-operative pain and discomfort
- Reduced need for pain medication
- Faster wound healing
- Better sleep quality
- More confidence in your ability to handle stress
- Fewer post-surgery complications
- Shortened hospital stays
Be an empowered patient and talk with your practitioner about your pain management and surgical care.
It’s time to lean in to the integrative, patient-centered approaches the CDC and IOM are calling for, which include:
- Supporting stress management through a variety of validated mind-body techniques (meditation, tai-chi, etc.)
- Reducing the co-morbidities of pain such as
- Mood instabilities
- Sleep disturbance
- Optimizing nutritional status (especially vitamin D, fatty acids, and protein)
- Improving active participation and movement throughout the pain support process
Written by Robert Bonakdar, MD – Scripps Center for Integrative Medicine and past president of the American Academy of Pain Management
Associated Thorne Research products: Nutrigesic Kit
- Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. http://www.ncbi.nlm.nih.gov/books/NBK92525/ [Accessed July 20, 2016]
- CDC Releases Guideline for Prescribing Opioids for Chronic Pain. http://www.cdc.gov/media/releases/2016/p0315-prescribing-opioids-guidelines.html [Accessed May 26, 2016]
- National Pain Strategy outlines actions for improving pain care in America. https://iprcc.nih.gov/National_Pain_Strategy/NPS_Main.htm [Accessed May 26, 2016]
- Kizhakkeveettil A, Rose K, Kadar GE. Integrative therapies for low back pain that include complementary and alternative medicine care: a systematic review. Glob Adv Health Med 2014;3(5):49-64.
- Michelson JD, Charlson MD. Vitamin D status in an elective orthopedic surgical population. Foot Ankle Int 2016;37(2):186-191.
- Iglar PJ, Hogan KJ. Vitamin D status and surgical outcomes: a systematic review. Patient Saf Surg 2015;9:14.
- Fu MC, Buerba RA, Grauer JN. Preoperative nutritional status as an adjunct predictor of major postoperative complications following anterior cervical discectomy and fusion. Clin Spine Surg 2016;29(4):167-172.
- Adogwa O, Martin JR, Huang K, et al. Preoperative serum albumin level as a predictor of postoperative complication after spine fusion. Spine (Phila Pa 1976) 2014;39(18):1513-1519.