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Ask Stanford Med: Pain expert responds to questions on integrative medicine

Ask Stanford Med: Pain expert responds to questions on integrative medicine

rolfing2Sometimes the best medicine is staying healthy. As more Americans look for ways to improve their health, prevent disease and manage pain, the subject of complementary practices may enter more conversations between patients and physicians. So for this installment of Ask Stanford Med, we asked Emily Ratner, MD, clinical professor of anesthesiology, perioperative and pain medicine and co-director of medical acupuncture and the resident wellness program at Stanford, to respond to questions on integrative medicine. Her answers appear below.

As a reminder, these answers are meant to offer medical information, not medical advice. They’re not meant to replace the evaluation and determination of your doctor, who will address your specific medical needs and can make a diagnosis and provide appropriate care.

Mary says: Please speak about the efficacy of integrative medicine to alleviate multi-point pain from a variety of causes (ITP, OA, aging). A relative has doctor fatigue as well, and is not interested in anything else.

Integrative Medicine (IM) may be defined as the combination of conventional and nonconventional modalities chosen by a patient and physician in a patient-centered decision-making process in order to achieve the best outcome for an individual. Patients often seek nonconventional modalities when conventional medicine techniques are unable to achieve a particular goal, often pain relief or pain management. As a general rule, multi- and inter-disciplinary measures are often most helpful in relieving suffering from pain. These may include five general categories of nonconventional modalities, although there is overlap amongst the different types:

  • Mind-body medicine: meditation, hypnosis, biofeedback, guided imagery, yoga
  • Biologically based practices: uses substances found in nature – herbs, foods, vitamins, supplements
  • Manipulative/Body-based practices – massage, chiropractic/osteopathic manipulation
  • Whole medical systems: Traditional Chinese Medicine (includes acupuncture), Ayurveda, naturopathy
  • Energy Medicine – Reiki, Healing/Therapeutic touch, Qi Gong, acupuncture, yoga

Depending on patient preference, available resources in the community and other factors, a decision is made where to begin. I often recommend acupuncture as a place to start, closely followed by a mind-body medicine technique, as my experience is that stress plays a large role in either pain or the perception of pain. However, it largely depends on the individual’s needs and preferences.

Scope Editor asks: A recent study of herbal products found that most of those examined contained contaminants, substitutions and unlisted fillers among their ingredients. What are the implications of these findings, and how can consumers protect themselves when buying supplements?

This is a significant issue that highlights the need for increased supplement regulation, although the study to which you refer has been criticized for some of its conclusions. While FDA regulations for supplements are a bit stricter than for foods, the regulations are far less comprehensive than those for pharmaceutical agents.

That being said, product contamination with heavy metals, undisclosed pharmaceutical agents (especially in products from outside the U.S.), and inaccurate product ingredient amounts plague this field.

Until improved regulatory procedures are instituted, I suggest looking at a reputable database that independently tests these products, such as ConsumerLab.com. This and other independent organizations add their seal of approval to product labels that have tested either the products or the manufacturing practice involved in production of the substance. Look for the Consumer Lab seal or other seals: cGMP (current Good Manufacturing Practice), USP (United States Pharmacopeia), or NSF (another independent lab).

Some experts note that specific stores have strict quality control for their products – like Sam’s Club, Costco, Whole Foods – but I typically look up each individual product on a database (I use consumerlab.com) prior to recommending it.

Another option is to consult with a trained Integrative Medicine practitioner who has access to these databases and is knowledgeable about these products.

Mark says: How do integrative medicine practitioners decide which body-mind practices are worthy of being researched and prescribed to patients, and which aren’t? I’ve practiced yoga, meditation and Feldenkrais and had bodywork such as Rolfing and acupressure massage, all with noticeable results. But I wonder about energetic practices such as Rosen Method, Reiki, and EFT/meridian tapping (which I’ve also tried and liked).  

Great question! From a practical standpoint, it often depends on what that practitioner is most familiar with, which modality is thought to be most helpful for an individual’s needs, and which practitioners are accessible to the patient (in the community, accept insurance, or are affordable). In terms of which modality may be most helpful, there is a growing body of scientific literature looking at many different methods, which helps us figure out what may be best. For example, acupuncture has been shown to be helpful for migraine headache, and it has none of the unwanted side effects of the pharmaceutical agents that may be used for treatment.

Colleen Davis says: Can you address the benefits of facial acupuncture, and can it/should it be used frequently as an anti-aging treatment?

Theoretically, it may make sense that it could be helpful in this scenario. Local acupuncture treatments can cause facial muscle relaxation, which some say makes one appear younger.  There may be other systemic effects also causing general relaxation. While some recipients of this type of acupuncture treatment swear by it, to the best of my knowledge, there are not good scientific studies to support its use for this purpose.  On the other hand, acupuncture often promotes a profound sense of wellbeing and improves mood, such that individuals feel much better, whether they look younger or not.

Lisa H. says: I have low back pain around the sacrum and have been told I have still SI joints. Some days are good and some days I am in back spasms. I really would like to take a holistic approach to healing and recovery. Any recommendations?  

Yes, I’d recommend acupuncture as a start. Other modalities may be indicated depending on the individual, including mind body techniques that target stress reduction, nutritional changes, massage or other body therapies, depending on the individual and what is available in the community.

Emily says: Are there any integrative medicine apps or wearable self-tracking devices? If so, any that you would recommend? If not, what kinds of technology would be useful to integrative medicine practitioners and their patients?

Like many other fields, new technologies are becoming available all the time to address these issues. My observation is that the primary benefits of some self-tracking devices (fitbit, Nike bracelet, etc) is in increasing an individual’s awareness of personal choices throughout the day, about how much one is really exercising, or what and when and how much is actually being eaten. Evidence supports documenting every item eaten may be an effective tool as part of a weight management program – along w/support groups, exercise, etc. This increased awareness of one’s choices is often surprising (I know because I’ve done it!), and recognition of less healthy habits is the first step in changing them.

HeartMath is another app that couples relaxation techniques/meditation/guided imagery with a device that measures heart rate variability, which is a proxy for stress measurement. This often appeals to those of us who like to see tangible effects and have immediate feedback for how effective our efforts are. It has been studied quite a bit in the scientific literature.

I’ve heard of some apps that remind individuals to take a “time out” from their daily activities in order to help manage stress/maintain balance. I can imagine how taking a few deep breaths, time for self care/meditation/reframing “bad” experiences as learning experiences/don’t forget to go to yoga class, or other prompts could be very helpful. I’m not aware of data tracking how successful these devices are at this time, but again, recognition of the problem – like needing to de-stress – is the first step in changing.

Dr. Ratner has no financial, family or other ties to any of the companies or products listed above.

Previously: Ask Stanford Med: Pain expert taking questions on integrative medicine, Ask Stanford Med: David Spiegel answers your questions on holiday stress and depression, Report highlights how integrative medicine is used in the U.S. and Americans’ use of complementary medicine on the rise
Photo by Dreaming in the deep south

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