The Holistic Treatment Of Chronic Pain
The Resilience Medicine Approach
Holistic Chronic Pain Treatment Overview
Intro To Holistic Chronic Pain Treatment
Chronic pain is any type of pain that has persisted for 12 weeks or longer.
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. This approach can be effective even if you have tried many different medications and treatments without much improvement.
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.
Chronic Illness & Chronic Pain
Chronic pain can come alongside conditions such as anxiety, depression, fatigue, brainfog and cognitive dysfunction 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.
If you are not able to get a restful sleep, pain signals are then amplified in the brain. The same goes with unchecked background brain stress, it can be a huge contributor to pain flares.
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.
Without addressing these symptoms together holistically, it is very difficult to get control over any of them because they all affect each other. As time goes on, all of the symptoms that go along with chronic pain can start to be hard to tease apart, especially since standard specialists only treat symptoms in their area and rarely consider cross-field research. This often leads to multiple ineffective or high side effect drugs to treat each symptom and fragmented care.
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 alone, unlike acute 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 Integrative Medicine Understanding of What Causes Chronic Pain
Pain is a complex process involving the brain, immune system and inflammation pathways, the gut-brain axis as well as multiple brain neural networks. The exact mechanisms are multifactorial and slightly different for each person
With chronic pain, you can start to get something called ‘central sensitization’ where the brain and nerve networks involved in pain-sensing and processing become jumbled and ‘smudged’ so that pain spreads through large regions. Inflammation may also play a key role, but is rarely seen on blood tests so standard medical care discounts this.
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 still possible to treat chronic pain effectively using a holistic approach even if the original source or cause of the pain has no permanent cure.
The ECS & Chronic Pain
The endocannabinoid system, or ECS, is a natural brain and body system involved with regulating most major brain and body functions including pain signaling as well as response to stress and trauma, immune signalling, sleep/wake cycles, mood regulation, motivation and even eating behaviors. 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.
The Resilience Medicine Toolkit for Chronic Pain
The Resilience Medicine Holistic approach to treating chronic pain conditions involves incorporating cannabinoid (cannabis-based) medicines, mindbody approaches, diet and microbiome, prescribed combinations of supplements, nutraceuticals & medications, and creating a resilience environment. These things when stacked together results in a synergistic effect in the brain and can help change pain networking, where the overall result is bigger than the the sum of each part.
These categories were chosen based on Dr Dani’s 15 years of experience using this holistic treatment framework with her patients.
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 the biggest difference and personalizing the plan to you since everyone’s pain illness is slightly different.
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 and a system to measure your progress helps remove confusion about what is working vs not and makes sure you are on the best treatment path for you.
This is a new way of thinking about pain medicine that goes beyond a ‘disease management’ system but aims to enhance quality of life, improve energy, mood and reduce the total brain and body stress burden which all affects pain processing.
Medical Cannabis for Chronic Pain
Medical cannabis is a legal medicine in the UK, now available 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 for the different subtypes of chronic pain, making it a highly personalized medicine.Unlike many other medications used in pain, medical cannabis is usually well-tolerated and can effectively treat clusters of symptoms with a single medicine.
Medical Cannabis can help patients with chronic pain conditions who have failed other approaches to get a quick win in terms of pain and associated symptom relief and starting off a positive neurological ‘cascade’ in the brain, letting them engage more fully with other aspects of a holistic treatment plan once you have more mental ‘bandwidth’.
Most patients see a significant improvement within the first month of treatment across multiple symptom clusters including pain, mood, fatigue, stress, sleep and global functioning. One reason medical cannabis may be effective in treating chronic pain is that it works on endocannabinoid system (ECS) dysregulation, as well as our other neurotransmitter systems and 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.
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 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.
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.
For most people with chronic pain, CBD hemp supplements are not effective because they lack this THC which works on the pain signalling pathways.
Altered States and 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.
Depression that is ‘treatment resistant’ is often comorbid in chronic pain, and also responds 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.
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 and biofeedback devices which can be used at home like alpha-stim, CES or vagal auricular stim devices can help regulate the nervous system and also improve sleep and anxiety that can go alongside pain. These can be monitored by the doctor as part of the holistic plan and often are 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.
Diet and Microbiome for Chronic Pain
Although Chronic pain is not a nutritional illness as the core cause, certain types of diets can influence and improve symptoms, especially when inflammation is playing a role.
Therapeutic diets work via multiple mechanisms such as:
- Influencing multiple inflammation and pain pathways
- Affecting neuro-immune modulation
- Affecting gut-brain axis function
- Shifting microbiome health which impacts neurotransmitter function
For example, a modified ketogenic diet may improve symptoms for some people, which may work better for men as a generalization.
Other people may respond better to a different therapeutic diet including one of 3 different types of plant-based diets, including a rich amount of plant polyphenols and reducing polyamines in some cases.
Changes in the microbiome and gut biomarkers can be impacted with dietary change and can affect pain signalling via the brain-gut axis. This is rarely considered as part of ‘standard’ medical care for chronic pain despite the large and growing body of evidence for this area.
Choosing the best diet approach is based on things like symptom cluster profile, gut and blood biomarkers and other individual factors which are assessed & taken into account.
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. Medical Cannabis is usually well tolerated even in cases where other medications were not, which makes it a bit unique.
Supplements for Chronic Pain
Supplements and Nutraceuticals including botanical extracts, medicinal fungi, adaptogens and amino acids and minerals can all be helpful for different aspects and different types of chronic pain. Inflammatory or autoimmune pain or fibro pain may respond to different nutraceuticals than neuropathic pain, for example. It’s important to get the dosage and combination right. For example, most drug store supplements have ineffective dosages or single ingredients that lack the synergistic effect and are usually ineffective.
Each person will have a slightly different ‘stack’ of supplements based on their specific case but may include:
- Magnesium Glycinate
- Alpha lipoic acid
- Liposomal curcumin
- 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
Resilience Environment for Chronic Pain
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 optimizing if you suffer from chronic pain. Ergonomic seating can make a difference as can changing sleeping equipment eg. mattresses, pillows etc for comfort and other occupational therapy approaches to reduce muscle fatigue and stiffness.
Supporting circadian rhythm function with the use of eye masks, completely dark sleeping environment, using low blue light bulbs or smart bulbs and blue-blocking glasses after dark can help improve sleep quality which supports pain processing.
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, since it is not recommending in all types of chronic pain.
Functional 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.
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, autonomic dysfunction and circadian rhythm dysfunction which can affect pain signalling. These tests can help further customize treatment in some cases.
Chronic Pain Patient Case Study
Patient: 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.
Measuring Quality of Life in Chronic Pain
One of the challenges of doing multiple things together is how to know what is working and how to keep track of everything without becoming overwhelmed. This is where a system for measuring and tracking is so important.
We use a simple resilience and quality of life score metric that you can track in a simple app, including measurements of pain, stress, mood, energy levels and mental clarity. This helps you track the different aspects of how you are feeling as you go on your healing journey.
Validated rating scales for pain and fatigue and sleep assessments can also be useful.
We track these metrics over time and put you in charge of your data with easy to read metrics so both you and your medical team can see what’s working and tweak the plan over time.
Living with chronic pain can be really difficult and exhausting to navigate on your own but you can start feeling better even if you’ve tried many treatments.
Dr. Dani has helped thousands of patients with difficult to treat chronic pain conditions over the past 15 years using this approach, first in North America where it is more developed and now in the UK.
Using a specific, personalized holistic approach to the pain and related symptoms can dramatically improve your quality of life even if you have failed multiple medications.
To take the next step in your journey, book an initial consultation with our expert physicians.