Kimberly M. Mauer M.D.
As the clinical director of the Comprehensive Pain Center, Dr. Mauer is certified in both pain medicine and anesthesiology. Her publications include work comprehensive pain management.
Scott D. Mist, Ph.D., M.Ac.O.M., M.S., M.A.
A clinical acupuncturist, Mist is an NIH and DoD funded researcher focused on Traditional Chinese medicine for the treatment of chronic pain and quantitative sensory testing in pain conditions characterized by central sensitivity.
Finding modalities to cope with pain
As the growing body of evidence shows, there is no one-size-fits-all approach to pain management. Often, a combination of nonpharmacologic strategies, with or without medical intervention, provides the most relief. As an alternative, these modalities have very low risk. In fact, the American College of Physicians recently recommended that physicians initially select nonpharmacologic treatment for patients with acute, subacute and chronic low back pain after reviewing published evidence and controlled trials. Complementary therapies are increasingly part of the treatment plan for autoimmune disorders, neuropathic and post-surgical pain, and cancer treatment pain.
Early intervention promising for keeping acute from becoming chronic
Most patients arrive at a pain center as a last resort, having failed other options after many years of coping with pain. However, if the model could be flipped to intervene when the cause is acute, the outcomes could improve. From posture and muscle strength to reducing tension and improving lifestyle choices, many injuries could be corrected before leading to co-diseases such as obesity, sleep disorders and more. Also, if used as a first-line treatment, pharmaceutical or medical intervention could be avoided.
Which modality for what pain?
Finding the most beneficial modality for the individual patient often requires experimentation. All over the country, including here at OHSU, research is underway to find evidence to support which alternative methods are truly beneficial. At this time, the modalities that have good medical research behind them for offering the least risk and most benefit include acupuncture, massage, spinal manipulation and mindfulness.
Acupuncture – poor sleep, anxiety, depression, nausea, headaches, neck pain, fibromyalgia, tendonitis, low back pain, sciatica and osteoarthritis
Chiropractic - neuro-musculoskeletal issues involving back, joints, neck as well as headaches
Massage – acute and chronic pain, stress reduction, headaches and migraines, anxiety and depression, autoimmune dysfunction, lymphatic flow and blood circulation, insomnia
Nutrition counseling – dietary counseling, lifestyle modification
Physical therapy – acute injuries, functional strength, orthopedic and arthritis, neurological issues
Rolfing – chronic muscle pain, repetitive motion injuries, postural problems, anxiety and headaches
Minimally invasive diagnostic and medical therapies
If the alternative therapies have limited success, a medical intervention may be recommended. For example, if the pain is a result of osteoarthritis, one option is a medial branch block. For myofascial pain, Botox injections can help stop spasms. For some disc or neuropathic pain, epidural steroids may be considered. The following examples used at the Comprehensive Pain Center all have evidence to support the effectiveness and are quick, outpatient procedures.
- Transforaminal epidural steroid injections
- Medial branch block and medial branch denervation
- Peripheral and sympathetic nerve blocks
- Botox injections
- Spinal cord stimulation
Pain psychology is key factor in chronic cases
For those patients with chronic pain, including pain psychology as part of the treatment plan is helpful to manage the impact of pain on lifestyle. These methods troubleshoot the emotional and mental influence of pain, enhancing quality of life. The purpose of these approaches is not to cure patients’ pain, but to help them find balance and still have fun in their lives while coping with pain. Pain psychology approaches can include:
- Cognitive behavioral therapy
- Relaxation techniques
- Stress reduction
Patient preference an important component
Though some modalities have better success rates with certain types of pain, patient preference also plays an important role. Previous experiences, referrals, personal research, pain tolerance and personality can influence an individual’s openness to a therapy. Depending on individual assessment, at the Comprehensive Pain Center we give patients all the options and keep them informed about which methods have the most studies behind them.
Navigating the options and customizing for each patient
By embracing an integrative medicine approach, the OHSU Comprehensive Pain Center provides a variety of therapies, supervised and combined with allopathic medical treatment in a single location with customized evaluation. All approaches are deeply researched and science-based, practiced within a biomedical framework.
After a consultation and review of the imaging, the Comprehensive Pain Center team considers the cause of the pain and patient preference in beginning one or more of these modalities separately or in combination with allopathic strategies. Having clinicians and practitioners of multiple modalities on one team assures that there is continuity of care. Our team meets biweekly to review challenging cases.
We believe in whole body health. We take the approach that pain medication works best when combined with lifestyle coaching and complementary alternative therapies.
When to consult or refer
- In acute and subacute cases, if the pain remains or progresses after 4-6 weeks, intervention could prevent chronic problems.
- Patients who have tried several traditional approaches, but need to fine-tune their strategies.
- Patients whose pain is impacting their activities to the point of affecting their quality of life.
- Complicated cases, particularly with other chronic health problems in addition to pain.
If you have a patient who may benefit from treatment at our Comprehensive Pain Center, or to consult with our team, please call 800-245-6478.
What is rolfing?
The founder of Rolfing Structural Integration was Dr. Ida P. Rolf, an American biochemist, who was an early holistic thinker. She developed Rolfing in the 1920s as a type of manual therapy.
Rolfing looks at how the entire body is working together through posture, gait and deep-tissue restrictions. Then, through touch therapy and guided movement, the patient experiences less pain, more comfort and improved posture. Rolfing can also improve range of motion and posture-related problems.
New guidelines on low back pain endorse CAM strategies
The American College of Physicians recently recommended that physicians initially select nonpharmacologic treatment for patients with acute, subacute and chronic low back pain. For acute and subacute pain, the recommendation specifically points to massage, spinal manipulation and acupuncture. These same therapies are also recommended for chronic low back pain, in addition to a panoply of other modalities from mindfulness meditation to yoga.
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