The term, "integrative pain therapy," can be used to describe a broad therapeutic approach to the management of chronic pain, which attempts to combine the best of traditional treatments for pain and disability with the best of the therapies widely considered complementary or alternative. It is part of a larger effort to develop an "integrative medicine approach" to many clinical problems.
This integrative medicine approach links traditional, so-called allopathic,
medical treatments with varied complementary and alternative treatments. It
is a comprehensive system of medicine, which emphasizes wellness and the healing
of the whole person (physical, psychological, social, and spiritual), above
and beyond the treatment of any specific symptom or disease (Bell, 2002).
It involves the use of all safe and effective therapeutic approaches that
can potentially facilitate healing, while empowering the patient to participate
in the process of healing. Integrative medicine acknowledges the complexity
of health and illness by identifying multiple causes of disease and multiple
interventions based on the physical, biochemical, psychological, social and
spiritual aspects of health and disease. It recognizes that multiple outcomes
may be positive for the individual, and that these outcomes may vary from
one person to the next (Rosomoff, 1999).
The goals of an integrative pain therapy approach may include:
- reducing or eliminating pain
- using medicines that are appropriate, provide sustained benefits, have tolerable side effects, and support the functional goals of the patient
- reducing distress and enhancing comfort, peace of mind and quality of life
- improving the understanding of the role of emotions, behavior and attitudes in pain
- improving the ability to function physically and perform activities of daily living
- improving the ability to function in social and family roles
- supporting the patient's ability to return to work and function on the job
- educating patients in ways to maintain rehabilitation gains and avoid re-injury
- empowering patients to actively participate in pain control strategies
- promoting awareness and understanding of the factors that contribute to physical and emotional distress related to pain
- developing the skills and knowledge needed to increase the patient's sense of control over pain
Integrative pain therapy draws from a broad spectrum of therapeutic approaches. It recognizes the value of multiple approaches to pain management (a multimodality approach) and acknowledges the individualized nature of good medical care. The goal is to employ the safest and most effective therapies to provide maximum benefit.
In developing an integrative approach to pain therapy, the starting point is a broad view of health and well being. The foundations of health include at least four elements:
There are literally thousands of studies confirming the importance of each of these foundations. Careful attention to each can have profound effects on health and illness. The work of Dean Ornish (Ornish, 1999), for example, demonstrated that interventions targeted to these areas can not only halt, but actually reverse, coronary artery disease.
- stress management
- proper diet and nutrition
- regular exercise
- psychosocial support
All people experience stress and some degree of stress may be needed to generate excitement, engage fully in tasks, and perform well. However, too much stress, or poor coping with stress, can undermine health and well being.
There are many tools available to help reduce the debilitating effects of acute and chronic stress. The most important approach is to recognize triggers and behavior patterns, and to utilize emotional and spiritual approaches to reverse stress's negative effects. These approaches can be learned in a variety of ways, such as psychotherapy, education, and training in mind-body techniques. Sometimes, herbal, nutritional or pharmacologic therapies are needed to assist in coping with persistent stress.
Although science has a great deal more to learn about the role of nutrition in health and disease, it is certain that poor nutrition can contribute to a range of problems. Poor nutrition is common in many developing countries, and there is clear evidence that people living in developed countries, such as the United States, may not obtain enough of the essential nutrients needed for maintaining health (Fairfield & Fletcher, 2002). Because the diet may not be a complete source of all the nutrients needed for optimum health, the use of supplements may be necessary, either to help prevent disease or to aid in treatment.
Proper exercise maintains fitness and is very helpful in reducing stress. Intense aerobic exercise is not necessary to achieve these benefits. Brisk walking may be sufficient for many people. Modest, regular exercise, particularly when combined with stretching and relaxation, or approaches such as yoga and tai chi, provides another essential element for optimum health.
There is a huge body of research that demonstrates the importance of psychological and social factors in health and disease. Emotions, thoughts, connections to others, the response of others to our behaviors-all these factors contribute. Dealing with these types of issues and problems is an essential part of pain management.