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Background: Pharmacological approaches to acute and chronic pain management, including non-steroidal anti-inflammatory drugs (NSAIDs) and opioids, are respectively associated with adverse reactions (such as gastrointestinal, cardiovascular, and renal effects) that might limit their use in patients with comorbidities and controversy related to inappropriate use. Naturopathic remedies might offer patients alternative and integrative treatments with minimal side effects. Objective: To explore the regional variation in the acceptance and use of naturopathic remedies in pain management. Methods: Two expert panel discussions were held by GlaxoSmithKline Consumer Healthcare (now Haleon Pte. Ltd.) over 9 and 12 hours in 2020 and 2021, respectively, and attended by multidisciplinary experts in naturopathy, Ayurvedic medicine, community pharmacy, physiotherapy, clinical pharmacy, Western medicine, academics, and naturopathic pain relief. Experts shared and discussed their experiences of naturopathic treatments and relevant clinical evidence related to different types of pain (including joint and muscle pain, migraine, sleeplessness due to pain, and general pain) and examined barriers to providing support to patients. Results: Experts agreed on the potential for curcumin (2020, 71.4% [5/7]; 2021, 91.7% [11/12]) and fish oil (2020, 100% [7/7]) for management of osteoarthritic joint pain although these are not uniformly recommended in osteoarthritis treatment guidelines. In treatment of migraines, coenzyme Q10 and magnesium were favored by experts (2021, 90.9% [10/11] and 63.6% [7/11], respectively). Conclusion: The need was emphasized for more and higher quality clinical studies to support naturopathic remedies, which might not be reflected in the latest treatment guidelines. The expert panel also highlighted missed opportunities for physicians and pharmacists to recommend effective naturopathic treatments.
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Introduction: The feasibility of an Early Subacute Pain Intervention Program was assessed for improving outcomes in patients with subacute pain and exposure to adverse childhood experiences (ACEs) at increased risk of long-term disability. Methods: Eligible patients were referred by their general practitioner for an open trial of individual case management with group-based education and psychological support sessions and access to allied health services. Measures of pain, disability, and mental health were assessed at baseline, on completion of the 6-month program, and 6 months after completion. Results: Thirty-nine participants (mean age 51 years, 72% women) completed the program. Pain at baseline was subacute (median duration 9.7 weeks) and of high intensity (median score 8/10), with a mean ACE score of 4.3. After completing the program, participants reported reduced pain severity and interference (~50% reduction), risk of future disability, psychological distress, and number of unhealthy days (~30% reduction) and were all statistically significant (p < 0.001). These gains were maintained at 6-months from the beginning of treatment. Higher ACE scores were associated with greater baseline levels of pain interference, risk of future disability, and psychological distress, and with less improvement in pain interference and psychological distress after completing the program. Discussion: This program suggested pain-related disability and mental health in patients with subacute pain and ACE exposure may be improved, although with reduced efficacy with higher ACE exposure. There need to be further robust investigation to quantify the value of targeted early intervention programs in primary health care settings to help reduce subacute pain persistence and progression to chronic pain in patients at increased risk of long-term disability.
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Traditionally, musculoskeletal pain management has focused on the use of conventional treatments to relieve pain. However, multi-modal integrative medicine including alternative/complementary treatments is becoming more widely used and integrated into treatment guidelines around the world. The uptake of this approach varies according to country, with generally a higher uptake in developed countries and in females aged more than 40 years. Integral to the concept described here, is that the body has an innate ability to self-heal, which can be optimized by the use of integrative medical strategies. Stress triggers for acute or recurring musculoskeletal pain are diverse and can range from physical to psychological. The mechanism by which the body responds to triggers and initiates the self-healing processes is complex, but five body networks or processes are thought to be integral: the nervous system, microcirculation/vasodilation, immune modulation, muscular relaxation/contraction and psychological balance. Multi-modal integrative medicine approaches include nutritional/dietary modification, postural/muscular training exercises, and cognitive behavioral mind/body techniques. This article will review the self-healing concept and provide plausible scientific evidence where available.
