When advocating for improved quality of pain management, it is important to consider integrative care and have an understanding of what this is and what it means in the spectrum of pain treatment.

Modern or traditional medicine includes treatments, medications and therapies that have been around for less than 100 years. The terms complementary and alternative medicine (CAM) refer to therapies other than the use of pharmaceutical products to relieve pain and treat and illness. According to the 2007 National Health Statistics Report, almost 4 out of 10 adults had used CAM therapy in the past 12 months. The most common CAM therapies used were national products, deep breathing, meditation, chiropractic and osteopathic, massage and yoga. ¹ 

The blend of CAM and traditional Western medicine has come to be defined as integrative medicine or integrative care. It combines the concepts of mind, body, spirit and community and supports the theory of healing, and not always attempting to cure an illness. Integrative medicine involves not only the relationships between the patient and the health care provider(s), but also the relationship the patient has with his entire body and mind – a holistic approach.

Integrative care models are individualized from person to person and should be created by a health care professional with the patient’s feedback. There is no “one size fits all” approach for pain management, and what works for one person may not work for another person with the same disease, gender or age. Integrative therapies include the use of medication, when appropriate, and when prescribed by a licensed health care professional. Below are several integrative care modalities that may be included in an integrative care model. This list is not all-inclusive, nor does it recommend that you try without discussing with your pain management team. When integrated in to a multidisciplinary (meaning a team of specialized health care experts in each area of your therapeutic regimen) treatment approach, these therapies may be effective in certain patients and in treating certain conditions. As with all forms of treatment, it is imperative that you discuss with your healthcare provider before trying anything new; certain herbal medications, for example, have side effects that are complicated by prescription or over-the-counter medication. 

People with pain need to take personal responsibility and be accountable for your own mental and physical health. Take the time to do your own research as preparation for a discussion with your health care provider. It is important that you tell your health care providers about any types of complementary or alternative medicine practices you use, or are thinking about using. By being an informed consumer, you can speak knowledgeably with your health professionals and make decisions about your health and wellness to include all integrative modalities available and appropriate.

Acupuncture
Acupuncture was developed in China and has been practiced in China and other Asian countries for thousands of years. The term “acupuncture” describes a family of procedures that involve stimulation of anatomical points on the body using a variety of techniques.  The most commonly used and most scientifically studied acupuncture technique used involves penetrating the skin with thin, solid, metallic needles that are manipulated by hand or electrical stimulation.²  

Ayurveda
Ayurveda is also called Ayurvedic medicine and originated in India thousands of years ago. Ayurveda incorporates a holistic approach in that it strives to integrate and balance the body, mind, and spirit leading to happiness, health and illness prevention. Practitioners of Ayurvedic medicine work with their patients to eliminate impurities, reduce disease symptoms, increase resistance to disease, and reduce worrying and increase harmony. This type of medicine relies heavily on herbs and other plants in treatment regimens.³ 

Biofeedback
Biofeedback is based on the concept of using your mind to improve your health. Some health professionals believe that individuals have the ability to influence their thoughts to control some of the body’s involuntary functions. Special monitoring equipment if used to teach control of certain body functions and their responses. Biofeedback has been used to treat stress-related conditions and other conditions such as asthma, headaches, irritable bowel syndrome and chronic low back pain.⁴  

Chiropractic
Chiropractic is a health care approach that focuses on the relationship between the body’s structure – mainly the spine – and its functioning. In 1895, Daniel David Palmer, a self-taught healer believed that the body has natural healing power, and spinal misalignments can interfere with the healthy energy flow of the body. He theorized that the key to health is to normalize the function of the nervous system, particularly the spinal cord. Chiropractors typically perform adjustments to the spine or other parts of the body with the goal of correcting alignment problems and supporting the body’s natural ability to heal itself. The most common conditions for which people seek chiropractic care are back pain, neck pain, sciatica, joint pain and headache.⁵

Homeopathy
The guiding premise in homeopathic medicine is that every person has an energy called a vital source or self-healing response. The imbalance or disruption of this energy can be healed through stimulation of the body’s own healing responses, according to homeopathic theory. Most homeopathic remedies are derived from natural substances that come from plants, minerals or animals. To date, there is no scientific evidence supporting the use of homeopathic medicine for pain.⁶ 

Hypnosis
Hypnosis is a heightened state of concentration and focused attention usually achieved with the help of a specially-trained therapist. The goal of hypnosis is typically to help a person overcome or deal with a specific health condition such as managing chronic pain, easing symptoms of asthma or quitting smoking. The purpose of hypnosis is to help one gain control over behavior, emotion or physical well-being by focusing attention and remaining relaxed and calm.⁷  

Massage Therapy
Massage dates back thousands of year in numerous cultures and is used for a variety of health-related purposes including to relieve pain, rehabilitate sports injuries, reduce stress, increase relaxation, address anxiety and depression and aid general wellness. Although there are many types of massage techniques, typically a therapist will press, rub, and otherwise manipulate the muscles and other soft tissues of the body with their hands, fingers and/or forearms to enhance function and promote relaxation.⁸

Meditation
Meditation is a mind-body technique that teaches a person to focus attention and relate to the flow of emotions and thoughts in the mind. Meditation is sometimes used to increase calmness and physical relaxation, improve physiological balance, cope with an illness or to enhance overall well-being.⁹  

Tai Chi
the ancient Chinese discipline of Tai Chi is sometimes thought of as a combination of yoga and meditation in the Western world. Tai Chi is derived from martial arts, is rooted in self-control and is performed through a series of slow, soft, graceful movements with smooth and even transitions. The meditative nature of these exercises is thought to be calming and relaxing, providing both physical and psychological benefits.^10,11

Yoga
Yoga is an ancient Indian discipline that teaches balance, flexibility and meditation. This ancient method involves stilling the mind, cultivating kindness toward ourselves and finding a quiet place inside ourselves which may provide consolation in times of stress or pain. Through proper breathing, the mind is calmed and the whole body is cleansed and revitalized.¹²

Physical Therapy
Many health care providers consider physical therapy  an integral part of multidisciplinary pain management. It is defined as the treatment of an injury or disease using physical therapeutic movement. Physical therapists may use therapeutic massage, mobilization and physical movement, exercises, patient education, water therapy, ultrasound, and heat and ice to help improve function, increase flexibility and strength, and decrease pain. Typically, physical therapy treatment goals are individualized and include improving muscle tone, muscle length, muscle strength, balance and stability, joint mobility, range of motion and overall function at home and work.¹³

Medications may be a critical component of managing diseases and alleviating painful conditions and are an important element of the integrative care model. We are fortunate to have available medications with the potential to lower cholesterol, relieve pain, enable fertility, ease cardiovascular disease, regulate diabetes and extend the lives of cancer survivors. We tend to rely more on the traditional forms of modern medicine, because there are more clinical trials and outcomes research involving these products and disease states. For many forms of integrative therapies, clinical research is limited due to lack of funding.

Advocacy Action Tools & Resources: Integrative Medicine
It is our responsibility as pain advocates, caregivers and health care professionals to raise awareness about the importance of treating the whole person with a variety of options and in an individualized manner. Health care professionals should have an understanding of some of the most common integrative therapies so they can provide patients with options to supplement their treatment regimen, in addition to prescribing medication. Listed below are just a few of the health care professional and patient advocacy organizations that offer information and education about integrative care.

• American Academy of Family Physicians (http://www.aafp.org/online/en/home.html)
• American Academy of Physical Medicine & Rehabilitation (http://www.aapmr.org/)
• American Academy of Pain Management (http://www.aapainmanage.org/)
• American Osteopathic Association (http://www.osteopathic.org/)
• American Pain Foundation (http://www.painfoundation.org/)
• National Center for Complimentary and Alternative Medicine (http://nccam.nih.gov/)
• National Council on Patient Information and Education (http://www.healthfinder.gov/orgs/HR1913.htm)
• Patient Advocate Foundation (http://www.patientadvocate.org/)
• The American Chronic Pain Association (http://www.theacpa.org/)

PubMed Central (PMC) (http://www.pubmedcentral.nih.gov/) is the U.S. National Institutes of Health (NIH) free digital archive of biomedical and life sciences journal literature and is another excellent resource for information on integrative therapies.