Incorporating Functional Medicine Into Chronic Pain Care
According to the Centers for Disease Control and Prevention (CDC), chronic diseases and conditions, such as heart disease, stroke, cancer, type 2 diabetes, obesity, and arthritis, are among the most common, costly, and preventable of all health problems.1 More concerning, the incidence of chronic pain is greater than that of heart disease, diabetes, and cancer combined.
In the US, 86% of all health care spending in 2010 was directed at people with 1 or more chronic diseases.1 Alarming projections suggest future generations may have shorter, less healthy lives,2 and health care costs are estimated to rise to $4.153 trillion—the equivalent of 4 Iraq wars in a single year, if current trends continue.3 Specific behaviors, including being sedentary, poor nutrition, tobacco use, and excess alcohol consumption, lead to much of the illness, suffering, and early death related to chronic diseases and conditions.1
According to the American College of Preventive Medicine, most chronic diseases are preventable and reversible if a comprehensive, individualized approach that addresses genetics, diet, stress, physical activity, and sleep is implemented through integrated functional medicine teams and based on empirical research.4 In this way, health is perceived as more than the absence of illness, just as illness is more than the absence of health.
What Is Functional Medicine?
Functional medicine (FM) addresses the underlying causes of disease, using a systems-oriented approach and engaging both patient and practitioner in a therapeutic partnership.5 In effect, the focus is better understood as the medicine of why, not what. By changing the disease-centered focus of medical practice to a patient-centered approach, the practitioner is able to support the healing process by viewing health and illness as part of a cycle—all components of the human biological system interact dynamically with the environment. FM also takes as its focus 1 relationship: the sacred trust between the physician and the person who chooses to be that provider’s patient. FM is further guided by 6 core principles5:
- Understanding the biochemical individuality of each person, based on the concepts of genetics and environmental influence
- Emphasis on a patient-centered rather than a disease-centered approach to treatment
- Searching for a dynamic balance among the internal and external experiences
- Familiarity with the complex connections of internal physiological factors
- Identification of health as a positive vitality, not merely the absence of disease
Promotion of organ preservation as the means to enhance the health span, not just the lifespan of each patient. The role of FM practitioners is to spend time with their patients, listening to their histories and looking at the interactions among genetic, environmental, and lifestyle factors that can influence long-term health and complex, chronic disease, such as chronic pain. Numerous experiences can contribute to the maintenance of chronic pain—diet, exercise, thoughts, feelings, and environmental toxins.
Science has lent support to what may be known intuitively—how we live, the quality of our relationships, the food we eat, and how we use our bodies, have a much larger impact than genetics ever will. In other words, FM treats chronic pain by addressing these poor habits. This is also a fundamental principle of sustainable health. Implemented correctly, FM can help practitioners to prevent, treat, and often cure chronic conditions more effectively and at lower cost than the conventional medical paradigm.6
The “i” in illness underlines how disease affects the body or mind of the individual, and the “w” in wellness directs us to work together to reach a state of being in good physical and mental health. Thus, the FM approach to the management of chronic pain is delivered in a group format with individual follow-up sessions as needed. The group treatment protocol consists of 4 sessions that are approximately 60 to 75 minutes each in duration. The interdisciplinary treatment team consists of an osteopath physician, a dietitian, and a health psychologist. Patients are coached to change their environment and live an anti-inflammatory lifestyle through 4 key pillars: 1) diet, 2) exercise, 3) stress management, and 4) sleep hygiene.
The Functional Medicine Clinic: How It Works
The FM clinic was established by relying on the aforementioned 6 core principles combined with a vital osteopathic principle. The osteopathic principle teaches that the body is capable of self-regulation, self-healing, and health maintenance.7 In order for the body to live up to this principle, it needs to be supplied with the necessary nutrients through a healthy diet, adequate sleep, movement/exercise, and management of stress.
The FM clinic teaches patients that their body is engineered to give a level of health through their genetic cellular code. If our cells are provided with the optimum necessities to thrive, they will express their greatest health through the genetic code. However, each person harbors a different genetic code—thus, every patient must be treated individually to achieve optimal health. As noted, patients are instructed on common factors of health, such as an anti-inflammatory diet, sleep hygiene, increased physical movement, and coping skills.
The onus is placed on the patient’s self-care to process this information and to determine what specific healthy behaviors are best for their cells. This process is not easy for most; it takes determination, focus, and dedication. For example, each patient is placed on a modified elimination diet for 3 weeks. Each patient performs a small, but quite important, self-experiment to determine foods that may be contributing to his or her medical symptoms (food log). Each patient is asked to identify side effects, whether positive, negative, or different from others, allowing them to start painting their own self-portrait of health (health journal).
Session 1: Employing Pillar 1—An Elimination Diet
Keep in mind that every time a person eats, that changes body chemistry. Therefore, during the first session, the FM clinic guides patients to implement a modified elimination diet.8-13 Patients are taught about removing specific foods, such as those containing gluten or dairy, and are encouraged to adjust (increase) the intake of vegetables and fruits that encompass every color of the rainbow. Patients are advised to remove all added sugars. This process is often difficult for people; therefore, the FM team must work with patients to encourage their compliance with the elimination diet.