Integrative pain management — combining the wisdom of nature with the rigors of modern science — is a growing movement in the pain field today. Yet, it is controversial, with some claiming that “integrative” is just the latest buzzword for a collection of superstitions, myths, or pseudoscience that have gone by various names through the years. The epicenter of the integrative medicine debate, in the United States at least, is at the National Center for Complementary and Alternative Medicine (NCCAM).
NCCAM is one of 27 institutes and centers that make up the U.S. National Institutes of Health (NIH) and is the government’s lead agency for scientific research on complementary and alternative medicine (CAM). The Center sponsors and conducts research using scientific methods to study CAM, which is defined simply by NCCAM as a group of diverse medical and health care interventions, practices, products, or disciplines that are not generally considered as part of conventional medicine.
In a recent posting at the NCCAM Research Blog [here], agency Director, Josephine P. Briggs, MD, explores what “integrative” means and concedes that the term has various connotations. She observes that the legislation authorizing the Center in the late 1990s clearly emphasized integration, as follows:
Jargon often influences attitudes and impedes communication between healthcare providers and patients, which can impact the quality of pain care. Nowhere is this more apparent than in the use of “narcotics” rather than “opioids” in reference to pain relievers, and the results of a recently reported study comparing patients’ understandings of the two terms were both surprising and disturbing.
Many persons experience muscle pain after heavy exercise, which may persist for some time. Taking nonsteroidal anti-inflammatory drugs (NSAIDs) to ease the discomfort is common practice; however, new research suggests that this may not be beneficial. In fact, the pain may be prolonged with NSAIDs.
In a battle against prescription drug abuse and diversion, primarily involving opioid pain relievers, the U.S. Drug Enforcement Agency (DEA) has launched attacks on wholesalers and pharmacies within the legitimate supply chain. Questions are being raised about the foresight of such tactics, as healthcare providers are becoming leery of prescribing and severe shortages of these vital analgesics loom over the horizon. In the end, patients with pain may become collateral damage in this “War on Rx-Drugs.”
It makes sense that anxiety, depression, and chronic pain often occur together and might influence each other in negative ways. Consequently, a newly-reported trial suggests that the assessment of patient mood, and appropriate treatment for anxiety and/or depression, can be important for maximizing the effectiveness of pain management therapies, such as with opioid analgesics. However, as is often the case, there were limitations of this research that should be taken into account in rating the quality of the evidence.
Urine drug testing, or UDT, can be an important component of effective clinical pain management. However, a recent court decision has labeled claims by a major diagnostic testing laboratory — that their approach to UDT could help clinicians identify potential abuse, misuse, or diversion of patient medication — as false and deceptive advertising. This latest judgment reinforces the principle that UDT must be carefully and properly used as a tool for helping to gauge patient compliance with medication regimens.
By guest author, Nicole Hemmenway
Recent systematic reviews assessed the effectiveness of spinal manipulation therapy, such as chiropractic, for managing various types of pain. Overall, this modality was found to be ineffective for relieving most types of pain and of debatable clinical usefulness for others, such as back pain. However, there also have been many weaknesses in past research that need further attention.
Practitioners and their patients are increasingly turning to acetaminophen for the management of mild to moderate pain. However, new research affirms that confusion and ignorance about the proper use of over-the-counter medications containing acetaminophen is commonplace, and the unintentional overuse and overdose of acetaminophen has the potential to become a health threat of major proportions.
Newly reported research studies reiterate the benefits of vitamin D in older adults for helping to prevent falls, maintain mobility, and reduce age-related disability. However, optimal dosing strategies and blood levels of vitamin D in this population need further elaboration, and the quantity and quality of clinical research in this area has been disappointing.
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