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Naturopathic Management of Chronic Pain in the Older Adult. Diana Quinn, ND Hygeia Center for Healing Arts Beaumont Hospital Integrative Medicine. Naturopathic Medicine. Licensed Naturopathic doctors ( NDs ) are general practitioners with a specialty in natural medicine.

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naturopathic management of chronic pain in the older adult

Naturopathic Management of Chronic Pain in the Older Adult

Diana Quinn, ND

Hygeia Center for Healing Arts

Beaumont Hospital Integrative Medicine

naturopathic medicine
Naturopathic Medicine
  • Licensed Naturopathic doctors (NDs) are general practitioners with a specialty in natural medicine.
  • Pre-med undergraduate degree, four years at nationally accredited naturopathic medical school, pass North American licensing exams (NPLEX)
  • NDs specialize in evidence-based complementary and alternative medicine (EBCAM).
naturopathic medical education
Naturopathic Medical Education
  • Basic Sciences
  • Organ Systems
  • Clinical Training
  • Naturopathic Modalities
naturopathic modalities
Naturopathic Modalities
  • Clinical Nutrition
  • Botanical Medicine
  • Homeopathy
  • Hydrotherapy
  • Physical Medicine
  • Lifestyle Counseling and Stress Management
  • Chinese Medicine, Acupuncture
naturopathic philosophy
Naturopathic Philosophy
  • The Healing Power of Nature
  • Identify and Treat the Cause
  • Treat the Whole Person
  • First Do No Harm
  • Doctor as Teacher
  • Prevention
who uses cam
Who Uses CAM?
  • Between 42%- 68% of Americans are using some form of complementary and alternative modality as part of their healthcare.
      • Nahin, RL, Barnes PM, Stussman BJ, and Bloom B. Costs of Complementary and Alternative Medicine (CAM) and Frequency of Visits to CAM Practitioners: United States, 2007. National health statistics reports; no 18. Hyattsville, MD: National Center for Health Statistics. 2009.
      • Eisenberg DM, Davis RB, Ettner SL, Appel S, Wilkey S, Van Rompay M, Kessler RC. Trends in alternative medicine use in the United States, 1990–1997 Results of a follow-up national survey. JAMA. 1998;280(18):1569–1575.
      • Kessler RC, Davis RB, Foster DF, Van Rompay MI, Walters EE, Wilkey SA, Kaptchuk TJ, Eisenberg DM. Long-term trends in the use of complementary and alternative medical therapies in the United States. Ann Intern Med. 2001;135(4):262–268.
cam use in older adults
CAM Use in Older Adults
  • 2007 National Health Interview Survey found that 38% of U.S. adults reported using CAM in the previous 12 months, with the highest rates among people aged 50–59 (44%)
  • 42 percent of adults who used CAM in the past 12 months disclosed their use of CAM to a physician (MD or DO)
    • Barnes PM, Bloom B, Nahin R. Complementary and Alternative Medicine Use Among Adults and Children: United States, 2007. CDC National Health Statistics Reports #12. 2008.
disclosure of cam usage
Disclosure of CAM Usage
  • AARP & NCCAM Survey Report (2010): telephone survey of 1000 participants ages 50+:
    • Over half surveyed use CAM and over 1/3 take herbal or nutritional supplements.
    • …Yet only a third of patients using CAM disclosed to their health care provider.
      • Complementary and Alternative Medicine: what people aged 50 and older discuss with their health care providers. NIH National Center for Complementary and Alternative Medicine, AARP
cam for pain management
CAM for Pain Management
  • Other studies have found that pain is the primary reason that older adults seek out CAM therapies
    • Astin JA, Pelletier KR, Marie A, Haskell WL. Complementary and alternative medicine use among elderly persons: One-year analysis of a Blue Shield Medicare sup-plement. J Gerontol A BiolSci Med Sci2000;55:M4–M9.
    • Cheung CK, Wyman JF, Halcon LL. Use of complementaryand alternative therapies in community-dwelling older adults. J Altern Complement Med 2007;13:997–1006.
cam for persistent pain
CAM for Persistent Pain
  • Persistent pain is defined as a prolonged experience of pain that continues for an extended period of time and may or may not be associated with a well-defined disease.
  • Negative outcomes associated with persistent pain include poor health, depression, cognitive decline, and higher usage of pharmaceuticals.
    • Munk et al. Massage therapy usage and reported health in older adults in experiencing persistent pain. J Alt Complementary Med 2011;17(7):609-16.
causes of persistent pain
Causes of Persistent Pain
  • Musculoskeletal pain
    • Osteoarthritis, Rheumatoid Arthritis, Fibromyalgia
  • Visceral pain
    • Cancer, gastrointestinal disorders, urogenital disorders
  • Neuropathic pain
    • Herpes zoster, neuralgia, neuropathy, MS
integrative therapeutics for pain management

Integrative Therapeutics for Pain Management

Anti-Inflammatory Agents

Analgesics

Supportive Nutrients

Acupuncture

Massage

Mind/Body Medicine

natural anti inflammatory agents
Natural Anti-Inflammatory Agents
  • Turmeric (Curcuma longa)
  • MSM
  • Others include Holy Basil (Ocimum sanctum), Rosemary (Rosmarinusofficinalis) and Green Tea extract (Camellia sinensis)
turmeric curcuma longa
Turmeric (Curcuma longa)
  • Anti-inflammatory through inhibition of LOX and COX, antihistamine
  • Antioxidant and hepatoprotective
  • Anti-nociceptive
    • Basnet P, Skalko-Basnet N. Curcumin: an anti-inflammatory molecule from a curry spice on the path to cancer treatment. Molecules 2011, 16, 4567-4598.
    • Liju V et al. An evaluation of antioxidant, anti-inflammatory and antinociceptive properties of essential oil from Curcuma longa. Indian J Pharmacol. 2011 Sep;43(5):526-31.
    • Arora RB, Basu N, Kapoor V, Jain AP. Anti-inflammatory studies on Curcuma longa (turmeric). Ind J Med Res 1971;59:1289–95.
turmeric curcuma longa1
Turmeric (Curcuma longa)
  • A preliminary trial in people with RA found curcumin to be useful for reducing inflammation, pain and stiffness.
    • Deodhar SD, Sethi R, Srimal RC. Preliminary studies on antirheumatic activity of curcumin (diferuloyl methane). Ind J Med Res 1980;71:632–4.
  • In a blinded studay, curcumin was superior to placebo or phenylbutazone (an NSAID) for alleviating post-surgical inflammation.
    • Satoskar RR, Shah SJ, Shenoy SG. Evaluation of anti-inflammatory property of curcumin (diferuloyl methane) in patients with postoperative inflammation.Int J ClinPharmacolTherToxicol 1986;24:651–4.
turmeric curcuma longa2
Turmeric (Curcuma longa)
  • Contraindications
    • Pregnancy, gallbladder disease
  • Adverse effects
    • None documented
  • Drug interactions
    • May inhibit CYP3A4 drug clearance
  • Supplementation considerations
    • Poorly absorbed in whole form, quality of supplement imperative for efficacy
    • Dosage of standardized 90% extract 375-500 mg TID
methylsulfonylmethane msm
Methylsulfonylmethane (MSM)
  • Organosulfur molecule that can be synthesized commercially from dimethylsulfoxide (DMSO).
  • Anti-oxidant, chemoprotective properties, anti-atherosclerotic action.
  • RCT of 49 subjects aged 49-90 received either 1.125 g TID or placebo. After 12 weeks, total symptoms decreased in treatment group by 20% and increased in placebo group by 14%.
    • Debbi et al. Efficacy of methylsulfonylmethane supplementation on osteoarthritis of the knee: a randomized controlled study. BMC Complementary and Alternative Medicine 2011, June 11:50
methylsulfonylmethane msm1
Methylsulfonylmethane (MSM)
  • Contraindications
    • None documented
  • Adverse effects
    • Rare diarrhea, rash, headache reported
  • Drug interactions
    • None documented
  • Supplement considerations
    • Dosage
botanical analgesics
Botanical Analgesics
  • A Cochrane Review published in 2007 found ten trials of herbal analgesicsDevil’s Claw Harpagophytumprocumbens), White Willow Bark (Salix alba) and Cayenne pepper (Capsicum frutenscens) were found to reduce pain more than placebo.
    • Gagnier J et al. Herbal Medicine for Low Back Pain: A Cochrane Review. Spine. 32(1):82-92, January 1, 2007.
devil s claw harpagophytum procumbens
Devil’s Claw (Harpagophytumprocumbens)
  • Has a broader mechanism of action than NSAIDs by interacting with both COX- and LOX-mediated pathways of the arachidonic acid cascade as well as with the release of cytokines
    • Loew D et al. Investigations on the pharmacokinetic pro- perties of Harpagophytum extracts and their effects on eicosanoid biosynthesis in vitro and ex vivo. ClinPharmacolTher 2001;69:356–64.
    • Fiebich B et al. Inhibition of TNFa synthesis in LPS-stimulated primary human monocytes by Harpagophytum extract. Phytomedicine 2001;8:28–30.
devil s claw harpagophytum procumbens1
Devil’s Claw (Harpagophytumprocumbens)
  • In subjects taking 50 mg of Devil’s Claw, the percentage with no pain or mild pain increased over the 4-week period (from 2% in week 1 to 24% in week 4), whereas the percentage with unbearable or severe pain decreased over the 4 weeks (from 59% in week 1 to 35% in week 4).
    • Chrubasik S, Junck H, Breitschwerdt H, et al. Effectiveness of Harpagophytum extractWS1531 in the treatment of exacerbation of low back pain: a randomized, placebo-controlled, double blind study. Eur J Anaesthesiol 1999;16:118–29.
devil s claw harpagophytum procumbens2
Devil’s Claw (Harpagophytumprocumbens)
  • RCT of 88 patients aged 45-72 having chronic LBP were randomized to receive either 2400 mg of the active compound harpagoside plus placebo, or 12.5 mg tablet of Vioxx plus placebo.
  • 79 subjects completed the study with 20% of patients receiving Devil’s Claw pain-free and 10% reofecoxib pain-free.
    • Chrubasik S et al. A randomized double-blind pilot study comparing Doloteffin and Vioxx in the treatment of low back pain. Rheumatology 2003;42:141–148
devil s claw harpagophytum procumbens3
Devil’s Claw (Harpagophytumprocumbens)
  • Of the original 88 patients in previous study, 53 patients remained in a one-year follow-up.
  • At 24, 43 and 54 weeks there continued to be no difference between treatment with Devil’s Claw and rofecoxib on Arhus Index and health assessment questionnaire scores (HAQ)
  • Long-term treatment with Devil’s Claw was effective and well tolerated.
    • Chrubasik S et al. A 1-year follow-up after a pilot with Doloteffin for pain. Phytomedicine. 2005 Jan;12(1-2):1-9.
devil s claw harpagophytum procumbens4
Devil’s Claw (Harpagophytumprocumbens)
  • Contraindications
    • Cardiovascular disease, patients taking warfarin
  • Adverse reactions
    • Dyspepsia – increases stomach acid production
  • Drug interactions
    • Medications cleared by the liver via CYP450 2C19, H2 blockers, PPIs
  • Supplement considerations
    • Dosage 2400 mg BID
white willow bark salix alba
White Willow Bark (Salix alba)
  • Contains salicin
  • Anti-inflammatory and anodyne
  • Slow-acting and long-lasting pain relief
white willow bark salix alba1
White Willow Bark (Salix alba)
  • A total of 228 subjects were given a daily dose of 240 mg salicin against 12.5 mg per day of rofecoxib in a 4-week trial.
  • Both the rofecoxib and the salicin groups improved on the pain scale (by 44% in both groups), the Arhus scale invalidity index, pain index, and physical impairment index.
  • The percentage of patients requiring NSAIDs and/or tramadol was 10% for the S. alba group and 13% for the rofecoxib group.  
  • … there are no differences in effectiveness between a 240-mg salicin dose of an extract of S. alba and 12.5-mg rofecoxib per day in treatment of acute episodes of chronic pain
white willow bark salix alba2
White Willow Bark (Salix alba)
  • 4-week RCT of 210 subjects tested two doses of S. alba, standardized to either 120 mg or 240 mg salicin per day, against placebo.
  • In the 4th week, greater number of subjects with pain-free days in treatment groups than placebo.
  • 120 mg salicin dose of an extract of S. alba was more effective in relieving pain than placebo, with the effect being dose-dependent and greater at 240 mg.
    • Chrubasik S, Eisenberg E, Balan E, et al. Treatment of low back pain exacerbations with willow bark extract: a randomized double-blind study. Am J Med 2000;109:9–14.
white willow bark salix alba3
White Willow Bark (Salix alba)
  • Total of 261 patients in two studies demonstrated an increased number of pain-free patients, decreased number of patients requiring relief medication, and improved Arhus index scores.
  • Significant differences between the 120 mg and 240 mg groups, demonstrating that 240 mg reduces pain more than placebo and 120 mg dose of S. alba.
    • Chrubasik S, Kunzel O, Model A, et al. Treatment of low back pain with a herbal or synthetic anti-rheumatic: a randomized controlled study. Willow bark extract for low back pain. Rheumatology 2001;40:1388–93.
white willow bark salix alba4
White Willow Bark (Salix alba)
  • Contraindications
    • Pregnancy and breastfeeding, patients with gastritis or ulcers, children
  • Adverse effects
    • Stomach upset, tinnitus at high doses
  • Drug interactions
    • Anticoagulants, beta blockers, diuretics, methotrexate and phenytoin
  • Supplement consideration
    • Dosage 60, 120 or 240 mg QD
cayenne capsicum frutescens
Cayenne (Capsicum frutescens)
  • Topical preparations containing 0.025% to 75% of capsaicin are applied TID-QID.
  • The mechanism of C. frutescens is partially related to its ability to deplete substance P.
  • Numerous double-blind trials have proven C. frutenscens to be effective for both musculoskeletal and neuropathic pain.
cayenne capsicum frutescens1
Cayenne (Capsicum frutescens)
  • In a recent RCT, 130 patients with severe fibromyalgia were randomized to receive 0.075 % capsaicin cream three times daily in a 6-week trial.
  • While no difference in Visual Analog Scale for pain, there were significant improvements in myalgic score and pain threshold in study group.
  • Reduced fatigue and depressive symptoms were also observed in trial group.
    • Casanueva et al. Short-term efficacy of topical capsaicin therapy in severely affected fibromyalgia patients. RheumatolInt2012 July (Epub ahead of print)
cayenne capsicum frutescens2
Cayenne (Capsicum frutescens)
  • Contraindications
    • None documented
  • Adverse effects
    • Caution must be used to avoid touching eyes and mucous membranes
  • Drug interactions
    • None documented
  • Supplement considerations
    • Topical preparations range from 0.025%-0.075% capsaicin
nutrients for pain support
Nutrients for Pain Support
  • Magnesium
  • Vitamin D
  • L-DLPA
  • D-Ribose
magnesium citrate
Magnesium citrate
  • Persistent pain syndromes that can be improved with magnesium supplementation include restless legs, MS, fibromyalgia and migraines.
  • Deficiency of magnesium is associated with many chronic disease states, such as diabetes, chronic fatigue syndrome and fibromyalgia, hypertension and arrhythmia.
  • Many drugs deplete magnesium, and supplementation is recommended to replenish.
magnesium citrate1
Magnesium citrate
  • 60 patients with fibromyalgia were randomized to receive either 300 mg magnesium, amytriptiline, or amitryptaline + magnesium.
  • The number of tender points, tender point index, FIQ and Beck depression scores decreased significantly with the magnesium citrate treatment.
  • Amitryptaline + magnesium was only group improved on all parameters.
    • Bagis et al. Is magnesium citrate treatment effective on pain, clinical parameters and functional status in patients with fibromyalgia? Rheumatol Int. 2012 January 22 (Epub ahead of print).
magnesium citrate2
Magnesium citrate
  • Contraindications
    • Patients with kidney disease
  • Adverse effects
    • Diarrhea at high doses
  • Drug interactions
    • Dexamethasone, misoprostol, spironolactone, triamterene
  • Supplement considerations
    • Magnesium citrate or glycinate are best absorbed forms
vitamin d
Vitamin D
  • Vitamin D deficiency and insufficiency is prevalent, and correlated with many chronic disease states including diabetes, cancer and cardiovascular disease.
  • Insufficient vitamin D intake exacerbates conditions causing persistent musculoskeletal pain, such as osteoarthritis, osteoporosis and fracture, and fibromyalgia.
vitamin d1
Vitamin D
  • British study of 2070 adults >65, measurements included serum 25(OH)D, pain status and covariates (age, sex, social class, season of examination, use of vitamin supplements and physical health status).
  • Results show that the symptoms of moderate/extreme pain (present in 53 % of the sample) were associated with poor vitamin D status, independent of other covariates.
    • Hirani V. Vitamin D status and pain: analysis from the Health Survey for England among English adults aged 65 and over. Br J Nutr. 2012 Apr;107(7):1080-4.
vitamin d2
Vitamin D
  • Contraindications
    • Hyperparathyroidism, sarcoidosis
  • Adverse effects
    • Increased thirst, increased urination, kidney stones
  • Drug interactions
    • Verapamil, warfarin
  • Supplement considerations
      • Cholecalciferol (D3) is best absorbed form, daily doses range 2000-10,000 IU
d l phenylalanine dlpa
D,L-phenylalanine (DLPA)
  • Amino acid precursor, can be converted into L-tyrosine and subsequently L-dopa, norepinephrine and epinephrine.
  • Believed to up-regulate the endogenous analgesia system (EAS).
  • Promotes enkaphalin activity by inhibiting enkephalinase.
d l phenylalanine dlpa1
D,L-phenylalanine (DLPA)
  • Improves mood, may alleviate persistent pain.
  • Mixed responses in clinical trials for improvement of persistent pain, little effect on acute pain.
  • Several studies demonstrated that DLPA improved the efficacy of acupuncture for relief of persistent pain.
  • May improve efficacy of opioid pain medications.
    • Russel AL, McCarty MF. DL-phenylalanine markedly potentiates opiate analgesia – an example of nutrient/pharmaceutical up-regulation of the endogenous analgesia system. Med Hypotheses. 2000 Oct;55(4)283-8.
d l phenylalanine dlpa2
D,L-phenylalanine (DLPA)
  • Contraindications
    • Patients with tardivedyskinesia, PKU
  • Adverse effects
    • Nausea, dyspepsia, transient headaches
  • Drug interactions
    • L-dopa, potentiates opioids
  • Supplement considerations
    • Dosage range from 500-1500 mg
d ribose
D-Ribose
  • A 5-carbon sugar produced in the body from glucose
  • Important role in synthesis of RNA, DNA and ATP.
  • D-ribose shown to increase cellular energy production in heart and skeletal muscle, may improve pain from fibromyalgia.
    • Teitelbaum JE, Johnson C, St Cyr J. The use of D-ribose in chronic fatigue syndrome and fibromyalgia: a pilot study. J Altern Complement Med. 2006 Nov;12(9):857-62.
d ribose1
D-Ribose
  • Contraindications
    • None known
  • Adverse effects
    • Greater than 10 g daily may cause diarrhea
  • Drug interactions
    • None known
  • Supplement considerations
    • Powdered dose of 5 g BID
acupuncture
Acupuncture
  • Acupuncture is thought to directly modulate the affective-cognitive aspect of pain perception, and changes in brain function have been observed using MRI during acupuncture treatment.
  • Useful for:
    • Neuropathy (diabetic, CIPN)
    • Musculoskeletal pain
    • Visceral pain in oncology patients
acupuncture for persistent pain
Acupuncture for Persistent Pain
  • A meta-analysis of 29 RCTs with a total of 17,922 found that acupuncture was superior to both sham and no-acupuncture for the relief of neck and back pain, shoulder pain, osteoarthritis and headaches.
    • Vickers et al. Acupuncture for chronic pain: individual patient data meta-analysis. Arch Intern Med. 2012 Sep 10:1-10.
acupuncture in cancer
Acupuncture in Cancer
  • A Cochrane review of trials investigating acupuncture for pain in cancer patients found only one high-quality study, which demonstrated that auricular acupuncture was effective in reducing pain.
    • Paley CA, Johnson MI, Tahsani OA, Bagnall AM. Acupuncture for cancer pain in adults. Cochrane Database Syst Rev. 2011;(1): CD007753.
massage
Massage
  • 9 male cancer patients (mean age 56.6 years) who received two consecutive 30- minute evening massages reported significant reductions in pain (according to VAS 0–100 mm) as compared to baseline.
  • There was a mean reduction in pain, anxiety and enhanced feelings of relaxation.
  • In a case series involving 103 patients with cancer, a combination of massage and aromatherapy promoted pain relief in 33% of patients who concluded the study (47%).
massage1
Massage
  • In an un- blinded RCT, 28 patients (mean age 61.5 years) with cancer were assigned to either Swedish massage therapy or a visitor for 10 minutes. Pain was assessed by a visual analog scale (VAS) from 0 to 10 cm.
  • Men experienced immediate pain but this effect subsided by an hour after the massage. There was no significant benefit in women, although their base- line level of pain was mild.
mind body modalities
Mind-Body Modalities
  • Biofeedback
    • 15 fibromyalgia patients received 40 biofeedback treatments and reported reduced stiffness, pain, tenderness, fatigue and psychological distress.
    • 63 patients receiving standard care served as control and did not experience these improvements.
    • Caro XJ, Winter EF. EEG biofeedback treatment improves certain attention and somatic symptoms in fibromyalgia: a pilot study. ApplPsychophysiol Biofeedback. 2011 Setp;36(3):193-200.
mind body modalities1
Mind-Body Modalities
  • Meditation
    • Extensive mental training can result in thickening of cortical regions associated with pain processing, including midcingulate cortex (MCC) and primary and secondary somatosensory cortices.
    • Functional imaging demonstrated that during pain, practitioners had reduced activation in amygdala, hippocampus, and emotional/evaluative regions of prefrontal cortex, as well as increased activation in the MCC, thalamus, and insula.
      • Salomons T and Kucyi A. Does meditation reduce pain through a unique neural mechanism? Journal of Neuroscience, September 7, 2011 31(36):12705–12707.
mind body modalities2
Mind-Body Modalities
  • Mindfulness-based stress reduction is a mind-body intervention described by Kabat-Zinn.
  • The participants met weekly for eight 2.5 hour sessions.
  • Mindfulness-based stress reduction may have a positive impact on mental health in these patients, an effect that seems to persist after the classes are completed.
    • Plews-Ogen et al. A pilot study evaluating mindfulness-based stress reduction and massage for the management of chronic pain. J Gen Intern Med 2005; 20:1136–1138.
support for side effects of pain medication
Support for Side Effects of Pain Medication
  • Probiotics
  • Magnesium
  • Ginger
  • Homeopathy
  • Acupuncture
probiotics
Probiotics
  • Changes of the gut microflora in the elderly appear to involve a reduction in numbers of healthy bacteria (lactobacilli and bifidobacteria) and an increase in numbers of potentially pathogenic species.
  • Older adults have greater susceptibility to gastroenteritis and functional bowel problems
    • Malaguarnera G et al. Probiotics in the gastrointestinal diseases of the elderly. J Nutr Health Aging. 2012 Apr;16(4):402-10.
probiotics1
Probiotics
  • More than 80% of nursing home and extended-care facility residents are reported to suffer from constipation.
  • This population includes persons with higher frequency of risk factors: immobility, polypharmacy including opioid pain medications, and chronic medical conditions.
probiotics2
Probiotics
  • One study of 19 nursing home residents with chronic constipation found improvement when supplemented with a probiotic formula of Lactobacillus acidophilus, Pediococcuspentosaceus, and BifidobacteriumlongumBID x 14 days
  • Subjects’ defecation habit (frequency of defecation, amount and state of stool) in nursing home residents with chronic constipation.
    • An et al. Efficacy of lactic acid bacteria (LAB) supplement in management of constipation among nursing home residents. Nutrition Journal 2010, 9:5.
probiotics3
Probiotics
  • Contraindications
    • Neutropenic patients with WBC <2.5; immune compromised patients should avoid Sacharomycesboulardii
  • Adverse effects
    • Rarely gas, bloating, loose stools
  • Drug interactions
    • None known
  • Supplement considerations
    • Quality of product is imperative for clinical efficacy
magnesium oxide
Magnesium oxide
  • Osmotic laxative and stool softener
  • Doses 500-2500 mg daily for severe constipation
  • Magnesium oxide is poorly absorbed, making it the preferred form of magnesium for laxative effect
magnesium oxide1
Magnesium oxide
  • 456 patients were given magnesium prophylaxis for opioid-induced constipation
  • Constipation incidence was 33.7% in treatment group, and 54.6% in untreated group
  • Preventive effect was dose-dependent, requiring doses over 1000 mg
    • Ishihara M et al. A multi-institutional study analyzing effect of prophylactic medication for prevention of opioid-induced gastrointestinal dysfunction. Clin J Pain. 2012 Jun;28(5):373-81.
magnesium oxide2
Magnesium oxide
  • Contraindications
    • Patients with kidney disease
  • Adverse effects
    • Diarrhea at high doses
  • Drug interactions
    • Dexamethasone, misoprostol, spironolactone, triamterene
  • Supplement considerations
    • Doses over 1000 mg required to achieve laxative effect as preventive for opiate-induced constipation
ginger zingiber officinale
Ginger (Zingiberofficinale)
  • Preclinical studies have shown that ginger is effective as an anti-emetic agent and that it possesses 5HT3 antagonistic activity, which is responsible for reducing chemotherapy-induced nausea and vomiting.
  • Animal studies suggest that ginger is effective in preventing cisplatin-induced emesis and gastric emptying.
    • Clinical studies have shown that ginger possesses an anti- emetic effect in many circumstances such as during pregnancy, postoperatively and in motion sickness. Haniadka R et al. Zingiberofficinale (Ginger) as an anti-emetic in cancer chemotherapy: a review. J Alt Compl Med. 2012;18(5):440-44.
ginger zingiber officinale1
Ginger (Zingiberofficinale)
  • Contraindications
    • Patients on blood thinning medication, before surgery
  • Adverse effects
    • None known
  • Drug interactions
    • Heparin, warfarin
  • Supplement considerations
    • 500 mg of dried ginger powder every 2-4 hours
homeopathy
Homeopathy
  • Arsenicum – vomiting, diarrhea, anxiety
  • Carbovegetalis – severely depleted states, nausea, vomiting
  • Ipecac – nausea and vomiting with increased salivation
  • Nuxvomica – nausea, dry retching, constipation with urge
acupuncture1
Acupuncture
  • Acupuncture has a potential role in managing the following cancer symptoms: pain, nausea and vomiting, xerostomia, hot flushes, fatigue, anxiety, depression, and insomnia.
      • Pan et al. Complementary and Alternative Medicine in the Management of Pain, Dyspnea, and Nausea and Vomiting Near the End of Life: A Systematic Review. 2000.
naturopathic approaches to pain management

Naturopathic Approaches to Pain Management

Diana Quinn, ND

Hygeia Center for Healing Arts

Beaumont Hospital Integrative Medicine