A Holistic Approach to Management of Chronic Pain

As pain practitioners know all too well, management of chronic pain is complicated. And despite the best tests, procedures and medications that modern medicine has to offer, chronic pain is still a major cause of disability. Can a holistic approach improve the quality of life for individuals with chronic pain, or perhaps heal the person completely?

Jay Sandweiss, DO, shared his experience as a wellness-focused practitioner in the final keynote presentation of the 2014 annual clinical meeting of the American Academy of Pain Management, in Phoenix, AZ. According to Sandweiss, there is a difference between doctoring and healing. “Doctoring is important; it has to do with investigating, testing and examining patients.” On the other hand, he explained, “healing has to do with making a deep connection to the person, where you create a relationship and try to help them heal their mind, body, spirit and sole. A healing doctor is the best combination.”

The triangle of health, or the “triune concept,” can help practitioners visualize the relationship between the three main components of health: chemical, mental/emotional and structural. Picture an equilateral triangle with each side representing one of the components. All sides must be maintained, and all sides must be in balance. If one side is out of line, the triangle will fall apart. “One side out of balance will lead to disease,” Sandweiss explained.

On the chemical side, patients need to be tested for nutritional deficiencies, toxicities and endocrine problems. According to Sandweiss, many individuals with chronic pain have deficiencies and toxicities that are the underlying cause of the problem. For example, within the hypothalamic-pituitary-adrenal axis, which is always stressed after trauma, adrenal dysfunction is the most common finding. The list of symptoms caused by adrenal dysfunction includes fatigue, depression, gastrointestinal irritation, weakened ligaments and susceptibility to joint injuries.

The mental and emotional state of a patient can also either exacerbate or cause structural problems and pain. As an example, Sandweiss described the theory of tension myositis syndrome (TMS), which was developed by John Sarno, MD. In TMS “stress leads to unconsciously tightening the muscles, which leads to ischemia, which leads to true physiological pain due to lack of blood and oxygen,” he said. The theory and treatment for TMS was developed for patients with chronic back pain, and Sandweiss reported that one of his patients with a severe herniated disk made a complete recovery after declining surgery in favor of this mind/body approach to healing.

In closing, Sandweiss emphasized the importance of offering patients reassurance, “let people know the pain isn’t going to last,” he said “talk in positive ways, and give people positive expectations.”