Pain Management Works with Functional Medicine to Help Patients with Chronic Pain

More physicians now believe that true lifestyle modification can play a major role in the management of chronic pain because it can help address underlying causes. This promising approach to pain treatment is the impetus behind collaboration between Cleveland Clinic’s Pain Management Department physicians and specialists from its Center for Functional Medicine. They work together in caring for patients with conditions like fibromyalgia, chronic migraine, back pain, sciatic pain and osteoarthritis.

This collaboration brings the two specialties together in helping patients to make changes that can improve their daily functioning and quality of life and enhance the effectiveness of other pain treatment modalities. In some cases, the lifestyle changes are so successful that they can eliminate the need for other pain treatment modalities altogether.

“I’ve found that incorporating functional medicine’s integrative approach into an overall treatment plan can greatly improve a patient’s response to treatment,” says pain management specialist Hong Shen, MD.

The two types of treatment can work hand in hand, she says. “Steroid injections alone may not control inflammation if some underlying cause is perpetuating the inflammatory process. Functional medicine can help patients achieve better results with fewer injections because it supports changes that allow the body to heal.”

That’s a good thing, because while steroid injections have their place, they also carry risks of complications, including weight gain, increased blood pressure, blood glucose elevation, and, in rare cases, infection. Steroid injections are not a permanent solution for chronic pain, but significant lifestyle changes can yield lasting results.

“I always say that functional medicine in combination with almost any specialty or subspecialty is adjunctive. It provides added care and added value. It takes the best of both ‘brains’ from the specialties,” explains Elizabeth Bradley, MD, Medical Director of the Center for Functional Medicine at Cleveland Clinic.

The Center has created a program called Functioning for Life® that helps patients make changes in four pillars of health: nutrition, exercise, sleep, and stress management. The program’s several disease-specific tracks include one for chronic pain.

Individualized care plans are developed based on a comprehensive one-on-one evaluation with a functional medicine physician and use of an online tool called a Living Matrix, a comprehensive review of the patient’s experience and environment from birth that identifies the patient’s clinical imbalances, psychological well-being, and readiness for change. A dietitian develops a diet plan and the patient meets with a behavioral health specialist and a health coach to develop an individualized strategy.

Treatment plans are individually tailored, but cornerstones of the program include:

• An autoimmune/anti-inflammatory diet rich in vegetables and fruits with minimal amounts of red meat, sugar, and processed foods.
• The use of dietary supplements with anti-inflammatory benefits, such as fish oil, curcumin (a component of turmeric), and Inflammatone™.
• Restorative exercise, with an emphasis on various forms of yoga and low-impact activity, such as chair yoga on difficult days. “We work individually with patients to find out what they’re able to do instead of just giving general recommendations,” says Dr. Bradley.
• Weight loss for overweight patients. “Fat cells secrete adipokines, which increase cytokines and aggravate pain,” she notes.
• Meditation and other stress management techniques. “A lot of pain happens in the brain. We work on reducing the brain’s perception of pain. Meditation reduces cortisol, which decreases pain,” she says.
• Education and support in improving sleep habits. Patients who sleep poorly have worse pain. Patients may be evaluated for sleep apnea, which can prevent restorative sleep and contribute to pain and other serious health problems.

“If a person with chronic pain is not sleeping or eating well, pain medication and other treatments will only do so much,” Dr. Bradley says. The use of steroid injections to treat chronic pain offers a case in point. The technique delivers a high dose of corticosteroid directly to the source of inflammation. It can be useful when more conservative approaches, such as NSAID therapy and physical therapy, have failed.

The functional medicine model also looks for other underlying problems that could be playing a role in a patient’s pain. For example, a patient might be found to have a heavy toxic burden from occupational exposure to heavy metals. “We keep diving deeper, especially if, after the 10-week program, the patient is still not where they want to be or where we think they could be,” Dr. Bradley says.