Best To Treat Pain in an Integrated Way

Best To Treat Pain in an Integrated Way

By Ed Coghlan.

The importance of integrated care for treating chronic pain has long been accepted as optimum for patients. Chronic pain, by its very nature, is not something that can be treated only one way.

The prestigious Mayo Clinic is talking about the issue this week, publicizing  a review of several case studies in Explore, where Mayo Clinic researchers examined the potential role of integrative medicine as a therapeutic and diagnostic benefit when combined with a patient’s treatment plan.

“We have done over two dozen studies on massage and acupuncture showing the benefits that both treatments have on patients. Skilled practitioners of integrative medicine are able to be a member of the care team and contribute their expertise, while also delivering care directly to patients,” says Brent Bauer, M.D., director of research for Mayo Clinic’s Integrative Medicine Program, who is the lead author.

For the Executive Director of the Academy of Integrative Pain Management, the fact that the Mayo Clinic is talking about integrative care is a good thing.

“I’m really happy to see that some of the thought leaders in American healthcare are making greater use of complementary and integrative treatments, especially in the context of pain management,” said Bob Twillman, Ph.D., FAPM. “It’s always been true that, the more eyes you have on a patient, the greater the likelihood that you will be able to accurately identify existing issues, and these anecdotes reinforce that notion.”

Twillman thinks expanding the use of integrative treatments, clinicians will bring anticipated benefits like improving pain, function and quality of life and some unanticipated, like identifying previously undetected pathology.

“Having been a clinician for a long time, the benefits of this approach are intuitive to me and it’s really good to see thought leaders like the folks at Mayo Clinic reaching the same realization,” Dr. Twillman said. “We need to continue telling this story to people who make insurance coverage decisions, so that these treatments will be available to every person who needs them.”


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Authored by: Ed Coghlan

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No wonder they have case histories to boast about! They screen out people who might fail: Exclusionary criteria
A person may not be considered a candidate for admission if he or she has:
• Been unwilling to discontinue use of pain medications and other targeted medications affecting cognition or substances that would prevent meaningful participation in the program
• An intrathecal opioid delivery system in place
• Shown insufficient motivation to participate in medication management, physical and occupational therapy, or group therapy

So people who have tried, failed, or been made worse by physical therapy can’t take part? Sounds just like “rehab” for addiction for which there is no evidence that residential treatment is better than outpatient and that costs a boatload more.

Jackie Melcher

No doctor wants to help me. Except my pain management doctor who is retiring. I was told my case was too complicated. To go to the Mayo Clinic or the Cleveland Clinic. Both turned me down. I’m a medical mistake. If you aren’t going to give us quality of life, at least give us euthanasia.


Had a rough experience with acupuncture, from an MD. I felt run down, slightly nauseated, and very achy. The MD said she may have used too many needles, that maybe I was sensitive. This may be true. I thought I would either feel better or no change — not worse!

I’m not eager to try again. Massage can give me mixed results. I really would need very frequent massage, which would be quite expensive.

The medication helps me (opioid, muscle relaxant, NSAID). PT helped until I just wasn’t getting stronger and pain relief didn’t last for more than 3-4 days after a session (at best). Warm water is nice, but I have to pay a PT copay, which is prohibitive. They have to have someone watch me in the pool rather than leave me unattended. Warm water pools are hard to come by. I use warm showers, heating pads at home. I use over the counter muscle creams. I do meditation and relaxation, which has some benefit – particularly shaking off the normal daily grind and helping with sleep — not directly with pain, necessarily. TENS and an acupressure mat seem to be beneficial to a degree. T’ai chi is nice… but none of this is a cure. It all works together… INCLUDING THE PILLS. Hey, the pills give me the ability to focus on these complementary therapies — particularly anything to do with movement and physical activity.

If you take away opioids, I’ll tell you what you’ll get with me. I’ll be heavier, diabetic (and all that comes with that), frustrated with my physical limitations (and most likely then depressed, which helps nothing). YOU MIGHT AS WELL JUST SIGN MY DEATH CERTIFICATE because the diabetes and inactivity will kill me off. That’s what the doctors are doing to their patients! And sadly, they know it, too.

Where’s the AMA? Where are the physician organizations who still want doctors to do their doctoring instead of politicians? Heeellllloooooooooooo…..!!!!

I’ll tell you what would help everyone… Politicians, media and doctors who actually listened to what their patients are saying.

That’s the best treatment ever.


I love my integration care doctor. One of the kindest, empathetic doctors I have ever had. He cured me of infections I had for 4 years, so he is very special to to me. But the cost kills me. Not covered by insurance. I think my first visit was over 500.00. (Blood work and vitamins included). Money I dont have to spare but for the cure it was worth it. I would see him more often but just cant afford the price.

Debbie Nickels Heck, MD

I apologize for the typos in my post below. MIRACULOUSLY my fibro went away in the fall of 2017 and I was weaned off my meds with saboxone tx. Then in early March I was diagnosed as God spoke to me in Feb to thoroughly examine my rt breast. He’s helped me discover pts before. This time it was ME! It’s a small and early breast cancer and I’m seeing the surgical oncologist today, BUT NOBODY WOULD TREAT THE HORRIBLE PAIN I’VE BEEN HAVING! I don’t know why I have this much pain but no Dr cares enough even give 7.5mg of vicodin while I’m writhing in pain, can’t sleep, can’t eat, can’t walk and have lost 10 lbs in 2 wks. I a painful cyst on my rt kidney that’s still being worked up as well. This ridiculous nonopiod noncrisis has GOT to stop. The neophyte Drs have GOT to be trained better. Yes I have a hot tub in my house but I can’t sit there day and night. And unfortnately my message therapist died several years ago. I’ve been traveling in the intervening years to see my 7 grandkids now 2, 4, 6, 7, 8, 9 & 10. I’m now too weak to Skype them thanks to no pain. BUT my neophyte Dr gave me the LOWEST dose of Ultram yesterday. Apparently she doesn’t realize w/o tylenol it doesn’t work effectively, BUT she knows I take Tylenol so MAYBE that entered her mind. THIS is why I want to be a mentor. BUT you’ll likely kick me out because of that sham peer review thing and I chose not to fight a losing battle but chose my grandkids because you can’t get back time with children AND to always attend your meetings unless there was a conflict because continuing education is also important. Practicing or not, I’ll always be a physician. I just can’t make money at it.

Debbie Nickels Heck, MD

Until I read railroaded out of practice due to a false accusation, an unethical social worker, her atty accomplice, & a Dr who cleared me THEN suddenly thought he’d get in trouble for doing off-label dinner meetings on product which was how we’d met and did a 180 on me then suddenly went from saying I was perfectly fine to “bipolar, hypomanic and a danger to the community”, I ran an outstanding pain management practice. I was very good at detecting those with true acute & chronic pain, in part because I had an experienced massage therapist on staff 3 half-days a week. If someone seemed fishy, I’d offer them a free massage. If they turned it down, I knew right off they were a scammer. If my therapist detected something legit I’d not quite detected myself, we worked on the problem. I also had a contract dietitian they could see for dietary advice who did her own billing. I did a lot of counseling which became overwhelming and eventually hired a chaplain I worked with at a hospice. Those suffering pain often have troubles as well. Unfortunately, he came along right at the time I’d JUST set up everything to take away the burdensome aspects away from me and then was hit out of the blue with a false accusation after going out of my way to do something nice for a patient who wanted to avoid going to the ER at 9pm when I was dead tired but stayed to see her, even taking a growth off her back while we waited the necessary 20 minutes after the Rocephin shot just to take advantage of the time while we were there. The problem? It was the 2nd day in my ne office and she accidentally saw me take my breakthru meds for my severe fibro WHICH she knew I took because she also had fibro and we’d discussed possible treatments and had I NOT taken it I couldn’t have treated her as I’d been in too much pain. Problem was we’d not arranged the office for adequate privacy. It was a simple mistake. She was a longterm patient. She was seeing a psychiatrist who knew me well & encouraged her to speak with me. She chose the unfortunate option of speaking to the unethical social worker and my spiral into hell, as she’d done many Drs before and since began.


Integrated medicine is great. Certain things help, different people but most insurance doesn’t cover intregated medicine proceduces. Most people who r disabled & unable to work, they r unable to try intregated medicine solutions. After being sent to Mayo clinic & getting no help or even having MD’s there call other hospitals / doctors to assist in getting me treatment/answers,was so disappointing. I lost my faith in Mayo clinic so I don’t always trust their opinion.


Oh I remember when the VA kicked me off a “Pain Program” in the late 90’s and they offered me this procedure while I was withdrawing. Pins in the ear for 45 minutes, then back to withdrawals. Having some stranger put needles in one’s ear sure does get one’s attention, and when they come out, it’s worthless.
Thank you Mayo Clinic!!


When I participated in the training from the American Academy of Pain Management, in 1993 (!!?!?#**#^#), we talked about true interdisciplinary care. Sadly, no one would pay for it then. They won’t pay for it now! And, what makes things worse, is when it fails, the jerks don’t know a way to make us better, again. They don’t understand the success with treating chronic pain patients with opiates! They don’t understand we are the least at risk for addiction! But what can they understand, when half of them don’t know what true addiction is! Thing is, they would rather continue their media wars, spouting the ignorance that drives them to the wrong conclusions. I don’t know who decided to tell everyone that the opiates don’t work. But, it is a lie straight form Satan’s mouth. When will these people learn? I hope for karma for them, every day. May they suffer from poorly treated chronic pain! As a pain doctor, who is now a chronic pain patient, I have seen it, from both sides. Too bad it is the ignorant, and uneducated, who decide, for us doctors, which is the best way to treat our patients, whom they have never met, like we do, face to face!

L. Brockington

Well, good for them! Now tell me how someone like me who’s on disability is supposed to pay for integrative care? My husband still works full time and we have decent insurance, but we are just breaking even and there’s no way we can afford acupuncture and massage until our insurance company will pay for it. I would love to try different therapies, but don’t have the money.

Roberta Glick

Frankly, the best way to treat chronic pain is to recognize that integrated approaches include medication: opioids are legitimate and necessary for many people whose chronic pain requires them. Acupuncture and massage have been part of my “ treatment” plan for years. So have opioids. Without them in the mix alternative therapies don’t cut it. They are adjunctive therapies, both useful and helpful, but on their own ineffective. It is time some recognition be accorded to the fact that NSAIDS, often touted as the only medications to be used ( maybe Tylenol too) can cause problems, serious problems.. We need to treat the patient; to stop the biased, one-sided argument against opioids. Stop telling us that mindfulness, meditation, and “ alternative” therapies are enough AND, if we say they’re not, stop essentially telling us to “ suck it up”. I am pro the use of a combination of methods to help a patient have some relief from unremitting pain, a plan developed and managed between a patient and his/ her doctor, not a universal approach that treats everyone the same. I, along with millions of others, suffer from chronic pain. We also suffer from being victimized by being labeled as addicts, denied medications that help, and yes, having our pain discounted.


Thank you for your article. Sadly, no amount of Massage or acupuncture is going to make up for a 40% decrease in pain control! I’ve told all my doctors I can’t stand this much pain but they say there’s nothing they can do. The sad truth is that some of us have too much pain than the government will allow and therefore have to reach a disgusting conclusion. It doesn’t matter to a pain doctor what condition you have or how much you hurt we have to fit to the mme program. Some sadly cannot and I think it’s been talked about in this forum for months. It’s sick and it’s not fair but I’m afraid that some of us fall into a too sick to live category according to the DEA and FDA and CDC.


Loved the earlier reply about whacking merrily away with a sledgehammer. There is a similar meme out there that tries to portray what chronic, unrequited pain feels like. It includes boiling water being poured on us, having someone punch us hard in our kidney area, and putting our hands and arms in vise grips, among others. But that describes Fibromyalgia. I can’t imagine the pain that cancer sufferers endure!

Could we be in a time of tribulation, of sorts, when Scripture suggests there is a time when we will seek death, but it will elude us? I should have been raptured by this time, according to rhe Bible, so I guess we’re not there yet.

For now, my vote is with one tiny tablet that wrought the miracles in my life; the tiny tablet that worked so I could effectively ignore the sensations described in my first paragraph above. With pain controlled by the little blue tablet, I could:

1. Stop taking blood pressure medication. No more 170/125 numbers when pain is controlled. With just two or three a day, 120/74 is the norm.
2. Stop taking anti-depressants. No more feelings of doom and gloom and overt sadness. Gone with the little blue pill.
3. Work in my beloved gardens, both flower and vegetable, later canning and preserving the fruits of my labor. All made possible with the little blue

The government, however, says nonsense! And lowered the dosage and frequency and discontinued altogether the long-acting one. They don’t like for me to feel better and be productive. Now the popular thing is so have all these treatments and whatnot. I live out in the country, and even dressing to go deal with treatments that have been tried and don’t work for me, plus traffic, is labor-intensive and puts my nerves into orbit. So by the time I get home I’m a tangle of pain, nerves, and have to spend the rest of the day, night, and the next day in bed.

The little blue pill at the correct dosage/time was working for me. Government, you vilified me and criminalized my physician. We’re all scratching our heads.
Go get the dope fiends who have no legitimate reason to have our medicine, but leave us alone!!!

Nikki McCuin

It amazes me every time Congress chooses to act. There are so many more causes that are truly urgent in this country. We have all followed the Opiod Crisis, and it is extremely obvious where the problem lies. But, the White House chooses to attack the doctors, pharmacies, and patients who are in no way responsible for the overdose numbers. Congress, please focus on the illegal Fentanyl and Heroine that is actually taking lives, not those of us who have to suffer every waking moment and our doctors who have the courage to help us.

Cindy Deim

I’ve done it all. All out of my own pocket. How do they expect people on disability to do all of this?


Terry and Veronica, your comments truly moved me. I am so very sorry that your suffering is so great. I too was struck by this terminology “thought leader”, and wondered what in the world has the medical community concocted now to help play along with excuses for this increased suffering across this country.

I also watched a report on a network where they were showing how many hospital emergency rooms have decreased their opiod output by truly substantial percentages. The administrators were all applauding themselves for this : all about the numbers that’s it.

All I could think about was “how can you be so happy with yourselves about not treating very real and very severe pain? ”

I get the whole deal about addicts running to the ER for a fake fix, but there is no way these ER’S are NOT also treating non-addicted chronic pain patients as well! Yet the applause was all a numbers applause that’s it.

My heart aches for you!
Thank you for your comments, they are truly moving.

Louis Ogden

There is one kind of medicine – one that works. I have tried some of the alternative treatments and NONE have helped with the pain associated with a rare disease I have that causes excruciating pain. Opioids have been the only relief from that pain and they have given me back a quality of life I thought I could never have again. I had a bout with cancer (cancer of the tongue) and I have been in remission for two years. I took the standard surgery, chemo, and radiation. According to my doctors, a remission of two years is a good sign that the cancer will stay gone.

One can’t turn on the TV or go to a website without hearing of this opioid Injustice and or a quick fix to help it. They are blaming the pain patients for the actions of the addicts. For the actions of the young people who experimented in the wrong bottle. They’re wanting to blame, not to mention shame us for what they are calling so many overdoses when in fact most of those overdoses before 2016 were suicides. From what I’ve read and understand the overdoses stemmed from mixing opioids with alcohol and other street drugs. Also from heroin and illegal Fentanyl. In other words people looking for a high, NOT relief from chronic pain, but relief from life. If they can’t find it with our opiods they will find another way. (By the way, there is no such thing) I’ve said it before and I’ll say it again, opioids give life not death when they are takin for chronic pain and prescribed by one’s physician. How many thousands of stories on this website alone have said such? Blame is a moral issue, it has no business in the medical field. Yet somehow it continues to creep in daily taking precious life away from those whose very lives depend on opioids so they can get out of bed and have a somewhat productive life. Since this law has been put into effect what about the suicides of chronic pain patients? Those who’ve taken their lives because their life saving medicine has been taken from them? Just where are their stories? So far I’ve not heard of any except on this website. If I’m wrong, someone please correct me. Now our comfort is to hear about “prestige” people and places finally wanting to do something such as make massage therapy and acupuncture available to all? Man am I relieved! Finally an answer to give us back our lives! Poppycock and that’s putting it VERY nicely. I wish there were a way to send the hundreds of stories and thousands of comments on this website alone back to those in the government that have caused so much unnecessary pain. Back to those in such “prestige” places who have come up with an answer to save us all. This is one of those days and when I read the word prestige it ran all over me. Call it the cherry on the whipped cream of the milkshake, if you will. I’ll go for now, back to bed I do believe. To hopefully get some relief. Usually I’m trying to put on a brave face and have faith, though today I just needed to vent, sorry.


It seems the UK is way ahead of the US on this one. All the pain rehab courses, which are usually for three weeks residential in hospital, introduce pain patients to many ways which if they employ will reduce their daily pain. This is AS WELL AS not instead of medication. Disciplines taught include how chronic pain works and what it is (understanding this enables better self management and reduces fear of injury) Pilates, hydrotherapy, occupational therapy (posture, how to lif and carry etc), pacing, meditation, yoga, Physio, Locus of Control Management (prioritising and never multi tasking), regular suitable exercise which is known to reduce pain. Any other disciplines the patient finds helpful are encouraged eg, acupuncture, massage (proven to help pain), Cranio Sacral Therapy, Bowen, trauma counselling (pain is trauma and pain states generate trauma), Margaret Morris Dancing (a therapeutic, fun and safe for anyone movement system which gently engages all neurological -muscular systems) etc. I’m so glad you,are,working on this it gives patients hope.

My best friend who had leukemia was a massage therapist. She practiced aromatherapy, meditation and chicong just to mention a few. As her cancer progressed she was bound and determined she would not take a pill for pain. She kept her practice up so she could afford acupuncture. I would ask her if it helped any, she replied a little bit as she lay on the couch with more than one heating pad. The transfusions became weekly so she opted for a stent just below the shoulder for the pain in her hands was all she could bear. A couple of days after the surgery she knew something was horribly wrong. Infection had set up in the stent. In a couple of months it would take her life. Towards the end she was more than happy to take pain medicine. She looked at me one day and said I’ll never know how on earth you stood the pain for so many years without the help of pain medicine. Thank God He finally answered our prayers and sent you Doctor D. This man looked at me and knew I needed something for pain, I mean all he had to do was look at me and could see it! He didn’t have to feel of my ankle, knees or my back, he could just see it! Yes finally someone saw it AND wanted to do something about it!! I couldn’t believe it! Now thanks to the government I’m on 1/4 of what I used to take. Massage therapy and acupuncture come with a hefty price tag. Insurance won’t touch either. “Prestige” or not, I wish until someone had an answer or a miracle cure all that every Tom, Dick and Harry would just keep their mouths shut. I’m not in a good mood today so I say the best way to treat pain in an integrated way is for those in our government who have taken our pain medication away and continue to want to take our livelihood and our lives away to go grab yourselves a sledgehammer. Now hit your ankles just as hard as you can, oh I’d say about 50 times per ankle will do it. Now do both your knees, 30 times per knee should do. Now have your associate take the sledgehammer and politely ask them to hit you as hard as they possibly can in the back about 75 times. Perhaps then you will understand what chronic pain is all about. Something tells me you won’t want to wait until they figure out a way everyone can afford these so-called miracle cure-alls. Something tells me you will have wished you would not have put such a law into effect to where your doctor is too afraid to help you even though he can see you need such. NOW….SEE WHAT YOU HAVE DONE??????

Veronica Clark

A ‘thought’ leader? Does that imply that we chronic pain patients do not have intelligence? I’ve been through acupuncture, physical therapies, and pain clinics – only to be made worse by each and every one, or to no avail. I fought taking pain medication, as I always believed we control our body, therefore control our pain – until a neurologist told me I was just making myself worse. She was right. I’m one of the few who doesn’t get addicted to pain meds. Don’t know why. They don’t make me high, and most don’t even help with my pain. I am allergic to several. Have had no pain medications for over a year now because of all of the ‘intelligent’ people out there saying we don’t need them, so my clinic refuses to medicate, along with many others. The result? I’ve gained over 70 lbs. due to the lack of movement, can’t walk much, can barely stand to wash dishes, and so very many other daily things that people take for granted. I truly didn’t realize just what that pain medication helped me accomplish, until I had to do without. How’s that for a ‘thought’?


Good concept. Very much believe that Acupuncture and Massage are very beneficial. As mentioned in the article, most Insurances do NOT cover the procedures. My insurance covers less and less every year..

Cecelia Taylor

It would be wonderful if Medicare Medicaid covered massage and acupuncture, but as far as I know it doesn’t