Chronic Pain Care Requires a Multifactorial Approach

"Details matter" when taking an integrative approach to chronic pain care.

LAS VEGAS—Adults spend more than $33 billion annually on complementary and alternative medicine (CAM) approaches, suggesting that CAM meets treatment needs that may be unaddressed with the allopathic model of medical care.1

Being able to speak with patients about CAM methods is important when delivering quality care, according to a presentation at PainWeek 2016.  Heather Tick, MD, discussed an integrative approach to medicine.1 Dr Tick is an integrative pain practitioner and clinical associate professor in the department of family medicine, as well as the department of anesthesiology and pain medicine, at the University of Washington in Seattle.

For many years, physicians were known as “sharp shooters,” using medicines like antibiotics to treat deadly illnesses like pneumonia. However, to address issues like chronic pain, the “sharp shooter” approach to medicine has to change, Dr Tick explained.

“We are no longer the sharp shooters with the magic bullet answers. We’re here to accompany our patients on the journey they are taking and to advise them on the medical decisions they want to take and advise them on other issues like self care,” Dr Tick said.

Accompanying patients on this journey will mean a shift from the allopathic model of treatment, which centers on disease management, to a more integrated approach, Dr Tick noted. She said that the allopathic method does not address essential aspects of health that can influence an individual’s experience of pain, including nutrition, exercise, stress management, and sleep.

Dr Tick addressed several areas of chronic pain specifically where the allopathic model will not suffice as a treatment. 

The current model fails to address myofascial pain, which Dr Tick cites as the most common cause of pain. One review of the evidence, for example, reported a 30% to 93% prevalence of myofascial trigger points (MTrPs) in patients experiencing pain at any body location.3 Additionally, patients with conditions such as arthritis and herniated discs frequently have co-occurring myofascial pain syndrome (MFPS). “The muscle tightness and its consequences are treatable and, in most cases, when the tight muscles are released there is some relief of the pain and improvement in function,” she explained in the presentation. Addressing this tightness means looking at other means beyond medication, she said.

Another chronic pain area that could benefit from a multifactorial model of integrative pain management is fibromyalgia, Dr Tick said.

While there are numerous validated CAM treatment strategies that can effectively address pain, these are not typically taught in allopathic medical schools, Dr Tick explained. She said massage therapy and acupuncture are just some areas that commonly get glossed over in medical schools, but are beneficial.4.5

“Diagnosis is important—especially in acute care—because we need an algorithm to find out what is going on with the patient and how best to treat them, but in chronic care medicine, we don’t need a rapid diagnosis and the details matter much more than we give them credit for in many cases,” Dr Tick noted.


1. National Institutes of Health: National Center for Complementary and Integrative Health. The use of complementary and alternative medicine in the United States: Cost Data. Bethesda, MD; NIH. Accessed: September 6, 2016.

2. Tick H. It takes a village – part I: caring for the whole patient from an integrative therapies perspective. AAPM-01. Presented at: Pain Week 2016. Las Vegas, NV; September 6-10, 2016.

3. Simons DG. Clinical and etiological update of myofascial pain from trigger points. J Musculoskelet Pain. 1996; 4(1-2):93-122.

4. Mitchinson AR, Kim HM, Rosenberg JM, et al. Acute postoperative pain management using massage as an adjuvant therapy: a randomized trial. Arch Surg. 2007; 142(12):1158-1167.

5. Vickers AJ, Cronin AM, Maschino AC, et al. Acupuncture for chronic pain: individual patient data meta-analysis. Arch Intern Med. 2012; 172(19):1444-1453.