Medications Aren't All We've Got

Medications are great. Sometimes they are even lifesaving. But there are other times that medications fall short.

In medical school we spend a lot of time learning about pathophysiology and how to cure disease, but we don’t spend that much time learning to manage patient discomfort. We learn a bit about NSAIDs, opiates, Compazine and Benadryl, but there is so much that never makes it into the medical school curriculum.

We are healers, not just technicians; therefore, it is in our job description to do all we can to help patients feel better, regardless of whether their disease can be cured. Here are some tools to add to your toolbox:

·     Acupuncture. Acupuncture is evidence supported to help patients relieve nausea, depression, anxiety and multiple types of pain, including neuropathic pain. It is now covered by some insurance companies. For patients with no insurance coverage and limited resources, some acupuncturists offer group acupuncture for a lower price.

·     Acupressure. Acupressure is philosophically similar to acupuncture but instead of using a needle, pressure is applied to the acupoints, often with a finger. Common uses include applying pressure to the fleshy part of the hand between the thumb and first finger to treat a headache and applying pressure slightly below the inner wrist to treat nausea.

·     Pain education. Pain is multifactorial and the brain is a pain management organ that can increase or decrease our perception of pain. Teaching patients, especially those with chronic or recurrent pain, about central sensitization can have a huge impact on the intensity of their pain.

·     Mind-body techniques. An activated sympathetic nervous system can exacerbate pain, nausea, fatigue, insomnia, and PTSD and negatively impact overall wellbeing. There are multiple mind-body techniques that can calm the stress response and bring the parasympathetic nervous system back online. Examples include guided imagery, diaphragmatic breathing, focusing exercises, prayer, walking in nature, tai chi, qigong, taking a warm bath and many, many more. I suggest that you practice as many techniques as possible, so that you can expertly guide your patients to use them. As a side benefit, your wellbeing will improve!

·     Elimination diet trial. Some people with GI distress, fatigue or “brain fog” have a low-level food sensitivity. There are many elimination diets available online, but the simplest approach is to remove common offenders for 2-4 weeks and see if symptoms improve. If they do, add the foods back one at a time every 4-5 days and see if symptoms return. It can be helpful for the patient to keep a food and symptom diary. Foods to avoid during the elimination diet include, but are not limited to, dairy, wheat, eggs, soy, peanuts, tree nuts, fish/shellfish, sesame and corn. If the patient has a feeling that a particular food might be a problem, eliminate that one too.

·     Aromatherapy. Our sense of smell is powerful and can be used for relaxation and for energy. Incorporating simple aromatherapy into a patient’s wellness routine is easy, safe and can give the patient a sense of control. Some essential oils, such as peppermint, can be activating while others, such as lavender, tend to be calming. Essential oils can be placed on a cotton ball, kept in a sealed container and brought out to inhale deeply at will. You might suggest that the patient take 3-5 slow deep breaths while holding the cotton ball under their nose. This will encourage them to slow their breathing which stimulates the relaxation response. Essential oils can also be placed on the floor of a shower, on a pillowcase or used with a diffuser.

·     Movement. Movement can improve fatigue, anxiety, depression, sleep and overall wellbeing. Some people have a negative association with the word “exercise,” but most people have some kind of movement that they enjoy. A walk outside, dancing in the living room or wrestling with a rambunctious dog all count!

There are many other non-pharmacologic approaches to wellbeing that physicians can incorporate into our patient treatment plans. There is no need to choose between pharmacologic and non-pharmacologic approaches – a bigger toolbox is the best approach.

I’m in your corner,

Delia Chiaramonte, MD

www.integrativepalliative.com

Learn with me! Starting in October 2022, I am offering a physician program in integrative symptom management. Check it out:

https://trainings.integrativepalliative.com/symptom-management-training