Naturopathic approaches to managing patients with chronic pain

Wei-Ru Taye

doi:10.25918/thesis.540

Osteoarthritis (OA) is a leading cause of chronic pain, affecting the majority of working-aged Australians. Individuals with OA seek treatment across multiple healthcare disciplines, including complementary and alternative medicine, due to medication side effects or a desire to avoid surgery. Naturopathy is a holistic medical system that emphasises health literacy to empower individuals to modify diet and lifestyle. This thesis explores naturopathic approaches to chronic pain using an empowerment framework across patient, professional, and interprofessional levels. A sequential mixed methods design incorporated four studies. Clinical investigations employed N-of-1 and multiple baseline designs to evaluate individual treatment effects. A qualitative study examined empowerment at the professional level, while a scoping review explored interprofessional collaboration. All studies adhered to internationally recognised reporting guidelines. Study One investigated probiotics to treat OA pain in an N-of-1 trial. The participant rated daily pain using a Visual Analogue Scale, and their mobility through the Patient Specific Functional Scale (PSFS). Study Two used a multiple baseline design to expand on Study One and included palmitoylethanolamide to treat symptoms of low mood, common in individuals with chronic pain. Four participants rated their pain and nominated their own outcomes through the PSFS. Additionally, the Personal Wellbeing Index questionnaire assessed their wellbeing and the DASS-21 questionnaire assessed their emotional state. Study Three explored naturopaths’ perceptions of empowerment through interviews with seven practitioners. Study Four identified barriers and facilitators to naturopathic inclusion in interprofessional teams via a scoping review. Patient-reported outcomes demonstrated that probiotics alone or combined with palmitoylethanolamide may improve pain, mobility, and wellbeing. Study One demonstrated reduced mean pain scores. Study Two indicated three of four participants experienced gains on the Personal Wellbeing Index. Study Three identified themes influencing empowerment: establishing a therapeutic relationship, the therapeutic relationship as a mechanism for transformation, facilitating shared decision-making, and practitioner critical reflection. Study Four highlighted limited interprofessional integration due to industry fragmentation, bias, and lack of support. Limitations include small sample sizes and restricted generalisability in the clinical studies. However as the focus was on individual effects, larger sample sizes were not required. Qualitative findings may also be context-specific due to international regulatory differences. Despite these constraints, the findings offer valuable insights into naturopathic care for chronic pain, including the innovative use of probiotics and palmitoylethanolamide, and the supportive role of the therapeutic relationship. These findings contribute to the evidence base for naturopathy and provide groundwork for future research and collaboration.

Naturopathic approaches to managing patients with chronic pain

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Naturopathic approaches to managing patients with chronic pain

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