practical pain management and the functional medicine matrix

FUNCTIONAL MEDICINE FOR CHRONIC PAIN?
WHY NOT?

Functional Medicine

Mozilla, Jahobr, Cygomezm

“Until a magic medication comes along to stabilize β-cell function or, better yet, to reverse β-cell dysfunction, it will remain difficult to improve diabetes outcomes very much…”  From Diabetes Care (How Our Current Medical Care System Fails People With Diabetes).  This is something I’ve shown you over and over again (HERE).

“The medical knowledge we gained in the 20th century had very narrow goals: stop people from dying. It was focused on treating short bouts of illness caused by a specific disease often localized to a particular organ or organ system. However, the CDC estimates that over half of adults in the U.S. suffer from one or more chronic diseases that cannot be cured, only managed. The costs of treating these diseases now represents 75 percent of the $2 trillion in U.S. annual healthcare spending. While we will always need acute care, managing chronic illness requires a different mindset.  It is no longer enough to simply treat the most pressing symptom and wait for the patient to return when the condition gets worse.”  From RX: The Quiet Revolution (How Disease-Based, Doctor-Centered Medicine is Failing Us)

“A 2012 study found that almost half of the practicing physicians surveyed had one or more symptoms of burnout. An online poll in the same year of more than 24,000 physicians found that only 54 percent would choose medicine again as a career, compared with 69 percent in 2011.”  From Dr. Diane Shannon’s article on Common Health (Why I Left Medicine: A Burnt-Out Doctor’s Decision To Quit).  You can read my piece on BURNOUT simply by clicking the link.

“The US spends more on health care than the next 10 biggest spenders combined: Japan, Germany, France, China, the U.K., Italy, Canada, Brazil, Spain, and Australia, yet the US ranks last in health and mortality when compared with 17 other developed nations.  Sadly, 30 cents of every dollar spent on medical care in America is wasted, which amounts to $750 billion annually. That is the same amount the Department of Defense estimates we spent on the ENTIRE Iraq War! This $750 billion of waste is made up of inefficient delivery of care and excessive administrative costs, unnecessary services, inflated prices, prevention failures, and outright fraud. The largest defrauder of the federal government is the pharmaceutical industry.”  From Dr. Joe Mercola’s Top Ten Ways the American Health Care System Fails.  If you want to see how Big Pharma is defrauding the American Taxpayer, simply click THIS LINK.

“American’s high rates of chronic disease are a massive cost-driver, attributable, according to research, for about 2/3rds the rise in health spending over the past few decades.  So given the high prevalence of such diseases, and the pressures they exert on our system, you’d hope our system had evolved so as to treat these diseases more effectively.  Not so.”  From the American Prospect (Ten Reasons Why American Health Care Is so Bad)

I worked hard, but not for the money. Did my best to please.
I used to think it was funny, til I realized it was just a tease.
Looking for the next best thing.  Looking for the next best thing.
I appreciate the best, but I’m settling for less, cause I’m looking for the next best thing.

Warren Zevon from 1982’s The Envoy (Looking for the Next Best Thing)

When it comes to CHRONIC PAIN, there’s one thing we know for sure; that the old model of prescribing what I refer to as “THE BIG FIVE” (pain meds, antiinflammation meds, muscle relaxers, corticosteroids, and antidepressants) has been an abject failure.   For instance, recent reports have put the annual cost of the opioid epidemic at an almost unimaginable 3% of GDP or 500 billion dollars.  No matter how you slice it, the current trajectory of our nation’s healthcare paradigm is UNSUSTAINABLE.  And when the American Prospect above says “not so” regarding our national ability to handle “CHRONIC HEALTH PROBLEMS,” we should start realizing that these problems are frequently self-induced.  What’s the solution?

A pair of doctors working with the VA (Osteopath, David Schaefer and Psychologist, David Cosio) wrote an article for Practical Pain Management called A Model to Incorporate Functional Medicine into Chronic Pain Care.  In the article’s synopsis (just under the title), the authors made sure to let readers know that this program requires “patient participation“.  The point?  Functional Medicine is not the same old, same old.  It’s not the kind of care that you can receive without taking an active part in.   In fact, a failure to engage patients to take responsibility and “actively participate” in their own intervention has historically been a huge failure of the standard medical model.  In other words, far too many people have been led to believe that what we today refer to as “healthcare” is something that someone else does for them; not something that they largely have to do for themselves.

It is very common for Americans to numb themselves with low-quality foods, reality TV, and a variety of socially acceptable addictions, which may be ascribed to the idea that ‘ignorance is bliss.”‘

These authors hit the nail on the head with this statement.  People are “medicating” (drugging / numbing) themselves with foods — some of which have been shown to be more addictive than hard drugs (HERE).  Another common non-pharmaceutical medication is media (TV, video games, porn, cell phones, computers / internet, or even reading, HERE).  But what are some of the other “socially acceptable addictions” they might be talking about?   Alcohol and tobacco are probably the most obvious, but there are any number of others.  I’ve seen things like shopping, gambling, caffeine, ADERALL / RITALIN, work / ambition, etc, mentioned here, but even “healthy” habits like EXERCISE can become problematic for some people.  

The next topic touched on was EPIGENETICS.  Although these authors never mentioned it by name, they described it thusly.  “Two factors — genetics and the environment — have an infinite number of combinations with a potential to support health or yield to disease.” In English, this means that you are not nearly as much a product of your genetic makeup as you have been led to believe.  Sure, you can’t change the color of your eyes or hair without contacts or dye, but as far as chronic sickness and disease are concerned, most can be changed.  This is because few chronic illnesses are largely genetic, although most treating doctors seem to heavily promote this myth.  Why?  Because when your health problems can be blamed on someone else (your ancestors in this case), everything is easier. Your doctor doesn’t have to confront you, and you can continue to live the same old self-destructive lifestyle in the “blissful ignorance” that put you in this condition in the first place, not having to take any responsibility for you actions because after all, it’s not your fault — IT’S THOSE PESKY GENES!

Epigenetics is one of the most important aspects of your health that you’ve probably never heard of.  It means that one of the biggest goals of following the diagram above is not simply to lose weight, get your blood sugar right, or lessen your body’s inflammatory load (noble goals one and all), but the fact that accomplishing these things actually helps prevent “bad” genes from being “epigenetically” turned on or activated.  We all carry genes for any number of nasty diseases, but in many cases (hopefully most cases), we never express those genes because the trigger never gets tripped.   And even though you might not be familiar with this term, most of you already intuitively know what these triggers are — bad habits, bad lifestyles, bad diets, bad sleep habits, too many bad medications, etc, etc, etc.

One thing I must mention is that this post talks about something that cannot be measured, but is critical to one’s health; love.  The power of love has similar healing properties and is intimately related to the healing power of touch that I wrote about on Christmas Day (HERE).  And interestingly enough, decades before Bernie Siegel and Patch Adams were talking about this concept, Dr. Jim Parker was teaching thousands of chiropractors the importance of what it means to LLL (Lather Love Lavishly).  The problem is that in today’s “corporate” medical environment, love is frequently left by the wayside.  In fact it’s frequently so non-existent in today’s students that medical schools are actually hiring actors to teach soon-to-be physicians HOW TO FAKE IT.  Get real folks.  True empathy can’t be faked (HERE) — patients know whether or not you give a rip.

FUNCTIONAL MEDICINE is all about helping restore HOMEOSTASIS (the medical word for balance or equilibrium) to every area of the patient’s life (spirit, soul, and body). Thus, the quote below should be a no-brainer, and realizing that it’s not — that it’s “novel” in the field of medicine — is rather disconcerting. It should also help you understand the difference between gross pathology and the “functional” health problems that so frequently occur in its absence (HERE). 

“Rather than seeking to alleviate a symptom, the practice of functional medicine aims to identify the root cause of the disrupting symptoms. A functional medicine provider is trained to recognize an underlying clinical imbalance and then seek the best approach to restore balance or a health equilibrium.  The functional medicine specialist usually relies on the health matrix, which compiles information from each of the seven nodes, which work in unison, rather than individually. The interconnectedness of the nodes aims to reinforce the impact that each will have on the others, which will ultimately reflect as health or dysfunction, which may manifest as pain and disease.”

If there is one thing our medical profession is good at it’s finding gross-pathology.  In fact, current “evidence” clearly shows how far out of balance the practice of medicine has been tipped in this direction (HERE).  Lest some of you accuse me of being mean or over-exaggerating the problem, bear in mind that this is common knowledge.  You can’t even call it a dirty little secret (or even an open secret) because it’s not a secret at all.  If you wanted, you could find dozens of articles and studies showing that while our medical profession is fantastic in dealing with trauma or life-threatening events, when it comes to CHRONIC INFLAMMATORY DEGENERATIVE DISEASES, we are failing miserably.  Why?  Mostly because with standard care, the COMMON DENOMINATORS of almost every chronic disease you can think of are not being addressed (the link is the proof, and as you’ll see if you click, many chronic issues are actually being caused by medical interventions — the best example being our love affair with IMMUNE SYSTEM SUPPRESSION).

What’s really cool is that Drs. Schaefer and Cosio saw the beauty of the Functional Medicine model and put it into practice.  What’s doubly cool is that they have actually used this system in a trial to see whether it could outperform standard medical care in veterans (the study is through the VA).   Rather than me go through each and every circle in the diagram above, you can read their article free online if you desire.   Although I added and shifted things around just a bit from their diagram, my “matrix” remains essentially the same as theirs, and is covered step by step in the post I wrote back in the summer of 2014 (HERE), with the biggest difference I see being my emphasis on BLOOD SUGAR and BIOMECHANICAL ISSUES.   The best news of all is that making the right kinds of changes works!

“According to the American College of Preventative Medicine, most chronic diseases are preventable and reversible if a comprehensive, individualized approach that addresses genetics, diet, stress, physical activity, sleep, and relationships is implemented through integrated functional medicine teams and based on empirical research.”

If you are into research, my site is loaded.  Although I tend to be rather opinionated, I try to back everything on my site with research.  What’s truly shocking is that the research is now showing that when it comes to taking care of patients, we’ve been going about things bass ackwards for decades (HERE).  Not surprisingly, the number one way mentioned by these authors to achieve the things set forth in the quote above is by changing your diet.  Failing to consume a diet BASED ON WHOLE FOOD NUTRITION is not only why drug therapy so often fails (you can’t overcome a poor diet with MONOTHERAPIES), but is usually the reason people are given SO MUCH MEDICATION in the first place — medication that completes this self-perpetuating cycle by screwing their systems up even further (HERE and HERE).

As far as the results of the study itself, the trial lasted one year, had four (educational) group-sessions to kick things off, and then focused heavily on using an ELIMINATION DIET to determine what foods your IMMUNE SYSTEM might be reacting against.  And remember when I said that Functional Medicine was something that you had to play a participating role in?  Unfortunately, half of the veterans enrolled dropped out (they chose to swallow MORPHEUS’ BLUE PILL). The other half saw a change in their weight, but failed to see changes in “waist/hip circumference, walking speed, and insomnia.”  They did score better on some of their blood work as well as joint pain, HEADACHES, and PERCEIVED STRESS, although they failed to change overall pain scores.

Why weren’t the results better?  For one thing it’s the VA. It’s a real challenge to take  50 veterans with chronic illnesses and try run true Functional Medicine protocols in a VA setting.  Because of this (and not to pick on the authors) it was, as I referred to it in the past, “FUNCTIONAL MEDICINE LITE“.  For another, I thought their Elimination Diet could have been better (among other things, ALL GRAINS — not just the gluten-containing grains —must be eliminated in the beginning).  Looking at their Elimination Diet made me realize I probably need to redo my post on the topic.  But overall, it was a definite improvement over the norm, as the authors concluded. 

I still think that it all boils down to education and motivation.  And while educating patients is critical, unless the treating physician is excellent at extracting from each patient what truly and deeply motivates them, making the sort of connection that will help drive them to want to get healthy will, in many cases, remain difficult.  My hope is that this is the beginning of some real changes in our veteran’s healthcare, and not simply a case of government placating TICKED OFF CITIZENS, while looking for the next best thing.

I applaud the individuals who did this study.  If you — my readers — are looking to break out of the prison that is your health, I’ve got the perfect post for you (HERE).  And if you know others that could benefit from this information, be sure to get it in front of them.  The easiest way is to like, share, or follow on FACEBOOK.
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