In this interview we ask Dr. Theresa Oswald, a pain and rehabilitation specialist, about her practice of integrative medicine, and how she is using it to empower her patients.
Q: How does an integrative approach to working with pain differ from a holistic approach? Do you use both?
A: Technically, holistic and integrative medicines are different, and yet they work synergistically. Both tend to empower patients to take an active role in their own healing. Holistic medicine looks at the individual patient as a whole human being (mind, body, spirit, emotions, lifestyle, etc.), not as a disease process or injured part. The holistic approach considers the big picture—how the patient functions and how alternative therapies can help.
Integrative medicine uses all available means—both conventional and alternative therapies—to help with the health and healing of a patient. In some situations, conventional medicine may be the best approach, but in others it may not offer a surefire cure. Adding well-selected alternative or complementary approaches offers greater healing potential. Options for working with pain, for example, may include breathwork, nutrition, herbs, group support, yoga, meditation, and even volunteering. In this sense, integrative medicine is also holistic, because it understands that our body and mind are intertwined. So when I describe my practice as integrative, I am referring to both approaches combined.
Q: How did you become interested in an integrative approach to pain?
A: I became interested in integrative medicine because the treatment options available for patients with pain, particularly persistent pain, were limited in the conventional practice of physical medicine and rehabilitation. Patients would often find no lasting relief from their pain, even though they diligently pursued physical therapy, anti-inflammatory medications, diagnostic and therapeutic injections, opiate-based pain relievers, and surgical consultations. They often felt hopeless and as if they were running out of treatment options.
I practice yoga and meditation to deal with stress and to maintain a level of flexibility and fitness. I noticed that these techniques could also be helpful for my patients. After years of study and clinical application, I knew that the best thing I could do for my patients was to help empower them to take back control of their own wellness and well-being with basic lifestyle interventions.
Q: What kinds of lifestyle changes empower your patients? Can you give some examples?
A: Many patients who suffer from pain have shallow breathing patterns, or even paradoxical breathing patterns—in slow, deep breathing, their abdomen does not rise with inhalation, but actually moves inward. This is an ineffective and problematic way of breathing. It can be very agitating to the nervous system. I take the time to teach them how to breathe properly. I ask them to lie on their back on the exam table and to watch the rise and fall of their belly while breathing. I encourage them to take 5–10 minutes at home to practice this breathing exercise several times a day. If they could see the effects on their physiology using heart-rate monitors and oxygen sensors, they would see that this intervention is very powerful and beneficial.
The next important strategy is a dietary intervention. We know that the standard American diet can be the cause of many ailments, so asking patients to make small changes in their diet is important—for example, reducing processed food and food high in sugar is helpful in reducing inflammation. Increasing the amount of plant-based nutrients, especially those found in vegetables and fruits, is great for healing, too. I also recommend using anti-inflammatory spices like turmeric and ginger.
Now the big powerhouses of health are in place: proper breathing and improved nutrition.
Q: What other strategies have you found helpful?
A: The next thing in basic intervention is a comprehensive relaxation program. Early in my career, I developed and tested a relaxation module with the assistance of a nurse in my clinic. The 60-minute class taught techniques of breath awareness and relaxation, and culminated with a short period of meditation. This program, You Are in Control, was taught once a week for eight weeks. It allowed me to teach relaxation skills to the participants that they could then do at home. The program was quite successful, but an even more powerful outcome surprised us all—the participants did not want the class to end after eight weeks because it was so helpful for them. The healing power of connection—the group effect—was so important that it kept them coming back each week. The class chose to continue for over a year because of the supportive fellowship they found. This was my first experience of the power of the group effect. I’ve incorporated this intervention into many of my treatment plans since then.
Lastly, the healing power of connection is so valuable that I often write a prescription for one of the most potent remedies I can use—volunteer service. Research shows that it really is better to give than to receive, and volunteering at a local food bank or animal shelter actually enhances the volunteer’s healing, both physically and psychologically.
Stay tuned for more insights from Dr. Oswald in the next installment of our “Ask the Expert” series with her.