Treating chronic pain could be very frustrating.
As healthcare providers, we see these conditions all the time.
Inflammatory conditions, including joint pain, arthritis, osteoarthritis, and rheumatoid arthritis are quite common.
A study published in 2014 reported that the second and third most common complaints of chronic conditions, that have led patients to see their provider, were joint-related conditions and back pain. [Mayo Clinic proceedings, 88(1), 56–67]
Arthritis, one of the most common causes of disability, might slowly lead to discomfort, pain, and loss of function. Eventually, some people might lose their ability to work, their ability to be active, and to enjoy being active. Furthermore, chronic pain is also associated with an increase in the risk of mortality. [PloS one, 9(6), e99048]
The treatment of chronic pain might include NSAIDs and opioids. While these are often effective in reducing pain, NSAIDs are not intended for long-term use due to their side effects and opioids carry a substantial degree of risk.
Several studies reported that long-term use of NSAIDs by older patients might increase the risk of peptic ulcer disease, acute renal failure, and stroke or myocardial infarction, as well as aggravate chronic conditions, such as hypertension and heart failure. [The annals of long-term care: the official journal of the American Medical Directors Association, 18(9), 24–27]
How can you treat chronic pain with Functional Medicine?
As a Functional medicine practitioner, you’ll know how to identify the factors that led to the development or aggravate chronic pain in your patients. Here are a few of the most common factors that you’ll review:
Environmental factors – Several studies have reported an association between accumulation of environmental toxins and an immune reaction, metabolic dysregulation, and chronic inflammatory diseases, such as joint pain, osteoarthritis, and rheumatoid arthritis.
A study published at the American Journal of Epidemiology evaluated the serum levels of environmental contaminants in 49,432 adults in mid-Ohio Valley and reported a strong association between the accumulation Perfluorooctanoate and perfluorooctane sulfonate, both persistent environmental contaminants, and osteoarthritis. [American journal of epidemiology, 174(4), 440–450] Another study reported that serum levels of heavy metals were significantly higher in patients with rheumatoid arthritis in comparison to healthy individuals. [Iranian journal of public health, 46(5), 626–633]
Adrenal insufficiency – Lower cortisol levels, an anti-inflammatory steroid, caused by adrenal insufficiency might increase inflammation and chronic pain. In one study, patients with higher levels of inflammatory markers, Tumor Necrosis Factor (TNF-a) and interleukin 6 (IL-6) had lower levels of cortisol in the morning than healthy patients. Furthermore, patients with fibromyalgia and lower back pain were found to have lower levels of cortisol [Psychoneuroendocrinology, 37(7), 1009-1018; J Rheumatol. 1998 Jul;25(7):1374-81] These studies and others reporting that lower cortisol levels are associated with chronic inflammatory disease and/or chronic pain might indicate that sub-clinical adrenal insufficiency might lead to or aggravate inflammation and pain.
Pro-inflammatory diet – Diet plays a significant role in health and disease. Consumption of sugar, for example, is not only involved in the pathogenesis of metabolic diseases but also inflammatory and possibly, autoimmune conditions. According to a study published in the American Journal of Clinical Nutrition, regular consumption of soda drinks sweetened by sugar is associated with an increased risk of seropositive RA in women. This was reported to be independent of other dietary and lifestyle factors.
Want to learn more about the evaluation and treatment of chronic pain and inflammatory diseases with Functional and integrative medicine? Join our Functional Medicine training to provide your patients with life-changing protocols.
During the online Functional Medicine training, Dr. David Musnick, MD will be teaching about the evaluation and treatment of patients with chronic pain and osteoarthritis with Functional and integrative medicine.
DAVID MUSNICK, MD, is an author, teacher, a board-certified in Internal Medicine and Sports Medicine physician with 24 years of clinical experience in Functional Medicine for Pain Management and Head Trauma. He has written numerous book chapters on Osteoarthritis and taught Sports Medicine and Pain Management at Bastyr University for 16 years.
Resources:
Appelboom, T., Maes, N., & Albert, A. (2014). A new curcuma extract (flexofytol®) in osteoarthritis: results from a belgian real-life experience. The open rheumatology journal, 8, 77–81. https://doi.org/10.2174/1874312901408010077
CDC: 1 in 4 US adults live with a disability. Center for Disease Control and Prevention. Retrieved from https://www.cdc.gov/media/releases/2018/p0816-disability.html
DeSantis, A. S., DiezRoux, A. V., Hajat, A., Aiello, A. E., Golden, S. H., Jenny, N. S., & … Shea, S. (2012). Associations of salivary cortisol levels with inflammatory markers: the Multi-Ethnic Study of Atherosclerosis. Psychoneuroendocrinology, 37(7), 1009-1018. doi:10.1016/j.psyneuen.2011.11.009
García Rodríguez, L. A., & González-Pérez, A. (2005). Long-term use of non-steroidal anti-inflammatory drugs and the risk of myocardial infarction in the general population. BMC medicine, 3, 17. https://doi.org/10.1186/1741-7015-3-17
Griep, EN, Boersma, JW, Lentjes EG, Prins AP, van der Korst JK, de Kloet ER. Function of the hypothalamic-pituitary-adrenal axis in patients with fibromyalgia and low back pain. J Rheumatol. 1998 Jul;25(7):1374-81.
Henrotin Y, Priem F, Mobasheri A. Curcumin: a new paradigm and therapeutic opportunity for the treatment of osteoarthritis: curcumin for osteoarthritis management. Springerplus. 2013 Dec; 2(1):56.
Hu, Y., Costenbader, K. H., Gao, X., Al-Daabil, M., Sparks, J. A., Solomon, D. H., Hu, F. B., Karlson, E. W., & Lu, B. (2014). Sugar-sweetened soda consumption and risk of developing rheumatoid arthritis in women. The American journal of clinical nutrition, 100(3), 959–967. https://doi.org/10.3945/ajcn.114.086918
Innes, K. E., Ducatman, A. M., Luster, M. I., & Shankar, A. (2011). Association of osteoarthritis with serum levels of the environmental contaminants perfluorooctanoate and perfluorooctane sulfonate in a large Appalachian population. American journal of epidemiology, 174(4), 440–450. https://doi.org/10.1093/aje/kwr107
Irfan, S., Rani, A., Riaz, N., Arshad, M., & Kashif Nawaz, S. (2017). Comparative Evaluation of Heavy Metals in Patients with Rheumatoid Arthritis and Healthy Control in Pakistani Population. Iranian journal of public health, 46(5), 626–633.
Kong, L. J., Lauche, R., Klose, P., Bu, J. H., Yang, X. C., Guo, C. Q., Dobos, G., & Cheng, Y. W. (2016). Tai Chi for Chronic Pain Conditions: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Scientific reports, 6, 25325. https://doi.org/10.1038/srep25325
Marcum, Z. A., & Hanlon, J. T. (2010). Recognizing the Risks of Chronic Nonsteroidal Anti-Inflammatory Drug Use in Older Adults. The annals of long-term care : the official journal of the American Medical Directors Association, 18(9), 24–27.
Smith, D., Wilkie, R., Uthman, O., Jordan, J. L., & McBeth, J. (2014). Chronic pain and mortality: a systematic review. PloS one, 9(6), e99048. https://doi.org/10.1371/journal.pone.0099048
St Sauver, J. L., Warner, D. O., Yawn, B. P., Jacobson, D. J., McGree, M. E., Pankratz, J. J., Melton, L. J., 3rd, Roger, V. L., Ebbert, J. O., & Rocca, W. A. (2013). Why patients visit their doctors: assessing the most prevalent conditions in a defined American population. Mayo Clinic proceedings, 88(1), 56–67. https://doi.org/10.1016/j.mayocp.2012.08.020
Tedeschi, S. K., Frits, M., Cui, J., Zhang, Z. Z., Mahmoud, T., Iannaccone, C., Lin, T. C., Yoshida, K., Weinblatt, M. E., Shadick, N. A., & Solomon, D. H. (2017). Diet and Rheumatoid Arthritis Symptoms: Survey Results From a Rheumatoid Arthritis Registry. Arthritis care & research, 69(12), 1920–1925. https://doi.org/10.1002/acr.23225
Wang, C., Schmid, C. H., Hibberd, P. L., Kalish, R., Roubenoff, R., Rones, R., & McAlindon, T. (2009). Tai Chi is effective in treating knee osteoarthritis: a randomized controlled trial. Arthritis and rheumatism, 61(11), 1545–1553. https://doi.org/10.1002/art.24832
