HHS Pain Management Report offers unprecedented potential to support advancement of integrative pain management protocols
The recent release of Pain Management Best Practices Inter-Agency Task Force Report from the U.S. Department of Health and Human Services (HHS) is an unprecedented opportunity to shed light on the potential of integrative and non-pharmacological approaches to pain management, according to the Integrative Health Policy Consortium (IHPC). Although the nation has been justifiably focused on the action of the pharmaceutical industry that has helped to perpetuate the opioid crisis by promoting drugs for pain that have known potential to cause addiction and harm, this report has received far too little attention, the Washington. D.C.-based non-profit organization said. “This document paints a path forward to effectively address pain with a multidisciplinary strategy utilizing non-pharmacologic approaches,” said IHPC Policy Committee co-chair Sharad Kohli, MD. “Many of the therapies recommended are not only safer, but more effective than opioids, will prevent unnecessary deaths, and will improve the quality of life for the millions of Americans currently suffering with pain.” The report identifies gaps and inconsistencies in pain management and offers recommendations for improving pain management best practices. The task force emphasizes key non-pharmaceutical centered approaches to improve the lives of patients living with acute and chronic pain. They include individualized patient-centered care fostering a therapeutic alliance between patients and clinicians and multidisciplinary approaches using one or more treatment modalities and the biopsychosocial model for pain care. The report also considers special patient populations and comorbid conditions that accompany complex pain. The Task Force also recommended that the Centers for Medicare & Medicaid Services (CMS) and other insurers align their reimbursement guidelines with these findings. The Inter-Agency Task Force Report is a welcome addition to the pile of reports generated by government agencies in the context of the opioid overdose syndemic, noted Robert Twillman, Ph.D., an IHPC at-large member and pain management psychologist at St. Luke’s Health System in Kansas City, MO. It is notable, he added, that the work resulting in the document was done by a select group of individuals directly involved with pain management in one way or another, and that it included a broad spectrum of such individuals, as mandated by the SUPPORT Act for Patients and Communities. “Asking those ‘in the trenches’ as people with pain, health care providers, and policymakers to survey the landscape and make recommendations for where we go from here is exactly the way such exercises should be carried out,” Twillman said. “Couple that with robust opportunities for public comment, both online and at the Task Force’s meetings, and you have a document that stands out as an example of the way things should be done.” The Task Force’s recommendations span five broad treatment approaches to pain management: Medication, Restorative Therapies, Interventional Procedures, Behavioral Health Approaches, and Complementary and Integrative Health. They are reinforced by four cross-cutting themes critical to all treatment approaches: Risk Assessment, Stigma, Access to Care and Education. It represents a philosophical and cultural shift to addressing chronic and acute pain by using Complementary and Integrative Health Protocols, IHPC said. It is gratifying, Twillman added, to see the task force recognize these ideas because previous guidelines and policies have given little more than lip service to these notions. “Many times non-pharmacological treatments for pain are recognized as preferred first-line therapy, but recognition of the tremendous access barriers to that kind of care is rare,” he said. “Those of us in the field know all too well how difficult it is for most people with pain to access non-pharmaceutical care, and for the Task Force to fully recognize this and recommend changes to coverage policies to promote access is very important.” Twillman sees this report as a tremendous opportunity for the field of integrative health and medicine. “It is a foot in the door that is enabled by the country’s tremendous problems related to the opioid misuse, abuse, overdose, and overdose death syndemics,” he said. The tremendous opportunity here for integrative providers to demonstrate the value of these interventions can’t be ignored, and the integrative health community needs to do everything in its power to leverage this report to improve access, Twillman added. “Any time a good report is issued, we talk about not letting it just gather dust on a shelf, and far too often, that is exactly what happens. I’m not sure we’ve ever had an opportunity like this, and we can’t allow it to go unrecognized.” You can read the full report and visit HHS’s accompanying toolkit here
Pain Insights, Inc. announces a comprehensive market research study conducted among 1,044 patients with moderate-to-severe chronic pain and measured patient views/satisfaction/outcomes on the use of opioids, non-opioids, OTCs, and non-pharmacologic therapies for treatment of chronic pain. The report, published in July 2019, updates “Harmonizing Clinical Practice and Clinical Guidelines in the Management of Chronic Pain: — From the Patient Perspective” published in June 2017. The updated report also looked at the impact of recent guideline recommendations on patient/practitioner views regarding opioids, the uptake of medical marijuana/cannabis, utilization of non-opioids and opioids for post-surgical pain (inpatient/outpatient). Among the study’s key findings: Patients currently taking an opioid for chronic pain declined from 59% to 48% in the updated study; approximately one in five patients with chronic pain indicated they have tried medical marijuana/cannabis as part of their pain therapy; and moving forward patients are recommending a broader approach that can be tailored to individual needs and include pharmacologic, non-pharmacologic, cognitive and spiritual support. Read more here http://www.paininsights.com/tracking-pain-in-america
Group medical visits are exceptional methods delivering critical components of integrative health care for treating and reducing the risk of a wide variety of chronic diseases, particularly in underserved populations. A Special Focus Issue on Innovation in Group-Delivered Services is published in The Journal of Alternative and Complementary Medicine (JACM), a peer-reviewed publication dedicated to paradigm, practice, and policy advancing integrative health. The Special Issue was developed in partnership with Integrative Medicine for the Underserved (IM4US) and Centering Healthcare Institute. The issue was led by Guest Editors Paula Gardiner, MD, MPH, University of Massachusetts Medical School (Worcester, Mass.), Maria Chao, DrPH, MPA, University of California, San Francisco, and Marena Burnett, Centering Healthcare Institute (Boston). The issue includes two editorials, four commentaries, a systematic review and eight original research articles. The broad diversity of contexts that are conducive to review are featured, from applications in federally qualified health centers to integrative oncology, and with themes ranging from the growing movement for community acupuncture to a commentary exploring the special ingredient that group brings. Read more here https://medicalxpress.com/news/2019-07-group-medical-access-advance-heath.html
A proposed study from the Centers for Medicare and Medicaid Services (CMS) on acupuncture for chronic low back pain represents what the IHPC Partner for Health, American Society of Acupuncturists (ASA), called a massive step toward incorporation of acupuncture into national health care. The goal of the CMS work is to conduct studies in the age group covered by Medicare, in order to determine if the evidence for acupuncture’s effectiveness in this specific group is sufficient to include it under general Medicare coverage. Once the studies are completed, the data will be analyzed to determine whether to cover acupuncture for low back pain in this population. While it is a step in the right direction and good news that acupuncture is being studied at this level, the ASA does have some concerns, according to David W. Miller, MD, L.Ac., chair of the group’s Board of Directors and a private practitioner at East-West Integrated Medicine in the Chicago area. “Our main concern is that licensed acupuncturists be explicitly included in the process, and that the service they provide be clearly recognized.” The association asked its members to provide comments to CMS by Aug. 15, asking that the section regarding “auxiliary providers” be changed to more clearly name “Licensed Acupuncturists or state equivalent.” The group also asked members to request that the supervision required during the study period be done only by medical doctors. The current language states that other practitioners such as Physician’s Assistants, Nurse Practitioners, and Nurse Specialists can also provide supervision. The ASA does not see this as appropriate, given that these practitioners do not typically have the training required to supervise acupuncture practice, unless they themselves are also legally trained as licensed acupuncturists, Miller noted. Supervision by other licensure types does not have any legal precedent and does not add in any way to the safety or quality of the trials, the group said in a statement to members. ASA cautioned members to remember in their comments that this is a groundbreaking moment for this type of study, and some error in concept is inevitable. In general, the acupuncture community is thrilled that CMS is moving in this direction. This type of access will allow millions of American seniors access to this effective, non-pharmacological option for pain control. This care may be a significant component in boosting quality of life for Medicare recipients, and decreasing our national opioid dependence.
Linking toxins to the diabetes epidemic Collaboration is an important way that IHPC moves forward in its mission to eliminate barriers to health. To advance that mission, we work in partnership with many experts and health care professionals around the United States. IHPC is pleased to note that one of these partners, Joseph Pizzorno, ND, is taking on an expanded role as co-chair of the Environmental and Health Committee. Dr. Pizzorno is a naturopathic physician, educator, researcher and expert spokesperson, as well as the founding president of Bastyr University. He is also an author or co-author of 12 books including the Textbook of Natural Medicine and the Encyclopedia of Natural Medicine and is one of the world’s leading authorities on science-based natural medicine. Under his leadership, Bastyr became the first accredited multidisciplinary university of natural medicine and the first NIH-funded center for alternative medicine research. He retired from Bastyr in 2000 and has since served on President Clinton’s White House Commission on Complementary and Alternative Medicine Policy and the George W. Bush administration’s Medicare Coverage Advisory Committee. IHPC recently had a conversation with Dr. Pizzorno about natural medicine, the group’s overall mission as well as the agenda for the Environmental and Health Committee: IHPC: You have been at the forefront of integrative medicine for more than four decades. Are you satisfied with the progress you have seen? Pizzorno: We have made dramatic progress in awareness of natural medicine. When I graduated in 1975, natural medicine was only licensed in six states and practicing was a felony in some states. Now, 22 states allow the practice of natural medicine and that is a dramatic increase. Clearly conventional medicine has had lots of successes over the years, obviously in areas like infection and acute care. But for everyday health and chronic disease the natural model works best. We now know that optimal medicine is integrating the best of both conventional and natural medicine. That is why IHPC is so important–because it brings together health professionals from all fields to develop better medicine. I think it is an incredible time to be in natural medicine. What we have accomplished is being recognized, and we have changed the dialogue of what medicine should look like. We are at the forefront of this change, so it’s a pretty exciting. IHPC: You are now working with the Environmental and Health Committee. Are people connecting the dots between chronic health issues and environmental toxins? Pizzorno: I have been involved with the committee since it was created to respond to the water contamination issues in Flint, Michigan. We formed the committed and offered guidance to the city of Flint about lead toxicity and ways to use natural medicines to facilitate excretion. It proved to be a fairly frustrating situation. Even though we had a good committee and local influence, we couldn’t get the powers that be interested. IHPC: It sounds like a difficult task. Explain the new work you are doing with the committee. Pizzorno: We are now working on the growing diabetes epidemic in most of the world. Fifty years ago diabetes affected less than one percent. Now it is projected that 30 percent of the U.S. population will get it in their lifetime. That is a dramatic increase. Why? Most people would say it is because we are eating more sugar. And that is true we eat too much sugar. But the diabetes epidemic doesn’t correlate with sugar consumption, which has been fairly stable. Then people say it is because of obesity. And it’s clear obese people do have far more diabetes, especially morbidly obese women who have a 50 percent higher risk than men. But if you look at obesity, those at the bottom 10 percent of environmental toxin load don’t have increased risk for diabetes. Even if someone is morbidly obese, if they don’t have high levels of toxins, they don’t have significantly increased risk for diabetes. IHPC: What is the committee doing with this? Pizzorno: About a year ago, I brought a hypothesis to the committee that the diabetes epidemic is due to environmental toxins. I developed a three phase research protocol to see if it is a correct hypothesis. So that is what we are working on. In the first phase, we will take 10 early stage diabetes patients and measure not only insulin and blood sugar levels, but also several measures of toxin load. We will teach those with a high-toxin load how to avoid these toxins, and then re-measure after three months. We will then determine if there is a correlation between decreasing toxin load and improving blood sugar regulation. Assuming Phase I is successful, Phase II will take on diabetes with an aggressive program of toxin avoidance and sophisticated detoxification protocols to help the patients get rid of toxins over a six-month period. If this shows promising results, we will go to Phase III, which is to propose a large, controlled National Institutes of Health study that will take about one year. IHPC: In general, what do you see as some of the biggest challenges still facing natural medicine today? Pizzorno: Getting the resources we need to research foundational concepts. The problem is, the money comes from the federal government, which is dominated by pharmaceutical companies and their priorities. The money is there to promote the drug and medicine model, but for most health problems is not a curative system. And there is really no group that makes large amounts of money from our medicine. You might say, well, there are successful supplement companies, but the challenge is even the largest is far smaller than the typical pharmaceutical company, and they don’t have the resources to subsidize the research that is needed. IHPC: Are there still issues in formatting of research to provide solid answers and deliverables? Pizzorno: I think at this point we know that the research can be done. We know what to do and how to do it–it’s just a matter of getting the resources to […]
There is an African proverb that says, “if you want to go fast, go alone. If you want to go far, go together.” IHPC couldn’t agree more. We know there is a long road ahead and much work to do in our mission to eliminate barriers to health. That is why we have our Partners for Health Program, in which we work together with like-minded, non-profit organizations toward our common goals. These organizations work tirelessly in their respective areas to advance the cause of integrative therapies for pain management and to support protocols for overall health and wellness. Here is an update from a few of these partners on their recent activities in Washington, DC: American Society of Acupuncturists hosts inaugural convention in Washington, DC IHPC Partner for Health, American Society of Acupuncturists (ASA), which strives to promote the highest standards of professional practice for acupuncture and East Asian Medicine in the United States, held its inaugural convention on May 31-June 3, 2019. The event, entitled “The State of Our Union: Licensed Acupuncturists in U.S. Healthcare,” featured speakers from both integrative healthcare and regulatory agencies discussing both the status of working relationships with licensed acupuncturists and development of opportunities for integration within our healthcare system. IHPC Chairman Leonard Wisneski, MD, fired up the crowd with opening remarks, and IHPC Board Member Robert Twillman, Ph.D., provided an overview of the work that is being done in the realm of comprehensive integrative pain management. Other presenters were brought in from the Department of Veterans Affairs, the Department of Defense, and Indian Health Services, along with important speakers in the field of insurance from both the Hartford Group and American Specialty Health. The keynote speaker for the first day was Ellen Hamilton, representing the Office of Representative Judy Chu (D-CA). With more than 40 exhibitors and break-out sessions that included topics on social media, billing and research, there were over 300 attendees over the two-day event. Nearly 200 of the attendees spent the latter part of Sunday being trained in advocacy by IHPC director of government affairs, Kallie Guimond. The group had 3 asks that included asking House Members of Congress to join the Congressional Integrative Health & Wellness Caucus, and to co-sponsor Congresswoman Judy Chu’s bill HR 1182: Acupuncture for Our Heroes Act. IHPC has tirelessly advocated to help build the new Caucus and recently endorsed this bill as well. For their last ask, they accomplished adding nine co-sponsors to HR 1959: Preserving Patient Access to Compounded Medications Act. All in all, 183 people across 200 Congressional and Senate offices resulted in 565 meetings on the hill Monday June 3rd. They also held a Health Fair and provided acupuncture demonstrations to 180 additional offices in the Rayburn Foyer. AANP Canvasses the Hill with advocacy efforts IHPC Partner for Health American Association of Naturopathic Physicians (AANP), which strives to enhance human health and wellness by advancing the profession of naturopathic medicine, held its annual Washington, DC Federal Legislative Initiative for practitioners and students of naturopathic medicine on June 10. This is the second year that AANP has included as one of their “asks” that their Members of Congress join the Congressional Integrative Health & Wellness Caucus. AANP’s advocacy effort generated 954 meetings scheduled over 239 Congressional and Senate offices with many people visiting between 9 and 12 offices over the course of the day. Their outreach yielded an immediate uptick in co-sponsors for New York Representative Paul Tonko’s bill HR 2482: The Mainstreaming Addiction Treatment Act of 2019 and additional sponsors for Virginia Congressman Morgan Griffith’s HR 1959: Preserving Patient Access to Compounded Medications Act of 2019. The day concluded with a Whole Health Reception in the evening where guests were treated to organic foods including salmon, dark chocolate, and organic wines as they reviewed display tables that introduced naturopathic methods of treatment for chronic conditions. Integrative Medicine Foundation to host Veterans benefit IHPC Partner, the National Foundation for Integrative Medicine, a group committed to finding 21st century health solutions, is holding a Veterans benefit event on July 13, 2019 to support Veterans Quick Response Initiatives for Veterans suffering from pain and addiction and to support the cause of ending Veterans suicide once and for all. The charitable event, to take place at Running Hare Vineyard in Prince Frederick, Md., will include a concert from High Voltage and a silent auction with rare military items along with food and beverages, ice cream for the kids, and a social corn hole tournament during the day. All proceeds are considered a charitable tax deduction. To contribute to the event or take part as an exhibitor for Veteran’s initiatives, please contact Kallie Guimond at 240-432-7522. For more information or to purchase tickets visit Vets and Voltage 2019.
Programs that support the concepts of integrative health and wellbeing are gaining traction at the Veterans Health Administration. According to Ben Kligler, M.D., director of the Integrative Health Coordinating Center at the VA’s Office of Patient Centered Care and Cultural Transformation, this huge organization, with 140 centers treating six million patients annually, is seeing these programs make a difference for veterans. At the recent Congressional Integrative Health and Wellness Caucus in Washington, D.C., Kligler discussed the department’s efforts to move forward with programs that focus beyond drugs and surgery, inquiring what patients are living for and their health goals. It is a big shift for both patients and physicians, Kligler told attendees. He stressed that the effort goes far beyond pain management. “We talk about pain, but the big opportunity in the opioid crisis is the opportunity to learn from it—that the whole concept of taking a pill for a disease is really flawed, and if we change how we handle pain, that will be great, but it won’t be enough,“ he said. “The same opportunity applies to how we’re handling diabetes, heart disease and mental health. It’s about flipping the concept of where healing takes place.” We have an opportunity to push the envelope, he added, and “the fact that this caucus exists shows that it’s time for this to happen.” Jill Sheppard Davenport, a certified nutrition specialist who works at VA hospitals in the Integrative Health and Wellness Program has first-hand knowledge of how programs like nutrition, meditation and health coaching are helping patients. “Nutrition is core to health,” she told Caucus attendees, “but not yet core to health care.” She explained how anti-inflammatory foods like ginger, sweet potato, cashew, and kale work as medicines to prevent the compounds that can cause pain and stoke the fires of inflammation. Davenport shared three policy priorities: to expand Medicare and Medicaid reimbursement to cover nutrition for pain; to educate patients about programs like SNAP-Ed funding and the USDA nutrition guidelines to help them understand the power of food as medicine; and to use existing programs like SNAP and WIC and expand funding so providers can prescribe food as medicine. There is tremendous progress. The VA is in the midst of a three-year project to coordinate the efforts among care teams and look at the outcomes for these programs. Kligler noted that in 2017, the VA passed a policy mandating that evidence-based complementary/integrative health and wellness approaches are now part of VA standard medical benefits, which, at least in the VA, address the current barriers of payment for these treatments. Chiropractic has long been included in the standard of care, but this policy means that other therapies that have published evidence meeting the evidentiary bar will be covered by the VA, he noted. “That doesn’t mean we are there yet,” Kligler added. “There is a huge amount of cost and work yet to be done and the list is not yet hard and fast, but it does mean the VA is committed to cover therapies that demonstrate this evidence.”
Collaboration and a team approach is an important part of the solution for addressing non-opioid, integrative therapies for pain management, health and wellness, according to two of the presenters at the recent 2nd meeting of the Congressional Integrative Health and Wellness Caucus in Washington, DC on March 6th. The presentations were part of a larger program devoted to addressing barriers to access and other models of care with nonpharmacological treatment options titled “Pain Management in the U.S.: An Underlying Contributor to the Opioid Crisis.” Both presenters, Susan Luria, director of University Hospital’s Connor Integrative Health Network in Cleveland, Ohio, and Casey Seenauth, ND, staff physician at the Neil Riordan Center for Regenerative Medicine in Tempe, Arizona, underscored the substantial evidence that current systems are not working to address prevalent chronic health conditions that are caused or exacerbated by lifestyle factors and lead to opioid use. Luria described how a collaborative integrative approach is working in the University Hospital system. “Our health system has a program, the Connor Integrative Health Network, with the belief that optimal health could best be achieved by a combination of traditional medicines and complementary therapies and support of patients to achieve lifestyle choices and behavior that supports their health.” She detailed the program, which provides hour-long integrative consults with patients to identify the underlying causes of their health issues and pain and then prescribe the appropriate therapies, such as chiropractic, acupuncture, massage, yoga and even music and art therapy. “We are taking these therapies and embedding them where they should be with the physician,” she said. “So the acupuncturist is in a primary care office, music and art therapy are in the inpatient setting and we are bringing these tools to the patient in their homes. It helps patients take care of themselves and provides physicians with tools to take care of their patients. In his presentation, Seenauth noted the ample evidence and recommendations supporting integrative therapies from both medical experts and governmental agencies specifically for patients who have lower back pain—95 percent of whom are using opioids to address their pain. The recommendations overwhelmingly endorse non-pharmacological treatments, such as exercise, multidisciplinary rehabilitation, acupuncture, mindfulness, stress reduction, tai chi, yoga and spinal manipulation. He described how the Riordan Center with Southwest College of Naturopathic Medicine and other integrative health organizations have put together a program using the naturopathic therapeutic order to develop curricula that can be used in academic programs in Arizona for physicians, NDs, dentists, and even veterinarians. “Physicians who don’t typically have training in these therapies will get more training emphasizing this team-based approach so they know from the beginning how to collaborate to help patients. ND’s are uniquely positioned to be a part of these integrative care teams because they understand when to apply these various modalities,” he said. Both presenters also discussed barriers to access. Even though there is evidence that these modalities are effective, they are largely unavailable, Seenauth said, because there seems to be an issue of insurance companies not covering these treatments so patients have pay out of pocket and others aren’t able to afford the treatments. “The good news,” said Luria, “is that some things are covered in our program. The integrative Consult and chiropractic are covered, but the therapies they might recommend are not—acupuncture, massage and yoga are all cash pay. So the real barrier we have to break is the physicians inside our system who really don’t want to have to make that choice about changing care based on a patient’s ability to pay. Our physicians want to know that they are providing the same fantastic care to all their patients.”
IHPC Board Member John Weeks recently interviewed Andrew Weil MD on his monetary gift $15 million to the University of Arizona Andrew Weil Center for Integrative Medicine. This contribution will allow the center to leadership roles and staff and support a much larger strategic plan for the future. Read More Here
Harvard T. Chan School of Public Health, Boston, released a much-anticipated manifesto in JAMA on April 2, 2019 that dramatically shifts the philosophy of patient care from an “absence of disease or infirmity” to a concept that embraces whole-person care and patient well-being. This important paradigm change that “reimagines health” is a concept that is not new to integrative health. It respects patients’ desires to grow and feel satisfied with their health and subsequent quality-of-life. Author Howard, K. Koh, MD, MPH defines this as a flourish index, which includes six domains of patient wellness: 1: happiness and life satisfaction, 2. physical and mental health, 3. meaning and purpose, 4. character and virtue, 5. close social relationships, and 6. financial and material security. Dr. Koh writes: “Measurement of flourishing makes possible weighing the effects of different treatment decisions not only on physical and mental health, but in the full context of what matters in a person’s life. While this makes treatment decisions more complex, it lies at the heart of patient-centered care.” Click to read the full report
Exclusive Interview with Dr. Paul Anderson: The FDA and the Fate of Compounded Medicines The following is an excerpt of interview with Paul Anderson, ND on the FDA’s recent stance on compounded medicine as published in the Journal of Restorative Medicine, Volume 8, Number 1, 4 January 2019, pp. 1-5(5). Excerpt provide by Today’s Practitioner. The Journal of Restorative Medicine (JRM) recently interviewed Paul Anderson, ND, who is testifying atU.S. Food and Drug Administration (FDA) hearings in support of maintaining the availability of several hundred compounded medicines. The FDA is considering enacting legislation that would make it illegal to compound or possess these commonly prescribed natural substances. If enacted, this legislation would affect clinicians as well as compounding pharmacies. JRM believes it is crucial for integrative medicine practitioners to have information about this process. JRM: You’ve been attending hearings at the FDA, where the fate of a large number of natural medicines is under review. Please give us an overview of what’s going on and how you came to be present at these hearings. Dr. Anderson: A number of years ago, the FDA asked compounding pharmacies, natural medicine practitioners, and integrative medicine practitioners to nominate substances for a hearing process. I believe the people who nominated substances took the FDA at its word, namely that all substances would get a fair hearing. However, the FDA’s motivation was that if any of these substances did not have what is known as a USP-NF federal monograph (a combination of two compendia: the United States Pharmacopeia and the National Formulary), regardless of whether the substance was a regular drug, an off-label drug, or a natural substance, it would become illegal to compound. These hearings are referred to as the “bulk drug substances for pharmacy compounding” under Section 503A of the Federal Food, Drug, and Cosmetic Act. Around 310 substances were nominated for review. The FDA said it would look at each of these substances individually. I’ve attended the hearings as a subject matter expert. Subject matter experts write testimony that gets included when a substance is nominated for review, as well as attending in person to testify on behalf of that substance. JRM: So, what is happening to the fate of these 310 substances? Dr. Anderson: Contrary to what we expected, the FDA went through the list of 310 substances and said that only a certain number of them even warranted a hearing. As a result, the list was cut down from 310 to about 68 substances that were deemed worthy of a hearing. The remaining approximately 242 substances, most of which happen to be natural medicines, got assigned to category 3, comprising bulk drug substances nominated without adequate support. This means that if the FDA process is enacted as a federal rule, these substances will automatically become illegal to compound, without even having had a hearing. JRM: What are examples of some of the substances listed under category 3 that would become illegal to compound? Dr. Anderson: Lactobacillus acidophilus, alfalfa, anise seed, certain types of copper, certain types of magnesium, a lot of minerals, a number of herbal substances that might be used in a compounded sense, and a whole host of things nominated by pharmacists that aren’t used as medicine but are used as binders or excipients (such as powdered milk) and would become illegal according to this list for a pharmacy to use. In reality, what it comes down to is everything will automatically be illegal to compound, except whatever tiny fraction of substances of the already small group deemed worthy of hearings that make it to the FDA “yes” list! JRM: What has happened to the remaining 68 or so substances that were deemed worthy of a hearing? Dr. Anderson: Those substances were put on the category 1 list. As of this time, hearings have taken place for 53 of them. Thirty have been deemed unsafe for compounding; 16 have been approved as safe; and about 18 are still awaiting hearings. Examples of things on the category 1 list that did get FDA hearings and which the FDA says should be illegal to compound include many substances that are inside our bodies, such as acetyl carnitine, certain forms of glutamine, chondroitin, D-ribose, and a number of other things that we actually can’t live without. The list also includes commonly used natural substances such as artemisinin, Boswellia, MSM (methylsulfonylmethane), glycyrrhizin, and certain B vitamins such as nicotinamide. The way the FDA hearings are set up, if these substances do not have some very clear medical indication for which they are the only treatments, the FDA essentially tells the committee that they should not approve it. Click on the link below to read the full interview and more on how the FDA’s stance places integrative providers in a difficult situation and what you can do to support Dr. Anderson and others. Click Here for the Full Interview Paul Anderson, ND, is a graduate of the National University of Natural Medicine and a full professor at Bastyr University. He is cofounder of Advanced Applications in Medical Practice and is a well-known continuing education presenter specializing in complex clinical medicine, intravenous and injection medicine, oncology, and genomics. Dr. Anderson has participated in National Institutes of Health – funded research in integrative oncology and is coauthor of Outside the Box Cancer Therapies: Alternative Therapies That Treat and Prevent Cancer. He has also authored or coauthored numerous peer-reviewed and educational publications in science and health.
Integrative Healthcare Goes to Washington with the Congressional Integrative Health and Wellness Caucus
Legislators and Staffers Get a Hands-On Introduction to Integrative Medicine By Kimberly Lord Stewart WASHINGTON DC – On March 6, 2019, the second annual Congressional Integrative Health and Wellness Caucus, co-led by Rep. Judy Chu (D-CA), and Rep. Jackie Walorski (R-IN), was held for an audience of 50 Democratic and Republican House offices, representing 24 states, and eight Senate offices, including the Democratic Leader, Democratic Whip, Assistant Democratic Leader, Senate HELP Committee, and Senate Committee on Homeland Security and Government Affairs. “The Congressional Briefing and interdisciplinary therapy demonstration were extremely successful with representation form 58 legislative offices from both sides of the aisle. The briefing provided important information regarding effective, non-opioid, integrative approaches to the treatment of pain which will hopefully impact future policy,” said Len Wisneski, IHPC Board of Director’s Chair. “The response was amazing,” said Kallie Guimond, IHPC’s Director of Government Affairs. “These people are the very same who are going to write legislation for non-pharma options to pain management. Eight Senatorial offices crossed the street to find out more.” Above all, this year’s caucus itinerary gave participants a true reflection of the heart and soul of integrative medicine. That humanistic touch started with the opening chairs remarks. “The two Co-chairs of the Congressional Caucus broke away from their critical Ways and Means Committee meetings to open the briefing, sharing touching personal stories about why they are committed to advancing non-pharmacological approaches to pain and doing so now,” said Margaret Chesney, PhD, IHPC’s Special Advisor, Professor of Medicine School of Medicine, University of California, San Francisco. In her remarks, Rep. Walorski shared the following, “I have heard from physicians and providers in my district who are eager to see the nonopioid methods of treating become more integral in patient’s conversations.” She closed by reiterating the horrific story of a death in South Bend, Indiana of a dear friend, Dr. Todd Graham, a local physician who believed in finding creative and alternative ways to address pain. A little more than a year ago, he was shot in his practice driveway from an opioid addict after trying to falsify records to get opioids. Graham’s refusal led to his death. Rep. Walorki said this tragedy is the motivation behind her work to expand the scope of integrative care for chronic pain. In her opening statement, Rep. Chu held nothing back as she praised the skills of experts in the room and how their respective professions can make a significant difference in the opioid crisis. “The opioid epidemic is taking over lives in every state every day. Right now, deaths from overdoses exceeds those of all other deaths for people under 50,” said Rep. Judy Chu in her opening statement. “The good news is that studies conducted by NIH have concluded that alternative treatments can be effective in treating conditions like chronic pain.” Rep. Chu shared how she has been a long-time advocate of acupuncture. In 2001, when she was elected to the state legislature, Chu worked to get approval for acupuncture to be included in the workman’s compensation system. “I understand well, how important these alternative therapies are. But here in Congress, our biggest challenge is convincing our fellow members that not only do these integrative therapies work, but they should be available to all patients no matter how they get their health coverage,” she said. Click here for video of opening remarks. The caucus made great headway this year to get that message across. There were multiple opportunities for legislators and staff to learn about integrative medicine. Integrative health experts from academic, government, and association settings held an educational briefing, a lunch featuring anti-inflammatory foods, as well as demonstrations on complementary therapies whereby attendees experienced the benefits of integrative medicine for pain and stress management. Speakers included members of the military who shared moving and captivating testimonials of how integrative care made a dramatic impact on their health, said Guimond. Other speakers included: Margaret Chesney, PhD, on an integration to integrative health; Bob Twillman, PhD, on comprehensive integrative pain management; Casey Seenauth, ND, on non-pharmacological multi-modality approach to pain; Susan Luria, MD, MPH, on models of care in the Veterans Administration; Jill Sheppard Davenport, MS, MPP, CNS, NBC-HWC, LDN, LN, on nutrition’s role in pain management. The integrative therapy room was remarkably successful thanks to teams of therapists and practitioners in acupuncture, chiropractic, massage therapy, and naturopathy, as well as certified reflexologists and craniosacral practitioners. “In a matter of minutes, a meeting room in the Rayburn Building was transformed into a healing environment, said Chesney. “This is a first. We’ve never had so many therapies and disciplines in one room on Capitol Hill. Ninety offices took time out of their day to stop in for 20 minutes for a therapy session. Many came back twice,” said Guimond. Capitol Hill is known for being a pressure tank. This was not lost on the therapists who immediately saw a difference after a 20-minute treatment. “The feedback that I got from staffers and legislators was how fried they were and how much better they felt with the treatment,” said Amy Mager, vice chair of the American Society of Acupuncturists. “A staffer came in and said she was so grateful we were there because she didn’t have time to get to her acupuncturist. It was a privilege to be of service and watch staffers and legislators slow down. I watched them hold their bodies with more ease during and after the treatment. Providing value and the opportunity for people to reframe what’s going on in their body and come to a place of ease is a privilege.” A common observation among the therapists was the level of genuine interest by those who came in for a therapy session. “What I found surprising, was that each person I worked with had quite a few questions about reflexology,” said Tish Gilmore, owner of Reflexology by Tish. “I thought people were just being polite, but I was given thoughtful, in depth and inquisitive questions. It was […]
Bipartisan Effort Cites Prevention and Healthcare Delivery Change The bipartisan Congressional Integrative Health and Wellness Caucus has been registered with two new co-chairs at the helm for the 116 th Congress. Representative Judy Chu (CA-21 st ) will serve as the Democratic leader with Representative Jackie Walorski (IN-2 nd ) as the Republican leader, replacing former Caucus co-chairs Colorado Congressmen Polis and Coffman, respectively. The Caucus will hold its first meeting of the new Congress on Wednesday, March 6, 2019 on Capitol Hill with an education program and active demonstrations of integrative treatments provided to House Members and staff. Given the recent passage of the HR6 SUPPORT Act addressing the country’s opioid crisis, the focus of the event will be integrative models of care for pain management. Both Representatives sit on the powerful Committee for Ways and Means, which ultimately governs Medicare, along with payments to health care providers delivering care to Medicare beneficiaries, such as those working in hospitals, surgery centers and outpatient departments. Both new Caucus co-chairs were instrumental in crafting language for the HR6 SUPPORT Act and are involved in seeking legislative solutions regarding patient access to nonpharmacologic treatments and services for pain and addiction. Congresswoman Chu stated, “The opioid epidemic in our country has made it more important than ever to explore non-opioid alternatives to pain management. That is why I am so pleased to be a cofounder of the Integrative Health and Wellness Caucus. Through this caucus, we hope to educate our colleagues about safe alternatives like acupuncture, which for millennia has been successful at treating a number of health conditions in addition to pain. I am hoping we can help make more healthcare options available and accessible to all Americans.” “Integrative health care approaches are critical to treating pain, one of the biggest health challenges Americans face,” said Congresswoman Walorski. “As co-chair of the bipartisan Integrative Health and Wellness Caucus, I look forward to working with my colleagues to combat the opioid crisis and help patients by improving access to innovative and multidisciplinary approaches to pain management. I am committed to working across the aisle to ensure patients and providers have access to non-opioid alternatives and the comprehensive care they need.” The event sponsored by the bipartisan Representatives is open to all members of Congress and their staff. Hosted by the Integrative Health Policy Consortium, speakers will educate lawmakers on what integrative health models of care look like, what current barriers to access for these care models are, as well as hold demonstrations of services designed to treat chronic neck and back pain with nonpharmacologic methods. IHPC Director of Government Affairs, Kallie Guimond, stated “IHPC applauds the efforts of the Integrative Health and Wellness Caucus co-chairs in addressing the current opioid crisis and looking for innovative ways to deliver healthcare services and treatment options that include nonpharmacologic options for the millions of Americans that struggle with pain and addiction. We look forward to working with the co-chairs to build Caucus membership and to be a resource for its members for many years to come.” Members of Congress who would like to join the Caucus should contact Representative Chu’s office directly at 202-225-5464. For more information on the IHW Caucus, contact IHPC’s Director of Government Affairs, Kallie Guimond, at firstname.lastname@example.org or visit IHPC Info For Congress. See Full Report Here
As we enter the latest week of the Federal Government shutdown, there is still a flurry of activity in the states that impact Integrative Health organizations, practitioners and patients. IHPC is currently tracking 84 bills nationwide with most of the state legislatures looking to resolve the opioid crisis by expanding access to complementary treatment services and fill gaps in healthcare delivery regarding pain management. Read Our Full Report Here
Want your voice heard about integrative pain management? The Pain Management Best Practices Interagency Task Force issued its draft report in late Dec. 2018. The comment period is open for the next 90 days. Read more here.
While Congress spent much of 2018 locked in a stalemate, a key integrative health and wellness legislative effort gained traction and was moved to enactment, which created a significant opportunity for 2019. HR6, the SUPPORT Patients and Communities Act (PL 115-271), touted by mainstream media as “the opioid package,” was signed into law on October 28, 2018 and set up the integrative health community as stakeholders in a series of government studies. The anticipated outcomes will shape new integrative models of care for people who suffer from pain and addiction to include a variety of treatment options and therefore, reduce both the amounts of opioids being prescribed and the number of people suffering from substance-use disorders. HR6 was an unusually bipartisan effort on the part of the 115th Congress, answering the call of an immediate crisis that has brought what seems to be a rare example of cooperation between Republican and Democratic constituencies. Upcoming studies will identify barriers of access to nonpharmacologic treatment options and define appropriations for demonstration programs to state acute care and emergency room settings. These actions will determine effective models of care for pain management that are medically-assisted, nonpharmacologic and incorporate multiple modalities. Many members of the Congressional Integrative Health and Wellness Caucus (IWHC) contributed directly to language that was enacted in HR6. IHPC will continue to help build out this Caucus as the 116th Congress begins their duties following the Democrats taking the House gavel on January 3, 2019. Priorities for the upcoming members of Congress will continue in this arena, with an effort to provide appropriations for coverage and reimbursement for integrative treatment options not currently covered. The legislative environment in the states also mimicked this trend of efforts to combat the opioid crisis with numerous states passing legislation that would either provide coverage for integrative treatment options or fund pilot programs to study the issues. As the 2019 legislative season unfolds, the states will begin to apply for available funding to participate in the initial fifteen state demonstration programs to share data regarding models of care. IHPC and their Partners for Health played instrumental roles in building out the new IHW Caucus, helping shape language surrounding pain management, expansion of providers who can prescribe medically assisted treatments and the study and implementation of nonpharmacologic treatment options. These efforts will continue and grow through state and federal initiatives as we move forward in 2019. The Integrative Health Policy Consortium (IHPC) is a unique interprofessional federation of organizations focused on health creation—the proactive promotion of and focus on prevention, wellness, and well- being. As the policy and advocacy voice of integrative health and wellness professionals, IHPC has achieved groundbreaking success toward the transformation of health and healthcare delivery, even as the prevailing paradigm of healthcare remains entrenched in a disease-based philosophy. IHPC–a 501(c)(4) non-profit organization—advocates 1) for better access by individuals to their choice of licensed or certified providers within a pluralistic healthcare system, 2) for non-discrimination in payer coverage of all licensed providers within their scope of practice, and 3) for collaborative efforts among healthcare providers and other stakeholders to take a whole-person healthcare-delivery approach to the individual, which includes consideration of the social, cultural, economic, and environmental determinants of health.
National Strategy for Comprehensive Integrative Pain Management Gaining Momentum at 2nd Annual Integrative Pain Care Policy Congress
The Integrative Health Policy Consortium (IHPC) again partnered for the 2nd invitation-only Integrative Pain Care Policy Congress, in Boston, on Saturday, November 10, 2018. Sixteen IHPC Partner for Health (PFH) members attended. The Congress was facilitated by the Academy of Integrative Pain Management in partnership with IHPC and Pain Action Alliance to Implement a National Strategy (PAINS). The Integrative Pain Care Policy Congress event brought together as many as 100 leaders and 65 organizations (see the complete list here), who have expertise and are dedicated to advancing integrative pain management. The organizations represented the licensed and certified health care professionals, public and private payers, people with pain, members from the Executive Branch, purchasers of healthcare, researchers, policymakers, and policy experts. “Patients and clinicians and public health policy makers are really being forced to confront the reality that we have a number of Americans who suffer from chronic pain,” said Clayton Jackson, MD, president, Academy of Integrative Pain Management (AIPM), and clinical assistant professor of family medicine and psychiatry, University of Tennessee College of Medicine, Memphis, said in a statement to Medscape Medical News. “Those patients have inadequate access to proper resources for pain management. We can’t just throw opioids at the problem; we have to acknowledge that many patients require multimodal treatment to achieve best symptomatic reduction and functional improvement,” he added. On the heels of recent passage and signing into law of HR6, the Support Act, this Congress is all the more important to helping solve the opioid crisis. “Comprehensive, integrative pain management (CIPM) will improve the lives of millions of Americans, save billions of dollars, and reduce opioid prescribing,” says Len Wisneski, MD, Board Chair of IHPC. “The only way this crisis will ever be resolved is if stakeholders come together to advocate and identify federal and state action. The Integrative Pain Care Policy Congress is providing a platform for that consensus development of policy change,” he said. In 2017, participants of the inaugural Policy Congress developed a consensus definition of comprehensive, integrative pain care. Since then, three working groups mobilized to advance this definition of care through timely and relevant action. The Workgroups include: Coverage and Constraints; Promoting Comprehensive, Integrative Pain Care; and Strategic Communication—with participants comprising the breadth of stakeholder views mentioned above. The agenda this year included interactive presentations and discussions in the morning and over lunch from invited policymakers, regulators, payers, people with pain, and members of the Executive Branch agencies. During the break-out sessions IHPC members joined other integrative pain care experts to discuss key issues affecting the advancement of a CIPM system. They included Executive Branch programs and activities, state and federal policy and advocacy activities, provider reimbursement and best practices of care for pain and how to transition toward these best practices. There is no shortage of work to be done to advance comprehensive integrative pain care. However, despite the somewhat daunting task, there are a number of opportunities for best practices within the integrative community to be transformed into scalable policies. The participants identified a number of next steps that are critical to accomplishing these goals and lowering the barriers to care. Jackson says that by the end of the year, white papers are expected to be published, which will provide a blueprint and clear framework for policy makers. At present, it is very difficult for patients to access and afford the treatments that are the most beneficial. “This is the whole reason for the congress’s existence — so we can use the power of multiple patient advocacy organizations, professional societies, and others to say this is what we need,” said Jackson in a MedScape statement. “Everybody is under the same tent; everybody is working together and pulling in the same direction for what’s best for patients,” he said. The Integrative Health Policy Consortium (IHPC) is a unique interprofessional federation of organizations focused on health creation—the proactive promotion of and focus on prevention, wellness, and well- being. As the policy and advocacy voice of integrative health and wellness professionals, IHPC has achieved groundbreaking success toward the transformation of health and healthcare delivery, even as the prevailing paradigm of healthcare remains entrenched in a disease-based philosophy. IHPC–a 501(c)(4) non-profit organization—advocates 1) for better access by individuals to their choice of licensed or certified providers within a pluralistic healthcare system, 2) for non-discrimination in payer coverage of all licensed providers within their scope of practice, and 3) for collaborative efforts among healthcare providers and other stakeholders to take a whole-person healthcare-delivery approach to the individual, which includes consideration of the social, cultural, economic, and environmental determinants of health. ###
This survey, Life in Rural America, conducted for National Public Radio, the Robert Wood Johnson Foundation, and the Harvard T.H. Chan School of Public Health, shows that rural Americans identify drug addiction or abuse (including opioids) and economic concerns as the two biggest problems facing their local communities. This summary infographic of the report paints an alarming picture of the problem. To access full report, click here.
On Wednesday, October 24, 2018, the President signed into law: H.R. 6, the “Substance Use–Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act” or the “SUPPORT for Patients and Communities Act,” which addresses the opioid crisis by reducing access to and the supply of opioids and by expanding access to prevention, treatment, and recovery services. Passage was overwhelmingly bipartisan (98-1 in the Senate and 396-14 in the House). “While much remains to be done, the Integrative Health Policy Consortium (IHPC) is encouraged by this first legislative step to give patients better access to integrative therapies for pain treatment,” says Leonard Wisneski, MD, FACP, Chair of the IHPC Board of Directors. The bill contains more than 200 provisions designed to improve opioid prevention and treatment efforts. The IHPC believes the H.R.6 Act provides opportunities for the integrative healthcare community to align themselves around a single mission for patients to have better access to non-pharma, whole-person integrative care for pain management. “Regardless of modality, the integrative community is ideally positioned to serve as experts in education, evidence-based approaches and treatments and as an important community resource regarding non-pharma solutions to pain management,” says Kallie Guimond, IHPC’s Director of Government Affairs. “There are a number of provisions in HR6 that IHPC will be pursuing as the opportunity to unite and educate physicians about the science and effectiveness of integrative approaches and solutions for pain,” she says. Among the hundreds of provisions, Guimond identified a number of opportunities: By January 1, 2019, The Secretary of Health and Human Resources (acting through the Administrator of the CMS), “will present one or more financial documents (new or updated) to states for mandatory and optional items and services for non-opioid treatment and management of pain, including evidence-based, non-opioid pharmacological therapies and non-pharmacological therapies.” The Social Security Act (42 U.S.C. 1395b-2) has been amended to include: 1) “references to education resources regarding opioid use and pain management;” 2) “descriptions of categories of alternative, non-opioid pain management treatments covered under this title;” and, 3) “a suggestion for the beneficiary to talk to a physician regarding opioid use and pain management.” As part of the Opioid Addiction Action Plan, within 3 months of enactment, there will be a request for public feedback regarding ways for the CMS to help address the opioid crisis. Within one year of enactment, a study will be conducted to analyze best practices and coverage for pain management. The study will include evidence-based treatments and technologies for acute pain, including treatments that are covered, not covered or have limited coverage under the title XVII of the Social Security Act. Evaluation of treatments, such as acupuncture, therapeutic massage and services provides by integrative pain management programs are included in the provision, as is the VA/DOD Clinical Practice Guideline for Opioid Therapy for Chronic Pain. Lastly, a variety of financially substantial grant programs will be available to develop strategies and train providers and personnel on protocols and best practices that target treatment alternatives to opioids in hospital and emergency room settings. This will include demonstration programs for experts with robust knowledge that have successfully implemented programs that use alternatives to opioids. Acceptable programs, including those from the National Center for Complimentary and Integrative Health or other centers within the National Institutes of Health will be included. IHCP’s Partner For Health member organizations will continue to advance alignment with key stakeholders in pain management to provide resources and tools for integrative health resources for education and treatment protocols for non-pharmacological and non-opioid pain solutions. Following their partnership with IHPC member the Academy of Integrative Pain Management for the upcoming 2nd Integrative Pain Policy Congress, IHPC will address a campaign strategy to integrate the provisions of H.R.6 within the organization’s policy goals and partnership with Congressional House members through the recently formed Integrative Health and Wellness Caucus. To assist in expanding collaboration, regardless of modality, IHPC has formed a new National Alliance for Integrative Health Policy Advocacy. “Our voices and expertise can make a dramatic difference to give patients more opportunities for effective, evidence-based integrative pain treatments,” says Dr. Wisneski. If you haven’t already done so, please support IHPC (more information here) and take a look at the Moving Beyond Medications guidelines for pain management and treatments. ______________________________________________________________________________ The Integrative Health Policy Consortium (IHPC) is a unique interprofessional federation of organizations focused on health creation—the proactive promotion of and focus on prevention, wellness, and well- being. As the policy and advocacy voice of integrative health and wellness professionals, IHPC has achieved groundbreaking success toward the transformation of health and healthcare delivery, even as the prevailing paradigm of healthcare remains entrenched in a disease-based philosophy. IHPC–a 501(c)(4) non-profit organization—advocates 1) for better access by individuals to their choice of licensed or certified providers within a pluralistic healthcare system, 2) for non-discrimination in payer coverage of all licensed providers within their scope of practice, and 3) for collaborative efforts among healthcare providers and other stakeholders to take a whole-person healthcare-delivery approach to the individual, which includes consideration of the social, cultural, economic, and environmental determinants of health. For more information go to IHPC.org or call, 202.505-IHPC (4472)
Having an undergrad in Aerospace Engineering was probably not the best preparation for acupuncture training. I was taught there were universal “laws” that could be communicated through equations (F=MA, E=Mc2…), and the cosmos operates predictably within those parameters. And then I was introduced to the concept of “Qi” (pronounced “chee”) that can’t exactly be measured, quantified, or mathematically modeled. Some call it universal energy, scientists refer to it as biophotonics, others describe it as life force, and they’re all correct. The Chinese actually have myriad types of Qi supporting the conceptual framework of Traditional Chinese Medicine (TCM). There’s Gu Qi (aka “grain Qi”) which is the energy contained in food. (A modern view would be fats, carbohydrates, protein, etc.) Yuan Qi (“original Qi”) – is the energy you receive from your parents; today we refer to it as DNA. Jing Qi (or “essence Qi”) is the actual genetic material that’s believed to be stored in the Kidneys. Wei Qi (or “Defensive Qi”) is visualized as an energetic protective layer on the surface of our bodies, in our muscles and skin – today we would call that our immune system. There are several others, but you get the point. In TCM, Qi is considered the commander of Blood, and Blood follows the Qi. If you have a contusion from an impact injury, a TCM practitioner would refer to that as “Blood stagnation” or Blood stasis. The Qi fails to move the Blood, thus Qi is “blocked” by the Blood, leading to pain. There’s a classic Chinese saying: “If there is free flow, there is no pain; If there is no free flow, there is pain.” If you look at a hematoma, it’s blood that’s extravasated from broken blood vessels (and is no longer moving) and is painful to the touch. Inserting filiform needles into precise acupoints will promote the free flow of Qi and Blood, and reduce pain. There are very interesting scientific explanations for how this works, but they’re beyond the scope of this article. From a western medical point of view, pain is categorized as nociceptive (that due to some kind of noxious insult to the tissue) which is further broken down into somatic and visceral, neuropathic (nerve related due to a lesion or disease in the somatosensory nervous system), and inflammatory. Similarly, TCM practitioners have various categories of pain that include: Blood stasis/stagnation (fixed location, sharp/stabbing pain, impact injuries) Qi stagnation (repetitive motion injuries, pain with emotional basis, paroxysmal pain) Internal cold (types of arthritis that get worse with cold weather, menstrual cramps) Heat or Fire (rheumatoid arthritis with redness and warmth, infection, burning eyes, sore throat, etc.) Dampness (dull, aching pain, fatigue) Wind Invasion (pain that moves around, like fibromyalgia) To further complicate matters, you can mix and match some of the above conditions, such as having wind-damp. Patients can have both internal wind conditions, and those related to external wind (like the common cold, that is further differentiated into “wind cold” and “wind heat”). This also applies to heat and cold: you can have both internal and external “invasion” of heat or cold as well as an “excess” or “deficient” condition. A simple example is a bladder infection; the TCM diagnosis is “damp heat of the bladder,” which corresponds to the symptoms – burning during urination, fever, and fatigue. There are acupuncture points that “clear heat,” “subdue wind,” or “resolve dampness,” that are applied to various pain conditions. Acupuncture/electroacupuncture, herbal medicine and moxibustion (burning moxa or mugwort/artimesia vulgaris), cupping, tui na (Chinese therapeutic massage) and gua sha (special scraping technique) are all effective techniques for resolving acute and chronic pain. Here’s an example to put all this together: A 55 year-old white male complained of right side facial pain for three months, and was diagnosed with trigeminal neuralgia. He had severe burning/cutting pain ten to twenty times per day. Physical examination showed a sallow complexion, red tongue with yellow coating, and string-taut, rapid pulse. His TCM diagnosis was heat of the three yang meridians attacking the head and qi stagnation. Excessive stomach fire combined with a qi stagnation can lead to facial pain. The point prescription was S 44, located on the foot. Oblique insertion (45 degree angle) to a depth of approximately .5 to .8 inches with rotating manipulation of the needle caused a cool sensation going upward along the lateral aspect of his abdomen, stomach and cheek. The pain was relieved immediately. After three treatments, he was greatly improved, and was cured after seven treatments. Chen, Y., Deng, L. Essentials of Contemporary Chinese Acupuncturists’ Clinical Experiences. Beijing, China: Foreign Languages Press; 1989
Did you know that Naturopathic Medicine Week, Oct. 7-13 and Acupuncture and Oriental Medicine Day (AOM Day), October 24th are coming up soon? This is the perfect time to highlight your professions and bring attention to the fabulous work that you do. There are a number of ways to get involved and the Integrative Health Policy Consortium (IHPC) is helping get the word out to practitioners. Naturopathic Medicine Week / In prior years, countless AANP members (practicing NDs as well as students) have organized events ranging from open houses, fun runs and lectures to wine tastings, film showings, health fairs and raffles. Here are a few ideas to spark your creative abilities: Participate in the Whole Patient Whole Person Photo Contest. From October 7th – October 13th, submit your photo on Instagram (@institutefornaturalmedicine, hashtags #NatMedWeek2018, #WholePatientWholePerson) to share your whole patient, whole person experience, describing how naturopathic medicine takes care of the mind, body, and soul. Shop for some Naturopathic Medicine Week gear or register for a special webinar offering on Resilience, Stress, and Epigenetics. Get creative. Do your bit to promote the benefits of what you do professionally! You’ll be helping to gain patients, generate visibility, and ultimately improve our health care system. Click here for more information. AOM Day / The website (www.aomday.org), sponsored by the Commission for Acupuncture and Oriental Medicine (NCCAOM), is an ideal resource to bring AOM awareness to your community. Whether you are an acupuncturist or not, IHPC encourages all of you to promote this unique day. Here are a few ideas to get started: Link the AOM Day website (http://www.aomday.org/) and Facebook page to your website. Inspire others and promote your events by registering your activities on the AOM Day website’s “Submit an Event” page. Hold an Open House or a free clinic day in your community where you demonstrate acupuncture, Asian bodywork or Chinese herbal treatments free of charge or at a discounted rate. Publicize your event for free on local radio stations and newspapers as a community event. There is even a handy toolkit from ASA and Acupuncture Media Works to promote your practice and acupuncture. For more ideas go to the “Get Involved” page to take advantage of the various free marketing tools to advertise AOM Day as well as their practice.
Chronic Pain: In Search of the Underlying Cause A Naturopathic Perspective By Emily Telfair, ND Within my first few weeks of beginning naturopathic medical school at Bastyr University, I was introduced to a core naturopathic principle, Tolle Causam, or “Treat the Underlying Cause.” While the concept seemed to make perfect sense – of course my patients will improve when I treat the root source of their illness – in actual practice, identifying the underlying cause(s) for those with complex and long-standing health concerns proved to be quite challenging. Treating individuals living with chronic pain quickly stretched my learning curve and broadened my understanding of Tolle Causam to include the multifaceted layers of biochemical, environmental and experiential influences that manifest as pain. Naturopathic Doctors (NDs) are well positioned to serve as “first responders” to the chronic pain epidemic based on our unique medical training which encompasses an understanding of traditional diagnostic methods and pharmacology along with comprehensive training in natural therapeutics such as clinical nutrition, herbal medicine, homeopathy, counseling and physical medicine. Research studies further demonstrate that naturopathic treatments compared to conventional medical treatments show similar or greater pain relief, with an increase of quality of life, and diminished health care costs. Pain is perhaps one of the most deeply personal experiences in medicine which can be all consuming to the mind, body and soul. Descriptors such as “sharp” or “shooting” and 1 – 10 rating scales can often fall short of the impact and emotional toll that chronic pain can have on a person, their family and even our society. If the role of pain is to signal danger and to bring something of importance to our attention, when that signal becomes chronic, it often represents an unresolved stressor to the musculoskeletal, immune, endocrine or nervous system. When uncovering the roots of chronic pain, a history of trauma is often at the core. The structure of our current healthcare system leaves little room to unpack the complex relationship between chronic pain and the shame, guilt, fear and grief often held in the memory of injured musculoskeletal tissue. A naturopathic approach to supporting and treating individuals living with chronic pain will be as varied and diverse as the origin stories related to their unresolved physical or emotional trauma. A multi-tiered treatment approach that interweaves a compassionate and healing presence with knowledge of the biochemical sequelae of chronic stress has the potential to not only relieve the patient’s current suffering but also to improve resiliency in the face of future stressful events. Naturopathic Treatment Plan for Chronic Pain: 1. Calm Inflammation: In the face of chronic stress, the immune system produces pro-inflammatory cytokines which can cause tissue damage and block healing progress. Introducing an anti-inflammatory diet (similar to the Mediterranean Diet), anti-inflammatory herbs such as turmeric and boswellia along with omega-3 fatty acids found in wild, cold-water fish can modulate the immune response in favor of cell mediators that relax the inflammatory cascade. 2. Balance the HPA Axis: The hypothalamic-pituitary-adrenal axis is particularly sensitive to early impressions of trauma that occur in childhood (Adverse Childhood Events or ACES). Stressors that occur later in life can reawaken those pathways and bathe the body in “fight or flight” hormones such as adrenaline and cortisol. Adaptogenic herbs such as ashwagandha, holy basil, eleutherococcus and cordyceps can help to regulate adrenal health, especially when coupled with relaxation practices such as yoga and daily meditation. 3. Restore the Spirit: A truly holistic approach to chronic pain will pave a path for the patient to reconnect with his/her sense of purpose in life and self-love. Arriving there may begin with counseling, energetic therapies such as Reiki or cranio-sacral treatments, art therapy or Nature-based therapy. As providers, our success in supporting individuals living with chronic pain will naturally stem from how we cultivate our own practice of sitting with discomfort. I have often noticed my own impulse to want to “fix it” or “just make the pain go away” with any myriad of the naturopathic tools in my chest. A commitment to self-care as health care providers is vital to improving treatment outcomes for those we serve. When we learn how to sit compassionately with the discomfort and pain within ourselves, our experiences with patients will change as we will be modeling the medicine that we are recommending and transforming the culture of medicine from within. For more on this topic from Dr. Telfair, click here to watch her presentation at the Integrative Health and Wellness Caucus. Dr. Emily Telfair earned her doctorate in naturopathic medicine from Bastyr University and practices in Baltimore, Maryland where she has come to appreciate the deep-acting nature of simple therapies such as mindfulness and cranio-sacral therapy to address complex health concerns. She is past president of the Maryland Naturopathic Doctors Association and led the efforts to pass legislation to license naturopathic doctors in the state in 2014. Now Dr. Telfair serves as chair of the State Alliance Committee through the American Association of Naturopathic Physicians and supports state leaders working towards naturopathic licensure across the country.  Herman PM, Szczurko O, Cooley K, Mills EJ. Cost effectiveness of naturopathic care for chronic low back pain. (2008) Altern Ther Health Med Mar-Apr 14 (2):32-39.  Szczurko O, Cooley K, Mills EJ, Zhou Q, Perri D. Naturopathic treatment of rotator cuff tendinitis among Canadian postal workers: a randomized controlled trial. (2009) Arthritis Rheum 61: 1037-1045. In Case You Missed It: Speaker Videos at the Integrative Health and Wellness Caucus The lineup of speakers at the caucus was remarkable. Click on the image, the headline above or below to hear the wisdom of some of the finest integrative health experts in the country: Bill Reddy L.Ac, Dipl Ac.; Emily Telfair ND; Gerald Clum DC; Ben Kligler, MD, MPH; Margaret Chesney, PhD; Eric Schoomaker, MD; Len Wisneski, MD. Click here for access to all the videos Drug and Supplement Compounding at Risk, Take Action Did you know that the Food and Drug Administration (FDA) is imposing restrictions on what ingredients can be compounded and whether they may be held in the physician’s […]
In June, leaders in integrative care and advocacy met at the Integrative Medicine for the Underserved (IM4US) Conference on Capitol Hill. IHCP was honored to support the organizations first ever congressional briefing, Non-drug Solutions to Opioid Use and Chronic Pain Management in Underserved Populations. IM4US fundamentally believes that healthcare is a right, not a privilege. The organization advocates to preserve those rights and promote the benefits of Integrative Medicine and the impact it can have on not only improving health outcomes for chronic diseases, but also in addressing the opioid epidemic. The event, held at George Washington University (GW) School of Medicine and Health Sciences (SMHS) and the Milken Institute School of Public Health, attracted hundreds of experts in integrative care who shared practical ways of making people healthier, and discussed sustainable care models that make integrative health care more accessible. “We are sincerely grateful for the GW School of Medicine and Health Sciences and Dr. Misha Kogan for hosting our annual conference,” IM4US President Priscilla Abercrombie, RN, NP, PHD. “It was incredible to see so many local practitioners and organizations who provide integrative services for the underserved participating in our conference either as presenters, attendees or volunteers. Our organization and movement is stronger when more voices like those from GW are engaged in the work we do.” The conference attendees learned about affordable integrative approaches to common health conditions, shared evidence-based best integrative practices, and what does and doesn’t work when it comes to advocating for integrative medicine for the underserved. “IM4US is a bright light that attracts holistic providers who cares for people unable to afford the cash prices required to receive care at most of Integrative Medicine clinics,” said IM4US Conference Co-Chair Mikhail “Misha” Kogan, MD, an assistant professor of medicine and associate director of the Integrative Geriatric Fellowship at the GW SMHS. “One would think that a deteriorating health care system, access disparities, poor federal and local funding for underserved communities would stop us from trying to do this work. Yet this conference proved that the light of passion in hearts of those trying to care for all is only getting stronger.” Conference speaker, John Weeks, a writer, speaker, chronicler, and event organizer, was particularly struck by the leadership of IM4US in exploring the value of group visits and group-delivered services. For example, there were workshops and breakout sessions on various aspects of group visits, including how to build the facilitation skills needed to do them effectively. “The rest of medicine, and specifically those in the integrative health field, have a good deal to learn from the pioneering of people who presented,” Next year’s event will be held in San Francisco. For more on the organization and the toolkit it designed for healing professionals interested in working in underserved settings, go to im4us.org. Act Today! Your Voice Can Make the Difference. The IAM4US congressional briefing on alternatives to opioids for chronic pain management is just one of the ways that IHCP is advancing awareness about integrative care, The only way to really make this happen, is for you to enlist your elected officials to join the Integrative Health and Wellness caucus. Constituent phone calls are effective in making change. Don’t hesitate! Click here for more information to make your call. Contact Your Representative to Join the Caucus Interview with Tracy Gaudet, MD, Founding Director, VA Office of Patient-Centered Care and Cultural Transformation Medical Acupuncture, Dr. Gaudet discusses with John Weeks, how she and her colleagues have worked to change the culture of the Veterans Administration. Her work is relevant to all practitioners who wish to change communication patterns and organizational “wellness” to improve the workplace interactions, physician burnout and patient outcomes. Read More Here
It was my good fortune to be among the speakers at the initiation of the Congressional Integrative Health and Wellness (IWH) Caucus in March 2018. Three disciplines, chiropractic, acupuncture and naturopathy, were highlighted from the perspective of their contributions to an integrated approach to care. My task was to address the contribution that the chiropractic profession could make to the needs of our population as well as to the system of healthcare itself. In closing, I addressed six areas of emphasis for the IHW Caucus members to consider were detailed. These included: 1. Increase the budget of the of the National Center for Complementary and Integrative Health (NCCIH) to fund the comparative research and systematic reviews needed to better understand the clinical and economic value of integrative care. This need speaks for itself. The percentage of healthcare research dollars directed toward the promotion of health and well-being is laughable. The application of complementary and alternative care in the American healthcare system is remarkable from the consumer perspective and unremarkable from the perspective of the overall system of healthcare delivery, research and payment. To change this reality, we need to demonstrate clinical and economic value more clearly. To accomplish this, at the level needed, increased federal funding will be essential. 2. Address the restrictions inherent in Medicare related to payment of various forms of integrative care Far too many American citizens are denied the healthcare strategies of their choice by the lack of funding for integrative care under programs such as Medicare and Medicaid. Clearly, we appreciate the demands on the healthcare dollars that these programs are under—that is the point, with a shift in payment and access policies needed to allow integrative care approaches to be more fully involved in these systems less costly, more effective care can be grown. 3. Expand active duty military and veteran’s access to integrative health care delivered by providers with expertise in the various disciplines involved The inclusion and growth of integrative approaches within the military and veteran’s communities has been exciting to witness. The task now is scaling these offerings and assuring that these services are available our active duty and veterans populations. This is important on many levels, first and foremost to provide these individuals with the full range of healthcare services that their service to our nation demands, and second, active duty military and veteran’s health care represent the training grounds for the majority of physicians in America. Exposure of these persons’ training toward effective and efficient applications of integrative approaches to care will equip them to be more integrative in their professional lives over the years ahead. 4. Encourage the full implementation of non-pharmacologic approaches to pain management Pain management is a critical need in the United States, particularly as we try and extricate ourselves from the debacle of misuse, overuse and abuse of licit and illicit opioid containing products. The CDC, FDA, and the IOM among others have all called for an increase in the use of non-pharmacologic approaches to pain management—the forte of the integrative care community. Our population will be well served by the continued minimization of opioid use and the enhanced application of non-pharmacologic strategies for pain management. 5. Appreciate and respect the feedback of consumers expressed in the National Health Interview Survey (NHIS) related to complementary care, i.e., chiropractic care and its impact on health and well-being One of the pillars of evidence-based healthcare is taking into consideration the perspective of the patient on the care they are to be provided. The National Health Interview Survey has gone to the horse’s mouth to learn how consumers are using various forms of health care and how they see that care impacting their circumstances. The movement toward patient-centered care further supports the need to listen to this counsel from the end users of the system. 6. Support and implement the spirit and intent of Section 2706 of the Patient Protection and Affordable Care Act (PPACA). Section 2706 of the PPACA offers an important guarantee to the public that the providers of their choice are available to assist them with their care needs. We cannot and should not overlook the important policy statement that Section 2706 represents to Americans (for more on this go to CoverMyCare from IHPC). A successful launch does not guarantee a successful mission! Now that this Caucus is off the ground the hard work of growing and sustaining the effort is before the House of Representatives and the integrative health care community. For this to be the success the American public needs in terms of changing the landscape of health care it will require broad-based, grassroots efforts from as many organizations and individuals as possible. In Good Health, Sincerely, Gerald Clum, DC Integrative Health Policy Consortium Board of Directors ______________________________________________________________________________ For those of you who called your elected officials to support the caucus, we thank you. If it slipped your mind, it’s time to enlist your elected officials to join the Integrative Health and Wellness caucus. Constituent phone calls are effective in making change. Don’t hesitate! Click here for more information to make your call. Integrative Pain Care Options In this video, Gerry Clum, D.C. reviews health gaps in pain management and why chiropractic care is a key piece in addressing chronic pain. As he explains, 25% of opioid prescriptions written in the United States are for low back pain, despite the fact that all the guidelines from major medical institutions advise otherwise. Click below or on the image to hear more from Dr. Clum. Chiropractic Treatments for Pain Management with Gerald Clum, DC at the Integrative Health Wellness Caucus. Contact Your Representative to Join the Caucus Effectiveness of Dry Needling as Compared to Other Protocols In this study, researchers compared the effectiveness of dry needling to other forms of integrative care for lower back pain. Given that 85% of all people suffer from back pain at one time in their lives, this study goes a long way in establishing effective protocols for back pain. Study provided by our partners at Today’s Practitioner. Read More Here
Any service that is on track to consume 40 percent of the gross national product of the world’s largest economy by the year 2050 cannot be ignored and that service is US healthcare. The reason that IHPC encouraged House of Representative members Mike Coffman (R-CO) and Jared Polis (D-CO) to form the bipartisan Congressional Integrative Health and Wellness Caucus was explicitly to ensure that Integrative Health has an authoritative voice at the table with people making decisions about policy, legislation and regulations. Both Members Coffman and Polis also belong to the congressional Problem Solvers Caucus working to craft bipartisan healthcare solutions. They know that when it comes to costly, chronic diseases, and crises like the opioid epidemic, integrative health approaches can offer improved outcomes with lower costs. In fact, a just released study today in JAMAshows there is no time to wait. The study revealed sad and striking numbers, “all deaths attributable to opioids increased 292% (from 0.4% to 1.5%) between 2001 and 2016, resulting in approximately 1.68 million person-years of life lost in 2016 alone.” Sadly, 20% of those deaths were adults age 24-35, a demographic that should be celebrating the future, not losing their lives to drug overdoses. While there is high skepticism and often cynicism as to what Congress can accomplish in the current highly partisan and polarized environment, there are committed bi-partisan Members working to make a difference. What Congress does matters to more Americans than you might think! Congressional action has direct impact on the Centers for Medicare and Medicaid Services (CMS), the Marketplace, the Children’s Health Insurance Program (CHIP), the Federal Employees Health Benefits (FEHB) Program, the Veterans Administration and the Department of Defense health services. Millions of Americans are impacted by these services, and the private insurer and health services market usually follow their lead. The Capitol Hill Caucus briefing on March 15, focused on integrative pain care and the opioid crisis, generated significant interest and requests for education and information from more than 30 Congressional offices (thank you to IHPC member AANP who included Caucus info in their Lobby Day). IHPC has continued to meet with legislators and their staff. On April 9, along with Board Member and AIPM Partner for Health Bob Twillman, PhD and interim Executive Director Susan Haeger, I met with both new Members and many interested in joining the Caucus. The whirlwind day across multiple buildings and offices confirmed high enthusiasm and interest in transforming healthcare to focus on prevention, wellness and well-being for health creation. There is a sea change in the landscape for health and healthcare. Large systems of care are embracing integrative health and turning attention to how communities and states can promote health and wellness, as well as encourage more attention to disease prevention. In pain care and especially in the opioid crisis – non-pharmacological and integrative approaches are being sought out. The time is now for communicating with, connecting and catalyzing legislators to champion this shift so that Integrative Health and Wellness can take center stage in health and healthcare in America. If you haven’t already done so, it’s time to enlist your elected officials to join the caucus. Constituent phone calls are most effective. Don’t hesitate! Click here for more information to make your call. In Good Health, Sincerely, Leonard A. Wisneski, MD Chair, Integrative Health Policy Consortium Video Highlights from Caucus Briefing on Capitol Hill In March, the inaugural Health and Wellness Caucus took place in Washington DC. The bipartisan efforts of Reps. Jared Polis (D) and Mike Coffman (R) with the support of IHPC, were met with great success. We’ve collected the various presentations from the caucus speakers. Click on the image to the right to access all the videos. Click on the titles below to listen to the highlighted speakers: 1. Introduction by Len Wisneski, MD, IHPC Board of Directors Chair 2. Opening Remarks from Caucus Co-Chairs Reps. Jared Polis (D) and Mike Coffman (R) 3. Ben Kligler, MD, MPH presents a segment on integrative practices within the Department of Veterans Affairs (VA). CONTACT YOUR REPRESENTATIVES TO JOIN THE CAUSE New Study: Active Integrative Protocols for Pain Management In this new study, researchers show that when patients are educated in integrative-care solutions, they are most likely to elect an active complementary pain management program. Study provided by our partners at Today’s Practitioner. Read More Here