Why more than one modality is required for chronic pain management
Australian pain specialist Dr Chris Hayes recommends a holistic approach to the management of chronic pain. At Vibe we embrace this approach to chronic pain because it is supported by a large body of research and takes a broad and holistic view of all the factors that contribute to your chronic pain. Our holistic approach looks at the interaction of:
- Biological (genetic, biochemical, injury or trauma, sleep, nutrition),
- Psychological (mood, behaviours) and
- Social factors (family, medical, work place, support network)
This holistic model was developed to counter the biomedical model, which suggests that disease is the result of only physical factors.
While a holistic model is considered best practice, there is a lack of awareness within both the healthcare system and broader community and as such a biomedical approach to treatment often predominates. The upshot is that some non-invasive and more gentle treatment options aren’t available to those in chronic pain and the focus on surgery and medications and other invasive treatments is continued without further investigation of options (Hayes, 2016).
The key to patient’s accessing the best treatment is based on an integrative and individual treatment model. Care may be provided across multiple areas with the development of an overall treatment plan based on 6 key foundations of chronic pain treatment, as outlined by Dr Hayes:
- Education – explaining the role of the brain and nervous system interpretation of pain, which commonly has little to do with ongoing trauma. It also incorporates engaging patients in self-management, which over time will help reduce pain intensity. There is a growing body of research to show that pain education has significant pain-relieving effects. Brainman videos are useful resources to promote understanding about why a ‘definitive diagnosis’ may be elusive.
- Biomedical boundaries – setting boundaries around pain medication is key to avoid the treadmill of searching for external solutions e.g. increasing use of opioids or other biomedical approaches, instead focusing on broader treatment approaches. Interestingly this also includes medication de-prescribing and the importance of self-management strategies for the patient if surgery is recommended.
- Mindbody approaches – identifying unhelpful beliefs and using mindfulness and other techniques to reduce nervous system sensitisation with the aim of reducing pain intensity. Thoughts and emotions impact on our bodies in ways we only recently comprehend, via the gut-brain axis, nervous, endocrine and immune systems. What is empowering is that we can influence how our body responds over time using mindful practices.
- Connection – the importance of social interaction is critical for individuals in chronic pain. Loss of connection hurts and this can translate to increased physical pain. Reconnecting with friends, family, workmates and community can become part of a recovery process.
- Activity – engaging in activity or exercise appropriate to the individual and their level of disability can help to reduce the pain we experience. Activity in the open air and out in nature also helps calm and has a restorative effect on the nervous system (van den Berg, 2015)
- Nutrition – yes what we eat can influence individual experiences of pain. Specifically, nutrition helps to reduce the risk of co-morbidity such as depression, anxiety and obesity. Poor nutrition is also known to contribute to systemic inflammation, which can play a role in chronic pain.
It is important to highlight that this model includes manual therapies such as musculoskeletal therapy, chiropractic, osteopathic, physio or acupuncture. Research supports that these modalities have a significant role as treatment options for chronic pain and should be tried prior to more invasive treatment options.
Based on the above recommendations, it is not surprising that a treatment formulation for an individual with chronic pain could be quite comprehensive and involve a number of health care professionals over a period of time. These treatment options can occur concurrently or be paced out depending on patient need and preference. In our integrative pain clinic, a multi-modality team might include input from a chiropractor, an osteopath, a naturopath or nutritionist, and a counsellor or psychologist. It is important to note that this is a patient-centered approach and that the needs of the patient are first and foremost.
At first this all may seem overwhelming, the important thing to remember is that this model has been shown to have better long-term outcomes than a strict biomedical approach and that is hugely significant when it comes to chronic pain and quality of life.
Hayes, C, 2016. Six Foundations of Chronic Pain Treatment. The Australian Pain Society Newsletter, 6(3), pp. 24-25.