A New Model for Managing Pain

March 7, 2022

How physical medicine, integrative therapies & exercise can deliver better outcomes

Article was written by WholeHealth Living

For chronic pain sufferers, exercise seems contraindicated

“Take some ibuprofen and take it easy” is the typical advice from doctors today. With musculoskeletal pain, the urge to limit physical activity seems logical, but studies now show that movement can be an effective form of medicine.

In 1992, Tivity Health® pioneered senior fitness programs for health plans by introducing SilverSneakers. Today, By partnering SilverSneakers® with WholeHealth Living®, Tivity Health has enhanced the impact by incorporating physical medicine, integrative health practitioners, and a broad range of services to promote exercise and socialization. Together these two programs empower their members to access new effective care options over the traditional medicine cabinet filled with over-the-counter drugs, addictive opioids, or even worse, surgery.

According to a National Institute for Drug Abuse (NIDA) report, 1 in 3 Americans used prescription opioids for pain in 2015.1 The report also found nonpharmacological approaches to be more appropriate for the initial treatment of acute and chronic pain management.2 WholeHealth Living offers these nonpharmacological approaches, including acupuncture, chiropractic, massage therapy, naturopathy, and more.

Painkillers come with a high cost

The National Institute for Drug Abuse report entitled “The Impact of the Opioid Crisis on the Healthcare System” details a dramatic increase in opioid usage over the last decade:3

  • From 2007 to 2014, opioid dependence rose by 3,203% among patients privately insured.
  • From 2011 to 2015, privately insured opioid abuse or dependence charges rose from $72 million to $722 million.
  • The maximum amount an insurer will pay for opioid abuse/dependence healthcare services grew over 13-fold during the same period, from $32 million in 2011 to $446 million in 2015.
  • And in 2015, the average annual per-patient chargesand estimated allowed amounts by insurance were more than 5x higher for patients with diagnoses of opioid abuse or dependence than for patients with any diagnosis.

Given the high cost and growing toll from opioids, health plans, patients, and practitioners are now seeking effective ways to help pain sufferers start moving again.

“Exercise improves your pain threshold,” Trent Nessler, PT, DPT, MPT, told WebMD. “With chronic pain, your pain threshold drops. In other words, it takes less pain to make you feel more uncomfortable. With cardiovascular, strengthening, and flexibility exercise, you can improve that pain threshold.”4

Tracey Louise Marinelli’s story illustrates how mind-body therapies can relieve chronic pain. As a young airline worker, Marinelli would come home exhausted from her overnight shift every day. As time went on, her fatigue evolved into chronic debilitating pain. After inconclusive x-rays and multiple tests, the doctors could not diagnose her ailment, but her desperate condition took an increasing toll on her life, including her marriage.5

Ten years into her struggle, a new doctor noticed how she flinched when he touched a tender spot. He diagnosed Marinelli with fibromyalgia and prescribed antidepressants and painkillers.

 “The doctor told me those were my only options for treatment,” Marinelli told Prevention magazine. “But being on strong medication for the rest of my life just didn’t sit well with me.”

After the doctor explained that she might end up in a wheelchair, Marinelli tried yoga with meditation. “The impact was pretty much instant,” she said. “As each week passed, I could tell my body was freeing itself, and I could hold my [yoga] positions for longer without as much discomfort.”

Marinelli now works as a wellness coach. She explained, “These activities have helped me manage the condition to a point where I can pretty much lead a normal life.”

Tracey Marinelli is the exception. Chronic pain sufferers don’t always get past the painkillers, but the problem is broader than prescription opioids. Unfortunately, today the healthcare system faces a crisis in medical pain management because patients and practitioners still expect to fix most pain problems with a drug or procedure.

Primary Care Providers not versed in pain management

Part of the issue stems from patients with complex medical histories and overlapping causes of pain. These presentations place intense time pressure on primary care providers. Rather than addressing the complexities of chronic pain, the constraints of a short office visit naturally result in a quick fix – typically a prescription painkiller.

According to a report from the National Academy of Sciences: “Any meaningful effort to improve pain management will require a basic culture shift in the nation’s approach to mandating pain-related education for all health professionals who provide care to people with pain.”6

Musculoskeletal issues multiply conditions

Musculoskeletal disorders can make other conditions more challenging to live with, multiplying their impact. For example, back or knee pain may limit daily physical activity and aggravate diabetes or heart disease.

“Being inactive will tend to reinforce pain sensitivity pathways,” said Daniel Belavy, a professor of physiotherapy in Bochum, Germany, who studies the effect of movement on chronic pain.7

Jonas Bloch Thorlund, a professor of musculoskeletal health in Denmark, concurs: “International clinical guidelines for most chronic musculoskeletal pain conditions recommend exercise therapy and physical activity as core treatments.”8

Managing pain through exercise results partly from the mind-body connection. According to Dr. Matt Jones, an accredited exercise physiologist, “Today’s evidence suggests chronic low back pain likely comes from the brain and nervous system being a bit over-protective and generating a pain response – despite no obvious physical damage to the body.”9

A new model for managing pain

Policymakers are now advocating a shift toward a more comprehensive, patient-centered, and health-enhancing approach to pain. In the new model, chronic pain is addressed by both pharmacologic and nonpharmacologic approaches. The goal is to empower patients to improve their health and pain-related behaviors.

At the forefront of this movement, Tivity Health is leveraging the synergies of its two leading health enhancement programs:

  • SilverSneakers, the nation’s leading fitness program designed specifically for seniors, and
  • WholeHealth Living, Tivity Health’s national network of physical medicine and integrative health practitioners, including chiropractors, acupuncturists, massage therapists, naturopathic physicians, and other modalities.

Together, the two programs help solve the musculoskeletal pain barriers to movement and get health plan members into a regular exercise and activity plan to get back to the life they love.

“We have found pain to be a significant barrier to physical activity,” said Richard Ashworth, President and CEO of Tivity Health. “With chronic pain, physical activity suffers or ceases altogether. As a result, a host of health conditions proliferate for the member. Our synergistic model uses WholeHealth Living’s Physical Medicine and Integrative Health to relieve pain and encourage health plan members to become increasingly active through SilverSneakers. It’s a cost-effective approach to musculoskeletal conditions.”

Social isolation from pain

Musculoskeletal conditions are the most reported medical condition among those under age 65 and the second most reported among those 65 and older.10

Because of musculoskeletal conditions, millions of people live with pain, avoid physical activity, and find everyday tasks difficult. Musculoskeletal pain also severely impedes the health plan’s member’s ability to engage with others – leading to self-imposed isolation. As a result, pain becomes a risk factor for social determinants of health.

The next steps in pain management

The next generation of medical education needs to incorporate holistic treatments and nonpharmacological options as the first line of care in the education of primary care physicians in addressing pain.

Tivity Health offers that first-line care. Through the partnership of SilverSneakers and WholeHealth Living, Tivity Health offers an integrated pain management approach for health plans that empowers members to restore their health and well-being.

To learn more about WholeHealth Living’s member-centric approach to improving health outcomes while reducing costs, please visit www.wholehealthliving.com.

  1. https://www.drugabuse.gov/news-events/news-releases/2017/07/pain-relief-most-reported-reason-misuse-opioid-pain-relievers
  2. Evidence-Based Nonpharmacologic Strategies for Comprehensive Pain Care: The Consortium Pain Task Force White Paper, EXPLORE, Volume 14, Issue 3, 2018,
  3. AIR Health, The Impact of the Opioid Crisis on the Healthcare System: A Study of Privately Billed Services (September 2016)
  4. https://www.webmd.com/pain-management/features/exercise-relief
  5. https://www.prevention.com/fitness/a20482664/exercise-to-manage-chronic-pain/
  6. https://www.nap.edu/resource/24781/Highlights_071317_Opioids.pdf
  7. https://www.nytimes.com/2021/11/09/well/move/exercise-chronic-pain.html
  8. https://www.nytimes.com/2021/11/09/well/move/exercise-chronic-pain.html
  9. https://newsroom.unsw.edu.au/news/health/exercise-low-back-pain-beneficial-no-one-agrees-why
  10. https://www.acatoday.org/news-publications/national-chiropractic-health-month-take-steps-to-better-musculoskeletal-health/