Strong collaboration among all the health sciences—medical and alternative—is necessary

Divine is the work to subdue pain —Hippocrates

Initial thoughts concerning the topic of this article have led me to the conclusion that the subject of pain management leads to a tremendous body of scientific and philosophical concepts and definitions of “pain” that are much too expansive to include in this article. One central scientific fact and observation that all health care practitioners can agree with is that pain is a definite cognitive experience regulated specifically by the individual person’s unique psychological and emotional experiences. As health care practitioners, we can develop (and have developed) ingenious methods to quantify this emotional experience via outcome assessments and computerized technology, albeit still producing information of a subjective nature. For a discussion of pain management, I believe it is worthwhile to discuss and acknowledge historical and current treatment modalities that offer pain relief.

Throughout history, pain has been documented as a scourge to mankind; hence, it has been the subject of philosophical ideas and scientific theories for thousands of years. One thing for sure is that the feeling of pain is a survival mechanism designed to tell us that something wrong is happening to our body (and even the mind). Because of the strong cognitive aspect of the sensation of pain, there seems to be almost just as many analgesics available. An intriguing look into the history of pain relief can be seen in the accounts of once-popular treatment methods such as bloodletting and trephination (the process of drilling holes in the skull) performed by the medical profession. However, we cannot discount that no matter how strange a treatment or modality may seem, past and present, there is a person, or persons, that may have received much anticipated relief and therefore may have experienced a better quality of life because of it.

A Collaborative Effort
Current scientific findings related to pain, especially chronic pain, have shed more light into the physiology of pain and its consequences—either by its treatment or by its very presence in the body. For example, a 2004 study found a link between reductions in the brain’s grey matter equal to the amount lost through 10–20 years of normal aging and the presence of chronic back pain for 1 year.¹ Negative iatrogenic effects will continue so long as pharmaceuticals are looked upon as the only solution to chronic pain. There is even strong evidence to show that surgery for chronic lower-back pain is ineffective, such as in “failed back surgery syndrome.” As the number of people affected by chronic pain continues to rise with the aging of the population, we will be forced to find effective solutions for neuromusculoskeletal pain and other health conditions. My opinion is that the demand for effective solutions to pain and other conditions will force a strong collaborative effort by all the health sciences—medical and “alternative.”

Interdisciplinary health care management is the new model for the most progressive of health care institutions. In the forefront of research on the efficacy (and cost-efficiency) for long-term management of the pain patient is chiropractic care. A recent study concluded that “access to managed chiropractic care may reduce overall health care expenditures through several affects.”² A randomized clinical trial comparing chiropractic adjustment to muscle relaxants recently found that “chiropractic was more beneficial than placebo in reducing pain and more beneficial than either placebo or muscle relaxants.”³ So, as one can clearly see, research continues to validate chiropractic care for the management of the pain patient.

As mentioned earlier, the fast-approaching age wave will force collaboration within the healing arts and sciences. Chiropractic has shown its validity and efficacy of management of the pain patient. However, it is my opinion that to best serve the chronic pain patient, a physician must make an effort to handle all the complexities involved with this patient. It has been my experience that until one handles all of these complexities, then and only then will one achieve a more positive and long-lasting outcome for the patient. For example, a treatment plan based on objective and subjective improvements in the chronic pain patient can include chiropractic adjustments, soft-tissue therapies, clinical nutrition, physiological therapeutics/rehabilitative exercises, and even psychological modalities.

As we explain to patients in our office, “Our treatments will include chiropractic care to relax the nerve system and create balance in the spine and body. Deep-tissue massage will be used to relieve the tension and knots that have accumulated around your body, and then we will provide you with the proper nutritional support to promote a decrease in inflammation, promote proper healing, and provide pain relief. You then will perform exercises to help heal your body correctly, and in the meantime you will be shown and be referred to the appropriate person to help you deal with stress-management skills that quite possibly could be influencing your condition.” A thorough explanation of the reasoning behind this approach, we find, makes sense to the patient.

One example of a successful outcome using the above concept was seen with a patient, Ms Morrison, a 42-year-old nurse. She presented with a myriad of symptoms, including leg cramps, foot pain, back pain, neck pain, and migraines. The patient had experienced a “crack” from a chiropractor at a dinner party and decided to try it as a treatment “because it felt good.” She was referred to our office by a local hospital-run “alternative care” clinic. She was prescribed a corrective adjustment regimen of three visits each week for 12 weeks. Each visit included subluxation-based chiropractic care using a tonal-based technique called Dynamic Spinal Analysis, trigger-point therapy (specifically the Nimmo Technique), and postural/spinal corrective exercises using balance balls. In addition, she was counseled on basic nutritional supplementation and diet. She began daily whole food and omega-3 supplements. Throughout the care plan, she also received 1-hour neuromuscular therapy massages approximately once per month. As discussions centered on occupational stress, we discussed avenues for stress management. She chose daily walks as her source, and she found them very relaxing. When the patient was analyzed for spinal-pelvic stability due via digital foot analysis, we found correlating findings that required customized spinal-pelvic stabilizers. After this intensive collaborative effort, and investment in time and money by the patient, she was released from active-corrective care symptom-free and today enjoys wellness checkup visits once per month. She had totaled approximately 40 visits within a 7-month period. Due to scheduling at the hospital where she works, she averaged 2 visits per week. When patients understand the treatment approach, feel the results, and can see that they are on a corrective process with an end, they are willing to finance their care out of pocket, just as Ms Morrison did.

One note: To date we have found that only a handful of patients are open, or willing, to seek psychological assistance, and this can be a very touchy situation. A very careful and gentle approach is important, so as not to offend a patient.

It is my opinion that what has been termed as “holistic,” “alternative care,” “integrated,” or “complementary” to explain a “whole-body” therapeutic approach to the human body is fundamentally based on basic anatomy, physiology, and biology. Spinal manipulation was recently found to be the most effective in the treatment of lower-back pain. Manual therapies such as deep-tissue massage have also shown their efficacy in managing the pain patient. Physical therapy and rehabilitative exercises, and even yoga, have been beneficial. Nutrition also plays a critical role in proper healing, pain control, and inflammation management. Biofeedback and hypnosis have helped many control neuromusculoskeletal pain. The belief we have at our clinic is that each person can be affected differently by the various treatments available. However, an approach that incorporates as many treatments as possible that support proper functioning and healing of the basic physiological, anatomical, and psychological processes in the human body is the most powerful and promising for the chronic pain patient. Some practitioners would even argue the importance of acknowledging and incorporating bioenergetic modalities such as acupuncture or healing touch. The synergy achieved with this approach, we have seen, is incredibly powerful and specific to the individual. Results vary from person to person, but the key is that this approach handles all the “basics” and empowers people through education and awareness of their body, health, and self-healing. This approach also provides the patient with tools that he or she can use for a lifetime. As Thomas Edison said, “The doctor of the future will give no medicine, but will interest his patients in the care of the human frame, in diet, and in the cause and prevention of disease.”

Various Treatments Help
An example of how such an approach can dramatically affect a person’s quality of life can be seen in the case of Ms F. Hauck, a 56-year-old secretarial assistant, who sought our services for pain of 30-plus years. Chronic pain plagued her head, neck, shoulders, lower back and hips, and would cause her to stay in bed sometimes 24 hours at a time. She stated, “I

couldn’t participate in anything physical…which made me feel left out.” She had a history of chiropractic care, physical therapy, medical “back specialists,” and lots of drugs for pain. Her attitude when we first met was that chiropractic provided “some temporary relief but (did) nothing to change the overall way I felt.” She said, “My sense was that they just wanted me to keep coming back…I had resigned myself to a life of pain.” After we educated her about our approach, she agreed to and proceeded with a corrective care plan. Care consisted of an initial schedule of three visits per week for 12 weeks. Her visits to the office included subluxation-based chiropractic care using Dynamic Spinal Analysis. Manual therapy in the form of trigger-point work—specifically Nimmo Technique—was included. Spinal/postural rehabilitative exercises using propioceptive core restructuring via the Bosu Ball and balance ball were also used. The results can be summed up simply by her remarks: “I have very few headaches, and my mobility and flexibility has increased considerably. My husband has commented how my activity level has increased and I enjoy things again.” We find that a systemic approach provides great results for these types of patients. This patient was “graduated” to wellness care after completing the 12-week program and a total of 32 in-office visits.

We have seen that current isolated treatments, such as drugs, can be limited and even dangerous if used as the sole treatment of chronic pain. We have also seen that the aging of the population will force a collaborative effort of all the health sciences. In the near future, a systemic approach to the patient that incorporates treatments toward healthy functioning of basic anatomical, physiological, psychological, and arguably bio-energetic processes will most likely be borne out of necessity to provide the patient with real solutions to pain and quite possibly other health conditions. The reality is that a person will seek out as many solutions as possible for their seemingly unrelated health conditions, from physical conditions to systemic conditions, and typically seek a multitude of physicians and health providers for services. Compartmentalized approaches to health care will be a thing of the past.

The challenge will be to let go of the ego and realize that people need the services of a team approach toward their health and well-being. Chiropractors are highly qualified to serve as the team captain for the systemic approach. Are you ready to step up in your community?

Tony Peters, DC, is in private practice in Charlotte, NC, and can be reached at cafeoflife@bellsouth.net.

References
1. Apkarian AV, Sosa Y, Sonty S, et al. Chronic back pain is associated with decreased prefrontal and thalamic gray matter density. J Neurosci. 2004;24:10410–10415.
2. Legorreta AP, Metz RD, Nelson CF, Ray S, Chernicoff HO, DiNubile NA. Comparative analysis of individuals with and without chiropractic coverage: patient characteristics, utilization, and costs. Arch Intern Med. 2004;164:1985–1992.
3. Hoiriis KT, Pfleger B, McDuffie FC, et al. A randomized clinical trial comparing chiropractic adjustment to muscle relaxants for subacute low back pain. J Manipulative Physiol Ther. 2004; 27:388–398.