A Functional Medicine Framework for Pain

by Henri Roca, MD, Integrative Functional Medicine Specialist

Pain is a natural experience that most everyone will have at some time in their lives. Whether the pain occurs when touching something hot, seeing a light that is too bright, breaking a bone, or having a cut or injury, we all learn through pain. These types of pain are a way of teaching us limits or letting us know that a particular behavior is dangerous for ourselves. This type of pain comes and then goes. Pain is an essential part of life, an important part of life, and something that should never be completely suppressed or removed.

Pain usually occurs because of irritation. Sometimes the irritation has a structural basis. Pressure from something in the body pushing against a tissue or a nerve can cause pain. This is the type of pain caused by arthritis in the spine or by tight muscles. Both the muscle and the arthritis can push on nerves. Sometimes the irritation is caused by direct stretching or tearing of the nerve itself. This type of pain can occur if there has been a significant injury like a fracture, a military injury, or a motor vehicle accident. Sometimes the pain is caused by inflammation that affects the nerves or the receptors. This type of pain is caused by infection, autoimmune disease, gastrointestinal dysfunction, genetic inefficiencies, and other causes. Nutritional deficiencies, neurotransmitter deficiencies, and toxins make pain worse.

These causes: pressure, stretching or tearing, and inflammation can occur with any tissue or organ. Mostly pain arises from connective tissue, especially in the back, joints or muscles. Connective tissue includes bone, discs, cartilage, tendons, ligaments, muscles, and fascia.

Wherever possible we want to address the underlying causes of pain so that we can work to resolve the issue.

The final arbiter of pain is the brain. All nerve signals and inflammation molecules are interpreted in the brain. Once these signals reach the brain they are modulated by our memories, the meanings we ascribe to the sensations, and our emotions.

As you can see there is no such thing as PAIN as a single entity. This is vitally important to understand. Pain as a large concept, as a single concept, is not a very useful concept. The concept of singular PAIN leads us to use only big-gun medications to suppress the brain’s perception of pain. Often other medical conditions such as diabetes, depression, neuropathy, liver disease, or bowel disease makes the pain worse. Ignoring the underlying causes of pain or the emotional or “meaning” context of the sensation of pain only impedes the healing process. Such treatment approaches often lead to dependence and addiction.

The best approach to evaluate and treat pain is a functional medicine approach that evaluates all of the underlying causes of pain as well as those issues that can worsen pain. In this approach we use anything and everything that works: from nerve stimulators and tissue injections to medications to nutrition, hypnotherapy, biofeedback, acupuncture, and counseling. Functional Medicine addresses not only the physical causes of pain but also the mental/emotional circumstances that can worsen pain. Auricular acupuncture approaches developed by the military are even more helpful. Dr. Roca utilizes all of the above techniques when working with patients to help relieve pain.