Four professions' approach to acute and chronic pain

by Taylor Walsh

A current metaphor describing the advancement of integrative practices, methods and approaches for pain treatment is often that of a door gradually being wedged open by persistent practitioner advocacy, accumulated evidence and patient demand.  The intractable opioid addiction crisis has recently applied serious lubrication to the door hinges that is accelerating this opening.

As a session "Integrative Pain Panel: Four Professions' Approach to Acute and Chronic Pain "at the Integrative Healthcare Symposium in New York last week suggested, these doors to recognition and acceptance of non-pharmacologic integrative treatments for pain may well keep opening.  Presentations by leaders in acupuncture, chiropractic, naturopathic medicine and expertise on fascia mounted an impressive aggregation of outcomes, treatment successes, safety and cost effectiveness that are rarely presented together: a kind of coherent integrative treatment front.  As elsewhere in medicine and healthcare, the ravages of the opioid epidemic, and the pain-prescribing dysfunction that has driven it, have brought professions together.

Bill Reddy, L.Ac, board secretary for the Integrative Health Policy Consortium set out successes gained in acupuncture.  Gerard Clum, DC, President Emeritus at Life Chiropractic College West, concisely summarized the extensive data describing chiropractic effectiveness.  Michael Cronin, ND, laid out a thoroughgoing view of getting to the roots, the deepest roots, of pain to engage the body's natural healing qualities through prolotherapy and platelet therapy.  Hal Blatman, MD, explained the still unfolding qualities of the fascia and how its structure when inflamed can lead to pain that can be difficult to locate, much less treat.

Their reporting was individually and collectively compelling:

  • Reddy reported that the VA has found that using acupuncture for patients suffering from phantom limb pain reduced opioid prescribing by some 80 percent.
  • Clum's data went beyond pain management to show that in a large 2017 survey 43.4 percent of patients used chiropractors for "general health and wellness." 64.8 percent said their main reason for selecting a chiropractor was for "therapy and medical treatments."

Clum, who has spent 40 years as a chiropractor and as an engaged national leader in education and policy, also reported on new evidence that is showing that spinal care can affect neuroplasticity: manipulation, he said, has shown effects in the pre-frontal cortex.

Cronin, who founded and served as president of Southwest College of Naturopathic Medicine & Health Sciences in the 1990s pointedly observed that "it takes time to pinpoint structure problems" in joints, ligaments and tendons.  Regenerative Injection Therapy or prolotherapy, in which his Scottsdale practice specializes is showing increasing effectiveness, he said, in particular for geriatric patients who can attain restabilization and resume life with "less wear and tear."

Blatman, a past-president of the American Holistic Medical Association who practices in Cincinnati and New York, was the most fervent in directing attention far deeper into what he called the "fascial anatomy" where "mitochondrial injury" can be identified and dealt with.  "Chronic pain remains until the source is fixed," he said.  "Injuries can't be found by x-ray or MRI…but rather by touch."

In this "new view of biology," he reiterated Cronin's heavy focus on regenerative medicine, Platalet Rich Plasma (PRP), and stem cell therapy (notably Mesenchymal stem cells that can differentiate into a variety of cell types) that do far better at getting to baseline inflammation than can a pharmacologic agent like percoset.

These presentations also suggested that the decades-long efforts that the predecessors and colleagues of these panelists have undertaken—always in the face of dismissive and hostility—to create what is by now a massive story of efficacy, innovative views of human biology and patient desire have led to an interesting moment.  Wedging open the opioid-lubricated door to medical "respectability" is one thing: a huge thing.  But beyond pain treatment, as experienced practitioners know well, there are other qualities, other healing attributes that are also understood by patients: they are plainly visible in states where naturopaths are licensed as primary care providers; and in chiropractic patient preferences for "general health and wellness" the Clum cited above.

A sign of this moment came from an audience member, Ronald L. Stram MD, whose integrative practice in Albany, NY offers a deep catalog of integrative treatment options and of course not a hint of insurance reimbursement.  This status was acknowledged as the continuing fact of practice for which Cronin advised "keep plugging away," and Clum tersely noted, "the data can be there, but is dismissed out of hand."

Stram stood to report to the room that after 15 years of unsuccessful entreaties to New York's regulated insurance companies to consider reimbursement, four week ago they came knocking on his door.  The insurer representatives wanted to talk about opioid treatment.  Whether this was because their plan's members have been demanding coverage of acupuncture and other modalities is not yet known.  But when the door is pulled open from the inside the path through presents far different and more interesting prospects.  Not to get too far ahead of inquiries in Albany, but it may also serve to queue up the disciplines to prepare their non-pharmacologic healing qualities for many conditions of chronic illnesses that may or may not address pain.