Once considered "alternative" in American healthcare, integrative medicine is now a widely respected, evidence-based option for pain management, and The Osher Center for Integrative Medicine at Vanderbilt is leading the way.
Founded in 2007, the Nashville clinic is one of six Osher Centers worldwide dedicated to healing the mind, body and spirit. The center blends traditional medicine with proven, mind and body research-based therapies including yoga, meditation, acupuncture and massage.
David Vago, PhD,
Research Director David Vago, PhD, said the holistic, interprofessional team helps patients adopt a somewhat non-traditional attitude toward chronic pain.
"The crucial aspect of pain is that no one wants to experience it so we typically turn away from it and want it to go away now," Vago said. "One thing The Osher Center does in general is to help change the relationship to pain so that it's not something we want to avoid or get rid of ... but rather approach and accept. That's a huge part of our model."
Part of that conversation is challenging patients to rethink the traditional definition of "health," often viewed as lack of disease.
Linda Manning, PhD
"That's not our only definition," said Linda Manning, PhD, assistant professor in the Department of Psychiatry at Vanderbilt University Medical Center and interim director of The Osher Center. "If we could make all pain go away, we would be delighted; but the reality is chronic pain by definition lasts more than three months, often times after an original injury has healed. It's about the brain telling the body it's in pain so we work with relationships that help us improve quality of life and function optimally."
Treatment after Opioids
Traditional pain treatment protocols stem from decades-old medical training focused solely on physical relief.
"An important quality of pain is also its emotional aspect," Vago said. "Providers often just deal with the physical by prescribing opioids with no fear of addiction or concern for the emotional aspect of the pain itself." That model triggered the current opioid abuse epidemic and bolstered the prescription pain management industry.
"When you experience chronic pain, there's almost always anxiety and depression, and symptoms can actually change the way the brain physically interprets pain signals," said Manning, a clinical psychologist. "The sensitization of the central nervous system is exasperated by emotional pain, and opioids are a Band-Aid that doesn't fix the issue."
While The Osher Center won't prescribe opioids, providers sometimes rely on medications proven to reduce hyperactivity of the central nervous system, often triggered by physical or emotional trauma and making patients more vulnerable to the sensitization process. They also work with opioid patients in multiple stages of treatment.
"Many use opioids appropriately but don't like the side effects and want to try something different," Manning said. "We take people anywhere along the spectrum and have them learn strategies to help with the pain. Many choose to come off opioids altogether, and many have tried everything and aren't getting any relief. We help give them tools to cope."
Better Tools for Pain Management
Group training is also an important part of The Osher Center's model. That's because patients treated with opioids often experience social isolation, sending them further down the rabbit hole of anxiety and depression.
"Opioid patients can't continue high quality relationships because opioids dull everything," Manning said. "We work with patients around social isolation, and our group approach helps patients in similar circumstances feel like they're not alone."
Patients also are trained in mindfulness, a systematic form of mental training in which patients become more aware of mental habits and how they react to pain and cravings for pain relief. "Mindfulness affects specific brain networks that improve attention and regulate negative emotion and mental habits," Vago said. "It helps train patients to be more adaptive at managing those skills."
Meanwhile, practices like yoga work with both body and mind, training the body to engage in parasympathetic responses. "Yoga training allows you to take it off the mat and engage in that relaxation response more readily," said Vago, noting the body's natural response is to tense up when in pain.
The New "Normal"
Proven effectiveness of the integrative model means it no longer bares the "alternative" label from the federal government and National Institutes of Health. In fact, The Osher Center accepts Medicare and private pay insurance and sees patients across the economic spectrum.
"Science is finally catching up," Vago said. "Integrative medicine is equal to or better than traditional medicine alone in terms of outcomes. The evidence is there. It's just good medicine."
The Osher Clinic