Many years ago I recall being asked to lecture about current advances in treating chronic pain. My presentation covered topics using medical management and interventional pain management techniques, one of the most common being the epidural steroid injection that most people are familiar with.
The last five minutes covered medical marijuana, which was timely considering Missouri was on the verge of legalizing its use. At the end of my presentation, the majority of questions were about the use of marijuana and not about the other more accepted therapies. This struck me as ironic because in the past, this discussion would never have come up due to marijuana's legal status and less than stellar reputation by the public at large.
Many patients now face chronic pain that is not relieved by traditional pain management therapies and are seeking other avenues for pain relief. Pain management best practices use a variety of methods to treat chronic pain that help patients live a better quality of life. Beyond medications, they also include restorative therapies, interventional procedures, behavioral health approaches as well as complementary and integrative health.
Current statistics on pain in the United States are overwhelming. Based on the most recent national data, 178 million Americans (or 41 percent of the adult population) has dealt with at least one painful condition. Further, 20 percent of Americans have chronic pain, which is typically defined as pain that is three months or more in length. Additionally, 8 percent report high-impact severe chronic pain, which is accompanied by at least one major activity restriction, such as being unable to work outside the home, go to school or do household chores.
This rise in pain has occurred at a time when Americans have more access to pain medications and procedures than ever before. This paradox has been attributed by some researchers as overtreatment of chronic pain because it is incorrectly viewed as extended acute pain, which can be fixed with unimodal approaches -- one shot fixes all -- which are medications and/or injections. This approach underappreciates chronic pain as a multifaceted condition involving nutritional, psychosocial, biochemical, neurological and physical components, which need to be comprehensively approached. The field of Integrative Medicine (IM) may represent a future viable alternative.
There are many misconceptions regarding the definition of Integrative Medicine. Simply put, integrative medicine combines the concepts in traditional medicine along with other less traditional non-western therapies; such as, acupuncture, herbal therapies, movement therapies and energy modalities. Integrative medicine encompasses the whole spectrum of health interventions, from prevention to treatment to rehabilitation and recovery. The pillars include nutrition, stress management, exercise and sleep. It has been gaining popularity and acceptance and now physicians can acquire advanced training in the form of a fellowship at highly regarded institutions, including: University of Arizona, University of Michigan, Ohio State University and UCLA to name a few.
The efficacy of IM strategies for pain control is proven in the literature. Insurance company's lack of reimbursement for many IM therapies continues to be an issue both for many patients and their practitioners. Now that the health care system is beginning to examine the evidence, the medical literature is expanding with studies on the use of integrative medicine use for chronic pain. Much of this literature supports the use of an integrative approach for pain, often with the same efficacy as our current model and with far fewer side effects.
John Lucio, DO, is a board-certified pain management specialist with SSM Health Spine and Pain Management Center, 2505 Mission Drive, Suite 200. Dr. Lucio's medical interests include: chronic pain management, diabetic peripheral neuropathy, epidural steroid injections, implantation of pain pumps, joint injections, nerve injections, regenerative medicine, spinal cord stimulators and stem cell injections. To make an appointment with Dr. Lucio, please call 573-681-3759.