Opioid addiction has been making headlines across the nation since October 26, 2017, when it was declared a public health emergency.1 Since then, numerous states have passed legislation that impose some limit or guideline on prescribing opioids in an effort to reduce the hundreds of Americans who die every day from overdoses.1
Yet despite these drastic efforts, and despite research that has shown that the extended prescription of opioids for the treatment of chronic pain has questionable benefits,2 opioids are regularly prescribed for a wide range of pain conditions. Over 1.5 billion people suffer from chronic pain worldwide.3 If patients are denied access to opioids even further, will we add to the burden of suffering? What are the alternatives? Functional Medicine offers an integrative approach.
“Our objectives are to recognize the process of how centralized pain syndromes develop, to recall the key metabolic factors that influence chronic pain states, and to apply the Functional Medicine Timeline and Matrix in the assessment and treatment of these syndromes.”
— FM Educator Lisa Portera-Perry, DC.
Specifically, Dr. Portera-Perry encourages clinicians to understand the relationship between mitochondrial function and chronic pain.
Mitochondria have a variety of essential functions within neurons, including oxygen consumption, ATP generation, calcium buffering, and reactive oxygen species generation.4 Studies have shown that the five major mitochondrial functions (the mitochondrial energy generating system, reactive oxygen species generation, mitochondrial permeability transition pore, apoptotic pathways, and intracellular calcium mobilization) may play critical roles in neuropathic and inflammatory pain.5
Although this area of pain research is relatively new, mitochondrial dysfunction has been confirmed in both chronic pain patients and in animal models of chronic pain.4 Substantial data have demonstrated mitochondrial involvement in painful peripheral neuropathies evoked by chemotherapy, diabetes, and HIV.4 For some patients, treating mitochondrial dysfunction may be a promising strategy to alleviate or prevent chronic pain states.5
Mitochondria produce 95% of cellular energy and play a critical role in protecting the cell from oxidative stress. Lifestyle and environmental stressors can alter mitochondrial function and cause the onset of disease processes within the body. As a first step in enhancing mitochondrial stability, the Functional Medicine model educates patients about the Mitochondrial Food Plan, an anti-inflammatory, low-glycemic, gluten-free, low-grain, high-quality fats approach to eating. The plan, which was developed through the combined efforts of a team consisting of Functional Medicine physicians, leading experts, and nutrition professionals, focuses on supporting healthy mitochondria with therapeutic foods that improve energy production.
“No two pain patients are the same; every pain patient has a unique underpinning—a unique pattern of neurological and mitochondrial change, so we want to widen our lens and broaden our thinking.” says Dr. Portera-Perry about personalizing care for patients with chronic pain.
Pain unravels in many layers.
To learn more about how mitochondrial function affects patients with chronic pain, migraines, cognitive dysfunction, and more, consider IFM’s Energy Advanced Practice Module.
- Opioid overdose crisis. National Institute on Drug Abuse. https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis. Updated February 2018. Accessed February 11, 2018.
- Chou R, Turner J, Devine EB, et al. The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a National Institutes of Health Pathways to Prevention Workshop. Ann Intern Med. 2015;162(4):276-286. doi:10.7326/M14-2559.
- AAPM Facts and Figures on Pain. American Academy of Pain Medicine. http://www.painmed.org/PatientCenter/Facts_on_Pain.aspx. Accessed February 11, 2018.
- Flatters SJ. The contribution of mitochondria to sensory processing and pain. Prog Mol Biol Transl Sci. 2015;131:119-146. doi:10.1016/bs.pmbts.2014.12.004.
- Sui BD, Xu TQ, Liu JW, et al. Understanding the role of mitochondria in the pathogenesis of chronic pain. Postgrad Med J. 2013;89(1058):709-714. doi:10.1136/postgradmedj-2012-131068.
What is the role of stress in increasing the risk of chronic pain and maladaptive behaviors such as addiction? How can primary care clinicians help patients manage present-day anxiety and unravel the stressful patterns of childhood? Functional Medicine teaches clinicians how to help patients develop healthy coping mechanisms through lifestyle modifications like exercise, meditation, an anti-inflammatory diet, and more. This therapeutic relationship has the potential to change the trajectory of pain and addiction in a patient’s life.Read More
In this free Grand Rounds presentation recorded at Cleveland Clinic Center for Functional Medicine, Henri Roca, MD, elaborates upon the group visit framework used at the Veterans Administration for chronic pain.Read More