Chapter 16: Alternative and Complementary Modulation

complementary medicine

any of a range of medical therapies that fall beyond the scope of conventional medicine but may be used alongside it in the treatment of disease and ill health

integrative therapy

a form of medical therapy that combines practices and treatments from alternative medicine with conventional medicine

hollistic

the treatment of a patient as a whole, taking aspects of mental and physical health into account in addition to social factors

integrative therapy

implies that these different therapies can actually be coupled together to achieve an additive effect

additive effect

a combined effect of at least two treatments equal to the sum of their individual effects

biopsychosocial model

a model that incorporates the connection between biological, psychological, and sociological factors to understand the behaviors or disease

biopsychosocial model and fear avoidance model

utilized by complementary and integrative therapy to achieve holistic pain management

pain self-efficacy

an individual’s belief in their ability to exert manageability of their pain and the degree to which their pain impinges on important aspects of life

motivation-decision model of pain

according to this model, perception of pain will be inhibited in the context of perceived reward so it may be beneficial for individuals with chronic pain to seek enjoyable integrative therapies

exercise

a subset of physical activity and is defined as structured activity with a goal of improving physical performance and/or health

few negative side effects as a therapy, normally does not take extensive training to do safely, and can be applied across ages

supported as a first line therapy for the treatment of nearly all types of chronic pain

fear-avoidance model

a model that explains how catastrophizing can lead to avoidance of activity, which in turn can lead to disability and increased pain

sedentary

chronic pain patients are more likely to be this than other people and some of this immobility may be due to anxiety associated with catastrophizing and kinesiophobia

kinesiophobia

a fear of pain due to movement

common exercises for pain relief (studied)

running, walking, resistance training, aquatic exercise, and Tai Chi

what makes exercise studies challenging?

participants know if they are exercising or not. This lack of blinding can then lead to expectancy effects that influence the outcome in either a positive or negative manner

additionally dosing can be an issue because could include training volume, training intensity, and rest

meditation

a broad term that encompasses diverse experiences, some of which have been practiced for thousands of years as a method of healing and stress reduction

challenge of meditation

challenge of classifying practices because of the number of types

classification is necessary in order to easily study the effects of this on pain and cognition and compare data from different studies

three main groups of meditation

constructive, deconstructive, and attentional

constructive

there is a focus on reappraisal of a situation

in context of chronic pain, this would include increasing pain self-efficacy to improve a patient’s belief about how much control they have of their pain and how the pain impacts daily life

deconstructive meditation

focus is on the insight of one’s being

in chronic pain, the process of self-inquiry can help an individual deconstruct why they are feeling a certain way

attentional meditation

focuses less on deconstructing and rationalizing pain or “spinning the pain as positive (constructive) and more on nonjudgemental attention to the pain

mindfulness meditation

one of the most commonly studied and prescribed types of meditation to manage pain

associated with decreased levels of the stress hormone cortisol

days of practice

pain relief from meditation occurs after at least this amount of time

acupuncture

defined as the insertion of extremely fine needles through a person’s skin at specific points on the body

Traditional Chinese Medicine (TCM) theory

focuses on restoring the balances of one’s mind, body and spirit as well as one’s relationship with nature by restoring the energy (qi) flow, along energy pathways or channels (meridians or Jing Lou) throughout the body

acupressure

practitioners use proper finger placement to apply pressure over acupoints along the body’s medidiaons

laser acupuncture

practitioners use low-energy laser beams to stimulate acupuncture points

electroacupuncture (EA)

therapists uses current delivered through the needle applied to acupoints

teishein acupuncture

utilizes blunt placebo needles that touch the skin without actually penetrating it

challenge of researching acupuncture

difficult to determine an appropriate control group

principle of point specificity

the belief that stimulation of specific acupoints is necessary to alleviate certain conditions and that selecting the right acupoints is necessary for the most beneficial clinical response

cannabidiol oil

a nonintoxicating set of compounds extracted from Cannabis sp. plants (sometimes referred to as marijuana or hemp)

medical marijuana

can attenuate chronic pain as evidenced by both basic and clinical research findings

endocannabinoids

small molecules that naturally occur in the body and activate cannabinoid receptors

endocannabinoid system

consists of cell-surface receptors, endocannabinoids, and metabolic enzymes that break down endocannabinoids once they are used

how might CBD contribute to pain relief?

anti-inflammatory effects mediated by CB2 receptor

CBD interacting with TRPV1 receptors

CBD antagonistic effects of CB1 and CB2 receptor agonists

challenges that remain in developing effective treatment strategies

some therapies can be time-intensive to learn

access to training can be low, especially in healthcare systems using private insurance or public-payer systems that fail to support complementary health practice

poor patient compliance and adherence to a therapy

few dosing studies exist so best dose for each pain condition is largely unknown