Authored by Dr. Roger Mignosa – Rightful Educator
One of the first questions someone has prior to starting a new therapy is whether or not the treatment will be effective for them – but what does it mean for a treatment to work?
In the case of pain and inflammation, treatments work by supporting the body’s innate ability to heal itself. This core principle is often lost in pain medicine. We administer treatments that numb the body and destroy coordination to block the pain. We give people therapies knowing they will not help them with the underlying problem.
The body is always attempting to adapt to inborn mechanisms for self-regulation. In the case of a viral infection, the body temperature rises to kill the virus. In the case of a stroke, the body increases the blood pressure to maintain oxygen levels for the brain. In the case of pain, the body tenses the muscles to protect itself from harm.
The symptom of pain is a call to arms to slow down and figure out what needs to be given attention in our life. Let us slow down to address the principles that indicate the value of treatment.
Fast-acting treatments that address the root cause of pain are desirable. Pain is a state of overactivity; as our tension grows so does our pain. With pain, we need to slow down. We need to rest the nervous system so that it has a chance to heal. We need to nourish the body with nutrients, movement, and therapies to correct the imbalances causing continued pain.
The speed of action is not as important as sustainability. Valuable treatments are cumulative, like many healthful habits. With exercise, we slowly get fit; with nutrition, we slowly improve our habits to support health; with mindfulness, we gradually improve our ability to relax and focus. Similarly, rehabilitation is a slow and gradual process of improvement
Sustainable treatments are a continuous process. There is no upper limit on fitness, nutrition, or mindfulness. These are aspects of life. For evidence that they work look to the long-term studies that have been in the area of lifestyle medicine. Two of the most famous long-term studies include the Framingham Heart Study which has been ongoing since 1948 and the Grant Study (1939) which followed over 700 men for 75 years. Both studies provided profound insight into the benefits of nutrition, exercise, and relationships. The knowledge of physical and mental health was made possible because the scientists observed small changes grow larger and larger over a long period of time.
Valuable treatments that work to improve pain gradually are taken consistently and over a period of time.
Safety is a concern with all of pain medicine. With each treatment that we administer we take into account the risks and the benefits. An ideal medicine would be one that carries no risk of dependence, addiction, or overdose. Safe medical treatments can be taken in large doses without concern for adverse effects.
The great equalizer for medicine is cost. Many people who suffer from pain elect to choose a treatment that they can afford. Tragically, many people who weigh the balance of what is effective and what is safe are forced to choose what they can afford. We want to do what is best for our health, but we have to be able to live.
The issue of cost is a societal value issue. Each of us votes with our wallet every day and this vote carries more weight than our vote for political office. The culture of medicine will not be changed by physicians, universities, or institutions. The culture of medicine will be changed by the supply and demand chain of the population.
Nearly 20 years ago, the Eisenberg study showed that people were spending similar amounts of money on both integrative and traditional medical care. This means that people were spending significant amounts of money outside of their insurance programs on supplements, manual medicine, and alternative care that is not trained in medical school. People are intelligent and they spend money on things that bring value to their life. Much has happened in the past 20 years. Integrative care has been the fastest-growing field of medicine in America and pain medicine was the first field of traditional care to embrace integrative therapies. Today, the Academic Consortium for Integrative Medicine & Health has over 60 US institutions including Harvard, UCLA, and USC. This list continues to grow every year.
The bottom line, we need treatments that support the body’s ability to heal itself and support a healthy response to pain and inflammation. We need treatments that support restorative sleep, elevate mood and enhance movement. We need our treatments to become our lifestyle of nutrition, exercise, community, and joy.
People continue to use therapies that have benefits. People pass down knowledge of health to future generations. The benefits of nutrition, exercise, meditation, and every other lifestyle practice will show themselves over a lifetime. In time, health will improve when we use the wisdom of yesterday and the science of today with patience and persistence.
Dr. Roger Mignosa
Physical Medicine & Rehabilitation and Rightful Educator