Integrative Medicine: Not Just "Alternative" Therapies

LAS VEGAS—Integrative medicine is more than alternatives or add-ons to standard medical tools and approaches, according to Cynthia Knorr-Mulder, MSN, APRN-BC, NP-C, Administrative Director of Pain, Palliative, Spine and Integrative Medicine at Englewood Hospital and Medical Center, in Englewood, New Jersey.

It's the development of a therapeutic relationship based on listening and respect that can “place meaning back into healthcare,” she said to attendees at PAINWeek 2014.

“Integrative pain management is a multidimensional approach to chronic pain” that encompasses a range of unconventional therapies, Knorr- Mulder said. “It starts with a therapeutic relationship that combines the top interventional medical treatments with the best of behavioral therapies.”

“Every patient is looking for a ‘magic wand' to cure pain,” Knorr-Mulder said. That's nothing new. Early examples of integrative medicine in Greece, circa 300 BC, included relaxing spring water fountains, gymnasiums and spas, hands-on healing, massage, aromatic oils and herbs, dream interpretation and drugs, surgery and opium vials, she added.

The ancient Greek medical schools had holistic approaches to wellness, Knorr-Mulder noted. “They emphasized the therapeutic environment (and) recognized the importance of psychological and emotional factors of stress on the healing process.”

Patients with chronic pain frequently seek new providers because they feel dissatisfied with how busy their previous provider was, or because they feel the provider did not believe the pain was real. Patients also seek new providers when “they think the provider is only treating symptoms, but not the overall disease process or patients' wellness,” or when providers are uncomfortable prescribing pain medications.

“Each patient has their own story,” she said. Providers should understand the body in physiological terms and the patient's “real life story.” “With technological advances we measure and diagnose symptoms, but many providers in a busy healthcare system have lost the ability to touch a patient's life, to feel and understand their suffering,” she said.

Developing a therapeutic relationship involves listening, connecting, caring and accepting “that most patients are knowledgeable and well educated about their disease,” she said. That relationship is based importantly on listening. Providers interrupt their patients, on average, only 18 seconds after the patient begins to speak, she noted. “As a result, the patient is deprived of a chance to tell their story. Patients withhold their real reasons for a visit until the end or subsequent visits.”

“Our ability to gather important patient information is compromised,” as a result, she warned. “Patients may not be properly diagnosed because they have not had a chance to express their complete symptoms.” “Keep current with the latest research,” she advised. “Respect patient beliefs. Be available and make the most of the visit while the patient is in the office.”

“There is a difference in studying life and knowing life,” Knorr-Mulder concluded. “The meaning of life is not something we learn in a university. Knowing the patient's story is the bridge to effectively treating patients.”

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