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A Model to Incorporate Functional Medicine into Chronic Pain Care

A pilot study assesses the benefit of patient participation in a functional medicine program to decrease idiopathic chronic pain and related symptoms among a group of veterans.
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According to the Centers for Disease Control and Prevention,1 chronic diseases and conditions including arthritis, cancer, chronic pain, dementia, depression, diabetes, and posttraumatic conditions, are among the most common, costly, and preventable of all health problems. More concerning, the combined incidence of heart disease, diabetes, and cancer is lower than that of chronic pain.1 In addition, specific health risk behaviors, such as being sedentary, poor diet, tobacco use, inadequate sleep, and excess alcohol consumption, contribute to illness, suffering, and early death associated with chronic diseases and conditions.1

It is very common for Americans to numb themselves with low-quality foods, reality TV, and a variety of socially acceptable addictions, which may be ascribed to the idea that “ignorance is bliss.” Yet, each human has a unique genetic code that is guided by and responsive to the surrounding environment. Almost daily, two factors—genetics and the environment—have an infinite number of combinations with a potential to support health or yield to disease.

The authors initiated a pilot study to assess the efficacy of a functional medicine model of care to reduce pain and other symptom complaints in a group of veterans. In order to fully appreciate the methodology behind the study, a full explanation of the functional medicine model is needed.

Functional Medicine Encompasses Individual Biopsychosocial Needs

Functional medicine is a comprehensive, integrated approach to care that aims to address the underlying causes of disease, using a systems-oriented approach and engaging both patient and practitioner in a therapeutic partnership.2

The functional medicine approach looks to optimize the health of the body’s cells, and to offer support to the biopsychosocial functions that support healthy aging. When the cells meet with negative environmental assaults, the result is usually poorer outcomes. Conversely, when the body is provided with a personalized best in environmental options, the person has the greatest chance for good health. It is a dramatic departure from the standard Western methodology, which may be described, by some, as assembly-line medicine. The heavy focus on technology (ie, imaging, blood labs, EKG) has led to less touch, and a focus on basic proficiency without any emotional engagement. Modern medical care has evolved to offer better care for acute ailments, but less so for chronic conditions. In effect, the practice of clinical care would be best served by evolving to one of—why, not what—which is the fundamental goal of functional medicine.

Taking Time for a Thorough Patient Assessment

The role of functional medicine practitioners is to dedicate the time needed with patients. It is essential to listen to patient histories and to look for  possible interactions between genetic, environmental, and lifestyle factors that may influence long-term health, aging, and the development of chronic diseases, including chronic pain.

As part of assessing the patient’s current status, the provider may assess the person’s social environment in order to help them recognize that they only have control over their own lives. The focus is then changed from patients trying to get something from their loved ones to a perspective of the patient nurturing what is desirable from social connections. 

While love is integral to every person’s life, it is not something that can be measured or tested because each person experiences it differently. Yet, it is easily felt when it is present. Another way to consider this is to view love as if a concert of all the chemical reactions in the body, including hormones and neurotransmitters. If the practitioner prepares these instruments to perform at their best, than it is anticipated that love may have its best expression, and manifest as health.

Forming an Intimate Impression of the Patient

To gain a full understanding of a patient’s cellular needs, a thorough history and exam may include gathering information from the patient in the form of antecedents, triggers, and mediators:3

  • Antecedents are the predecessors to our health, such as our unique genetic code  
  • Triggers are those activating events that can lead to dysfunction, such as exposure to environmental toxins
  • Mediators are those issues that may perpetuate dysfunction, such as a poor diet or lack of sleep.

The functional medicine provider typically plots the accumulation of information on a timeline (see Figure 1, page 29), as a means of determining where the greatest area(s) of cellular dysfunction may originate and to act as a guide to care.  

Seeking the Underlying Cause of Chronic Pain

Rather than seeking to alleviate a symptom, the practice of functional medicine aims to identify the root cause of the disrupting symptoms. A functional medicine provider is trained to recognize an underlying clinical imbalance and then seek the best approach to restore balance or a health equilibrium.3  

The functional medicine specialist usually relies on the health matrix, which compiles information from each of the seven nodes (see Figure 2), which work in unison, rather than individually. The interconnectedness of the nodes aims to reinforce the impact that each will have on the others, which will ultimately reflect as health or dysfunction, which may manifest as pain and disease.

To find the initiating cause(s) of dysfunction, the functional medicine provider will utilize the seven nodes of the matrix to target the origin of the greatest clinical imbalances.3 The nodes of health include: assimilation, defense and repair, energy, biotransformation and elimination, transport, communication, and structural integrity, as denoted in Figure 2.  

Nutrient Assimilation and Gut Health

A common functional medicine concept, “heal the gut,” is used to describe not only the need for a fit GI tract but also calls attention to the influence the gut has in supporting the integrity of the entire physiological system well beyond the digestive tract.

Last updated on: December 7, 2017
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