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Chronic pain is characterized by episodic pain that causes sensory and emotional discomfort and lasts for over three months.¹ It affects millions of Americans every year; prescription pain relievers such as NSAIDs and opioids are among the most prescribed drugs in the US.² Pharmaceuticals may be effective in their ability to target pain receptors in the brain and reduce the sensation,³ but because of adverse side effects and the risk of chemical dependency in long-term use in adults, these medications are advised only as short-term solutions.^2,4

Due to the rise of opioid-related deaths in the US in recent years, much attention has been placed on nonpharmacological approaches to pain management and their effectiveness in treating both acute and chronic pain. Some studies report improved patient quality of life outcomes⁵ and even reduced opioid use when patients receive alternative pain-management therapies.⁶ Combination therapies that include both pharmacological and nonpharmacological options have been shown to be more effective in reducing pain symptoms than a single treatment alone.⁷

Many factors contribute to pain symptoms, such as physical tissue damage, inflammation, or psychogenic causes, and a whole-person approach may optimize long-term outcomes for these patients. Treatments such as acupuncture, massage, spinal stimulation, exercise, and mind-body practices may improve pain symptoms with minimal side effects.^8,9 In particular, acupuncture has demonstrated significant qualitative improvements in physical, behavioral, and emotional function⁵ and is as effective as other physical modalities in lowering pain levels.⁹

Board-certified pain-management physician Elizabeth Board, MD, became disheartened with the pharmacological approach to pain management, especially in patients with chronic pain. Not seeing improvements in the pain levels or quality of life of her patients, some of whom she observed as being in a constant state of sedation, Dr. Board turned to acupuncture as a way to expand the scope of treatment options in her practice. Her approach to pain management favors mind-body therapies and integrative approaches using nutrition before prescribing opiates or NSAIDs, although she notes: “There are cases where pharmaceuticals may be necessary, but a measured, thoughtful approach must be taken in every case.”

In the following video, Dr. Board describes the influence of the functional medicine model on her practice and how she incorporates her background in pain management to treat patients.

Matching patients to an appropriate therapy is dependent on the desired outcome, the underlying issue causing the pain, and ultimately the patient’s preference, according to Dr. Board. “People interpret and respond to pain differently. I look for and recognize the impact of treatment modalities on the patient’s social, spiritual, and psychological health,” she said. Dr. Board no longer placates pain through medication but intervenes with a holistic and lifestyle-driven approach. “Although I came in as a pain-management physician, now I really treat the whole person.”

Dr. Board is an IFM Certified Practitioner and is the founder of Atlanta Functional Medicine in Alpharetta, Georgia. She holds board certifications in pain management and anesthesiology, has completed the Helms course in acupuncture, and holds a certification from the American Board of Integrative Holistic Medicine. Dr. Board is passionate about teaching her patients and other physicians about opiate-free pain management using the functional medicine framework.

References

1. Venes D, ed. Pain. Taber’s Medical Dictionary Published 2017. Accessed April 30, 2021. https://www.tabers.com/tabersonline/view/Tabers-Dictionary/735288/all/pain
2. Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain—United States, 2016. JAMA. 2016;315(15):1624-1645. doi:1001/jama.2016.1464
3. Vanegas H, Vazquez E, Tortorici V. NSAIDs, opioids, cannabinoids and the control of pain by the central nervous system. Pharmaceuticals. 2010;3(5):1335-1347. doi:3390/ph3051335
4. Wongrakpanich S, Wongrakpanich A, Melhado K, Rangaswami J. A comprehensive review of non-steroidal anti-inflammatory drug use in the elderly. Aging Dis. 2018;9(1):143-150. doi:14336/AD.2017.0306
5. Davis RT, Badger G, Valentine K, Cavert A, Coeytaux RR. Acupuncture for chronic pain in the Vermont Medicaid population: a prospective, pragmatic intervention trial. Glob Adv Health Med. 2018;7:2164956118769557. doi:1177/2164956118769557
6. Lin YC, Wan L, Jamison RN. Using integrative medicine in pain management: an evaluation of current evidence. Anesth Analg. 2017;125(6):2081-2093. doi:1213/ANE.0000000000002579
7. Dydyk AM, Yarrarapu SNS, Conermann T. Chronic Pain. StatPearls Publishing. Updated January 5, 2021. Accessed April 30, 2021. https://www.ncbi.nlm.nih.gov/books/NBK553030/
8. Skelly AC, Chou R, Dettori JR, et al. Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review. Agency for Healthcare Research and Quality (US); 2020. Accessed April 30, 2021. https://www.ncbi.nlm.nih.gov/books/NBK556229/
9. Swedish Council on Health Technology Assessment. Methods of Treating Chronic Pain: A Systematic Review (Summary and Conclusions). Swedish Council on Health Technology Assessment (SBU); 2006. Accessed April 30, 2021. https://www.ncbi.nlm.nih.gov/books/NBK447986/