Suffering from chronic pain or know someone who is?
We invite you to review the following hopeful information and to book an appointment to experience the paradigm shifting benefits of natural & integrative medicine pain relief.
Our program combines a wide range of low-risk natural pain relief strategies into one super power integrative program.
The therapies utilized have been endorsed, and continue to toward greater extents, by a wide range of major public health organization due to an ever growing body of research evidence linking these therapies to similar benefits as conventional treatment yet with lower side effect risk.
Even more importantly, evidence shows that combining these therapies into one program can produce up to 2-3 fold benefits over conventional treatments alone.
*see comprehensive research summary below for more details about this evidence and the natural therapies involved
OUR COMPREHENSIVE, EFFECTIVE, NATURAL & INTEGRATIVE MEDICAL APPROACH TO OVERCOMING PAIN, INCLUDING:
- Low Back Pain
- Osteoarthritis of Knee, Hip, Neck, Back, Hand, Wrist and Others
- Autoimmune conditions including rheumatoid arthritis, IBD, multiple sclerosis, lupus and other conditions
- Neck Pain
- Extremity Pain including Shoulder, Elbow, Ankle/foot, Hand/wrist and Hip Pain
- Fibromyalgia
- Extremity Pain including Shoulder, Elbow, Ankle/foot, Hand/wrist and Hip Pain
- Headaches
- Irritable Bowel Syndrome and Other Functional Gastrointestinal Disorders
- Inflammatory bowel diseases like crohns and ulcerative colitis
- Gastro-esophageal Reflux
- Carpal Tunnel syndrome
- Neurological Pain
- Pelvic pain
- Insomnia related to pain and otherwise
- Facial pain including temporomandibular joint disorder
- Overuse of opioids, nsaids and other medications with strong side effect risk
- Other forms of non-emergency acute and chronic pain
Our therapies include:
-
Mobilizations, Manipulations, Cranial Sacral Therapy and Other Manual Therapies
-
Inflammatory and Autoimmune Modulation Via Nutrition
-
Acupuncture/Acupressure
-
Medical grade massage Therapy (offered at discounted sliding scale rates for program participants)
-
Mind-body medicines including cognitive behavioral therapy, mindfulness, meditation, relaxation and hypnosis.
-
Home Based Education On Managing Acute And Chronic Pain
-
Therapeutic Exercise
-
Weight Loss
-
Yoga, Tai Chi, Pilates And Qi Gong
-
Hot/Cold Packs And Other Water Therapies
-
Dead Sea Salt/Mud Packs and Baths
-
Low Level Laser Therapy
-
Instrumented Assisted Soft Tissue Mobilization aka Gua Sha
-
Herbal Medicines
-
Homeopathy
-
TENS
-
Transcranial Electric Nerve Stimulation
-
Sleep Optimization
-
Nutritional Supplements
-
TH1/TH2 Immune Modulation
-
Detoxification
-
Postural Balancing Exercise
-
Whole Person Naturopathic, Chinese and Integrative Medicine
(more on these therapies below)
Introduction:
Pain is the most common reason people visit doctors including complementary and integrative health providers. A growing body of evidence suggests that many complementary and integrative approaches can help effectively manage painful conditions with lower side effect risks than conventional medicines like drugs and surgery. More so, bundling these natural therapies together using an integrative model produces effects that can be 2-3 x more effective than conventional care alone. This is particularly important due low effectiveness of conventional approaches to chronic pain, which resulted in the “opioid crisis” currently impacting millions of lives worldwide (i.e., physician started relying on opioids to treat chronic pain, despite their ineffectiveness for most forms of chronic pain). Importantly, side effects from other drugs, such as ibuprophen, are becoming more substantiated (i.e., the FDA has issued warnings that it increases the risk of heart attacks, strokes, gastrointestinal bleedings, delayed healing, and renal failure). Based on these findings, the research on complementary and integrative approaches for chronic pain continue grow and we are learning more and more about effective management of pain through complementary and integrative approaches.
Based on this growing evidence, major public health groups have endorsed the usage of complementary and integrative medicines for pain including:
- Oregon Health Authority
- Federal Drug Administration
- World Health Organization
- National Institutes of Health (multiple agencies)
- Centers for Disease Control and Prevention
- American Medical Association
- American College of Physicians
- Institute of Medicine
- Joint Commission
- Department of Workers Compensation
- Department of Defense
- United States Department of Veterans Affairs
- Institute for Health and Care Excellence, United Kingdom
- American Pain Society
- American College of Rheumatology
- American College of Gastroenterology
- American Academy of Neurology
- American Headache Society
For example:
In 2019, Oregon Health Authority encouraged, and nearly required, that all patients taking opioids for chronic pain receive complementary and integrative treatments to help them wean of these drugs and provide improved pain relief. In their guidelines, it states, “Opioids may lack efficacy in relieving chronic non-cancer pain long-term, and are inferior to sleep restoration, manipulation therapy, acupuncture, massage, mindfulness training/CBT, and physical exercise in providing long-term benefit to patients.
In May 2017, the Federal Drug Administration (FDA) recommended that physician be aware of the availability of complementary approaches for musculoskeletal and chronic pain conditions. This same year the the FDA Education Blueprint For Health Care Providers Involved In The Management or Support of Patients with Pain suggests acupuncture among a range of available therapies as part of a multidisciplinary approach to pain management.
In July 2017, The Joint Commission for hospital credentialing started to rank hospital on whether they offered nonpharmacological options for pain including complementary and integrative approaches.
In February 2017, American College of Physicians published new guidelines (based on evidence grading system) for the management of non-specific (i.e., non-radicular) low back pain. These guidelines recommend that several complementary and integrative medical approaches be used as first-line therapies for acute, subacute and chronic low back pain (see low back pain section for further details). These guidelines also recommend that drugs be used for chronic low back pain (i.e., NSAIDS and
opioids) only when nonpharmacological approaches do not provide adequate relief, and that acute and subacute low back pain indicated drugs (i.e., NSAIDs
and skeletal muscle relaxants) be used only when pharmacological treatments are desired by clinician and patient.
In April, 2017, several complementary and integrative therapies were included within new standard of care guidelines for guidelines for the treatment of osteoarthritis of the knee by the U.S. Department of Health and Human Services.
In 2016, the Center for Disease Control and Prevention (CDC) Guideline For Prescribing Opioids For Chronic Pain focused on the use on nonpharmacologic approaches for chronic pain including several complementary and integrative approaches such as cognitive behavioral therapy and exercise.
A September 2016 Mayo Clinic Proceedings review publication authored by the National Center of Complementary and Integrative Medicine (NCCIH) of the National Institutes of Health (NIH) reported, “Medications may provide only partial relief from chronic pain and can be associated with unwanted side effects. As a result, many individuals turn to complementary health approaches as part of their pain management strategy . . . Based on preponderance of positive versus negative studies, certain complementary and integrative medicine approaches may help some patients manage their painful health conditions.”
In November 2016, the Journal of American Medical Association published a follow-up article entitled “As Opioid Epidemic Rages, Complementary Health Approaches to
Pain Gain Traction,” where the previous article’s finding were described as, “Welcome news as health care professionals and agencies grapple with the crisis of opioid abuse.”
Since 2002, World Health Organization has published global strategies for the implementation of traditional (or non-conventional) and complementary medical approaches within healthcare. It describes traditional and complementary medicines as being either a mainstay of healthcare delivery or complement to it in nearly every country, with demand for its services increasing. It also describes how countries are increasingly recognizing the contributions that these approaches can make to health and well being, as well as the need to develop a cohesive and integrative approach to healthcare. A portion of WHO 2014-2023 strategy includes increased integration and access of traditional and complementary medicines into national and primary healthcare. The clinical and economic efficacy of complementary and integrative approaches for pain was also highlighted in this report.
For over a decade, NCCIH has been involved with other NIH consortiums and federal agencies to investigate and develop national strategies for pain, including leading development of the most recent standards for back pain research. In 2014, NCCIH, National Institute of Drug Abuse and Department of Veterans Affairs funded thirteen 5-year studies to address pain and related conditions using non-drug approaches in U.S. military personnel, veterans, and their families. In 2017, this important partnership expanded to include additional populations and Department of Defense and additional NIH agencies (National Institute of Neurological Disorders and Stroke, National Institute of Alcohol Abuse and Alcoholism, National Institute of Child Health and Human Development, Office of Research on Women’s Health, and National Institute of Nursing Research). The overall goal of this jointly supported initiative is to develop the capacity to implement cost-effective, large-scale clinical research in military and veteran health care delivery organizations focusing on nonpharmacologic approaches to the management of pain and comorbid conditions.
Institute of Medicine’s 2011 national blueprint for pain includes multiple references to the potential value of integrative health strategies. The report emphasized a model of ‘integrated, interdisciplinary pain assessment and treatment’ that includes complementary and alternative medicine.
Standard of care guidelines by Department of Workers Compensation recommend that patients be referred for complementary and integrative therapy when the patient’s cultural background, religious beliefs, or personal concepts of health suggest that these medical approaches might assist in the patient’s recovery or when the physician’s experience and clinical judgment support these approaches.
*Additional endorsement details are described in condition specific areas below.
What is our Integrative Medicine Based Pain Relief Program?
Supporting the global trend endorsing complementary and integrative approaches for pain, our program offers and wide range of natural or complementary and integrative forms of medicine into one superpower program. We generally follow the consortium guidelines for pain management, yet offer additional therapies.
Our pain relief program combines within one program the most proven forms of complementary and integrative medicines for pain relief including:
Manual Therapies are a non-surgical type of pain management that includes different skilled hands/fingers-on techniques directed to the patient’s body (spine, extremities, joints, musculature, etc.) for the purpose of assessing, diagnosing, and treating a variety of symptoms and conditions. Our manual therapies include spinal and joint manipulation, mobilization (gentle non-thrust manipulation), massage, cranial sacral therapy, myofascial release, energy medicine, postural training, post isometric relaxation, strain-counterstrain, acupressure, Bowen and other manual therapies. Our practitioners design and implement patient specific manual therapy approaches based on patient’s preference and condition specific needs. Our manual therapist are licensed naturopathic doctors or massage therapist, each with a decade or more of experience incorporating manual therapies. Our practitioners have received training by a very diverse range of manual therapy professionals include naturopathic doctors, doctors of osteopathy, chiropractic doctors, medical doctors – orthopedists and physiatrists, physical therapist, oriental medicine doctors, licensed massage therapist and others.
Weight loss involving our award winning program (1st Place by North Haven Citizen) involving nutritional counseling, assessment and correction of underlying endocrine, metabolic and nutrient deficiency conditions, metabolic typing, genetic testing, purification methods, therapeutic exercise, food intolerances, nutritional supplements and mind-body medicines. Practically all obese/overweight patients taking part in TLCPRP (particularly those with osteoarthritis) are offered the option weight-loss and additional nutritional services.
Mind-body Medicines are a variety of techniques that empower the mind’s functions (e.g., attention, thoughts, perceptions, decisions, emotions, understanding, self-knowledge and self-care) to improve mental, physical, behavioral, social and spiritual health. TLCPRP includes the most proven forms of mind-body medicines including cognitive behavioral therapy, mindfulness, world’s top meditation techniques, hypnosis, progressive relaxation, emotional freedom technique, yoga, tai chi, breathing exercises, and additional relaxation methods. The TLCPRP offers mind-body medicine services to practically all patients with chronic pain including complements to conventional medical care for patients with mental health disorders. TLCPRP can also provide additional mental health based strategies to support pain relief including herbal medicines, transcranial electric stimulation, therapeutic exercise, nutritional supplements and nutritional counseling, which meta-analyses report are about as effective as conventional treatments for mental health yet with lower side effect risk compared to prescription medications.
Therapeutic Exercise including condition specific exercises and comprehensive programs combining low to high intensity cardiovascular training, strength training, balance and mobility exercises, stretching, agility and other self care strategies. A licensed personal trainer with 20+ years of experience provides these services in conjuction with our naturopathic physicians. Our strategies incorporate recommendations based on guidelines by U.S. Preventive Services, Osteoartritis standards, and American Colleges of Sports Medicine, Cardiology, Rheumatology and Neurology in combination with novel integrative methods.
Tai chi, yoga, qi gong, and other forms of mindful movements are ancient to modern exercise and lifestyle practices. These practices are designed to help people cultivate greater awareness and peace, and move more gracefully and purposely. They can help improve pain, inflammation, balance, strength, muscle engagement, overall physical and mental health, mindfulness, and other health outcomes. They are also standard of care treatments for low back and potentially other forms of pain.
Acupuncture, acupressure, gua sha, Oriental herbal medicine, and other Eastern medical approaches. Acupuncture is a medical technique that involves insertion of tiny, hair-thin needles in particular locations of the body and can help relieve tension and improve circulation of blood, chi and other subtle energies. Acupuncture is amongst the most popular forms of medicine worldwide and it has been practiced in Asia and other continents for a few thousand years. Research is showing that it is particular helpful for the management of chronic pain, addictions and gastrointestinal health. Gua sha is an ancient oriental technique that can improve circulation, range of motion and healing of connective tissue. Gua sha is nearly identical to the modern orthopedic practices of instrument assisted soft tissue technique as well as Graston technique.
Self Care/Home Management Education including prevention and management of acute, subacute and chronic pain, as well as strategies to overcome side effects of prolonged sitting. These include use of hot-cold packs and baths, stretches and movements to engage in and avoid dependent on condition state, wrapping and bracing techniques, and pain/inflammation reduction and muscle relaxation through nutrition, herbal medicine, nutritional supplement, mind-body medicines and over the counter medications.
Autoimmune disease assessment and “paradigm shifting (several Nature and additional publications)” treatment strategies addressing lectin avoidance, inflammation, intestinal barrier function, t-helper cell immune modulation, and anti-oxidant function plus general dietary, pain and lifestyle factors through nutrition, herbal medicines, nutritional supplements, mind-body medicines, exercise, manual therapies, physiotherapies and naturopathic medicine.
Nutritional Counseling including condition specific strategies for pain, inflammation, autoimmune diseases, weight loss, blood pressure reduction, cholesterol reduction, heart disease, mental health, cancer, migraines, allergies, irritable bowel syndrome, inflammatory bowel diseases, gout and fertility.
Physiotherapies including low level laser therapy, gua sha/instrumental assisted soft-tissue technique, transcranial electric stimulation, TENS machine, microcurrent, postural correction, mobilization and application of heat/cold therapies. These low-risk techniques may help improve tension, pain, mobility, inflammation, cellular regeneration, joint healing and mental health outcomes, include long-term benefits.
Hot/Cold, Herbal, particular Mud and Mineral Packs/Baths applied during in office visits and at home, which safely help to improve pain and function and are proven standard of care treatments for low back pain, osteoarthritis and other forms of pain.
Herbal medicine, nutritional supplements and homeopathy for pain, inflammation, joint health, and other medical conditions based on evidence based strategies and traditional usage.
Inflammation, homocysteine, autoimmune and other nutrient assessment through blood testing and reduction through nutrition, nutritional supplements, cholesterol reduction, microbiome modulation, and mind-body medicines.
Sleep optimization through cognitive behavioral therapy, additional behavioral and relaxation techniques, nutritional counseling, and herbal and nutritional supplements.
Energy medicine including cranial sacral therapy, Reiki, pranic healing, chakra balancing, and other energy medicine techniques. These technique use very gentle hands-on to non-touch procedures to relax, coordinate, strengthen and mobilize bones, muscles, nerves, circulation and other subtle energies.
Whole system naturopathic, Western, traditional Chinese and homeopathic medicine plus additional integrative strategies for all underlying medical conditions that may be influencing pain and overall health – along with referrals as deemed appropriate.
Effectiveness of Multidisciplinary Integrative Models (similar to our program)
Importantly, multidisciplinary integrative approaches, similar albeit generally less comprehensive our program have been shown to consistently and substantially improve outcomes when added to usual care treatment.
For example:
– In 2017, Rhode Island’s integrative pain Medicaid pilot study reported 2-3 fold benefits by using a multidisciplinary integrative approach versus usual care treatment alone for chronic pain. In this study, high-risk opioid users (i.e., four of more ER visits in 12-month period) became eligible to receive acupuncture, spinal manipulation/mobilization and massage services through management of an integrative nurse practitioner. Participation resulted in reduced per member year medial costs by 27%, ER visits by 61%, opioid prescriptions by 86%, $2.71 medical expense savings for every $1 spent on complementary and integrative services, and high functional improvements.
–
Florida Medicaid Integrative Therapies Pilot Project (2003-2004, continued in
subsequent years), which reported 16 to 24% improvements in functional
outcomes, 20% reduction versus 23% increase in prescriptions, 94% participant
report of pain reduction, and 25% lower costs compared to usual care – after
two years, by allowing patients to seek spinal manipulation/mobilization,
acupuncture or massage services through coordination by a nurse practitioner.
–
Blue Cross Blue Shield’s integrative medicine primary care pilot on 70,000
participants in Chicago reported 60% decreases in hospital admittance, 59%
decrease hospital days, outpatient procedural cost decreases by 62% and pharmaceutical
cost decreases of 56% over 7-years (with increasing benefits afterward) by
allowing primary care referrals to “natural medicine” MD and DOs, broad-scope
primary care oriented” chiropractic, massage, homeopathy, herbal medicine,
nutrition, Ayurvedic, Chinese, mind-body medicine and cranial sacral therapy
practitioners.
–
A 2015 BMJ meta-analysis from 41 studies involving 6,858 people with chronic
back pain determined that a multidisciplinary approach – addressing biological,
psychological and social dimensions of pain – was also more effective at
reducing pain and helping people return to active lives than any single usual
care approach. More so, in two of these studies, the multidisciplinary approach
proved as effective as surgery in regards to pain and functional outcomes – yet
with far lower side effect risk and financial cost.
Acute vs. Chronic Pain
In
many situations, acute pain serves as a highly adaptive and beneficial
experience. Fundamentally, it serves as a protective warning of actual or
impending tissue damage. Acute musculoskeletal pain is a common example in the
injured worker and is often a signal of impending tissue damage.
Most acute
pain is self-limited and may respond to short-term administration of analgesics
and conservative therapies. However, continued activation of nociceptors with
less than adequate pain control can lead risk for persistent pain with
prolonged disability, delayed return to baseline function, and delayed return
to work.
Chronic pain
can be distinguished from acute pain by more than just the time course. Whereas
acute pain serves as a protective warning signal, chronic pain has no known
survival benefit. Evidence suggests that generation and subsequent maintenance
of chronic pain, as opposed to acute pain, may involve changes in central pain
processing mediated through mechanisms of neural plasticity and ultimately
leading to hyper-excitability of central structures in the spinal cord and
brain.
More so, whereas acute
pain is generally recognized as a biomedical process, chronic pain is recognized
as influenced by biological, psychological and social factors. Psychological
and social factors, as well as poor sleep, are amongst the strongest risk
factors for pain. These factors also explain why people with same anatomical
pathologies can experience distinctly different pain intensities.
Standard of care
guidelines for chronic pain recommend that psychological and social factors, as
well as sleep, be addressed along with physiological health. Therapies
addressing psychological and social health also are amongst the most effective
therapies for chronic pain.
Epidemiology of Chronic
Pain
Chronic
pain is pain generally defined as what lasts more longer than “normal healing.”
It’s a very common problem. Results from the 2012 National Health Interview
Survey show that:
- More
than half of American adults (125 million) had a musculoskeletal pain disorder
in 2012. - About
25.3 million U.S. adults (11.2 percent) had pain every day for the previous
3 months. - Nearly
40 million adults (17.6 percent) had severe pain. - Individuals
with severe pain had worse health, used more health care, and had more
disability than those with less severe pain. - More
than 40% of people with a musculoskeletal pain disorder used a complementary
health approach.
Chronic
pain generally becomes more common as people grow older, at least in part
because health problems that can cause pain, such as osteoarthritis, become
more common with advancing age. Not all people with chronic pain have a
physician-diagnosed health problem, but among those who do, the most frequent
conditions by far are low-back pain and osteoarthritis, according to a national
survey. Other common diagnoses include rheumatoid arthritis, migraine, carpal
tunnel syndrome, and fibromyalgia. The annual economic cost of chronic pain in
the United States, including both treatment and lost productivity, has been
estimated at nearly $635 billion.
Chronic
pain may result from an underlying disease or health condition, an injury,
medical treatment (such as surgery), inflammation, or a problem in the nervous
system (in which case it is called “neuropathic pain”), or the cause may be
unknown. Pain can affect quality of life and productivity, and it may be accompanied
by difficulty in moving around, disturbed sleep, anxiety, depression, and other
problems.
What the Science Says
About Complementary Health Approaches for Chronic Pain
Scientific
evidence supports several complementary and integrative health approaches for
the management of chronic pain. A comprehensive description of scientific
research on all the complementary and integrative approaches that have been
studied for chronic pain is beyond the scope of this packet. This section
highlights the research status of the most effective complementary and
integrative approaches used for the most common kinds of pain. Therapies
with strongest research evidence are listed first.
Chronic pain
in general
Research
has looked at the effects of complementary and integrative approaches on
chronic pain in general rather than on specific painful conditions.
- Therapeutic exercise,
cognitive behavioral therapy and patient education is considered
essential elements of pain management by standard of care guidelines (Colorado
Division for Workers’ Compensation, 2011).
- Manual therapies
including manipulation, mobilization and massage are recommended for
pain relief in standard of care workers compensation and other pain management
guidelines (Colorado Division for Workers’ Compensation, 2011).
- Complementary and
integrative medical systems (e.g., naturopathy and traditional Chinese medicine),
mind-body medicines, biological based practices (e.g., herbal medicines,
nutritional and nutritional supplements) and energy medicines are recommended for
pain by standard of care guidelines (Colorado Division for Workers’
Compensation, 2011). These modalities can be used to improve pain and function
in people who desire to utilize these techniques and have received non-adequate
relief from conventional treatments.
- Acupuncture is recommended for
chronic pain by standard of care worker’s compensation guidelines, in patients who
are trying to increase function and/or decrease medication usage and have an
expressed interest in these modalities (Colorado Division for Workers’
Compensation, 2011). Indications include joint pain, joint stiffness, soft
tissue pain and inflammation, paresthesia, post-surgical pain relief, muscle
spasm, and scar tissue pain.
- Cognitive behavioral
therapy for sleep should
be utilized as first line agent to improve sleep in people with pain based on
standard of care guidelines (Colorado Division for Workers’ Compensation,
2011). Cognitive behavioral therapy is regarded as the best first-line
treatment for insomnia. It appears capable of reducing severity and daytime consequences
of insomnia. It also can decrease insomnia drug usage and overall medical
costs. Melatonin can also be
considered as an alternative to drugs for insomnia in people with pain and sleep
disturbances, particularly those with difficulty falling asleep. - A
2014 evaluation of studies on active self-care complementary approaches that
individuals can do themselves after being taught the technique) found that
there is some evidence in favor of using yoga, tai chi, and music
for self-management of chronic pain symptom (National Center for Complementary
and Integrative Healthcare, 2016).
- Localized
injection in painful area can be utilized as secondary treatment options for
various types of pain (Colorado Division for Workers’ Compensation, 2011).
- A
2016 evaluation of the research on meditation and mindfulness found they
may be helpful for patients with chronic pain, with effectiveness similar to
that of cognitive-behavioral approaches (National Center for Complementary
and Integrative Healthcare, 2016). In some cases, such as on non-specific low
back pain, these therapies can be more effective than usual care treatments.
Meditation and mindfulness appear to reduce pain by improving mental,
emotional, behavioral, social, occupational and spiritual health, reducing
magnitude of pain transmission, recontextualizing pain sensations, improving
genetic expression of inflammation, placebo-like mechanism involving reward,
and improving balance and muscle activation. Public health cost benefit is also
apparent from these approaches.
- Research
shows that hypnosis is moderately effective in managing chronic pain,
when compared to usual medical care. However, the effectiveness of hypnosis can
vary substantially from one person to another (National Center for Complementary
and Integrative Healthcare, 2016). Hypnosis may act through similar mechanisms
as meditation and mindfulness.
- Inactive
sugar based placebo pills have been shown to reduce general pain as much as
certain medications with little to no side effects. Pain reduction occurs even
when people know the pill does not contain active ingredients.
- Traditional
medical usage also supports additional strategies for chronic pain including
inflammation reduction through nutritional and additional strategies, oral and
topical herbal and homeopathic medicines, hydrotherapy (hot/cold packs and
water baths), localized injection therapies and others.
Low-back pain
- American
College of Physicians 2017 clinical guidelines for management of low back pain
were developed based on a grading system of current evidence. The following
statements summarize their report:
Recommendation 1: Given that most
patients with acute or subacute low back pain improve over time regardless of
treatment, clinicians and patients should select nonpharmacologic treatment
with superficial heat (moderate-quality evidence), massage, acupuncture, or
spinal manipulation (low-quality evidence). If pharmacologic treatment is
desired, clinicians and patients should select nonsteroidal anti-inflammatory
drugs or skeletal muscle relaxants (moderate-quality evidence). (Grade: strong
recommendation.
Recommendation
2: For
patients with chronic low back pain, clinicians and patients should initially
select nonpharmacologic treatment with exercise, multidisciplinary
rehabilitation, acupuncture, mindfulness-based stress reduction
(moderate-quality evidence), tai chi, yoga, motor control exercise, progressive
relaxation, electromyography biofeedback, low-level laser therapy, operant
therapy, cognitive behavioral therapy, or spinal manipulation (low-quality
evidence). (Grade: strong recommendation)
Recommendation
3: In
patients with chronic low back pain who have had an inadequate response to
nonpharmacologic therapy, clinicians and patients should consider pharmacologic
treatment with nonsteroidal anti-inflammatory drugs as first-line therapy, or
tramadol or duloxetine as second-line therapy. Clinicians should only consider
opioids as an option in patients who have failed the aforementioned treatments
and only if the potential benefits outweigh the risks for individual patients
and after a discussion of known risks and realistic benefits with patients.
(Grade: weak recommendation, moderate-quality evidence)
- Most studies have shown that spinal manipulation
and mobilizations
can be more effective, at modest effect sizes, than other active therapies
commonly used for chronic low back pain including usual care treatment, physical
therapy, exercise, medications, massage, acupuncture, physiotherapies and light
touch (National Center for Complementary and Integrative Healthcare, 2016 and
Furlan 2010). A 2010 UK systematic review also determined that spinal
manipulation-mobilizations is effective in adults for acute and subacute low
back pain (Bronfort 2010). In a 2016 review paper, the National Center of
Complementary and Alternative Medicine also described this evidence as being a
“preponderance of positive versus negative studies,” and endorsed its usage for
low back pain. This statement was later supported by the American Medical
Association (Abassi, 2016).
- A 2016 National Institutes of Health funded study published in the Journal of back pain versus usual care treatment. Long term benefits were also apparent. The two mind-body medicine practices evaluated were mindfulness based stress reduction and cognitive behavioral therapy (National Center for Complementary and Integrative Healthcare, 2016).
- A 2012 combined analysis of data from several studies concludes that acupuncture is a reasonable option to consider for chronic low-back pain. A 2016 review of studies conducted in the United States found evidence that acupuncture can help some patients manage low-back pain (National Center for Complementary and Integrative Healthcare, 2016).
- Massage may provide short-term relief from low-back pain. It is not known whether it has long-term benefits on low-back pain. One study showed that massage is more effective than physical therapy and improving back pain and function (National Center for Complementary and Integrative Healthcare, 2016).
- Studies have shown that yoga can be helpful for low-back pain in the short term and may also be helpful over longer periods of time (National Center for Complementary and Integrative Healthcare, 2016)
- A 2014 Cochrane review on herbal products found preliminary evidence that several oral and topical treatments may be effective for low back pain. These therapies were shown to have little side effects.Preliminary evidence for additional studies suggest that these products reduce pain and inflammation, improve function, and one product has been shown to increase the proliferation of chondrocytes and cartilage production.
- A 2016 meta-analysis concluded that there is moderate quality of evidence to support a clinically important benefits of low level laser therapy for chronic non-specific low back pain and function in the short term, which was only seen following higher laser dose interventions (20 minutes; >3J per point) and in participants with a shorter duration of back pain (30 months).
- There is some evidence that progressive relaxation may help relieve low-back pain but studies on this topic have not been of the highest quality (National Center for Complementary and Integrative Healthcare, 2016).
- Additional studies, traditional medical usage and clinical evidence also supports additional strategies for low back pain including inflammation reduction, joint strengthening and immune modulation through nutrition, nutritional supplements, oral and topical herbal and homeopathic medicines, hydrotherapy (hot/cold packs and water baths), localized injection therapies and others.
Osteoarthritis
- Lectin avoidance, polyphenol rich diets represent a paradigm shift in osteoarthritis, which treats a root cause of the condition – joint damage.
- 2017 guidelines for the management of osteoarthritis of the knee recommend a multifactorial, integrative approach involving specific exercise methodologies, weight loss, self-care/at home education, tai chi, TENs, balneotherapy, hot packs, mud packs, manual therapies, whole body vibration and nutraceutical supplementation to optimize short to long-term pain and function outcomes. Only two treatments recommended by these guidelines (i.e., platelet-rich plasma injections and pulsed electromagnetic field therapy) are not available through our program.
- In 2012, the American College of Rheumatology issued recommendations for using non-drug approaches for osteoarthritis of the hand, hip, and knee
- Weight loss is considered to be an effective therapy for osteoarthritis and the most proven strategy for certain forms of osteoarthritis, especially osteoarthritis of the knee. Weight loss appears to reduce the wear and tear on joints, which is the hallmark of osteoarthritis (Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, 2016).
- Exercise is also considered to be an effective therapy
for osteoarthritis. Low to moderate quality evidence shows that it improves
pain and function associated with osteoarthritis. Various different exercise
programs have been shown to improve osteoarthritis related symptoms, and are
generally best prescribed based on a person’s current functional levels,
preferences and access (Agency for Healthcare Research and Quality, U.S.
Department of Health and Human Services, 2016). A Cochrane Review also described
aquatic exercise for people with knee and hip osteoarthritis as probably
improving pain, disability slightly, and maybe improving quality of life
slightly immediately after completion of a treatment course (Bartels, 2016) - Self management
programs were
recommended in 2012 American College of Rheumatology for osteoarthritis of the
knee. These strategies include methods to reduce flares and improve acute
flares if occurring. Low to moderate strength evidence show that these
therapies are effective.
- A
2017 meta-analysis involving large population studies determined that high
versus low consumption of a particular dietary component reduced the risk of
osteoarthritis of the knee by 30-61%.
- Tai chi is recommended
by 2017 standard of care guidelines for osteoarthritis of the knee for its
ability to improve function and pain. It has shown to be effective for
osteoarthritis of the knee symptoms in three of three randomized controlled
trials (Nahin, 2016). In the 2016 review paper reporting this, the National
Center of Complementary and Alternative Medicine also described this evidence
as being a “preponderance of positive versus negative studies,” and endorsed
its usage. This statement was later supported by the American Medical
Association (Abassi, 2016). In 2012, the American College of Rheumatology
conditionally recommended tai chi for osteoarthritis of the knee. Since then
additional positive research has been conducted.
- A
2012 combined analysis of data from several studies indicated that acupuncture
can be helpful and a reasonable option to consider for osteoarthritis pain. In
2012, acupuncture was also conditionally recommended by the American College of
Rheumatology for those who have chronic moderate-to-severe knee pain and are
candidates for total knee replacement but can’t or won’t undergo the procedure.
There is also considerable evidence from several meta-analyses and systematic
reviews that acupuncture may help to lessen pain and improve function in
osteoarthritis of other joints, including back, hip and hand. In these reports,
acupuncture was shown to improve pain and mobility.
- A 2010 UK systematic
review determined that manipulation are effective for hip osteoarthritis and
mobilizations are for knee osteoarthritis (Bronfort 2010). This same review also
determined that manipulations-mobilization plus exercise are effective for knee
osteoarthritis.
- Emerging of research suggests that massage may help reduce osteoarthritis symptoms. It may reduce pain and improve physical function (the ability to walk and move) (National Center for Complementary and Integrative Healthcare, 2016).
- Preliminary evidence is available in support of several oral and topical herbal medicines for osteoarthritis. Most of them benefit pain and inflammation yet one has also been shown to improve proliferation of chondrocytes and growth of cartilage (degradation of which is the hallmark of osteoarthritis) (National Center for Complementary and Integrative Healthcare 2016).
- Preliminary evidence shows that yoga may be helpful for osteoarthritis (National Center for Complementary and Integrative Healthcare, 2016).
- Studies of glucosamine, chondroitin and MSM for knee osteoarthritis pain have had some positive, particularly when a specific form of glucosamine is used. Some European studies show that glucosamine improves pain, function and joint structure, however, studies conducted by the National Institutes of Health and other groups haven’t been able to reproduce these results (National Center for Complementary and Integrative Healthcare, 2016). Based on emerging evidence and clinical expertise, however, we are able to target which individuals will benefits from these supplements.
- Additional studies, traditional
medical usage and clinical evidence also supports additional strategies for
osteoarthritis including inflammation reduction, joint strengthening and immune
modulation through nutrition, nutritional supplements, oral and topical herbal
and homeopathic medicines, hydrotherapy (hot/cold packs and water baths),
localized injection therapies and others.
Rheumatoid arthritis, Multiple Sclerosis, Inflammatory Bowel Disease and other Autoimmune Conditions
- Lectin avoidance and high polyphenols represents a paradigm shift these conditions as best described by work by Terry Wahls, MD, Stephen Gundry, MD and a wide range of research unveiled by these experts.
- The American College of Rheumatology recommends certain dietary strategies for the management of rheumatoid arthritis. Our program can provide nutritional counseling based on these recommendations as well as additional strategies that can benefit inflammation and overall health.
- Modern research including Nature publications has highlighted the paradigm shifting role of intestinal permeability/intestinal repair, t-helper cell modulation, lectin detoxification, anti-oxidant support and additional factors in autoimmune processes including rheumatoid arthritis and multiple sclerosis. Our program can provide testing for these conditions and offer safe treatments to help correct these underlying agents based on data from decades of clinical use combined with modern research findings.
- Dietary supplements containing certain fatty acids as well as herbal medicines has also been shown to help relieve rheumatoid arthritis symptoms. Our program can recommend and offer you high quality supplements based consistent with this evidence (National Center for Complementary and Integrative Healthcare, 2016).
- At least two anti-oxidants as well as additional herbal medicines has been shown to improve outcomes in patients with rheumatoid arthritis, autoimmune thyroiditis and other autoimmune conditions when added to usual care treatment. Our program can incorporate these products and additional nutritional approaches to boost anti-oxidant and improve autoimmune activity.
- Low level laser therapy could be considered for short-term treatment for relief of pain and morning stiffness for rheumatoid arthritis patients, particularly since it has few side-effects. Our program can provide low level laser therapy in combination with other treatments for rheumatoid arthritis.
- Preliminary
evidence on mind and body medicines for rheumatoid arthritis pain show
that these practices may reduce rheumatic arthritis symptoms (National Center
for Complementary and Integrative Healthcare, 2016).
- Meta-analyses
show acupuncture may reduce rheumatoid arthritis related pain.
- Evidence
also shows that hydrotherapy (hot/cold water therapies) reduces rheumatoid
arthritis associated swelling.
- Additional
studies, traditional medical usage and clinical evidence also support additional
strategies for rheumatoid arthritis and other autoimmune conditions including dietary
strategies, herbal medicines and mind-body medicines.
Headache
- Guidelines from the American Academy of Neurology and the American Headache Society recommend that certain triggers be avoided to prevent migraines. Our program can provide you with a comprehensive list of these triggers.
- Guidelines
from the American Academy of Neurology and the American Headache Society also classifies
a particular herbal medicine as being
effective for preventing migraines and additional herbs and nutritional
supplements as being probably to possibly effective. TLCPRP can recommend a
combination migraine supplement that includes all of these recommended nutrients.
- Relaxation approaches has shown to be effective for severe headaches/migraines symptoms in three of three randomized controlled trials (Nahin, 2016). In the 2016 review paper reporting this, the National Center of Complementary and Alternative Medicine of the National Institutes of Health also described this evidence a being a “preponderance of positive versus negative studies,” and endorsed its usage. This statement was later supported by the American Medical Association (Abassi, 2016).
- A
2016 stage 2 clinical trial published in a prominent neurological journal
determined that a common nutritional supplement can be as effective as
prescription triptans at preventing migraines yet with little to no side
effects. Previous studies over the past 2 decades reported similar benefits. TLCPRP
can provide you with this supplement as well as ways to increase your body’s
store through lifestyle methods.
- A
2013 study determined that a common household spice reduces severity of acute
migraine attacks equally as a standard of care prescription medication (to
about 90% in two hours) and with considerably less side effects than the
prescription. TLCPRP can provide you this herb and show you how to utilize it
for additional health benefits.
- A
2012 combined analysis of data from several studies indicates that acupuncture
can be helpful and a reasonable option to consider for headache pain (National
Center for Complementary and Integrative Healthcare, 2016). More recent
reviews, suggests that a course of acupuncture consisting of at least six
treatment sessions can be a valuable option for people with migraine (Linde,
2016) and that acupuncture is also effective for treating frequent episodic or
chronic tension-type headaches (Linde. 2016-2).
- A
2010 UK systematic review determined that spinal manipulation is effective for
migraine and cervicogenic headache as well as cervicogenic dizziness (Bronfort
2010). This same review determined that mobilization of the neck using a
particular traction technique is an effective treatment for cervicogenic
headaches and cervicogenic dizziness.
- A
2010 review paper concluded that yoga
helped reduce pain associated with migraines (National Center for Complementary
and Integrative Healthcare, 2016).
- A
common genetic mutation has been linked to migraines. The impact of this
mutation can be simply overcome through dietary and supplemental measures.
- Limited
evidence is also available in support of cranial sacral therapy, spinal
manipulation, massage, tai chi, biofeedback
and additional traditional medical approaches for headaches.
Neck pain
- Acupuncture A 2016 moderate sized study published in Annals of Internal Medicine found that
acupuncture added to usual care significantly improved neck pain and function
compared to usual care alone (MacPherson 2015). A large study in Germany also found
that people who received acupuncture for neck pain had better pain relief than
those who didn’t receive acupuncture (National Center for Complementary and
Integrative Healthcare, 2016).
- A
2015 Cochrane review paper concluded that evidence supports thoracic manipulation-mobilizations (but
not cervical manipulation) for neck pain and that multiple sessions may provide
better relief than certain medications (Gross, 2015). A 2010 UK systematic
review also concluded that spinal manipulation or mobilization of the thoracic (and not cervical) vertebrae are an
effective treatment for acute, subacute and chronic neck pain (Bronfort, 2010).
This same UK review paper described mobilization with exercise as effective for
acute whiplash-associated disorders. - A
2016 review of studies performed in the United States found that massage
therapy may provide short-term relief from neck pain, especially if massage
sessions are relatively lengthy and frequent. One study showed that
massage was better than exercise at improving neck pain and disability but not
flexibility (National Center for Complementary and Integrative Healthcare,
2016).
- A
2015 Cochrane review paper determined that cognitive
behavioral therapy was significantly better than other types of
interventions at reducing pain at short-term follow-up for patients with
subacute neck pain (Monticone, 2015).
- A
2016 moderate sized study published in Annals
of Internal Medicine found that a certain postural training program added
to usual care significantly improved neck pain and function compared to usual
care alone (MacPherson, 2015)
- A
2009 meta-analysis published in the Journal
of the American Medical Association
determined that low level laser therapy reduces
pain immediately after treatment in acute neck pain and up to 22 weeks after
completion of treatment protocol in patients with chronic neck pain (Chow, 2009).
It also noted that is a very low risk treatment.
- Additional
studies, traditional medical usage and clinical evidence also supports
additional strategies for neck pain including inflammation reduction through
nutritional and additional strategies, oral and topical herbal and homeopathic
medicines, hydrotherapy (hot/cold packs and water baths), localized injection
therapies and others.
Fibromyalgia
- Antidepressants
are standard of care treatments for fibromyalgia. There is also evidence from a
number of randomized controlled trials that an herbal anti-depressants (shown in a 2016 meta-analysis to be as
effective for depression as pharmaceuticals yet with lower adverse event risk)
improves outcomes of fibromyalgia – even in non-depressed people.
- A
large body of evidence reports that microcirculation
is impaired in populations with fibromyalgia. Particular exercise, herbal
medicine, nutritional strategies and nutritional supplements have been shown to
improve circulation by as much as 70%. The TLCPRP can provide you with these
treatment strategies.
- A particular supplement that supports mood and
pain with less side effect risk than prescription drugs has been described as
having good scientific evidence for fibromyalgia pain relief and function
improvement.
- Cognitive behavioral
therapy
is a standard of care treatment for fibromyalgia. Evidence is also available in
support of meditation, mindfulness and yoga for fibromyalgia.
- Exercise/therapeutic
exercise:
Studies have shown that fibromyalgia symptoms may be relieved by aerobic
exercise. Patients should consult with a physician before beginning an exercise
program. A therapeutic exercise profession may be helpful in deciding those
exercises that are most appropriate. Specific exercises may help restore muscle
balance and reduce pain. Stretching techniques may also be recommended.
- Tai chi has shown to be
effective for fibromyalgia symptoms in two of two randomized controlled trials
(Nahin, 2016). In the 2016 review paper reporting this, the National Center of
Complementary and Alternative Medicine of the National Institutes of Health
also described this evidence as being a “preponderance of positive versus
negative studies,” and endorsed its usage. This statement was later supported
by the American Medical Association (Abassi, 2016).
- National Center for
Complementary and Integrative Medicine describes good evidence for obtaining
adequate vitamin D levels in patients with fibromyalgia.
- Natural Medicines
Comprehensive Database describes a particular nutritional supplement, herbal
medicine, acupuncture protocol and mobilization/massage techniques as having
good scientific evidence for fibromyalgia.
- Research shows that various forms of
balneotherapy (or high mineral water therapies) as well as hydrotherapy may be
helpful for fibromyalgia related pain and function. These therapies are also
utilized as a conventional treatment option throughout parts of Europe and
Asia.
- Studies
show that between 40-70% of people with fibromyalgia also have irritable bowel
syndrome. Treating irritable bowel syndrome may help overcome fibromyalgia
related distress (see irritable bowel syndrome section of this packet for more
details).
- People
with poor sleep have a greater risk of fibromyalgia. Supporting sleep through
cognitive behavioral therapy, certain nutritional supplements and other methods
may help relieve fibromyalgia related distress.
- Physical
and emotional stress are known triggers of fibromyalgia flares. Addressing
these stresses through healthy exercise/activity as well as mind-body medicines
and additional relaxation techniques (in addition to cognitive behavioral
therapy and/or medications, particularly with depression) may reduce triggers.
- Particular
nutritional interventions have also been shown to reduce fibromyalgia triggers
and improve sleep.
- Traditional
medical usage also supports additional strategies for fibromyaglia including
inflammation reduction through nutritional and additional strategies, oral and
topical herbal and homeopathic medicines, hydrotherapy (hot/cold packs and
water baths), localized injection therapies and others.
Irritable
bowel syndrome (IBS)
Primary
care guidelines established in 2015 recommend that people with IBS be given
information that explains the importance of self-help in effectively managing
their IBS including information on general lifestyle, physical activity, diet
and symptom-targeted medication. People should also identify and make the most
of their available leisure time and to create relaxation time.
These
guidelines recommend professional in-office assessments, blood and related
laboratory testing, dietary counseling (e.g., single food avoidances, increased
soluble fiber diets, etc.), nutritional supplements (e.g., specific soluble
fibers, probiotic trials, etc.), as well as safe, non-habit forming ways to
reduce constipation and diarrhea.
Our program can provide these therapies including professional advice on healthy lifestyle, highest quality probiotics and nutritional supplements, comprehensive IBS specific and overall healthy diets, symptom and root cause targeted treatments, safe, gentle and non-habit forming ways to overcome constipation and diarrhea.
Our program also provides lactulose breath testing and treatment of a root cause of IBS (i.e., small intestinal bacterial overgrowth [SIBO]) found in 60-90% of people with IBS. A specific short-term herbal medicine based anti-microbial and prebiotic formula targeting SIBO is also available, which research shows can be as effective as prescription rifaximin yet with less side effects. This is remarkable as 2014 American College of Gastroenterology guidelines for IBS recommend rifaximin for IBS symptoms and bloating based on moderate level evidence. This same herbal treatment can also resolve chronic diarrhea in about 90% of people. More so, 2014 American College of Gastroenterology guidelines for IBS also state that there is moderate level evidence in support of another herbal medicine for IBS symptoms, which has low side effect risk.
Improving
mental health is also crucial for the management including remission of IBS
(even in the absence of mental illness). Anxiety is generally established as
the strongest risk factor for IBS. Several mind-body medicines including gut
directed hypnotherapy, cognitive behavioral therapy, mindfulness, meditation
and yoga have been shown to improve IBS symptoms. Preliminary evidence from
meta-analyses also reports that forgiveness therapies can reduce anxiety more
than any other treatment and can work synergistically with other mind-body
medicine. TLCPRP can provide these mind-body medicine options for anxiety and
IBS. Exercise, nutritional strategies, sleep support, several herbal medicines
and other nutritional supplements can also be effective at reducing anxiety and
stress.
Inflammatory Bowel Disease (IBD), irritable bowel syndrome (IBS), and other functional gastrointestinal disorders (FGD)
Our naturopathic physicians have extensive experience helping patients with IBD and other FGDs. Dr. Lee worked with leading naturopathic gastroenterologists that have helped 1000s of patients referred from conventional gastroenterologists for difficult to treat IBD, IBS and other FGDs. In most cases, these conditions can be quickly and safely resolved by healthy lifestyle, IBS, autoimmune and IBD specific dietary, herbal medicine and nutritional supplements, overcoming IBD and its underlying etiologies, as well as mind-body medicines and manual therapies. Evidence is also growing the efficacy of complementary and integrative treatments for these conditions.
Pelvic Pain including Premenstrual Syndrome, Fibroid, Endometriosis, Hemorrhoid, Prostatitis and Interstitial Cystitis Related Pain
Evidence
supporting this area is remarkable. Cochrane review publications report that
particular Chinese medicine herbal and acupuncture protocols equal to more
effective for fibroids and endometriosis pain patterns than conventional
treatments.
Herbal
medicines and nutritional supplements have also been shown to be more effective
than prescription and over the counter medications for premenstrual syndrome, polycystic
ovarian syndrome, prostatitis and other female pelvic concerns, with lower side
effect risks.
Preliminary
evidence also supports mind-body medicines, weight loss, pelvic and general
exercise, gastrointestinal health support, natural endocrine function
modulation, nutrition, nutritional supplements, herbal medicines, various
topical treatments, and additional complementary and integrative therapies for interstitial
cystitis, chronic urinary tract infection, kidney stone, vaginal infections as
well as other forms of pelvic pain.
Patients
seen for these conditions are generally pleased with the results in respect to
their conventional treatment recommendations.
Other types
of pain
- Various
complementary approaches have been studied for less common types of chronic
pain, such as complex regional pain
syndrome, neuropathic/nerve pain, facial
pain, shoulder pain, chronic pelvic pain, interstitial cystitis, prostatitis,
carpal tunnel syndrome and other extremity pain, pain associated with gout,
surgery related pain, and cancer
pain. There’s promising evidence that some complementary approaches may be
helpful for some of these types of pain. We have also seen complete to
near-complete remission for practically all of these conditions. TLCPRP can
provide you with this information and these services, which descriptions reach
beyond the scope of this report.
What do we know about
the safety of complementary and integrative health approaches for
chronic pain?
Although
many of the complementary approaches studied for chronic pain have good safety
records, that doesn’t mean that they’re risk-free for everyone. Your health,
special circumstances (such as pregnancy), and medicines or supplements that
you take may affect the safety of complementary approaches.
Acupuncture,
hypnosis, massage therapy, mindfulness/meditation, relaxation techniques,
spinal manipulation, tai chi/qi gong, and yoga, are generally safe for healthy
people if they’re performed appropriately.
There are few complications associated with acupuncture, but adverse effects such as minor bruising or bleeding can occur. At our program our licensed naturopathic doctors use only sterile, single use and disposable, stainless steel acupuncture needles and other standard of care clean needle techniques.
People
with medical conditions and pregnant women may need to modify or avoid some
mind and body practices.
Like other forms of exercise, mind and body
practices that involve movement, such as tai chi and yoga, can cause sore
muscles and may involve some small risk of injury.
It’s important for practitioners and teachers
of mind and body practices to be properly qualified and to follow appropriate
safety precautions.
Disclaimer:
- Do
not use an unproven product or practice to replace conventional care or to
postpone seeing a health care provider about chronic pain or any other
health problem. - Learn
about the product or practice you are considering, especially the scientific
evidence on its safety and whether it works. - Talk
with the health care providers you see for chronic pain. Tell them about the
product or practice you are considering and ask any questions you may have.
They may be able to advise you on its safety, use, and
likely effectiveness. - If
you are considering a practitioner-provided complementary health practice such
as spinal manipulation, massage, or acupuncture, ask a trusted source (such as
your health care provider or a nearby hospital) to recommend a practitioner.
Find out about the training and experience of any practitioner you are
considering. Ask whether the practitioner has experience working with your
pain condition. - If
you are considering dietary supplements, keep in mind that they can cause
health problems if not used correctly, and some may interact with prescription
or nonprescription medications or other dietary supplements you take. Our
naturopathic physicians can advise you. If you are pregnant or nursing a child,
or if you are considering giving a child a dietary supplement, it is especially
important to consult your (or your child’s) naturopathic physician. - Tell
all your health care providers about any complementary or integrative health
approaches you use. Give them a full picture of what you do to manage your
health. This will help ensure coordinated and safe care.
Selected References:
1. Ford AC, Moayyedi P, Lacy
BE, et al. American College of Gastroenterology monograph on the management of
irritable bowel syndrome and chronic idiopathic constipation. Am J Gastroenterol. 2014;109 Suppl
1:S2-26; quiz S27.
2. Institute of Medicine. Relieving Pain
in America: A Blueprint for Transforming Prevention, Care, Education and
Research, Reprint 2012, Washington, DC.
3. Abbasi J. As Opioid Epidemic Rages,
Complementary Approaches to Pain Gain Traction JAMA. E-print available online: November2016.
4. Nahin R, Boineau R, Khalsa P, Stussman
J, Weber W. Evidence Based Evaluation of Complementary Health Approaches for
Pain Management in the United States. Mayo
Clinic Proc. 2016;91(9):1292-1306.
5. Agency of Healthcare Research and
Quality, U.S. Department of Health and Human Services. Treatment of Primary and
Secondary Osteoarthritis of the Knee: An Update Review (Draft). 2016.
6. Fasano A. Leaky gut and autoimmune
diseases. Clin Rev Allergy Immunol. 2012;42(1):71-78.
7. Fasano A, Shea-Donohue T. Mechanisms of
disease: the role of intestinal barrier function in the pathogenesis of
gastrointestinal autoimmune diseases. Nat
Clin Pract Gastroenterol Hepatol. 2005;2(9):416-422.
8. Fasano A. Zonulin, regulation of tight
junctions, and autoimmune diseases. Ann N
Y Acad Sci. 2012;1258:25-33.
9. Cherkin DC, Sherman KJ, Balderson BH,
et al. Effect of Mindfulness-Based Stress Reduction vs Cognitive Behavioral
Therapy or Usual Care on Back Pain and Functional Limitations in Adults With
Chronic Low Back Pain: A Randomized Clinical Trial. JAMA. 2016;315(12):1240-1249.
10. National Center for Complementary and
Integrative Health, U.S. Department of Health and Human Services, National
Institutes of Health. Chronic Pain: In
Depth. 2015.
11. Apaydin EA, Maher AR, Shanman R, et al. A
systematic review of St. John’s wort for major depressive disorder. Syst Rev. 2016;5(1):148.
12. Irritable bowel syndrome in adults:
diagnosis and management of irritable bowel syndrome in primary care. London (UK): National Institute for Health
and Care Excellence (NICE). 2015;37.
13. MacPherson H, Tilbrook H, Richmond S, et
al. Alexander Technique Lessons or Acupuncture Sessions for Persons With
Chronic Neck Pain: A Randomized Trial. Ann
Intern Med. 2015;163(9):653-662.
14. Wang C, Schmid C, Iversen M. Comparative
effectiveness of tai chi versus physical therapy for knee osteoarthritis: a
randomized trial. Ann Intern Med. 2016;165(2):77-86.
15. American College of Rheumatology. Diet
May Determine Your Risk for Rheumatoid Arthritis. 2015; http://www.rheumatology.org/About-Us/Newsroom/Press-Releases/ID/704/Diet-May-Determine-Your-Risk-for-Rheumatoid-Arthritis.
16. Colorado Department of Workers
Compensation. Chronic pain disorder medical treatment guidelines. In: National
Guideline Clearinghouse, U.S. Department of Health and Human Services. Ed. Vol 0093302011.
17. Chow RT, Johnson MI, Lopes-Martins RAB,
Bjordal JM. Efficacy of low-level laser therapy in the management of neck pain:
a systematic review and meta-analysis of randomised placebo or active-treatment
controlled trials. The Lancet. 2009;374(9705):1897-1908.
18. Gross A, Langevin P, Burnie SJ, et al. Manipulation
and mobilisation for neck pain contrasted against an inactive control or
another active treatment. Cochrane
Database Syst Rev. 2015(9):CD004249.
19. Bronfort G, Haas M, Evans R, Leininger B,
Triano J. Effectiveness of manual therapies: the UK evidence report. Chiropractic and Osteopathy. 2010;18(3).
20. Holland S, Silberstein S, Freitag F,
Dodick D, Argoff C, Ashman E. Evidence-based guideline update: NSAID and other
complementary treatments for episodic migraine prevention in adults. Neurology. 2012;78:1346-1353.
21. World Health Organization. WHO Traditional
Medicine Strategy, 2014 – 2023; http://apps.who.int/iris/bitstream/10665/92455/1/9789241506090_eng.pdf?ua=1
22. Natural Medicine Comprehensive Medical
Database, www.naturaldatabase.com, Accessed: 2016-2017.
23. Newberry SJ, FitzGerald J, SooHoo NF,
Booth M, Marks J, Motala A, Apaydin E, Chen C, Raaen L, Shanman R, Shekelle PG.
Treatment of Osteoarthritis of the Knee: An Update Review. Comparative
Effectiveness Review No. 190. (Prepared by the RAND Southern California Evidence-based
Practice Center under Contract No. 290- 2015-00010-I.) AHRQ Publication
No.17-EHC011-EF. Rockville, MD: Agency for Healthcare Research and Quality; May
2017. www.effectivehealthcare.ahrq.gov/reports/final.cfm.
24. Amir Qaseem, MD, PhD, MHA; Timothy J. Wilt, MD, MPH; Robert M. McLean, MD; MaryAnn Forciea, MD; for the Clinical Guidelines Committee of the American College of Physicians/ Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017;166(7):514-530. Published on 14 February 2017 at: http://annals.org/aim/article/2603228/noninvasive-treatments-acute-subacute-chronic-low-back-pain-clinical-practice