Although many nonpharmacologic treatments are effective for managing chronic pain, both providers and patients face challenges in recognizing alternatives to injection or opioids, especially early in care episodes. To address this area of need, Duke has worked to increase the research associated with the routine delivery of nonpharmacologic care as initial treatment for back and neck pain, offering pain management options that cater to the whole patient.

In an August 2021 review published in Translational Research, Duke researchers summarized recommendations from clinical practice guidelines regarding nonpharmacologic treatments for back and neck pain and identified barriers to their delivery, including cultural, access, and financial challenges. Trevor A. Lentz, PT, PhD, MPH, a musculoskeletal researcher in the Department of Orthopaedic Surgery and Duke Clinical Research Institute and a co-author, says using complimentary integrative approaches is an integral step to reducing the impact of opioid use and misuse among people with chronic pain.

“At Duke, we are part of a paradigm shift in the way that care for pain is normally delivered,” Lentz explains. Instead of automatically starting with pharmacologic management of musculoskeletal conditions, Duke’s care models emphasize nonsurgical, noninterventional, nonpharmacologic approaches as frontline care options. But if a patient fails to respond to the initial treatment, “you would then consider pharmacologic or interventional care, and finally surgical treatment as a last resort.”

Lentz highlights several of Duke’s integrative pain management program offerings, including:

• The Duke Integrative Medicine Center, which incorporates psychotherapy, nutrition, yoga, acupuncture, and/or massage therapy into a patient’s treatment plan (led by Susan P. Blackford, MD)
• The Duke Joint Health Program, a condition-based care program that promotes physical therapy and cognitive behavioral therapy (CBT) as treatment for osteoarthritis of the hip and knee (led by William A. Jiranek, MD, FACS and Richard C. Mather, MD, MBA)
• The Duke Spine Health Program, a multidisciplinary collaborative care model focused on enhancing access to and use of non-pharmacologic options and self-care as frontline treatments for back and neck pain (led by Christine Goertz, DC, PhD)

Providers don't always recognize the full range of treatments that can be used for effective musculoskeletal pain relief, Lentz says, meaning that patients aren’t always offered nonpharmacologic care options. “But research shows that more patients are open to nonsurgical, nonpharmacologic treatments than many providers may realize.”

Lentz offers several approaches for incorporating more minimally invasive options for patients with chronic pain:

• Recognize the available options in your area. These may include acupuncture, chiropractic care, physical therapy, yoga, or CBT.
• Identify resources in your community. Start by developing relationships with integrative health care providers (e.g., local behavioral health providers and physical therapists trained in CBT) and learning more about what these different providers can offer your patients. Duke Integrative Medicine providers are also a resource.
• Talk with your patients about these options. Help them understand what it means to be referred to physical therapy, chiropractic care, or acupuncture and the potential benefits their services can offer.