Transcription:
Managing Chronic Pain through Integrative Medicine

Melanie Cole (Host): There are different types of practitioners that specialize in integrative medicine, but how do you know the difference so you can choose which one is most beneficial for you? My guest today is Dr. Scarlet Soriano. She's an integrative medicine physician at Boston Medical Center. Dr. Soriano, what is integrative medicine, and who is it for?

Dr. Scarlet Soriano, MD (Guest): Thank you so much, Melanie. That's a wonderful question. Integrative medicine is an approach to the healing process that really puts the patient at the center. It is based on the premise that the patient and the provider are in a partnership; that this is a process where the patient and the team are working in partnership in order to facilitate a healing process that is not just about the body, but about mind, body, and spirit.

And also, a unique and I think really essential feature of integrative medicine approaches is that the patient's expertise, their own wisdom, is foremost at the table. That they contribute the knowing- the deeply lived knowing of their own lives, their own bodies, their own minds. And all of those become then the ingredients through which a healing process as comprehensive as well as profound begins to take shape and that can support a person to really not just heal from a particular condition, but really to transform their life.

Melanie: What a wonderful description of integrative medicine so that people really understand how the patient is their own best health advocate, and they're working with the clinician on the whole body principle. Dr. Soriano, speak about the specific types of therapies that fall under the integrative medicine umbrella.

Dr. Soriano: Yeah you know, integrative medicine is sort of a term that has evolved out of what once was called comprehensive and alternative therapy, and I appreciate the term quite a bit because it really is about integrating the best of all worlds. It's using the best available evidence to ask the question, "Well, what works? What do we know with the best evidence we have to be for the highest good for a person in a particular condition or set of conditions?" And it opens the field so that we can draw from the best of allopathic medicine, what we consider to be regular medicine, or Western medicine, or the medicine that we learned in medical school, as well as other systems that may also have significant evidence behind them - maybe evidence-based, evidence-informed - that can support well-being in a patient, and in many instances not only do they offer benefit, but they may also have less side effects and less risk of harm than some of our other therapies.

And so weaving them together, integrating them together, while remembering again that we are activating at the very center of this interaction the self-efficacy, the 'I can' ability in a patient. That sort of becomes the ground of integrative medicine. To put it more specifically though, an integrative medicine physician, to start there as sort of a member of the integrative team, is a physician- and this doesn't have to be a physician, it can be other clinicians as well. Nurse practitioners can now also train in integrative medicine, and actually there is- the Academy of Integrative Health and Medicine has one interprofessional fellowship for a variety of clinicians and then goes on to do their residency in whatever branch of medicine they choose, and then from there does a fellowship. Especially now- before, integrative medicine physicians did not have to do fellowship and could sit for their boards, but now that integrative medicine is growing and is becoming embraced by a number of health systems throughout the country, and certainly throughout the world, in our country, the American Board of Physician Specialties has now developed a board that's the Board of Integrative Medicine- the American Board of Integrative Medicine. In order to sit for that board, you have to be a board certified physician in a particular branch of medicine, and have gone through a fellowship.

This is usually a 1,000-hour fellowship that is a course of study done in one or two years that really provides a physician with additional knowledge on the best evidence approaches that come from other therapies. So for example, during that fellowship time, we would learn a tremendous amount about nutrition and about the role of the diet in supporting health and preventing disease, as well as it helping reverse chronic disease.

We know that inflammation is a big core of a lot of ailments, a lot of chronic conditions, and so we spent a lot of time learning about ways of shifting the diet that are practical, that are sustainable, and that are able to support the body's own anti-inflammatory processes in providing the micronutrients that the body needs. So that's one area.

We would learn also about systems of medicine that have been proven to have a potential role in the healing and preventing of disease. So for example, acupuncture. There is now significant support for acupuncture as a therapy in chronic low back pain, and some of that research actually has been done right here in our program by Dr. Rob Saper, looking at the role of yoga in particular for low back pain, and finding that yoga provides significant decrease in pain and improvement in function for people that are suffering from low back pain.

So an integrative approach may have acupuncture, may have yoga or other movement modalities, will have nutrition as a component, will have as a very strong element to it, lifestyle modifications that support a transformation in a person's life in order to bring out their innate healing capacities and to give the body what it needs - the mind, body, and spirit - to take the whole person on a journey of self-transformation that allows them to move towards optimal health and functioning.

Melanie: Since the field of pain management is such a burgeoning field, and now it is being combined and complemented with integrative medicine, in just the last few minutes, Dr. Soriano, tell us a little bit about group sessions for chronic pain management, how integrative medicine can help to keep the joints moving, and to help with pain, and you mentioned acupuncture and yoga, and just a few of the other approaches to dealing with chronic pain that you might try.

Dr. Soriano: Well now that is near and dear to my heart. You really are asking the question that wakes me up in the morning, and I have to tell you, Melanie, that I am fortunate to be part of a team that is helping to design group visits from an integrative medicine perspective and a wellness perspective, and there's a rich history of group visits in our department. Dr. Paula Gardiner was a pioneer in the development of integrative medicine group visits for patients with chronic pain here, and now we're taking that model and adding a few new elements and are finding that our patients are responding.

So you're asking about pain and group visits and integrative medicine. I wish that we could be having this conversation in the middle of one of our groups, and you could see for yourself, or the listeners could see for themselves, the transformation that we see in our patients when they go through our longitudinal weekly wellness days, group visits for patients with chronic pain. So a group visit involves some form of important piece of information, whether we're talking about nutrition, we're talking about inflammation, we're talking about the role of the brain and basic neuroscience of chronic pain. One of those- there will be some aspect of learning that's involved in the group visit.

Each group visit also involves acupuncture. We do group acupuncture. We have a fantastic acupuncturist who works with us, and patients- I want to remind you that a lot of our patients are patients that would not be able to afford acupuncture or yoga or a lot of integrative modalities outside of this setting because they're not traditionally covered by insurance, although that's changing for acupuncture. But this is an incredible opportunity for our patients because they get to have acupuncture in the group.

We also have yoga, chair-based gentle yoga movements that are embedded into the group visit. We do quite a bit of nutrition, and one of our visits is at our teaching kitchen working with our chef Tracey Burg, and learning about using food to support treating inflammation and to help treat pain. We also talk about and spend time learning practically, "How can we make nutrition changes that are going to support in treating inflammation, decreasing pain, but do so on a budget?" And our partnering with opportunities in the community to bring patients greater awareness of avenues through which they can access those fresh veggies, those green cruciferous veggies, the kale, the brussel sprouts, the things that they need- the things that can help them to decrease inflammation in their body and decrease pain in their body.

We also do quite a bit of mind body practices. So we do guided meditations and visualizations, and are finding that not only does it induce tremendous relaxation, which in and of itself can help reduce pain just by reducing that stress response and all that that involves, but also it's a tool that patients can take home. They may not have the acupuncture needles at home, but they have breathing techniques, they have self-guided meditation techniques, they have ways that they can support themselves when they're feeling pain. And I think at the center of the group visit is an awareness and an understanding that we try to embed into everything we do that, number one, we are capable of healing. Number two, there's always something we can do. Number three, when we hold a vision of what we can do and what we are hoping for, that vision can become a strong driver for our motivation to make positive behavior change. And number four is going to sound perhaps even a little bit corny, but it truly is at the center of everything we do, that love. Especially unconditional self-love and acceptance as well as hope are powerful, powerful healers and we embed them into the group.

And at the end of group almost every week, there is literally elation among our patients. We take the time to really create a space that supports that which is well within a person and let that become the platform from which the tools are learned and from which hope is experienced, and then practical ways of supporting their health and be practiced, and garnered, and brought into life.

Melanie: Thank you so much, Dr. Soriano. What a beautiful way to look at medicine as a way to deal with chronic pain, and using your own body, and nutrition, and all of these things to really help your body heal. Thank you so much for joining us today. This is Boston MedTalks with Boston Medical Center. For more information you can go to www.BMC.org. That's www.BMC.org. This is Melanie Cole, thanks so much for listening.