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
IHPC has responded to an RFI from the Centers for Medicare and Medicaid Services, CMS, on the issue of the future of the CMS Innovation Center, known as CMMI
Help Us Grow Membership in the Congressional Integrative Health and Wellness Caucus: Make Sure Your Representative Knows You Care!
IHPC strongly endorses the bi-partisan formation of this important education and community learning resource for members of Congress as non-pharmacologic treatment options for pain management and addressing opioid-driven addiction become central to US health care and public policy.
IHPCs joins integrative health partner organizations to establish the Moving Beyond Medications campaign to emphasize the value of non-pharmacologic treatments for pain and opioid addiction. This position has been emphasized itself by the actions of 37 state attorneys general urging insurance payers to reimburse these treatment options. See the NAAG letter here.
Seasoned Advocacy Leader, Susan Haeger, Appointed Interim ED — After four years leading significant growth of IHPC, Executive Director Alyssa Wostrel has stepped down to focus on new professional opportunities. Veteran policy and advocacy leader, and IHPC board member, Susan Haeger, has taken the reins as interim Executive Director of IHPC.
In this short video, IHPC Executive Director Alyssa Wostrel speaks to the policy imperatives IHPC has pursued in support of Section 2706, the non-discrimination provisions of the ACA. Read More
IHPC submits “Comments on proposed 2016 Guidelines for Prescribing Opioids for Chronic Pain” to Centers for Disease Control. Letter available here. Read More
CAM professions are too often defined politically — by treatment modalities — rather than by full professional scopes, preventing licenses being honored in insurance coverage. Read More
IHPC and AIHM encourage the new NAM to embed integrative practitioners into its important initiatives such as Healthy America, and Grand Challenges in Health and Medicine. Read More
In August, IHPC’s Alyssa Wostrel introduced the real-world experience and benefits of integrative pain care to policy and legislative leaders of several of the nation’s primary pain advocacy organizations Read More
In addition to their important leadership experience in integrative health, Elizabeth Goldblatt and Martha Menard have contributed 20 years of volunteerism to ACCAHC. Read More
AANP is partnering with The Foundation for Care Management (FCM) to accredit naturopathic education programs for MDs, NPs, PAs, dietitians and others in the health care team. Read More
The Oregon Association for Naturopathic Physicians is preparing for its 20th Annual Conference in Portland in December and is accepting abstracts until June 30. Read More
IHPC congratulates John for his 8+ years of innovative leadership as ACCAHC’s Executive Director. He led many important initiatives with colleagues during this seminal time. Read More
IHPC is one of 38 organizations providing live testimony to an FDA review panel as part of its two-day hearings evaluating the current regulatory framework for homeopathy. Read More
John Weeks, Publisher and Editor, ‘Integrator Blog News & Reports’, publishes his latest edition of his annual Integrator Top 10 list for the emerging field of integrative health and medicine. Read more…
IHPC’s Call to Action on “The Expanding Care for Veterans Act” — H.R. 4887 — which would expand Federal support for complementary and integrative health (CIH) services for veterans — has generated more than 1900 letters of support . Read More
On September 29, 2014, more than 125 leaders and advocates for CAM and integrative healthcare met at the Georgetown University Conference Center to attend an invitational policy symposium entitled “A Call to Action on Integrative Health and Medicine Policy, Advancing the Legacy of U.S. Senator Tom Harkin.” Presentations assessed the state of the complementary and integrative health field in light of Senator Harkin’s immeasurable vision and legislative efforts in the last 20-plus years. Morning Session “From the 2010 Stakeholder Report Forward: Integrative Health in the ACA: Where Have We Come From? Where Do We Go Next?” Moderator, Len Wisneski, MD, and IHPC chair. Speakers included: Michael Traub, ND: Non-Discrimination in Health Care Janet Kahn, PhD, LMT: The National Prevention, Health Promotion and Public Health Council Christine Goertz DC, PhD: The Patient-Centered Outcomes Research Institute Courtney Baechler, MD: Integration in Practice: Accountable Care and Patient Centered Medical Homes John Weeks: Healthcare Workforce Interprofessional Practice and Education Keynote: Eric Schoomaker MD, PhD, former Surgeon General, US Army Introduced by Wayne Jones MD, CEO, Samueli Institute “The Imperative for Integrative Health and Medicine in the United States” Afternoon Session “Emerging Trends and Opportunities in Integrative Health & Medicine” Moderator: Margaret Chesney, PhD, Chair, the Consortium of Academic Health Centers of Integrative Medicine (CAHCIM). Speakers included: Josephine Briggs, MD: “Building the Capacity for Real World Effectiveness Research for Integrative Health” Clem Bezold, PhD: “intersecting Futures for Public Health, Primary Care and Integrative Health and Medicine” Christopher D’Adamo: “Mission Thrive and Nature as Health” Wayne Jonas MD: “Creating Wellbeing Leadership Group” Ahmed Calvo, MD, MPH: “Wholistic Approaches to Community Health and Wellbeing” Gerry Clum, DC, moderated the following small group discussions: “Where Do We Go From Here.” Mary Jo Kreitzer, RN, PhD, FAAN offered reflections on the day at the close of the program. Testimonial Dinner for Sen. Harkin The symposium was followed with a reception and dinner program honoring Sen. Tom Harkin, who was introduced by U.S. Senator Barbara Mikulski. Tributes were made by the major sponsors of the event including Life University, the Institute for Integrative Health, Georgetown University, the Academic Consortium for Complementary and Alternative Health Care, the Consortium of Academic Health Centers for Integrative Medicine, the Academy of Integrative Health and Medicine, the Integrative Healthcare Policy Consortium and the Samueli Institute.
The US Senate’s primary supporters of integrative health and medicine, Sens. Tom Harkin and Barbara Mikulski have moved for the second straight year — and the Senate has passed unanimously — a resolution declaring this week Naturopathic Medicine Week. Read More
Creating a defined new place — and role — for licensed complementary, alternative and integrative health practitioners in the nation’s redefined workforce: the Community Health Center. Read More
The national leadership of the integrative health and medicine fields meets in Washington Sept. 29 to honor the contributions of retiring US Sen. Tom Harkin. Harkin has been the leading voice on Capitol Hill demanding inclusion of integrative therapies in the country’s healthcare system. Read More
This Fall, IHPC will launch its consumer-facing education and information web site CoverMyCare which recently appeared in The Integrator Blog, and the integrative health business and marketing web site FON Therapeutics. Read More…