Conditions
Chronic pain and inflammation
Persistent pain is a symptom with many possible mechanisms rather than a diagnosis. What I can contribute is investigation of the inflammatory and metabolic contributors, which often go unexamined.
What I can and cannot help with
Where pain has a clear structural cause, that belongs with orthopaedics, rheumatology or a pain specialist, and I will say so.
Where pain is widespread, inflammatory in character, or accompanied by fatigue and cognitive symptoms, there is often more to investigate: inflammatory markers, nutrient status, sleep, metabolic health and gut function.
Contributors that are treatable and often missed
Before anything else, I look for the things that cause or amplify pain and can be corrected. Vitamin D deficiency can cause diffuse bone and muscle aching. An underactive thyroid causes muscle pain and stiffness. Low iron stores, poor sleep and untreated sleep apnoea all lower the pain threshold. Statins occasionally cause muscle symptoms. Joint hypermobility is a common and under-recognised source of widespread pain, particularly in younger women.
In older adults, new shoulder and hip girdle pain and stiffness with raised inflammatory markers can be polymyalgia rheumatica, which needs prompt conventional treatment. Early inflammatory arthritis is another that should not wait. If the history points to either, I will say so and make sure you are seen quickly.
Inflammation as a driver
Chronic low-grade inflammation contributes to pain sensitivity and is measurable and modifiable. Diet, sleep, weight, activity and specific deficiencies all feed into it.
This is unglamorous work and it is generally more effective than the supplement-led approach this area attracts.
What the evidence supports
NICE guidance on chronic pain, published in 2021, distinguishes pain that is secondary to an underlying condition from chronic primary pain, where no condition adequately accounts for it. For chronic primary pain, NICE recommends supervised exercise programmes, psychological therapies such as acceptance and commitment therapy or CBT, and in some cases a course of acupuncture or an antidepressant. It advises against starting opioids, gabapentinoids, benzodiazepines and several other commonly used drugs, because the evidence that they improve quality of life is weak and the harms are real.
That fits how I work. Where pain is secondary, I look for and treat the cause. Where it is primary, the priority is the nervous system and function, with exercise and psychological approaches at the centre, and the inflammatory, metabolic and sleep work alongside rather than instead.
A realistic aim
Long-standing pain is rarely abolished. The realistic aims are less pain, better sleep and more of the life you want to lead, which in practice often matters more than the pain score itself.
I will not offer a single test or supplement as the answer, and I will tell you if I think a pain service, a physiotherapist or a psychologist would help you more than I can.
Common questions
How effective are integrative approaches for long-term chronic pain?
It depends on the approach. Supervised exercise and psychological therapies have the best evidence and are recommended by NICE for chronic primary pain. Finding and correcting contributors such as vitamin D deficiency, thyroid disease or poor sleep can help substantially where they are present. Supplement-led and heavily marketed treatments have much weaker evidence. A good integrative approach combines the first two and is cautious about the third.
Is fibromyalgia real?
Yes. It is a recognised condition in which pain processing in the nervous system is altered. The pain is real, it is not imagined, and there is a good deal that helps, even though a blood test will not show it.
Will you stop my painkillers?
Not on my own. If you are on long-term pain medication, any change is something to plan carefully with your GP or pain team. Where I think a medication is doing more harm than good, I will say so and write to your GP.
Do I need a diagnosis before I come?
No. Many people come with pain that has not been fully explained. If something needs urgent investigation, I will make sure it gets it.
Related
Discuss your case with Dr Greenland
A short discovery call is the usual starting point. It costs nothing, and it is the fastest way to find out whether this approach fits your situation.