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Massage Therapy's Role in Integrative Care \u0026 Pain ManagementIntegrative pain relief therapies -
Various definitions have been proposed for integrative care, which generally addresses the combination of two or more healthcare strategies, but which also incorporate elements of being: 1 multidisciplinary, 2 interdisciplinary, 3 collaborative, 4 consultative, and 5 coordinated [].
For the purposes of the IASP Global Year, we define integrative pain care as the carefully planned integration of multiple evidence-based treatments — offered to an individual suffering from pain — that strives to be individualized person-centered , mechanism-guided, and temporally coordinated.
For the introduction of general principles, we will focus on the simplest example of integrating only two different interventions.
Clinical pain conditions are associated with various biological, psychological, and social dimensions and manifestations including, but not limited to, sensation of pain, fear, anxiety, sleep disturbance, fatigue, depression, and impaired physical, sexual, cognitive, domestic, occupational, and social function.
Preclinical study of the neuroscience of pain has revealed multiple concurrent pathways and mechanisms of pain perception.
Since pain involves these complex biopsychosocial interactions [4], any single intervention is unlikely to completely relieve pain or any adverse pain-related manifestations.
Two different interventions — acting via different putative mechanisms — could be integrated simultaneously , if feasible, with the expectation of an additive, or even synergistic treatment interaction e. exercise and cognitive-behavioral therapy for pain-related anxiety.
Alternatively, it may be preferable for two different interventions to be integrated sequentially e. epidural steroid injection followed by guided back exercises if the first intervention is expected to facilitate the delivery, and success, of the second intervention.
Available, albeit limited, evidence may guide mechanism based selection of which interventions to integrate for which treated person — either simultaneously, or sequentially. However, another benefit of integrative care is the acknowledgement to the person receiving treatment that several possible diverse treatments could provide meaningful benefit.
This illustrates to the person being treated the complexity of the pain experience and its modulation but also introduces the potential role of personal preference and engagement of the person being treated when developing a pain reatment plan.
Therefore, any additive costs, risks, side effects and benefits of the interventions being combined should ideally be evaluated in comparison with each singular intervention.
Producing valid evidence for pain treatments is vital but challenging and resource intensive. Rigorous studies may require a sizeable participant population, the most highly skilled providers of the intervention of interest and a suitable control intervention sham, placebo, or another active comparator.
Future success of integrative pain care will depend on: 1 effective collaboration between clinicians and researchers from diverse pain treatment settings; 2 standardization of treatment protocols for complex interventions; 3 development of valid, high quality evidence e. In an August review published in Translational Research , Duke researchers summarized recommendations from clinical practice guidelines regarding nonpharmacologic treatments for back and neck pain and identified barriers to their delivery, including cultural, access, and financial challenges.
Trevor A. Lentz, PT, PhD, MPH , a musculoskeletal researcher in the Department of Orthopaedic Surgery and Duke Clinical Research Institute and a co-author, says using complimentary integrative approaches is an integral step to reducing the impact of opioid use and misuse among people with chronic pain.
Lentz offers several approaches for incorporating more minimally invasive options for patients with chronic pain:. How to incorporate more minimally invasive options for patients with chronic pain.
By Lindsay Kenton. Published November 9, Blackford, MD The Duke Joint Health Program , a condition-based care program that promotes physical therapy and cognitive behavioral therapy CBT as treatment for osteoarthritis of the hip and knee led by William A.
Jiranek, MD, FACS and Richard C. Mather, MD, MBA The Duke Spine Health Program , a multidisciplinary collaborative care model focused on enhancing access to and use of non-pharmacologic options and self-care as frontline treatments for back and neck pain led by Christine Goertz, DC, PhD.
Building in Nonpharmacologic Options for the Treatment Plan.
Internet Explorer 11 has been retired by Microsoft as of Integratve 15, To get the best experience Integrqtive this relef, we Relied using a modern Intebrative, such as Safari, Thegapies or Edge. Scripps Center for Anti-cancer community Medicine Integrative pain relief therapies at the forefront Oranges for Heart Health the change in the way health care manages acute and chronic pain. Our multidisciplinary team calls on the full array of pain relief therapies, including natural and non-narcotic approaches, to optimize pain management. Our pain management doctors practice both conventional and evidenced-based mind-body techniques and offer a coordinated approach to chronic pain treatment. Integrative pain management brings together acupuncture, biofeedback, therapeutic massage, Healing Touch and other types of integrative therapiesharnessing the power of the mind, body and spirit to heal and relieve pain.Integrative pain relief therapies -
Massage therapy can be particularly beneficial for musculoskeletal pain, helping to relieve the pain of muscle strains or acute or chronic pain that affects the nerves, ligaments, and tendons. There are many massage techniques, including Swedish, deep tissue, sports, and chair massages, and all can differ in duration and intensity.
Therapeutic massage may relieve pain by several mechanisms. For example, it can help relax painful muscles, tendons, and joints, helping to reduce stress.
Also, massages can help stimulate competing nerve fibers by impeding pain messages to and from the brain 17 , A study published in Annals of Family Medicine in found that getting a minute massage session two-three times per week for four weeks relieved chronic neck pain. Massage has also been shown to benefit sleep and promote feelings of relaxation When assessing systemic pain in the body, it is paramount to look at all contributing factors and interconnected systems that can contribute to the manifestation of pain.
Factors such as over-reaction of the immune system, dormant viruses, hidden infections, and markers of inflammation such as antibodies and white blood cells can give more insight into the pathogenesis of pain and help to create a more individualized pain management protocol.
Awareness of these various markers is helpful as they can increase and decrease depending on how much inflammation is in the body. Testing helps the practitioner and patient see where to focus their attention with integrative approaches and can help assess treatment progress.
Various labs can be used to assess factors that play a role in pain throughout the body, such as systemic inflammation and inflammatory markers such as C-Reactive Protein. Other labs can check for dormant viruses and other infections , particularly those impacting the immune system, such as Epstein-Barr , Tickborne viruses, and HIV , as well as autoimmunity.
Chronic pain can affect nearly every aspect of your life and last for months or years. It is possible to experience chronic and acute pain. Managing all types of pain can initially feel daunting to many, so addressing pain from a holistic perspective is important.
This can look like creating an integrative pain management program that includes functional labs and incorporates complementary and alternative healing modalities such as acupuncture, yoga, chiropractic care, physical therapy, and massage.
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Yes No. Search All Content Magazine Podcasts Lab Companies Lab Tests Live Classes Bootcamps Health Categories. Basic Lab Markers. Case Studies. GI Health. Herbal Medicine Fact Sheets. Lab Interpretation. Men's Health. Mental Health. Metabolic Management. With extensive experience and expertise in pain management, our team specialize in a broad spectrum of conditions, including back and neck pain, arthritis, migraines, fibromyalgia, neuropathy, and more.
By employing cutting-edge techniques, advanced therapies, and top quality bracing we strive to alleviate your pain, enhance your mobility, and improve your overall quality of life. Beyond our commitment to excellence in pain management, we place great emphasis on cultivating strong patient-doctor relationships.
We believe in open communication, attentive listening, and thorough explanations of your diagnosis and treatment options.
Our aim is to empower you with the knowledge and resources necessary to actively participate in your pain management journey. We invite you to explore our website to discover more about our services, our dedicated team, and the state-of-the-art treatments we offer. Take the first step toward a pain-free life by scheduling an appointment with our experienced team at Integrative Pain Specialists today.
We provide a number of therapies to reduce stress, inflammation, and promote good overall health. Some might say Ben Seeman was destined to become a doctor. Early in life he…. Make an Appointment: W. While occupational therapy practitioners independently help patients implement health-promoting behavior change, they also overlap and reinforce treatment goals from other interdisciplinary team members.
For example, a patient with pain may learn relaxation techniques in pain psychology and physical exercises from their physical therapist, but they may have difficulty integrating these interventions into their habits and routines in a consistent and effective way.
Occupational therapy practitioners can address this challenge with the patient by analyzing activity patterns, problem-solving barriers, and facilitating sustainable carryover. Additionally, occupational therapy practitioners train caregivers and contribute valuable assessments regarding patient safety, environmental safety, and readiness for discharge.
This combination of skillsets prioritizes patient safety and independence and can even reduce risk for readmission.
Unfortunately, occupational therapy practitioners are commonly overlooked in the research and development of comprehensive pain management teams compared with fellow non-pharmacological providers e.
Occupational therapy practitioners collaborate with patients to identify and incorporate self-management strategies into their daily routines to reduce pain, increase participation in meaningful occupations, and improve quality of life. Examples: caretaking, driving, financial management, home management, meal preparation, safety and emergency maintenance, shopping.
Examples: symptom and condition management, communication with health care system, medication management, physical activity, nutrition management, personal care device management. The list of skilled occupational therapy interventions included in Table 1 demonstrates the diverse practices that are used during treatment sessions to achieve the overall goal of improving function and participation.
By working with patients to develop individualized strategies related to lifestyle, resource utilization, and self-advocacy, occupational therapy practitioners help to prevent future injury and pain. By helping patients develop and sustain health-promoting daily activities, occupational therapy practitioners empower them by improving self-efficacy, self-management, and overall quality of life.
However, there is wide variability in the terms of coverage, such as the number of visits and allowed interventions. Occupational therapy clinics often assist individuals with pain in determining insurance eligibility and coverage and, if necessary, gaining authorization for service.
Patients are typically responsible for a deductible, coinsurance, or copayment. Occupational therapy treatment is usually billed using the Current Procedural Terminology CPT codes depending on the payer source.
Depending on state guidelines and payer policy, occupational therapy can also be delivered successfully through telehealth platforms. Telehealth expands access for individuals with pain who may have a provider shortage in their area and for individuals who may experience barriers to transportation or increased pain with travel.
Pain management training and education is incorporated into the entry-level academic occupational therapy programs; therefore, all occupational therapy practitioners are qualified to provide pain management services.
While all occupational therapy practitioners are qualified to treat pain, those who have completed advanced-level training in pain management specifically is somewhat limited. Occupational therapy practitioners recognize this is a challenge and have recommended strategies to increase training in pain management, including the use of internships specializing in pain management, post-professional training courses, interprofessional education, and curriculum changes.
Baylor University offers Pain Science as one of three elective tracks in their post-professional occupational therapy doctoral curriculum. Additionally, institutions that have both post-professional occupational therapy doctoral programs and medical centers with multidisciplinary pain teams, like Boston University, provide the opportunity for students to build a residency that integrates additional pain management training.
Occupational therapy practitioners provide services in a variety of settings including hospitals, outpatient clinics, school systems, and homes. Depending on the state where occupational therapy services are received, referrals may be made by physicians, nurse practitioners, physician assistants, licensed social workers, and psychologists, among others.
Patients can also contact their insurance company to request information about occupational therapy practitioners who are covered under their health care plan. In a review of barriers to accessing interdisciplinary pain care, research found that there were few or no providers available in some ZIP codes despite insurance coverage of non-pharmacological services.
This scarcity led to patients relying on more high-risk options, such as opioid use. Increasing access to telehealth services can help to alleviate these barriers that are due to social determinants. The lack of practical understanding of how to provide, guide, and integrate the interprofessional part of comprehensive integrative pain management has been one of the most commonly mentioned barriers by all the stakeholders involved in AACIPM.
In other words, health care providers are not currently trained to understand exactly when, how, and why they should refer to other professionals, even if they know the evidence recommends other interventions and treatments for pain management.
Further, individuals with pain often must create their own pain care plans due to the paucity of comprehensive integrative pain management clinics and the fragmentation of existing care models when it comes to the complexities of pain.
For example, Maggie, who lives with Ehlers Danlos Syndrome EDS and is a Board-Certified Patient Advocate, knows exactly when and why she needs to visit the providers on her team e.
Unfortunately, this scenario is not the norm. On the importance of the patient needing to understand which treatments and referrals to ask for, Maggie states:. For example, an EDS-related shoulder subluxation with soft tissue damage can present similarly to a broken bone or torn rotator cuff.
If my regular doctor is not available, I have to accept a referral to orthopedics and go through additional exams and scans to confirm that it is, in fact, a normal EDS-related subluxation. This extends my pain and healing time. Unfortunately, it takes time and experience with repeated injuries to figure out the best pathways for care for each person, including learning what will be covered by their individual insurance plan.
In order to integrate occupational therapy services as part of a comprehensive pain management program, there must be better understanding and awareness of these services by 1 payers, 2 health care providers, and 3 individuals.
Additionally, payer-provider partnerships are extremely important when developing a comprehensive integrative program, such as the partnership between Blue Cross Blue Shield of Vermont and the University of Vermont Medical Center for the Comprehensive Pain Program pilot. This pilot includes a wider range of health care providers, including occupational therapy practitioners, than often found in one clinic and they are integrated, interprofessional, and integrative in their approach.
This training could be incorporated into medical school curriculum or provided to practicing physicians in clinical settings in the form of an in-service, presentation, or clinical observations of occupational therapy evaluation and treatment sessions.
Pain management treatments are more likely to be integrated when practitioners have a clear overview of timeline, workflow, and team members. Image 1 describes this continuum of care that a patient may experience with a comprehensive pain management team, from initial evaluation with a pain management specialist through development of a holistic treatment plan.
A few strategies to improve patient awareness are occupational therapy practitioners in primary care settings where they can educate patients about their role, and having occupational therapy practitioners present about their services at community patient conferences.
Image 1 highlights examples of comprehensive treatment plans that can result from interdisciplinary collaboration, where all disciplines are considered and integrated appropriately.
While some patients enter care teams with strong self-management skills, others may need additional training and intervention to develop this invaluable skillset. As noted in Table 1, occupational therapy practitioners can play a significant role in training patients to increase their confidence in their health management and IADLs, including symptom and condition management, communication with their health care system staff, medication management, and building health-promoting daily routines.
Image 1. Diagnostic Process and Treatment Examples From an Interdisciplinary Approach to Pain Management. Adapted from: U. Department of Health and Human Services , May.
Pain Management Best Practices Inter-Agency Task Force. Report: Updates, Gaps, Inconsistencies, and Recommendations. pdf Mark is a year-old male high school teacher with a diagnosis of complex regional pain syndrome CRPS Type 1 bilaterally in his hands caused by a repetitive strain injury at work.
His pain management doctor prescribed neuralgia medications Gabapentin, Ketamine, and Mirtazapine and educated him about additional interventional and non-pharmacological treatment options for CRPS including sympathetic nerve blocks, spinal cord or dorsal root ganglion nerve stimulators, occupational therapy, physical therapy, and pain psychology.
After reviewing his treatment options and insurance coverage for these recommended treatments, Mark participated in occupational therapy, physical therapy, and pain psychology as part of an interdisciplinary team approach.
Mark took a temporary leave of absence from work when he was diagnosed with CRPS due to his inability to perform his essential job functions. He utilized this time to participate in the interdisciplinary pain management program.
At the initial occupational therapy evaluation, Mark reported symptoms of aching and shooting pain, sensitivity to touch, and occasional edema. Mark identified fine motor movements, driving, and stress as pain triggers, and he identified the use of deep pressure as a pain alleviating factor.
He also was unable to participate in avocation and leisure activities, including playing the piano and transcribing a book he wrote into another language. Additionally, his pain negatively impacted his mood and caused interpersonal challenges with his partner, as he would avoid participating in social and community activities with her.
In collaboration with Mark, the following occupational therapy goals were identified: improve tolerance for fine motor activities in order to return to work, establish new health-promoting stress management strategies and routines, gradually resume participation in preferred avocation activities without triggering a CRPS pain flare up, and explore new activities he can tolerate and engage in with his partner.
He was seen for a total of 12 occupational therapy sessions before he met his occupational therapy goals and was discharged. Occupational therapy visits started at a frequency of once every 2 weeks, then gradually decreased in frequency as Mark became more independent with his pain self-management.
Image 2. Synergistic Interdisciplinary Team Between Physical Therapy and Occupational Therapy to Treat Mark. Image 3. Synergistic Interdisciplinary Team Approach Between Pain Psychology and Occupational Therapy to Treat Mark. Pain is complex and requires a person-centered, multimodal, interdisciplinary approach to care.
A best practice involves a team of providers working synergistically and with patient shared decision making so that individuals are able to achieve what matters to them.
The Alliance to Advance Comprehensive Integrative Pain Management AACIPM is the first-of-its-kind multi-stakeholder collaborative, comprised of people living with pain, public and private insurers, government agencies, patient and caregiver advocates, researchers, purchasers of healthcare, policy experts, and the spectrum of healthcare providers involved in the delivery of comprehensive integrative pain management.
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