Introduction to the Holistic Treatment of Chronic Pain
The Resilience Medicine Approach to the treatment of Chonic Pain with holistic, integrative and cannabinoid medicine.
Introduction
Chronic pain affects almost half (43%) of people in the UK population and is the most common cause of disability and reduced quality of life.
When it comes to all forms of chronic pain, a holistic approach can dramatically improve your pain, quality of life and other symptoms so you can return to life again as pain free as possible.
The Resilience Medicine Holistic approach to chronic pain incorporates cannabinoid (cannabis-based) medicines, specific mindbody techniques, therapeutic diets, prescribed combinations of nutraceuticals & medications, creating more passion and connection and optimising a resilience environment using evidence-based and evidence-informed interventions stacked together to create greater healing to help you feel better faster and stay well.
In this article you are going to learn about each of these holistic approaches in detail, how to use them for your healing journey as well as the latest research evidence, case studies, clinical trials and resources for chronic pain to help remove the confusion and help provide a path to feeling better.
Chronic pain becomes a brain networking condition
Chronic pain can come alongside conditions such as anxiety, depression, fatigue and sleep problems and often these issues go hand in hand. Chronic pain can actually cause these issues to start or if you already suffered with them before you were in pain, the chronic pain can make them much worse.
That is because pain disrupts the brain networks for mood, stress and energy management and the pain signalling can start to confuse the other brain networks so that your response to pain becomes more than just feeling pain in one area but involves energy and mood crashes as well.
Chronic pain can disrupt hobbies, family and relationships, work, energy levels and passion for living. Yet chronic pain is often poorly understood and poorly treated by standard drugs or surgical approaches which is why a holistic approach is needed to break this cycle of pain, fatigue and poor mental functioning due to pain so you can regain your quality of life.
Chronic Pain Creates a Tired but Wired Brain
When the pain goes from acute to chronic, the pain isn’t just in a specific body part any more, the pain messages and signals also become wired in our brains and our nervous systems. Chronic pain creates a constant stress burden and increases what is called our allosteric load, our total body and brain stress burden, and uses up mental and physical resources, and energy that can lead to a hyper-aroused ‘tired but wired’ nervous system that has trouble relaxing and calming down due to the constant internal threat of pain.
It is possible to treat chronic pain effectively using a holistic approach even if the cause of the pain has no permanent cure.
What is Chronic Pain & Types of Chronic Pain
Chronic pain is pain that has persisted for 12 weeks or longer.
Chronic pain can be from many sources and causes. Many people have more than 1 type including:
- Neuropathic or nerve pain-where the pain is in the nerve itself such as after a direct injury to a nerve or from a process like diabetes (diabetic neuropathy)
- Somatic or body pain- from a muscle or skeletal system/soft tissue or joint–like in arthritis or muscular pain
- Inflammatory pain-such as in autoimmune conditions and overlaps with other types of pain but with more specific biomarkers
- Central sensitivity Pain-where the brain’s pain networks begin to misfire and become dysregulated so that pain signals from the body become amplified in the brain. In a process known as smudging, pain becomes more widespread and difficult to pinpoint due to the nervous system becoming confused as the origin of the pain and the area of pain increases, sometimes without a discernable pattern of what makes it better or worse. This type of pain is very difficult to treat with standard drugs and often patients are not listened to or told they are exaggerating, which is both false and detrimental to treating the pain effectively. Fibromyalgia and EDS patients have this type of pain, but anyone can experience it.
- Neuropsychiatric pain-where there is a brain stress network component in addition to a physical component, such as in tension headaches where stress & anxiety brain pathways can worsen the muscle tension and spasm in a vicious cycle and can include mood changes, anxiety & mental anguish and intense suffering on top of the physical pain. This type of pain involves a brain networking issue.
The Endocannabinoid System & Pain
The endocannabinoid system, or ECS, is a natural brain and body system involved with regulating most major brain and body functions including pain signalling. There are ECS receptors in the brain as well as in nerves throughout the body and in our joints and most organs as well as in the gut.
Cannabinoid medications, or medical cannabis, that work on the ECS can interrupt the pain messages through a multitude of different chemical and brain messenger pathways, contributing to a strong anti-pain effect.
ECS differences in each of us can change not only how our brain processes pain, but also our emotional and behavioural ‘brain reactions’ to it, with our brain areas of emotion and mood becoming involved in the pain response. This is a very real part of chronic pain and ‘thinking positively’ or trying to ignore the pain does not work. Targeting the ECS with medical cannabis helps with the secondary symptoms of pain too, such as low mood, anxiety, brain fog and anxiety.
Exercise may also work via the ECS to help with chronic pain but it’s not as easy as just ‘getting more active’ when you are constantly in pain. For many patients when the first get to us, they are in too much pain or too deconditioned to be able to use exercise in this way, leading to a vicious cycle of no exercise, more weight gain & weakness and muscle wasting making it harder to exercise/move the body leading to having even less energy. Treating pain effectively using a holistic approach including cannabinoids can help break this cycle.
Common comorbidities with chronic pain
Many patients with chronic pain have other conditions too, such as depression, sleep issues, chronic fatigue, anxiety, brainfog and cognitive dysfunction & digestive issues. Without treating these symptoms together holistically, it is very difficult to get control over any of them because they all affect each other since pain is a complex process involving the brain, immune system and gut-brain axis as well as brain pain-processing networks.
The illness experience living with Chronic pain
The common experience of patients with chronic pain is a deterioration in their overall quality of life and ability to do ‘normal’ things from going for walks to seeing friends, going to work, or enjoying family time, due to a vicious cycle of physically debilitating pain on top of secondary pain-related brain symptoms like brainfog, unpredictable mood and mental fatigue. Many patients have tried many medications and had to stop due to side effects or the drugs not being effective. This can lead to losing hope of feeling better and becoming more disabled by symptoms over time that are not getting treated effectively. A holistic approach can be used to help break this cycle.
The Resilience Medicine Toolkit for Chronic Pain
The Resilience Medicine holistic approach involves incorporating interventions from 6 main categories: Cannabinoids & Novel Medicines, Diet + Microbiome, Mindbody, Supplements & Nutraceuticals, enhancing Passion and connection & creating a resilience environment.
In the clinic, we also use functional medicine tests and approaches to further personalise treatment based on biomarkers, gut markers and genomics in some cases. We also, where needed, use medications, often with prescribed combinations of nutraceuticals.
These categories were chosen based on Dr Dani’s 15 years of experience using this holistic treatment framework with her patients. Often it is when things from different categories are ‘stacked’ on top of each other to create a unique integrative plan or ‘stack’ that gives the most benefit in chronic pain, since everyone’s illness is slightly different.
It’s also worth remembering that even if you have tried some of these things before on your own, it is often getting the right combination of things done at the right time that makes a big difference.
It can be very overwhelming and confusing trying to navigate all of the pieces of a holistic treatment plan on your own. Having expert guidance helps remove this confusion and overwhelm and makes sure you are on the best treatment path.
Prescription Medical Cannabis
Medical cannabis is a a legal medication in the UK and is available now on private prescription from a specialist doctor. Medical cannabis are whole plant medicines which contain over 100 active cannabinoid compounds, which are thought to work together to deliver the medicinal effects although the main cannabinoids used for dosage currently are CBD and THC. The different strains or chemovars, can produce different therapeutic effects making it a highly personalised medicine.
Medical Cannabis helps pain patients with difficult-to-control symptoms & those who have failed other approaches, to get a quick win in terms of symptom control, relief from suffering and overwhelm.
It can help by starting of a positive neurological ‘cascade’ leaving you more able to engage with other aspects of a holistic treatment plan. For example, combining cannabis medicines with a specific mindbody relaxation training technique or with an exercise or diet change becomes easier due to the brain and body and the nervous system being in less distress.
Most patients see a significant improvement within the first month of therapy across multiple symptom clusters including pain, mood, fatigue, stress, sleep and global functioning.
Medical Cannabis for Chronic Pain
Medical cannabis is a promising treatment for chronic difficult to treat pain from a variety of causes and conditions. Unlike many other medications, medical cannabis is usually well-tolerated and can effectively treat clusters of symptoms with a single medicine.
It can help with different types of pain including nerve pain, central sensitivity pain, limb and body pain and functional digestive disorder pain as well as conditions such as fibromyalgia and musculoskeletal pain as well as back and neck pain. It can also help treat co-existing sleep disturbances, anxiety, headaches, fatigue and improve mental function.
Medical cannabis can help in these very different areas because it is a medicine that works on our endocannabinoid system (ECS), the overall brain and body balancing system which controls everything from pain signalling to stress responses, sleep and influences mood and eating behaviors and immune system response. It also has activity in the serotonin system and on inflammation pathways.
Cannabinoids have neuroprotective properties and prescription preparations containing even a ‘microdose’ of THC can work as an effective chronic pain reliever, even when other drugs have not worked or been tolerated .
Additionally, some experts and researchers believe that in some forms of chronic pain, the endocannabinoid system may become ‘deficient’ in the production of natural body cannabinoids. Plant cannabinoids in the right doses and ratio eg. cbd, thc and minor cannabinoids may help restore balance in this system leading to less pain signalling.
To maximise the benefits of medical cannabis, treatments should be tailored to each individual’s needs by an expert doctor. This includes factoring in different times of day and different effects.
Dr. Gordon is the most experienced cannabinoid medicine physician in the UK, has trained the first UK specialist physicians in the prescribing of medical cannabis for chronic pain and has treated thousands of patients with medical cannabis first in Canada and in the past few years in the UK since it has become legal. She uses a more holistic individualized approach to cannabinoid therapy, due to her expertise in Integrative & botanical medicine in addition to her conventional medical training as a physician.
How is Medical Cannabis Different to CBD I can buy in a shop without a doctor?
Hemp CBD oil wellness supplement products available over the counter at health shops are not the same as medical cannabis. Hemp CBD oil non-medical products do not contain any measurable THC and are not made as medicines.
Even a small amount of THC in medical cannabis prescription medicines makes a huge difference in the medicinal effect for patients.
For most people with chronic pain conditions, CBD hemp supplements own their own are not effective because they lack this THC which works on the pain signalling pathways in the brain and body via CB1 receptors.
Therapeutic Psychedelics for Chronic Pain
Ketamine therapy is another currently available therapy via a specialist doctor for severe chronic pain, although not generally available on the NHS. Some types of chronic pain tend to respond better than others to ketamine so it may depend on the type of your pain whether it is a good option for you or not. However, depression, which is often comorbid in chronic pain, does respond well to ketamine so in these cases it may be considered if other treatments have failed for the depression aspect of the pain in addition to the pain itself. This may be considered as part of your holistic plan.
Currently, there are clinical trials and studies ongoing investigating the potential of psilocybin and other compounds for the treatment of chronic pain and many anecdotal case studies and early trial evidence exists of benefit so this remains a promising area for more research and future clinical treatment options.
Therapeutic Diets for Chronic Pain
Although chronic pain is not a nutritional illness, certain types of diets may influence and improve symptoms of pain as well as the associated symptoms via multiple inflammation pathways, neuro-immune modulation, gut-brain axis and microbiome function which all play a role in pain regulation.
For example, different types of plant-based diets in patients with fibromyalgia pain may improve symptoms including many plant polyphenols and avoiding polyamines.
Other people with a different pattern of pain and symptoms may respond better to a different therapeutic diet based on altering specific nutrient levels and prescribed nutraceutical combinations based on symptom cluster profile, gut and blood biomarkers and other individual factors which are assessed & taken into account as part of your treatment plan.
Mindbody Medicine for Chronic Pain
Mindbody practices help to actually change the brain structure and function in multiple ways, turn down the volume on stress, anxiety and pain signals and help our brains become more resilient. Utilising the bi-directional brain-body communication link can be very effective at reducing pain signalling. For example, specific Mindfulness for pain practices have been shown to be highly effective for improving quality of life, pain and coping in patients who suffer with chronic painful conditions. This is because regardless of the type of pain, chronic pain becomes ‘wired’ into the brain and nervous system, not just in the place you feel the pain, like a shoulder. This starts a cycle of brain amplification of pain signalling and chemical messengers involving the limbic system, which mindfulness practices can help to regulate.
Techniques to activate the Relaxation Response, based on Dr. Gordon’s experience studying these techniques at Harvard University with Dr. Benson as well as other targeted techniques have been shown to have great benefit for chronic pain.
Brain training devices like alpha-stim or CES devices can help with sleep and anxiety relief that often goes alongside pain.
HRV training and vagal nerve noninvasive neuromodulation devices may be helpful as a pain management tool and can be combined with other mindbody approaches.
Many patients may have tried some of these things previously and not noticed an improvement. That is why creating a tailored mindbody practice to suit you best at each stage of the healing journey and making it easy and unburdensome to stick to is important for efficacy.
Supplements for Chronic Pain
Supplements including nutraceuticals, botanical extracts, medicinal fungi, adaptogens and amino acids and minerals may all be helpful for different aspects of pain and co-occuring symptoms like fatigue, anxiety and sleep disruption. Each person will likely have a slightly different ‘stack’ of supplements based on their specific case but may include:
- Magnesium Glycinate
- Alpha lipoic acid
- PEA
- Liposomal curcumin
- Boswellia
- Highly purified krill or high EPA fish oil
- If fatigue is present, Mitochondrial support nutraceuticals including lipid membrane support (NT factor lipids,alpha keto glutaric acid, acetyl L carnitine etc)
- sleep support botanicals which may include passionflower, hops, valerian and skullcap
- Lionsmane and Chaga mushrooms for cognition support
Medications for Chronic Pain
There are different medications that may be tried in chronic pain including antidepressants, painkillers, anti-inflammatories, muscle relaxants and sleeping pills, but everyone responds differently and there is no single medication that works well for everyone. Some people cannot tolerate medications due to side effects, or may not find them completely effective for their pain, which is why a holistic approach is needed alongside standard medications or consideration of novel medicines such as medical cannabis
Resilience Environment
Environmental factors also impact our resilience from noise and light pollution to actual air pollution and chemicals in the foods we eat. We have the most control over our home environment, so this is a good place to start optimising if you suffer with chronic pain. Ergonomic seating can make a difference as can changing sleeping equipment eg. mattresses, pillows etc for comfort and other occupational therapy approaches.
Adding plants which clean the indoor air such as snake plants, spider plants and ferns have been shown to have positive mood and anxiety reducing benefits to help improve quality of life.
Infrared saunas and cold water immersion therapy may also be helpful for some types of chronic pain conditions, but should be done gradually after discussing with a doctor or health practitioner to make sure it’s right for you.
Passion & Connection in Chronic Pain
Social connection, bonding and having warm close relationships can have a positive impact on physical, immune system and brain health. Many patients with chronic pain find that they feel isolated and are not able to keep up their passion projects because they don’t feel well consistently. Starting by engaging just 1 close connection for support and exploring a low-energy non physically demanding hobby is a good way to re-introduce this aspect back into life while you heal. Having contact with an animal can also help reduce distress and impact pain coping.
Testing for Chronic Pain
There are many different types of imaging tests that may be appropriate depending on the type of pain you have to help in the diagnosis. However, research has shown that often imaging doesn’t always match up with the level of pain you experience. For nerve pain, EMG studies may be helpful in diagnosis but may miss small fibre neuropathy.
Functional Medicine Tests for Chronic Pain
We can use functional medicine testing as part of the treatment in chronic pain conditions. These tests look at factors such as genetic stress tolerance, gut microbiome and gut-brain axis function, inflammatory biomarkers and circadian rhythm dysfunction which can affect pain signalling. These tests are optional and not needed for everyone. They can help further customise treatment in some cases.
Case Study for Chronic Pain
Julie, 65 years old.
Chronic pain for 15 years from arthritis, spinal problems and restless legs syndrome
Goal: Get control over her pain and stiffness so it no longer ‘ruled her life’ & could enjoy her retirement years and wake up feeling rested instead of exhausted.
History: After failing multiple medications including different painkillers, antidepressants, injections, steroids, sleeping pills and chiropractors, Julie was frustrated and felt it was hopeless to get control of her pain and sleep issues.
The plan: after a thorough integrative assessment, Julie was started on a specific medical cannabis plan to help with her daytime symptoms and also help regulate her sleep and reduce night pain and treat her restless legs symptoms. She was also started on a gluten-free specific therapeutic diet, with probiotics to support the brain-gut axis, prescribed nutraceuticals to target pain pathways and inflammation based on some inflammatory and gut markers and given a short progressive muscular relaxation (PMR) recording practice to listen to in order to help relax muscular tone, which was done alongside her evening medical cannabis dose.
Outcome: 6 months later, she started going to yoga classes again and was able to work, go out socially and live a more ‘normal’ life again. Her pain had gone from 8/10 most days to 0-1/10 most days and she felt more clear headed and energised.
Next Steps
In summary, using a specific, evidence-based holistic approach to treating chronic pain conditions can dramatically improve quality of life, relieve pain, improve energy, mood & cognitive function and remove the confusion and overwhelm of trying to navigate these complex conditions on your own. To take the next step in your journey, book an initial consultation with our expert physicians.
