Robert Bonakdar, MD, is the director of pain management at the Scripps Center for Integrative Medicine in San Diego.
Q: How many people with chronic pain use complementary remedies?
A: Surveys show that 40% or more of chronic pain patients use some level of complementary therapies. The number is high because pain is becoming epidemic. More people are experiencing pain, so you are going to have people who don’t get immediate relief and start searching for other options. According to several large surveys done by the National Institutes of Health, the needs of the pain patient aren’t always being met.
So it makes sense that pain patients will ask, "What else is out there?"
The most common treatments are manual therapies, such as massage or chiropractic, as well as herbal medicine, dietary supplements, acupuncture, and mind/body therapies (a catchall phrase for techniques like biofeedback, guided imagery, and meditation).
Q: Should anyone with chronic pain consider adding complementary approaches to their treatment?
A: Yes, within reason.
There are obviously many approaches that fall under that umbrella. Most of them are benign treatments—you aren’t going to necessarily mess anything up by doing them. My advice is always to use a health-care advocate like a doctor who can give you unbiased treatment advice. If you are getting to a point where other things aren’t working, most rational health-care providers will bring up other options. But we need a larger knowledge base—84% of doctors feel uncomfortable discussing complementary and alternative medicine (CAM). When probed, they say that they don’t know enough about it.
Q: How do the mind and body interact when you're in pain?
A: We know pain can create very significant emotional and physical stress in the body. The stress component can cause a large cascade of stress hormones that go on to damage other parts of the body and place a huge burden on the brain. The brain literally changes from pain; the brain actually will lose part of the gray matter so you have a less functional brain. You also have more depression, more insomnia, and more anxiety—the nervous system becomes its own enemy.
Mind/body therapies are an elegant avenue to retrain the brain, and one is not necessarily better than another. They are all shifting the mind to a better place. It might not take your back pain away tomorrow, but it can give you excellent coping strategies and increase awareness of what modifies the pain.
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