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Chronic Pain: In Search of the Underlying Cause, By Emily Telfair, ND

Within my first few weeks of beginning naturopathic medical school at Bastyr University, I was introduced to a core chronic pain emily telfair ND naturopathic principle, Tolle Causam, or “Treat the Underlying Cause.” While the concept seemed to make perfect sense – of course my patients will improve when I treat the root source of their illness – in actual practice, identifying the underlying cause(s) for those with complex and long-standing health concerns proved to be quite challenging. Treating individuals living with chronic pain quickly stretched my learning curve and broadened my understanding of Tolle Causam to include the multifaceted layers of biochemical, environmental and experiential influences that manifest as pain.

Naturopathic Doctors (NDs) are well positioned to serve as “first responders” to the chronic pain epidemic based on our unique medical training which encompasses an understanding of traditional diagnostic methods and pharmacology along with comprehensive training in natural therapeutics such as clinical nutrition, herbal medicine, homeopathy, counseling and physical medicine. Research studies further demonstrate that naturopathic treatments compared to conventional medical treatments show similar or greater pain relief, with an increase of quality of life, and diminished health care costs.[1][2]

Pain is perhaps one of the most deeply personal experiences in medicine which can be all consuming to the mind, body and soul. Descriptors such as “sharp” or “shooting” and 1 – 10 rating scales can often fall short of the impact and emotional toll that chronic pain can have on a person, their family and even our society. If the role of pain is to signal danger and to bring something of importance to our attention, when that signal becomes chronic, it often represents an unresolved stressor to the musculoskeletal, immune, endocrine or nervous system.

When uncovering the roots of chronic pain, a history of trauma is often at the core. The structure of our current healthcare system leaves little room to unpack the complex relationship between chronic pain and the shame, guilt, fear and grief often held in the memory of injured musculoskeletal tissue. A naturopathic approach to supporting and treating individuals living with chronic pain will be as varied and diverse as the origin stories related to their unresolved physical or emotional trauma. A multi-tiered treatment approach that interweaves a compassionate and healing presence with knowledge of the biochemical sequelae of chronic stress has the potential to not only relieve the patient’s current suffering but also to improve resiliency in the face of future stressful events.

Naturopathic Treatment Plan for Chronic Pain:

  1. Calm Inflammation: In the face of chronic stress, the immune system produces pro-inflammatory cytokines which can cause tissue damage and block healing progress. Introducing an anti-inflammatory diet (similar to the Mediterranean Diet), anti-inflammatory herbs such as turmeric and boswellia along with omega-3 fatty acids found in wild, cold-water fish can modulate the immune response in favor of cell mediators that relax the inflammatory cascade.
  2. Balance the HPA Axis: The hypothalamic-pituitary-adrenal axis is particularly sensitive to early impressions of trauma that occur in childhood (Adverse Childhood Events or ACES). Stressors that occur later in life can reawaken those pathways and bathe the body in “fight or flight” hormones such as adrenaline and cortisol. Adaptogenic herbs such as ashwagandha, holy basil, eleutherococcus and cordyceps can help to regulate adrenal health, especially when coupled with relaxation practices such as yoga and daily meditation.
  3. Restore the Spirit: A truly holistic approach to chronic pain will pave a path for the patient to reconnect with his/her sense of purpose in life and self-love. Arriving there may begin with counseling, energetic therapies such as Reiki or cranio-sacral treatments, art therapy or Nature-based therapy.

As providers, our success in supporting individuals living with chronic pain will naturally stem from how we cultivate our own practice of sitting with discomfort. I have often noticed my own impulse to want to “fix it” or “just make the pain go away” with any myriad of the naturopathic tools in my chest. A commitment to self-care as health care providers is vital to improving treatment outcomes for those we serve. When we learn how to sit compassionately with the discomfort and pain within ourselves, our experiences with patients will change as we will be modeling the medicine that we are recommending and transforming the culture of medicine from within.

For more on this topic from Dr. Telfair, watch her presentation at the Congressional Integrative Health and Wellness Caucus in Washington DC.


Dr. Emily Telfair earned her doctorate in naturopathic medicine from Bastyr University and practices in Baltimore, Maryland where she has come to appreciate the deep-acting nature of simple therapies such as mindfulness and cranio-sacral therapy to address complex health concerns. She is past president of the Maryland Naturopathic Doctors Association and led the efforts to pass legislation to license naturopathic doctors in the state in 2014. Now Dr. Telfair serves as chair of the State Alliance Committee through the American Association of Naturopathic Physicians and supports state leaders working towards naturopathic licensure across the country.
[1] Herman PM, Szczurko O, Cooley K, Mills EJ. Cost effectiveness of naturopathic care for chronic low back pain. (2008) Altern Ther Health Med Mar-Apr 14 (2):32-39.
[2] Szczurko O, Cooley K, Mills EJ, Zhou Q, Perri D. Naturopathic treatment of rotator cuff tendinitis among Canadian postal workers: a randomized controlled trial. (2009) Arthritis Rheum 61: 1037-1045.



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