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Book review: Integrative Pain Management

BY VICTOR S. SIERPINA, MD, ABFM, ABIHM, Director, Medical Student Education Program, WD and Laura Nell Nicholson Family Professor of Integrative Medicine, Professor, Family Medicine University of Texas Distinguished Teaching Professor

March 2016

We hear reports daily about the rising tide of prescription opiate addiction, overdoses, and countless lives ruined in the elusive treatment of pain conditions. In the face of this recent history, Integrative Pain Management is indeed a welcome addition to the Weil Integrative Medicine Library, which now lists 15 published and upcoming volumes spanning the waterfront of integrative medicine. If you have not had the pleasure of referencing one of these books, I strongly encourage you to do so. There is one for almost every major field of integrative practice.

The editors are Dr. Bonakdar, who is Director of Pain Management at Scripps Center for Integrative Medicine in La Jolla, California and the leadership at the American Academy of Pain Management. Dr. Sukiennik is an anesthesiologist and pain medicine specialist at Tufts Medical School. The book is organized into five sections with 56 chapters written by over 60 authors from various fields of health and pain management.

Section I, Pain and Integrative Medicine: Impact and Considerations offer chapters on creating a systems understanding of pain, transforming the paradigm of pain care, on making treatment choices, as well as on policy advocacy and economics. We read here the raw statistics on the increasing human and financial burden of pain as well as the rapid increase in the use of ineffective therapies and invasive interventions. The quick fix has not been working well. Dr.Victoria Maizes from the University of Arizona’s Center for Integrative Medicine, a noted integrative medicine physician and educator, introduces the principles of integrative management as applied to the patient with pain.

Section II, Current Understanding and Treatment of Pain describes the neurological and psychological substrates of chronic pain and helps the reader understand the physiology of pain and pain syndromes. The issue of central sensitization syndrome, mediated by microglia and driven by neuroinflammation, are key concepts nicely explained along with co-morbid conditions such as depression, anxiety, and PTSD. A biofeedback specialist provides a chapter I particularly liked on psychosocial mediators of chronic pain and described a model of the “body-self neuromatrix” which takes into account major inputs and outputs in the experience of pain.

Section III, Integrative Evaluation and Consideration is a clinician’s guidebook to the assessment of chronic pain, offers motivational interviewing and practitioner empowerment as interventions, addresses mood issues, obesity-related pain, emerging clinical and educational models on the management of chronic non-cancer pain, as well as information about self-care and group visits for chronic pain. I found the sections on motivational interviewing to be well developed and particularly salient as many chronic pain patients have maladaptive coping strategies that they need guidance in changing. Helping them through motivational interviewing to acknowledge their self-defeating inner dialogue and move to expressing more “change talk” is rewarding for both patient and clinician.

Section IV, Integrative Therapies and Systems for Pain management is replete with information on diet, supplements, fatty acids, herbal treatments, biofeedback, hypnosis, imagery as well as bringing in alternative systems like yoga, tai chi, manual medicine, traditional Chinese medicine, acupuncture, naturopathy, Ayurveda, and energy medicine. There is something in this section that could connect with every patient. Each chapter is well referenced.

The final Section V, Integrative Approaches to Condition Management provides approaches to common pain syndromes: headache, spinal problems, fibromyalgia, chronic pelvic pain, rheumatic disease, myofascial pain, cancer pain, abdominal pain, and IBS. There are also chapters on managing pain in children, the older adult, those in the military, palliative and end-oflife pain management, as well as dealing with addiction. Overall, this section offers robust and practical options for those dealing with these very common pain presentations in their clinical settings.

Each chapter is well referenced and also includes useful online resources on the content. Access is provided to those who purchase the book to online videos, photos, text, and tables to expand their learning along with appropriate graphs, tables, and illustrations throughout the book.

For those who treat patients with chronic pain, this new book is a must have resource. You will find new and well-evidenced approaches to managing difficult-to-manage pain problems and to provide new options of care for your patients. It can also help you in the creation of systems of care to more effectively care for pain, reduce addiction, and treat holistically and integratively some of our patients with the deepest kinds of suffering. I strongly recommend you acquire a copy for your clinic, home, or library.

Let me close with an endorsement by Karen Welch, M.D., a Fellow in Integrative and Behavioral Medicine at UTMB—Health:

“As a fellow specializing in integrative and behavioral approaches in primary care, I have leveraged this text both to refine my patient care approach and as a framework for curriculum development. Dr. Bonakdar’s book provides practical information that is immediately applicable in patient care and transformative to clinical practice. One needs only to consider national expenditure on pain management along with the obvious downfalls of narcotic overuse to sense the enormous need for this text. This book is a body of knowledge that rethinks pain management from an area of frustration and suffering to one of hope and potential.”

Bonakdar, Robert A. and Sukiennik, Andrew W. Integrative Pain Management. Weil Integrative Medicine Library: Oxford University Press, 2016 ISBN 978-0-19-931524