Abstract
Patricia Delzell, MD, President of Advanced Musculoskeletal Medicine Consultants, Inc., in Chagrin Falls, Ohio, has taken a circuitous career path, which has led to her practice of integrative pain medicine. Dr. Delzell first practiced conventionally as a board-certified musculoskeletal radiologist and then attended the Andrew Weil Center for Integrative Medicine Fellowship, Tucson, AZ. Dr. Delzell now combines her expertise specializing in the integrative treatment of chronic musculoskeletal pain. In her practice, she finds that being able to spend more time with patients and using both conventional and complementary tools helps yield the best results for her patients.
At that time, however, I found, that when one sees a lot of patients who have various types of chronic pain, they require a tailored approach. It seemed to me that using needle treatments and injections were more like a band-aid and did not last long for some people. For others it worked well, but for many it did not.
My philosophy is that I want people to actually get better and go live their lives separate from me, so I began thinking about how to make my treatments more effective. That was my first step in beginning to change my practice. I started working more with the physical and occupational therapists, and we conducted research together to develop optimal treatment plans that would actually heal the patients as opposed to just making them feel better. This worked in upwards of 80% of patients. There was still a group of chronic pain patients that needed something more.
At that point I started getting to know the practitioners in the integrative and functional medicine departments at Cleveland Clinic and through the functional forum, practitioners around the world. The concept of whole-body systems treatment became fascinating to me especially within the realm of the integrative approach. I realized that this was what I wanted to pursue and decided to attend the Andrew Weil Center for Integrative Medicine Fellowship, Tucson, AZ. I did that for two years, and it completely changed the way that I treat patients. It was a transformative experience for me.
I continued to work at the Clinic and was the director of musculoskeletal ultrasound there for 10 years. In 2017, I started doing pain consultations. I had a room attached to one of my ultrasound rooms and about twice a month, I would see chronic pain patients and would integrate my expertise with complementary medicine techniques.
There were a lot of services at the Clinic to support my work. For example, there was a chronic pain clinic that conducted group acupuncture and hypnosis in the integrative medicine center, so I could send patients there. The more I did the integrative piece, the more frustrated I became on my conventional medicine days where I was doing a lot of injections but not able to also implement the complementary piece. So, this became somewhat of a conflict of interest for me to do just the traditional piece. I ended up leaving the Clinic at that point and was able to rent space at The Northeast Ohio Institute of Functional Medicine, Center for Hope and Healing in Novelty, Ohio, owned by Dorothy Sprecher, MD one of the functional medicine physicians that I had gotten to know over the years who was mentoring me.
Dorothy and I would, and still do, refer patients to each other. She taught me a lot about functional medicine including the use of supplements, as well as the business aspect of owning and running my own practice. It was a great experience, and the only reason I moved to a different building was because I needed more space. So, in April 2022, I moved to a building where I had my own space, and now we are actually about to expand into the adjacent suite.
I also have a physical therapist who leases space in my office, and we share patients. He and I are expanding together into the adjacent suite. In fact, we are creating an all-purpose room. I do a lot of Traditional Chinese Medicine in my office. I offer acupressure and a Qigong program. The Qigong has been on video, but now I'll have a space where I can offer that in person in the office and some meditation circles as well.
One of the angles is from the conventional medicine standpoint. For instance, what is anatomically wrong, what are the underlying problems that are there. But that is only about a third of what I'm observing.
The second angle is looking at the internal and external environment. Some people label it chronic inflammation, I don't like to use that term, because people think they can take handfuls of Advil, and it will make it go away. So, it is more like their environment or their milieu. This includes looking at the medications they are taking, and investigating if there are deficiencies in minerals and vitamins? What is their lifestyle? How are they sleeping? What is their stress management? What are they eating? What is their physical activity like?
Finally, the third angle centers around the concept of central sensitization, or the mind-body biochemical connection. This can be very strong in some people. For instance, I could diagnose a clear nerve entrapment and after releasing the nerve entrapment, their pain will get worse, even if the procedure is successful. The way that their brain interprets any kind of input is dysfunctional. It is important to be aware and treat all of those imbalances because in and of themselves they can perpetuate pain, regardless of what the underlying anatomic problem is.
Every person that has chronic pain has percentages of all three of those components. When I meet with people and learn about their story, I try to figure out which pieces are most prevalent. When one uses integrative medicine to design a treatment plan it is very specialized to that person. Basically, that is my approach. Without integrating complementary medicine with conventional medicine, one misses out on innumerable tools that can improve the lives of many people.
Within the sessions themselves, at the very first session, I give them an index card, and the purpose of the index card is for them to write down the things that work for them, because I'm going to expose them to a lot of different types of breathing techniques, meditation, and acupressure, etc. I teach them how to utilize these tools, for instance different acupoints that may work for them to bring relief, and they use them at home. Everyone comes to the table with different issues. So, there is not one specific treatment plan that is going to make everybody better, and that is where the collaborative piece becomes important. It is a joint effort.
The other big collaborative piece that I am involved in is something called the Corridor of Care—a group that I helped to initiate. There are five practitioners that provide monthly education to the community. We offer a free round table discussion where we literally sit in a circle with whomever comes from the public, and we talk about a specific topic. The expert group includes myself, a sports medicine expert, a clinical psychologist, an energy healer and a naturopathic doctor. We each discuss how we would approach the particular topic on the agenda for that month as well as how we work together collaboratively to help patients along their healing journey. This makes the patient's journey more robust and more successful toward getting them where they want to be.
One patient in particular just wanted to go to the hairdresser and sit and get her hair done and be able to work again. She was working from her bed. After she saw me for about nine months to a year, she is now driving and doing all of the things that she wanted to do and traveling back to work. She is doing phenomenally well. Spending time listening to people helps to validate their experience and then helps me to give them the right tools to optimize their mind, body and soul to heal.
One of the great things about ultrasound is that I can show the patients their soft tissues and how they are functioning. This helps for instance if the patient feels like their muscle is severely damaged and tearing whenever they move. When they see that the muscle is normal and contracting well, it gives them the confidence to exercise and move, knowing now that they are not hurting themselves. This is very helpful because sometimes this realization transforms their journey. It takes a long time because they have been programmed to think a certain way, but it definitely causes a shift.
Integrative care just increases the quality of healthcare. I see a large proportion of elderly patients whose complaints are often completely dismissed by clinicians just because of their age. That's not the right approach for people. I have 90-year-old men in my office who now meditate. It's amazing, and their lives are changed.
I also see people who are total naysayers. They just want someone to do something to make them better, and it takes a long time to turn them around. But I eventually convince them to do the mind-body program, for example, and see how it works. Literally, there are counselors who will call me and say, “I don't know what you did, but they are so much better.” It is because when they go into the mind body program, they have to let go of this anatomic mindset that “this body part is hurting me, and someone needs to do something with this body part to make it better.” One experiences a complete shift in this mindset, which changes people's lives. But, again, it is not a quick fix. The other thing is that we live in an age of instant gratification. Everything is supposed to be easy, and the work I do with people is not quick or easy. For some people it can be all about lifestyle change which happens slowly over time.▪
To Contact Dr. Patricia Delzell
Patricia Delzell, MD
President, Advanced Musculoskeletal Medicine Consultants, Inc.
Chagrin Falls, Ohio, USA
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