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Clinical Approach Solutions to Manage Opioid Use Disorder


Unveil the clinical approach to opioid use disorder and learn about evidence-based methods for effective treatment.

Overcoming Barriers in Managing Opioid Use Disorder: Strategies for Effective Care

A lot of people today have opioid use disorder (OUD), which is a serious health problem. It falls under the larger group of substance use disorders (SUD). Treating OUD can be difficult because everyone has their own set of problems, like pain or other health issues. Doctors and other healthcare professionals must make plans that are specific to each patient. They also need to stay up to date on laws, ethics, and ways to protect patient information. The Health Insurance Portability and Accountability Act (HIPAA) of 1996 covers all patients, but those getting treatment for drug or alcohol abuse have to follow more rules.

In this tutorial, we talk about how to get around problems with OUD administration. We look at stigma, team-based approaches, ways to talk to patients, treatment that puts the patient first, and legal issues. Health care workers can help patients get better by using these methods. Keywords like “opioid use disorder management,” “overcoming stigma in OUD,” and “patient-centered care for SUD” highlight important ideas to help people understand better and find what they’re looking for.

Learning Objectives

  • Explain treatment planning methods that use patient-focused choices and proven ways to talk.
  • Name the three kinds of stigma and how they affect people with mental health issues, SUD, and especially OUD.
  • Talk about legal, ethical, and privacy concerns in caring for people with OUD.

Effective Treatment Planning with Patient-Centered Decisions

People with complex issues, like mental health problems, SUD, and pain, need special care. Each person shows up differently, so health systems are now focusing on care that puts the patient first.

Patient-centered care means building teams with doctors, patients, and families. They work together to plan, give, and check health care. This way ensures the patient’s needs are met, and their wishes, likes, and family situations are respected. It focuses on shared choices about treatments while seeing the patient as a whole person in their daily life (Dwamena et al., 2012; Bokhour et al., 2018).

Studies show key steps for a good patient-centered plan:

  • Take a full patient history and a check-up, reviewing old and new treatments.
  • Find all available drug and non-drug options.
  • Check the patient’s current health, recent changes, and patterns.
  • Look at risks for misusing or abusing opioids.

If starting opioids or if the patient is already on them, think about opioid stewardship. This means checking harms, benefits, risks, side effects, pain control, daily function, drug tests, stop plans, and ways to spot OUD. These programs, sometimes called analgesia stewardship, help manage opioids safely (Harle et al., 2019; Coffin et al., 2022). Guides exist to set them up (American Hospital Association, n.d.; Shrestha et al., 2023).

Integrative chiropractic care can play a big role here. It uses spinal adjustments and targeted exercises to get proper spinal alignment. This helps reduce pain without relying only on drugs, making it a good fit for OUD patients with pain. For example, adjustments fix spine issues that cause pain, and exercises strengthen muscles to keep alignment right.

A Nurse Practitioner (NP) adds full management and ergonomic advice. They look at work setups to prevent pain, such as how to sit or lift. NPs coordinate care by reviewing options such as therapy, meds, and lifestyle changes, ensuring everything works together.

Dr. Alexander Jimenez, DC, APRN, FNP-BC, with over 30 years in chiropractic and as a family nurse practitioner, observes that blending these methods cuts opioid use. At his El Paso clinic, he uses functional medicine to address root causes through nutrition and non-invasive treatments. He notes that poor posture from modern life worsens pain, leading to OUD risks. His teams help patients with self-massage and VR for recovery, reducing drug needs (Jimenez, n.d.a; Jimenez, n.d.b).

Evidence-Based Ways to Communicate

Good talking skills are key to building a patient-centered plan (Schaefer & Block, 2009). There are proven methods for starting conversations and getting patients involved.

One method is BATHE:

  • Background: Ask, “How have things been since your last visit?”
  • Affect: Ask, “How does this make you feel?”
  • Trouble: Ask, “What bothers you most?”
  • Handling: Ask, “How are you coping?”
  • Empathy: Say, “That sounds hard.”

This uses open questions to let patients lead and feel supported (Stuart & Lieberman, 2018; Thomas et al., 2019).

Another is GREAT:

  • Greetings/Goals: Start with hello and set aims.
  • Rapport: Build trust.
  • Evaluation/Expectation/Examination/Explanation: Check and explain.
  • Ask/Answer/Acknowledge: Listen and respond.
  • Tacit agreement/Thanks: Agree and thank.

This guide talks well (Brindley et al., 2014).

Motivational interviewing is also useful. It’s a team-style talk to boost a patient’s desire to change. Build a bond, focus on the issue, spark a desire for change, and plan steps (Frost et al., 2018).

These methods emphasize listening, clear communication, and a structured approach to planning. For OUD patients with pain or mental issues, mix techniques for the best results.

Dr. Jimenez shares that in his practice, these talks help patients see non-drug options, such as chiropractic adjustments. He finds that empathy reduces stigma and fear, encouraging openness about OUD (Jimenez, n.d.a).

Understanding Stigma in Mental Health and Substance Use Disorders

Stigma blocks good talk for many with mental health or SUD. It’s attitudes, beliefs, actions, and systems that lead to unfair views and bad treatment (Cheetham et al., 2022).

Studies show stigmas like linking mental illness to violence (Perry, 2011). Media on shootings with mentally ill people strengthens this (McGinty et al., 2014; McGinty et al., 2016; Schomerus et al., 2022). For SUD, people think they’re more dangerous than those with schizophrenia or depression (Schomerus et al., 2011). Society blames people with SUDs more and avoids them (McGinty et al., 2015; Corrigan et al., 2012).

Views come from knowledge, contact with affected people, and the media. Public ideas are tied to norms on causes, blame, and danger. Race, ethnicity, and culture shape attitudes too (Giacco et al., 2014).

Health workers have biases. A survey of VA mental health providers showed awareness of race issues but avoidance of talks, using codes like “urban,” and thinking training stops racism (McMaster et al., 2021).

There are three stigma types:

  • Structural Stigma: The ways Society and institutions keep prejudice. In health, it’s worse care, less access to behavioral health. Less funding for mental vs. physical issues (National Academies of Sciences, Engineering, and Medicine, 2016).
  • Public Stigma: General or group attitudes, like police or church norms. Laws reinforce it, like broad mental illness rules implying all are unfit (Corrigan & Shapiro, 2010).
  • Self-Stigma: When people internalize stigmas, it leads to low self-worth and shame. “Why try” affects independent living (Corrigan et al., 2009; Clement et al., 2015).

Dr. Jimenez observes that stigma makes OUD patients hide symptoms, delaying care. In his integrative work, he addresses this through education on holistic options, showing that recovery is possible without judgment (Jimenez, n.d.b).

Overcoming Stigma and Addressing Social Factors

To fight stigma, use education, behavior changes, and better care. Laws like the ADA and MHPAEA help ensure equal coverage and prevent discrimination (U.S. Congress, 2009; U.S. Congress, 2008; U.S. Department of Health and Human Services, n.d.; Busch & Barry, 2008; Haffajee et al., 2019).

These address social determinants of health (SDOH), such as coverage, access, quality, education, and stability (Centers for Disease Control and Prevention, n.d.).

Community programs help too:

  • West Virginia’s Jobs and Hope: Training, jobs, education, transport, skills, record clearing for SUD people (Jobs and Hope, n.d.).
  • Belden’s Pathway: Rehab for failed drug tests, leading to jobs (Belden, n.d.).

Education boosts provider confidence in OUD meds, reducing barriers (Adzrago et al., 2022; Hooker et al., 2023; Campbell et al., 2021).

Overcoming stigma is key to success in mental health and SUD.

Interprofessional Team Work

Teams improve outcomes for patients with chronic pain and mental health or SUD (Joypaul et al., 2019; Gauthier et al., 2019).

Teams include doctors, nurses, NPs, pharmacists, PAs, social workers, PTs, therapists, SUD experts, and case managers.

Each helps uniquely:

  • Pharmacists watch meds, spot interactions.
  • Case managers link specialists, find resources, and support families (Sortedahl et al., 2018).
  • Teams set goals, max non-opioid treatments (Liossi et al., 2019).

Integrative chiropractic care includes adjustments and exercises for alignment, easing pain naturally.

NPs give full care, ergonomic tips to avoid pain triggers, and coordinate options.

Dr. Jimenez’s clinic shows this. As a DC and FNP-BC, he leads teams with therapists, nutritionists, and coaches. He observes interprofessional work cuts opioid use by addressing the roots with functional medicine, VR, and nutrition. For OUD, he blends chiropractic care for pain, NP coordination for plans, and stigma-fighting through team support (Jimenez, n.d.a; Jimenez, n.d.b).

The Power of Chiropractic Care in Injury Rehabilitation-Video

Legal and Ethical Issues in SUD Care

Providers must know laws and ethics for mental/SUD patients, like discrimination, aid, and privacy (Center for Substance Abuse Treatment, 2000).

Key Federal laws:

  • Americans with Disabilities Act (ADA) of 1990.
  • Rehabilitation Act of 1973.
  • Workforce Investment Act of 1998.
  • Drug-Free Workplace Act of 1988.

ADA and Rehabilitation ban discrimination in government and in business services like hotels, shops, and hospitals. Protect those with impairments limiting life activities (U.S. Department of Health and Human Services, n.d.).

Provisions:

  • Protect “qualified” people who meet the requirements.
  • Reasonable accommodations for jobs.
  • No hire/retain if there is a direct threat.
  • No denial of benefits, access, or jobs in funded places.

For SUD: Alcohol users are protected if qualified, no threat. Ex-drug users in rehab are the same. Current illegal drug users are protected for health/rehab, not others. Programs can deny if used during.

Workforce Act centralizes job programs; no refusal to SUD people (U.S. Congress, 1998).

Drug-Free Act requires drug-free policies for federal funds/contracts: statements, awareness, actions on violations (U.S. Code, n.d.).

States have their own laws; check the local laws.

Public Aid laws:

  • Contract with America Act (1996): No SSI/DI if SUD key factor (U.S. Congress, 1996).
  • Adoption Act (1997): 15-month foster reunification limit (U.S. Congress, 1997).
  • Personal Responsibility Act (1996): Work after 2 years of aid, drug screens (U.S. Department of Health and Human Services, 1996).

These push work, sobriety.

Dr. Jimenez notes that legal awareness helps his practice by ensuring holistic plans comply and by reducing OUD risks through a non-drug focus (Jimenez, n.d.a).

Keeping Patient Info Private

Privacy is vital. Laws include:

  • HIPAA (1996): Protects PHI, sets use/disclosure rules (U.S. Department of Health and Human Services, n.d.).
  • 42 CFR Part 2: Extra for SUD records. No disclosure of name or status without consent. Fines for breaks. Applies to federal-aided programs (Substance Abuse and Mental Health Services Administration, n.d.).

Consent needs: program name, receiver, patient name, purpose, info type, revoke note, expire date, signature, and date.

This fights discrimination fears, encouraging treatment (Center for Substance Abuse Treatment, 2000).

Wrapping Up

As we deal with the ongoing problems of opioid use disorder (OUD), it’s clear that the best way to handle them is through a multi-faceted approach that puts the health of the patient first instead of quick fixes. Healthcare providers are essential to changing lives. They do this by supporting patient-centered decision-making and evidence-based communication, and by breaking down the three types of stigma—structural, public, and self—that make it harder for people to get better. Legal and ethical frameworks, such as HIPAA and 42 CFR Part 2 privacy protections, make sure that people who need help can get it without worrying about being treated unfairly. Interprofessional teams also help make sure that everyone receives the care they need.

Chiropractic care, which focuses on spinal adjustments and specific exercises to help with proper alignment, is a non-invasive way to ease pain and cut down on the need for opioids. Nurse Practitioners (NPs) improve this by offering comprehensive care, ergonomic advice to avoid injury, and the coordination of various treatment options, including therapy and lifestyle changes. Dr. Alexander Jimenez, DC, APRN, FNP-BC, stresses in his clinical practice that these integrative methods not only help with physical symptoms but also give patients the tools they need to make educated decisions and follow personalized plans. This leads to long-term recovery and less use of opioids (Jimenez, n.d.a; Jimenez, n.d.b).

Recent developments in OUD treatment as of 2025 indicate a transition towards more individualized and accessible alternatives. For example:

  • FDA-approved drugs like methadone, buprenorphine, and naltrexone are still the mainstays of treatment for OUD. They help reduce cravings and withdrawal symptoms while also assisting people to stay stable over the long term.
  • Precision medicine goes beyond one-size-fits-all approaches by tailoring treatments to each person’s genetic, psychological, and social factors. This should lead to better results.
  • New Guideline: The World Health Organization’s 2025 updates emphasize the importance of psychosocial support alongside drug treatments. They also focus on preventing overdoses in the community and making care more widely available.
  • Declining Trends: The number of deaths involving opioids dropped for the first time in 2023 since 2018, which is a good sign that ongoing efforts in policy, education, and treatment are having an effect.

We can create a future where OUD is not a life sentence but a condition that can be managed by combining these new ideas with reducing stigma and working together to care for people. Healthcare professionals, communities, and policymakers must continue to push for fair access to care so that everyone gets the compassionate, evidence-based help they need. In the end, overcoming the obstacles to managing OUD isn’t just about treatment; it’s also about restoring hope, respect, and a better quality of life.

References

Pain Management Explained for Opioid Therapy in a Clinical Approach


Understand the role of opioid therapy in a clinical approach to pain management and its impact on treatment strategies.

Key Points on Safe Pain Management with Opioids

  • Pain Affects Many People: Research suggests that about 100 million adults in the U.S. deal with pain, and this number might grow due to aging, more health issues like diabetes, and better survival from injuries. It’s important to address pain early to prevent it from becoming long-term (Institute of Medicine, 2011).
  • Non-Opioid Options First: Evidence leans toward starting with treatments like exercise, therapy, or over-the-counter meds before opioids, as they can be just as effective for common pains like backaches or headaches, with fewer risks (National Academies of Sciences, Engineering, and Medicine, 2019).
  • Team-Based Care Works Best: Studies show teams of doctors, nurses, and therapists can improve pain relief and daily life, though results vary. This approach seems likely to help more than solo care, especially for ongoing pain (Gauthier et al., 2019).
  • Opioids When Needed, But Carefully: Guidelines recommend low doses, short times, and regular check-ins to balance relief with risks like addiction. It’s complex, so talk openly with your doctor (Centers for Disease Control and Prevention, 2022).
  • Alternatives Like Chiropractic and NP Support: Integrative methods, such as chiropractic adjustments for spine alignment and ergonomic tips from nurse practitioners, can reduce reliance on meds. Clinical observations from experts like Dr. Alexander Jimenez highlight non-invasive approaches to managing pain effectively.

Understanding Pain Types

Pain can be short-term (acute), medium-term (subacute), or long-lasting (chronic). Acute pain often lasts less than three months and comes from injuries. If not treated well, it might turn chronic, affecting daily activities. Always respect someone’s pain experience—it’s personal and influenced by life factors (Raja et al., 2020).

Assessing Pain Simply

Doctors use tools like questions about when pain started, what makes it worse, and how it feels. Scales help rate it, from numbers (0-10) to faces showing discomfort. For kids or elders, special tools watch for signs like faster heartbeats (Wong-Baker FACES Foundation, 2022).

Treatment Basics

Start with non-drug options like rest, ice, or physical therapy. For chronic pain, meds like acetaminophen or therapies like yoga help. Opioids are for severe cases but come with risks—use them wisely (Agency for Healthcare Research and Quality, n.d.).

Role of Experts

According to clinical observations by Dr. Alexander Jimenez, DC, APRN, FNP-BC, who runs a multidisciplinary practice in El Paso, Texas (https://dralexjimenez.com/), combining chiropractic care with exercises targets root causes, such as misaligned spines, reducing opioid needs. As a nurse practitioner, he coordinates care and offers ergonomic advice to prevent pain from daily habits (LinkedIn Profile).


Comprehensive Guide to Safe and Effective Pain Management Using Opioid Therapy

Pain is a common problem that affects millions of people and can affect everything from work to hobbies. It’s important to find safe ways to deal with pain, whether it’s coming from an injury that happened suddenly or one that keeps coming back. This detailed guide goes over how to assess pain, the different treatment options available, and how to use opioids safely. We’ll talk about alternatives to opioids, team-based care, and advice from experts like Dr. Alexander Jimenez, who stresses the importance of a whole-person approach. There are words like “pain management strategies,” “opioid therapy guidelines,” and “non-opioid pain relief” that are mixed in to help you find good information online.

Introduction to Pain in America

The Institute of Medicine estimates that around 100 million American adults face acute or chronic pain daily. This number is expected to climb due to an aging population, rising rates of conditions like diabetes, heart disease, arthritis, and cancer, plus better survival from serious injuries and more surgeries that can lead to post-op pain (Institute of Medicine, 2011).

As people learn more about pain relief options and gain better access through laws like the Affordable Care Act (ACA), more folks—especially older ones—seek help. Passed in 2010, the ACA requires insurers to cover essential pain management benefits, including prescription drugs, chronic disease care, mental health support, and emergency services (111th Congress, 2009-2010). To use these effectively, healthcare providers need a solid grasp of pain assessment, classification, and treatment.

What Is Pain?

The International Association for the Study of Pain defines it as an unpleasant feeling associated with real or potential tissue damage. It’s subjective, shaped by biology, emotions, and social life. People learn about pain through experiences—some seek help right away, others try home remedies first. Respect their stories (Raja et al., 2020).

Pain falls into three main types, though definitions overlap:

  • Acute Pain: Lasts less than 3 months, or 1 day to 12 weeks; often limits daily activities for a month or less.
  • Subacute Pain: Sometimes seen as part of acute, or separate; lasts 1-3 months, or 6-12 weeks.
  • Chronic Pain: Persists over 3 months, or limits activities for more than 12 weeks (Banerjee & Argáez, 2019).

Poorly managed short-term pain can become chronic, so early action is important (Marin et al., 2017).

Assessing Pain Thoroughly

Pain is complex, influenced by body, mind, and environment. A full check includes history, physical exam, pain details, other health issues, and mental states like anxiety.

Basic pain evaluation covers:

  • When it started (date/time).
  • What caused it (injury?).
  • How does it feel (sharp, dull?)?
  • How bad it is.
  • Where is it?
  • How long does it last?
  • What worsens it (moving?).
  • What helps it?
  • Related signs (swelling?).
  • Impact on daily life.

Mnemonics help remember these. Here’s a table comparing common ones:

MnemonicBreakdown
COLDERRACharacteristics, Onset, Location, Duration, Exacerbation, Radiation, Relief, Associated signs
OLDCARTOnset, Location, Duration, Characterization, Aggravating factors, Radiation, Treatment
PQRSTProvoked, Quality, Region/Radiation, Severity, Timing

Pain scales provide information but aren’t diagnoses because they’re subjective. Single-dimensional ones focus on intensity:

  • Verbal: Mild, moderate, severe.
  • Numeric: 0 (none) to 10 (worst).
  • Visual: Like Wong-Baker FACES®, using faces for kids, adults, or those with barriers (Wong-Baker FACES Foundation, 2022). An emoji version works for surgery patients (Li et al., 2023).

Multi-dimensional scales check intensity plus life impact. The McGill Pain Questionnaire uses words like “dull” to rate sensory, emotional, and overall effects; shorter versions exist (Melzack, 1975; Main, 2016). For nerve pain, PainDETECT helps (König et al., 2021). Brief Pain Inventory scores severity and interference with mood/life (Poquet & Lin, 2016).

For babies, watch heart rate, oxygen, and breathing. Tools like CRIES rate crying, oxygen need, vitals, expression, sleep (Castagno et al., 2022). FLACC for ages 2 months-7 years checks face, legs, activity, cry, consolability (Crellin et al., 2015). Older kids use Varni-Thompson or draw pain maps (Sawyer et al., 2004; Jacob et al., 2014).

Elders face barriers like hearing loss or dementia. PAINAD assesses breathing, sounds, face, body, and consolability on a 0-10 scale (Malara et al., 2016).

The Joint Commission sets standards across various settings, which affect tool choice (The Joint Commission, n.d.).

Building Treatment Plans

Plans depend on pain type, cause, severity, and patient traits. For acute: meds, distraction, psych therapies, rest, heat/ice, massage, activity, meditation, stimulation, blocks, injections (National Academies of Sciences, Engineering, and Medicine, 2019).

Re-check ongoing acute pain to avoid chronic shift. Goals: control pain, prevent long-term opioids. Barriers: access to docs/pharmacies, costs, follow-ups.

For chronic: meds, anesthesia, surgery, psych, rehab, CAM. Non-opioids include:

  • Oral Meds:
    • Acetaminophen.
    • NSAIDs (celecoxib, etc.).
    • Antidepressants (SNRIs like duloxetine; TCAs like amitriptyline).
    • Anticonvulsants (gabapentin, etc.).
    • Muscle relaxers (cyclobenzaprine).
    • Memantine.
  • Topical: Diclofenac, capsaicin, lidocaine.
  • Cannabis: Medical (inhaled/oral/topical); phytocannabinoids (THC/CBD); synthetics (dronabinol) (Agency for Healthcare Research and Quality, n.d.).

Opioid use has risen, raising concerns (National Academies of Sciences, Engineering, and Medicine, 2019).

Key plan elements:

  • Quick recognition/treatment.
  • Address barriers.
  • Involve patients/families.
  • Reassess/adjust.
  • Coordinate transitions.
  • Monitor processes/outcomes.
  • Assess outpatient failure risk.
  • Check opioid misuse (Wells et al., 2008; Society of Hospital Medicine, n.d.).

Team Approach to Pain

Studies support the use of interprofessional teams for better results (Gauthier et al., 2019). Teams include docs, nurses, NPs, pharmacists, PAs, social workers, PTs, behavioral therapists, and abuse experts.

A 2017 report showed that teams improved pain/function from baseline, though not always compared with controls (Banerjee & Argáez, 2017). A meta-analysis found that teams were better at reducing pain after 1 month and sustained benefits at 12 months (Liossi et al., 2019).

Integrative chiropractic care fits here. It involves spinal adjustments—gentle manipulations to correct misalignments—and targeted exercises, such as core strengthening, to maintain alignment and reduce pressure on nerves/muscles. Dr. Alexander Jimenez observes that this helps sciatica/back pain without opioids, using tools like decompression (dralexjimenez.com).

Nurse Practitioners (NPs) provide comprehensive management, including ergonomic advice (e.g., better sitting postures) to prevent strain. They coordinate by reviewing options, referring to specialists, and overseeing plans, as seen in Dr. Jimenez’s practice, where his FNP-BC role includes telemedicine for holistic care (LinkedIn, n.d.).


Beyond Adjustments: Chiropractic and Integrative Healthcare- Video


Managing Opioids Safely

CDC’s 2022 guidelines cover starting opioids, dosing, duration, and risks (Centers for Disease Control and Prevention, 2022).

1. Starting Opioids:

Maximize non-opioids first—they match opioids for many acute pains (back, neck, etc.). Discuss benefits/risks (Recommendation 1, Category B, Type 3).

Evaluate/confirm diagnosis. Non-drug examples:

  • Back: Exercise, PT.
  • Low back: Psych, manipulation, laser, massage, yoga, acupuncture.
  • Knee OA: Exercise, weight loss.
  • Hip OA: Exercise, manuals.
  • Neck: Yoga, massage, acupuncture.
  • Fibromyalgia: Exercise, CBT, massage, tai chi.
  • Tension headache: Manipulation.

Review labels, use the lowest dose/shortest time. Set goals, exit strategy. For ongoing, optimize non-opioids (Recommendation 2, A, 2).

2. Choosing/Dosing Opioids:

Immediate-release (hydromorphone, etc.) over ER/LA (methadone, etc.). Studies show no edge for ER/LA; avoid for acute/intermittent (Recommendation 3, A, 4).

No rigid thresholds—guideposts. Risks rise with dose; avoid high if benefits dim (Recommendation 4, A, 3).

Taper slowly to avoid withdrawal (anxiety, etc.). Collaborate on plans; use Teams. If there is disagreement, empathize and avoid abandonment (Recommendation 5, B, 4).

3. Duration/Follow-Up:

For acute, prescribe just enough—often 3 days or less. Evaluate every 2 weeks. Taper if used for days. Avoid unintended long-term (Recommendation 6, A, 4).

Follow-up 1-4 weeks after start/escalation; closer for high-risk (Recommendation 7, A, 4).

4. Risks/Harms:

Screen for SUD/OUD. Offer naloxone for overdose risk (Recommendation 8, A, 4).

Check PDMPs for scripts/combos (Recommendation 9, B, 4).

Toxicology tests are performed annually to assess interactions (Recommendation 10, B, 4).

Caution with benzodiazepines (Recommendation 11, B, 3).

For OUD, use DSM-5 (2+ criteria/year); offer meds like buprenorphine (Recommendation 12, A, 1) (Hasin et al., 2013; American Psychiatric Association, 2013).

OUD signs: Larger amounts, failed cuts, time spent, cravings, role failures, social issues, activity loss, hazardous use, continued despite problems, tolerance, withdrawal.

Treatment: Meds, counseling, groups. Coordinate with specialists.

Conclusion

In conclusion, you don’t have to rely only on opioids to manage pain well. We can help millions of people live better lives by putting non-opioid options first, like acetaminophen, physical therapy, or mindfulness, and only using opioids when necessary and with close monitoring. Doctors, nurses, pharmacists, and specialists like chiropractors work together in teams to make plans that are right for each person. This lowers the risk of things like addiction. Integrative chiropractic care, which focuses on spinal adjustments and specific exercises, is a big part of getting your body back in line and relieving pain naturally, which often means you don’t need to take medicine. Nurse practitioners are valuable because they provide comprehensive management, ergonomic advice to prevent problems, and coordination of treatments for better overall results.

Experts like Dr. Alexander Jimenez explain how these methods promote long-term health by treating the root causes with functional medicine and non-invasive procedures. The future looks better for safer pain relief as new technologies and drugs that don’t contain opioids are approved by the FDA. In the end, getting patients involved in decisions and keeping them up to date gives everyone the tools they need to manage pain directly, which improves daily tasks and overall health. Talk to your doctor to find out what works best for you. Early assessment and balanced care are important.


References

A Clinical Approach for Treatment for Patients with Substance Use Disorder

Delve into the clinical approach for a comprehensive understanding of effective management and care for substance use disorder for patients.

Integrative Management of Substance Use Disorder (SUD) and Musculoskeletal Health: A Collaborative Model for Chiropractors and Nurse Practitioners

The musculoskeletal system, behavior, brain, and overall body are all impacted by substance use disorder (SUD), a chronic illness that may be treated. For many individuals, SUD coexists with functional restrictions, mental discomfort, chronic pain, and injury. According to the American Medical Association [AMA], n.d., the National Institute on Drug Abuse [NIDA], n.d., and the National Institute of Mental Health [NIMH], 2025, an integrative care model can lower risk, enhance function, and promote long-term recovery by combining evidence-based SUD screening and treatment with chiropractic care and nurse practitioner (NP)-led primary care.

This article describes SUD, how it may be recognized and classified, how physicians can treat it with useful processes, and how integrated chiropractic and NP treatment can address physical repercussions and overlapping risk profiles.


What Is Substance Use Disorder (SUD)?

SUD is a medical condition in which the use of alcohol, medications, or other substances leads to significant impairment or distress in daily life. It is not a moral failing or a lack of willpower; it is a chronic, brain‑ and body‑based disease that is treatable (NIDA, n.d.; NIMH, 2025).

SUD exists on a spectrum from mild to severe. People with SUD may:

  • Use more of the substance than they planned
  • Try and fail to cut down or stop
  • Spend a lot of time obtaining, using, or recovering from the substance
  • Continue to use even though it harms health, work, relationships, or safety (American Psychiatric Association, 2022; NIMH, 2025)

Person‑first, non‑stigmatizing language

Stigma can keep people from seeking care. Using respectful, person‑first language reduces shame and supports engagement. NIDA and the AMA recommend (NIDA, n.d.; AMA, n.d.):

  • Say “person with a substance use disorder,” not “addict” or “drug abuser.”
  • Say “substance use” or “misuse,” not “abuse.”
  • Focus on SUD as a chronic, treatable condition.

Categories and Diagnostic Features of SUD

DSM‑5‑TR framework: Mild, moderate, severe

Diagnostic criteria for SUD come from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM‑5‑TR) (American Psychiatric Association, 2022; NIAAA, 2025). A diagnosis is based on the number of symptoms present over 12 months.

Typical criteria include (paraphrased):

  • Using more or for longer than intended
  • Unsuccessful efforts to cut down
  • Spending a lot of time obtaining, using, or recovering
  • Cravings or strong urges
  • Role failures at work, school, or home
  • Social or interpersonal problems caused or worsened by use
  • Giving up important activities
  • Using in physically hazardous situations
  • Continued use despite physical or psychological problems
  • Tolerance
  • Withdrawal

Severity is determined by symptom count (American Psychiatric Association, 2022; NIAAA, 2025):

  • Mild: 2–3 symptoms
  • Moderate: 4–5 symptoms
  • Severe: 6 or more symptoms

Substance‑specific categories

Clinically, SUD is further categorized by substance type (NIDA, n.d.; NIMH, 2025):

  • Alcohol use disorder (AUD)
  • Opioid use disorder (e.g., heroin, oxycodone, hydrocodone)
  • Stimulant use disorder (e.g., cocaine, methamphetamine)
  • Sedative, hypnotic, or anxiolytic use disorder (e.g., benzodiazepines)
  • Cannabis, tobacco, hallucinogen, or inhalant use disorders

Each category has similar behavioral criteria but unique medical risks, withdrawal profiles, and treatment options (NIDA, n.d.; NIAAA, 2025).

Risk and severity categories for clinical workflows

For practical care, validated screening tools classify risk that guide next steps (AMA, n.d.; NIDA, n.d.; NIAAA, 2025):

  • Low/no risk: Negative screen or very low scores
  • Moderate risk: At‑risk use with potential consequences (e.g., falls, crashes, future disease)
  • Substantial/severe risk: High scores suggest likely SUD and active harm

For example, adult risk zones using tools like AUDIT and DAST (AMA, n.d.):

  • Low risk/abstain: AUDIT 0–7; DAST 0–2
  • Moderate risk: AUDIT 8–15; DAST 3–5
  • Substantial/severe risk: AUDIT ≥16; DAST ≥6

These categories help teams decide when to give brief interventions, when to intensify care, and when to refer to specialty treatment.


Epidemiology and Public Health Impact

National surveys show that millions of people in the United States live with SUD, yet only a fraction receive treatment (Substance Abuse and Mental Health Services Administration [SAMHSA], 2023). The 2022 National Survey on Drug Use and Health reported high rates of both substance use and serious mental illness, often co‑occurring (SAMHSA, 2023).

Key points from recent federal data (SAMHSA, 2023; NIMH, 2025):

  • SUD commonly co‑occurs with depression, anxiety, and other mental disorders.
  • Co‑occurring conditions worsen medical outcomes and increase healthcare use.
  • Early identification and integrated treatment can improve function, reduce complications, and lower long‑term costs.

Identifying Patients With SUD: Screening and Assessment

Early, routine identification is critical. Primary care teams, NPs, and chiropractic clinics that integrate behavioral health can all play a role (AMA, n.d.; NIDA, n.d.; NIAAA, 2025).

Building a safe, trauma‑informed environment

Before asking about substance use, the team should (AMA, n.d.; NIDA, n.d.):

  • Explain that “we screen everyone” as part of whole‑person care.
  • Emphasize confidentiality within legal limits.
  • Use a calm, nonjudgmental tone and body language.
  • Offer patients the option not to answer any question.
  • Acknowledge that stress, trauma, pain, and life pressures often contribute to substance use.

This aligns with trauma‑informed care principles promoted by SAMHSA and helps patients feel safe enough to share (AMA, n.d.).

Validated screening tools

Evidence‑based tools are preferred over informal questioning. Common options include (AMA, n.d.; NIDA, n.d.; NIAAA, 2025):

For adults:

  • AUDIT or AUDIT‑C (Alcohol Use Disorders Identification Test) – screens for unhealthy alcohol use and risk of AUD.
  • DAST‑10 (Drug Abuse Screening Test) – screens for non‑alcohol drug use problems.
  • TAPS Tool (Tobacco, Alcohol, Prescription medication, and other Substances) – combined screen and brief assessment.

For adolescents:

  • CRAFFT 2.1+N – widely used for youth; captures risk behaviors and problems.
  • S2BI (Screening to Brief Intervention) and BSTAD – brief tools validated for ages 12–17 (NIDA, n.d.; AMA, n.d.).

For alcohol‑specific quick screens:

  • AUDIT‑C (3 questions) or full AUDIT
  • NIAAA Single Alcohol Screening Question (SASQ):
    “How many times in the past year have you had 4 (for women) or 5 (for men) or more drinks in a day?” (NIAAA, 2025)

Results guide risk categorization and next steps.

Role of the care team

In integrated practices, roles can be divided (AMA, n.d.):

  • Medical assistants or nurses
    • Administer pre‑screens and full questionnaires.
    • Flag positive or concerning responses.
  • Nurse practitioners / primary care clinicians
    • Review screening results.
    • Deliver brief interventions using motivational interviewing.
    • Conduct or oversee further assessment.
    • Prescribe and manage pharmacotherapy for SUD when indicated.
    • Coordinate referrals and follow‑up.
  • Behavioral health clinicians (on‑site or virtual)
    • Perform biopsychosocial in-depth evaluations.
    • Provide psychotherapy and relapse‑prevention skills.
    • Support motivational enhancement and family engagement.
  • Chiropractors and physical‑medicine providers
    • Screen for substance misuse related to pain, function, and injury patterns.
    • Observe red flags (frequent lost prescriptions, inconsistent pain reports, sedation, falls).
    • Communicate concerns to the NP or primary medical provider.

Dr. Alexander Jimenez, DC, APRN, FNP‑BC, exemplifies this dual role. As both a chiropractor and a family practice NP, he combines neuromusculoskeletal assessment with medical screening and functional medicine evaluation to identify root causes of chronic pain and unhealthy substance use patterns (Jimenez, n.d.).

Clinical clues that may suggest SUD

Beyond formal tools, clinicians should stay alert for patterns such as (AMA, n.d.; NIMH, 2025):

  • Frequent injuries, falls, or motor vehicle accidents
  • Repeated missed appointments or poor adherence to treatment
  • Drowsiness, agitation, slurred speech, or odor of alcohol
  • Unexplained weight loss, infections, or liver abnormalities
  • Social and financial instability, job loss, or legal problems

In chiropractic and musculoskeletal settings, repeated injuries, delayed healing, inconsistent exam findings, or “pain behaviors” that do not match imaging or biomechanics may prompt gentle, supportive screening and medical referral.


Comprehensive Assessment and Risk Stratification

Once a screen is positive, the next level is a more detailed assessment. This should examine substance type, frequency, amount, impact, withdrawal, mental health, physical comorbidities, and function (AMA, n.d.; NIMH, 2025).

Structured assessment tools

Clinicians may use (AMA, n.d.; NIDA, n.d.; NIAAA, 2025):

  • Full AUDIT for alcohol
  • DAST‑10 for general drugs
  • CRAFFT or GAIN for adolescents
  • Checklists based directly on DSM‑5‑TR criteria to rate symptom count and severity (NIAAA, 2025).

These tools allow classification into mild, moderate, or severe SUD and support shared decision‑making regarding level of care.

Co‑occurring mental health conditions

SUD frequently co‑occurs with (NIMH, 2025):

  • Major depressive disorder
  • Anxiety disorders
  • Posttraumatic stress disorder (PTSD)
  • Bipolar disorder
  • Attention‑deficit/hyperactivity disorder

Co‑occurring disorders can:

  • Increased risk for self‑medication with substances
  • Worsen treatment outcomes if not recognized
  • Require integrated treatment plans (NIMH, 2025)

NPs, behavioral health clinicians, and chiropractors with integrative training should maintain a low threshold for mental health screening and referral.


Managing Patients With SUD: A Practical Clinical Process

Effective SUD care is chronic‑disease care: ongoing, team‑based, and tailored to readiness to change (AMA, n.d.; SAMHSA, 2023).

Core elements of management

Key components include (AMA, n.d.; NIDA, n.d.; NIMH, 2025):

  • Routine screening and re‑screening
  • Brief interventions and motivational interviewing
  • Harm‑reduction strategies
  • Medications for certain SUDs (when appropriate)
  • Evidence‑based behavioral therapies
  • Peer and family support
  • Long‑term follow‑up and relapse‑prevention planning

Brief intervention and motivational interviewing

For patients with low to moderate risk, brief intervention can be delivered in 5–15 minutes and often by NPs or primary care clinicians (AMA, n.d.; NIAAA, 2025). Using motivational interviewing, clinicians:

  • Ask open‑ended questions (“What do you enjoy about drinking? What concerns you about it?”)
  • Reflect and summarize the patient’s own statements
  • Ask permission before giving advice
  • Help patients set realistic, patient‑chosen goals (cutting down, abstaining, or seeking treatment)

This approach respects autonomy and builds internal motivation for change.

Determining level of care

The American Society of Addiction Medicine (ASAM) describes a continuum of care (AMA, n.d.; SAMHSA, 2023):

  • Prevention/early intervention
    • Brief interventions in primary care
    • Self‑management support and education
  • Outpatient services
    • Office‑based counseling and medications for AUD or opioid use disorder (OUD)
    • Integrated behavioral health visits
  • Intensive outpatient / partial hospitalization
    • Several therapy sessions per week, day or evening programs
  • Residential/inpatient services
    • 24‑hour structured care for severe or complex cases
  • Medically managed intensive inpatient services
    • Medically supervised detoxification and stabilization

NPs and primary care teams decide the appropriate level based on risk severity, co‑occurring medical and psychiatric conditions, social supports, and patient preference (AMA, n.d.; NIMH, 2025).

Medications for SUD

For some patients, medications support recovery by reducing cravings, blocking rewarding effects, or stabilizing brain function (SAMHSA, 2020; AMA, n.d.; NIAAA, 2025). Examples include:

  • Alcohol use disorder
    • Acamprosate – supports abstinence after detox
    • Disulfiram – creates an unpleasant reaction to alcohol, discouraging use
    • Naltrexone blocks the rewarding effects of alcohol
  • Opioid use disorder
    • Buprenorphine – a partial opioid agonist that reduces cravings and overdose risk; often prescribed in primary care with appropriate DEA registration
    • Methadone – full agonist, dispensed in specialized opioid treatment programs
    • Naltrexone (extended‑release) – opioid antagonist that prevents relapse after detox
  • Overdose prevention
    • Naloxone – rapid opioid‑overdose reversal, recommended for anyone at risk (AMA, n.d.).

NPs managing patients with SUD work within state scope‑of‑practice rules and in collaboration with addiction specialists where needed.

Behavioral therapies and peer support

Evidence‑based therapies include (AMA, n.d.; NIDA, n.d.):

  • Cognitive behavioral therapy (CBT)
  • Dialectical behavior therapy (DBT)
  • Motivational enhancement therapy
  • The Matrix Model (especially for stimulants)
  • Family‑based therapy for adolescents

Peer support groups (Alcoholics Anonymous, Narcotics Anonymous, SMART Recovery) can reinforce coping skills, hope, and accountability.

Long‑term follow‑up

SUD is chronic; relapse risk can persist for years. Best practice includes (AMA, n.d.; NIMH, 2025):

  • Follow‑up within 2 weeks after treatment initiation
  • Monthly to quarterly visits as patients stabilize
  • Peer support and care management between visits
  • Rapid re‑engagement after any relapse or lapse

NASW, NIDA, and NIMH stress that relapse should be treated as a signal to adjust care—not as failure (NIDA, n.d.; NIMH, 2025).


How SUD Affects the Body and the Musculoskeletal System

SUD impacts nearly every organ system. Many effects directly or indirectly worsen neuromusculoskeletal health and pain.

General systemic effects

Common systemic consequences include (NIDA, n.d.; NIMH, 2025; SAMHSA, 2023):

  • Cardiovascular disease and hypertension
  • Liver disease and pancreatitis (especially with alcohol)
  • Respiratory disease (especially with tobacco and some drugs)
  • Endocrine and hormonal disruption
  • Immune dysfunction and higher infection risk
  • Sleep disturbances and fatigue
  • Worsening of mood, anxiety, and cognitive function

These changes affect healing capacity, resilience, and the way patients perceive pain.

Musculoskeletal and pain‑related effects

Substance use and SUD can influence the musculoskeletal system through several pathways:

  • Increased injury risk
    • Impaired judgment, coordination, and reaction time increase the risk of falls, motor vehicle accidents, and sports injuries.
    • Heavy alcohol use is associated with fractures, soft tissue injuries, and delayed healing (AMA, n.d.; SAMHSA, 2023).
  • Bone, joint, and muscle changes
    • Alcohol and some drugs can impair bone density and quality, increasing osteoporosis and fracture risk.
    • Nutritional deficiencies associated with SUDs weaken connective tissue and muscle function.
    • Sedentary behavior and deconditioning are common in people with long‑standing SUD.
  • Chronic pain and central sensitization
    • Chronic alcohol or opioid use can alter pain pathways in the central nervous system, raising pain sensitivity.
    • Opioid‑induced hyperalgesia can make pain seem worse even at stable or increasing doses.
  • Functional and ergonomic stress
    • Disrupted sleep, poor posture, and prolonged sitting or immobility (for example, in recovery environments or during unemployment) can lead to spinal stress, neck and low back pain, and muscle imbalance.

Clinically, Dr. Jimenez and similar integrative providers often see patients with combined profiles: chronic low back or neck pain, sedentary work, ergonomic strain, poor sleep, high stress, and escalating reliance on medications, including opioids or sedatives. Addressing both the mechanical and behavioral contributors can change the trajectory of pain and SUD risk (Jimenez, n.d.).


Integrative Chiropractic Care in the Context of SUD

Philosophy of integrative chiropractic care

Integrative chiropractic care focuses on restoring alignment, mobility, and neuromuscular control while considering lifestyle, nutrition, sleep, and emotional stress. In the model used by Dr. Jimenez, chiropractic adjustments are combined with functional medicine strategies, targeted exercise, and collaborative medical care (Jimenez, n.d.).

For patients with or at risk of SUD, this approach offers:

  • Non‑pharmacologic pain management
  • Improved movement, posture, and ergonomics
  • Education that empowers patients to self‑manage pain
  • Reduced reliance on habit‑forming medications

Spinal adjustments and targeted exercises

Spinal and extremity adjustments aim to:

  • Restore joint mobility
  • Reduce mechanical irritation of nerves and soft tissues
  • Improve segmental alignment and overall posture

Targeted exercises are prescribed to:

  • Strengthen deep stabilizing muscles (core, gluteal, cervical stabilizers)
  • Correct muscle imbalances and faulty patterns
  • Increase flexibility and joint range of motion
  • Enhance proprioception, balance, and movement control

Examples of targeted exercise strategies often used in integrative chiropractic and rehab clinics include (Jimenez, n.d.):

  • Lumbar stabilization and core‑strengthening sequences
  • Hip mobility and glute activation drills for low back and sciatica‑like pain
  • Cervical and scapular stabilization for neck and shoulder pain
  • Postural retraining, including ergonomic break routines for prolonged sitting

By reducing biomechanical stress and enhancing functional capacity, these interventions may decrease pain intensity, frequency, and flare‑ups, which in turn can lower the drive to self‑medicate with substances.

Reducing overlapping risk profiles

Many risk factors for SUD and for chronic musculoskeletal pain overlap, including (NIMH, 2025; NIDA, n.d.; Jimenez, n.d.):

  • Chronic stress and trauma
  • Poor sleep and circadian disruption
  • Sedentary lifestyle and obesity
  • Repetitive strain and poor ergonomics
  • Social isolation and low self‑efficacy

Integrative chiropractic care can help shift these shared risk profiles by:

  • Encouraging regular physical activity and graded movement
  • Coaching ergonomic and postural strategies at work and home
  • Teaching breathing, stretching, and relaxation routines that reduce muscle tension and sympathetic overdrive
  • Collaborating with NPs and behavioral health clinicians to align interventions with mental health and SUD treatment plans

In Dr. Jimenez’s practice, this often includes structured flexibility, mobility, and agility programs that are adapted to age and functional status, with close monitoring to avoid over‑reliance on medications, including opioids and sedatives (Jimenez, n.d.).


The Nurse Practitioner’s Role in Comprehensive SUD and Musculoskeletal Care

NPs are well-positioned to coordinate SUD care and integrate it with musculoskeletal and chiropractic treatment.

Comprehensive medical management

NP responsibilities typically include (AMA, n.d.; NIMH, 2025; NIAAA, 2025):

  • Conducting and interpreting SUD screening and risk stratification
  • Performing physical exams and ordering labs or imaging
  • Diagnosing SUD and co‑occurring conditions
  • Prescribing non‑addictive pain strategies and medications where indicated
  • Managing or co‑managing medications for AUD or OUD (per training and regulations)
  • Monitoring for drug–drug and drug–disease interactions
  • Coordinating with behavioral health and community resources

In integrative settings like Dr. Jimenez’s clinic, the NP role is blended with functional medicine principles, looking at nutrition, metabolic health, hormonal balance, and inflammation that influence both pain and SUD risk (Jimenez, n.d.).

Ergonomic and lifestyle counseling

NPs also provide individualized counseling on:

  • Workplace ergonomics (desk height, chair support, screen position)
  • Safe lifting strategies and body mechanics
  • Activity pacing and graded return to work or sport
  • Sleep hygiene and circadian rhythm support
  • Nutrition strategies that support musculoskeletal healing and brain health

These interventions lower the mechanical load on the spine and joints, reduce fatigue, and increase a patient’s sense of control—all of which help reduce triggers for substance use and relapse.

Care coordination and team communication

NPs often serve as the central coordinator who (AMA, n.d.; NIMH, 2025):

  • Ensures all team members (chiropractor, physical therapist, behavioral health, addiction medicine, primary care, or specialty providers) share a coherent plan
  • Tracks progress on pain, function, substance use, mood, and quality of life
  • Adjusts the plan as conditions change
  • Supports families and caregivers in understanding both SUD and musculoskeletal needs

In a model like Dr. Jimenez’s, this may involve regular case conferences, shared EHR notes, and integrated treatment plans that align spinal rehabilitation with SUD recovery goals (Jimenez, n.d.).


Understanding Long Lasting Injuries- Video


Practical Clinical Pathway: From First Contact to Long‑Term Recovery

For clinics that combine chiropractic and NP services, a practical, stepwise pathway for patients with possible SUD and musculoskeletal complaints can look like this (AMA, n.d.; NIDA, n.d.; NIAAA, 2025; NIMH, 2025; Jimenez, n.d.):

Step 1: Initial visit and global screening

  • Intake includes questions on pain, function, injuries, sleep, mood, and substance use.
  • Staff administer brief tools (for example, AUDIT‑C and DAST‑10 for adults, CRAFFT for adolescents).
  • The chiropractor documents neuromusculoskeletal findings; the NP reviews medical and behavioral health risks.

Step 2: Identification of SUD risk

  • Negative or low‑risk screens → brief positive health message and reinforcement of low‑risk behavior.
  • Moderate risk → NP provides brief intervention, motivational interviewing, and a follow‑up plan.
  • Substantial or severe risk → NP initiates comprehensive assessment, safety planning, and possible referral to specialized services.

Step 3: Integrated treatment planning

The team crafts a unified plan that may include:

  • Spinal adjustments and targeted exercises to correct alignment and biomechanics
  • Gradual increase in physical activity with pain‑sensitive pacing
  • Non‑pharmacologic pain strategies (manual therapy, exercise therapy, education)
  • Behavioral health referral for CBT, trauma‑informed treatment, or other modalities
  • Consideration of medications for AUD or OUD, if indicated
  • Harm‑reduction measures (for example, naloxone prescription for those at overdose risk)

Step 4: Ergonomics and lifestyle

  • NP and chiropractor jointly review workplace and home ergonomics, posture, and activity patterns.
  • Patients learn micro‑break routines, stretching, and strengthening sequences for high‑risk tasks (for example, lifting or prolonged sitting).
  • Nutrition, stress‑management, and sleep interventions are introduced or refined.

Step 5: Monitoring and long‑term follow‑up

  • Regular follow‑up visits evaluate:
    • Pain levels and functional capacity
    • Substance use patterns and cravings
    • Mood, sleep, and quality of life
    • Adherence to exercise and ergonomic plans
  • The team updates the treatment plan to respond to progress, setbacks, or new diagnoses.
  • Patients are coached to view flare-ups or lapses as opportunities to learn and adjust, not as failures.

This kind of coordinated, integrative approach can reduce repeated injuries, unnecessary imaging or surgeries, and long‑term dependence on medications, including opioids.


Clinical Insights from an Integrative Practice Model

Although each practice is unique, Dr. Alexander Jimenez’s clinic illustrates several principles that can guide others (Jimenez, n.d.):

  • Whole‑person assessment: History taking includes injuries, lifestyle, trauma, nutrition, environment, and psychosocial stressors.
  • Functional movement focus: Care plans emphasize flexibility, mobility, agility, and strength to restore capacity rather than just relieve symptoms.
  • Non‑invasive first: Chiropractic adjustments, functional exercise, and lifestyle interventions are prioritized before invasive procedures or long‑term controlled substances.
  • Integrated roles: As both DC and FNP‑BC, Dr. Jimenez unifies neuromusculoskeletal, primary care, and functional medicine perspectives in a single, coordinated plan.
  • Patient empowerment: Education, coaching, and accessible care options help patients take a proactive role in maintaining spinal health and reducing SUD risk.

This model aligns with national guidance on behavioral health integration and SUD management in medical settings while adding the musculoskeletal and ergonomic expertise of chiropractic care (AMA, n.d.; NIDA, n.d.; NIMH, 2025).


Key Takeaways

  • SUD is a chronic, treatable medical condition that often co‑occurs with mental disorders and chronic pain.
  • Validated screening tools and non‑stigmatizing, trauma‑informed communication are core to early identification.
  • Risk and severity categories (mild, moderate, severe) guide brief intervention, level of care, and referral decisions.
  • SUD significantly affects the body, including bone health, soft tissue integrity, injury risk, and chronic pain pathways.
  • Integrative chiropractic care—with spinal adjustments, targeted exercises, and ergonomic guidance—can reduce pain, improve function, and lower overlapping risk factors for SUD.
  • Nurse practitioners provide comprehensive SUD management, coordinate care, and deliver ergonomic and lifestyle counseling that complements chiropractic treatment.
  • A collaborative, long‑term, patient‑centered model—such as the one exemplified by Dr. Alexander Jimenez—offers a promising pathway to healthier spines, healthier brains, and healthier lives.

Conclusion

Compassion, evidence-based screening, and multidisciplinary care coordination are necessary for substance use disorder, a complicated medical illness. Understanding what SUD is, how to recognize it, and how to respond with respect and evidence-based interventions are the first steps towards enabling healthcare professionals—whether they are primary care physicians, chiropractors, nurse practitioners, or behavioral health specialists—to identify and support patients with SUD.

For patients dealing with both chronic pain and drug abuse, the combination of chiropractic therapy with nurse practitioner-led primary care provides a unique benefit. Patients may not disclose that they are also struggling with alcoholism, prescription opioid abuse, or amphetamine use when they arrive with a job injury, car accident, or years of bad ergonomics. However, these difficulties often coexist. The burden of poor healing, muscular atrophy, elevated pain sensitivity, and increased fracture risk falls on the musculoskeletal system. Both the intellect and the nerve system are impacted, and the cycle of pain and drug abuse is exacerbated by sleep disturbance, mood swings, and a diminished ability to handle stress.

This loop may be broken by clinics and practices that include screening, short intervention, and coordinated therapy. Mechanical function is restored via spinal modifications. Strength and proprioception are restored via targeted activities. Re-injury may be avoided with ergonomic coaching. Nurse practitioners help with medication coordination, drug interaction monitoring, and lifestyle counseling to promote healthy spines and SUD recovery. Counselors in behavioral health provide peer support, treatment, and relapse prevention. This team works together to address the underlying issues rather than simply the symptoms.

A single physician with dual expertise—chiropractic and family practice nurse practitioner credentials—can skillfully weave these threads into a cohesive, patient-centered strategy, as shown by the clinical paradigm typified by Dr. Alexander Jimenez. Continuity, goal alignment, and a clinician who is knowledgeable about the neurology of addiction as well as the biomechanics of a herniated disc are all advantageous to patients. With intentional team communication, collaborative decision-making, and a dedication to non-stigmatizing, trauma-informed treatment, larger practices may get comparable outcomes.

There is no doubt that early detection improves results and saves lives. Tools for validated screening are accurate and fast. Brief interventions and motivational interviews are effective. When used carefully, medications for alcohol and opioid use disorders are both safe and effective. Exercise, physical therapy, stress management, and social support are all effective but underused non-pharmacologic methods. Additionally, patients recover more quickly, resume their normal activities sooner, and are far less likely to relapse into drug abuse when musculoskeletal and behavioral health treatment are integrated.

Patients who regain their health, relationships, and sense of purpose are the ultimate reward for healthcare teams that are prepared to go beyond isolated complaints—beyond “just” back pain or “just” worry. This is what integrative, team-based, evidence-based treatment for musculoskeletal disorders and drug use disorders promises.


References

An Overview of Somatovisceral Disorders & Head Injuries


Discover the connection between head injuries and somatovisceral disorders to enhance patient care and management.

Understanding Head Injuries and Their Impact on the Brain-Body Connection: A Comprehensive Guide to Somatovisceral Disorders and Non-Surgical Treatment Approaches

Millions of people worldwide are impacted by head injuries every year, making them a serious public health problem. The harm that results from head trauma, whether from a fall, auto accident, or sports collision, goes much beyond the location of the original hit. Researchers now identify somatovisceral illnesses as a result of these injuries, which cause a series of physiological alterations that interfere with the delicate brain-body communication system. Recovery outcomes and quality of life may be significantly improved by understanding how head trauma impacts this crucial brain-body link and by investigating effective non-surgical therapeutic options.

What Are Somatovisceral Disorders?

Complex connections between the body’s internal organs (visceral system) and physical structures (somatic system) are a feature of somatovisceral illnesses. Nerve impulses from body structures are transmitted to visceral organs through this complex process, resulting in specific physiological or pathological responses. In addition to involving two systems, the somatovisceral response is complicated because it may communicate in both directions, transferring information from somatic structures to visceral organs and vice versa. foundationhealth

Medical studies have focused more on the connection between somatovisceral diseases and brain trauma. According to a recent study, 15–27% of patients who had head trauma fulfilled the criteria for somatic symptom disorder six months after the injury, suggesting that mild traumatic brain injury (mTBI) may be a frequent precursor to this syndrome. This link demonstrates how brain damage may disrupt the normal communication pathways that control physiological processes, leading to chronic, often incapacitating symptoms throughout the body. neurologyopen.bmj

When people have upsetting physical symptoms together with excessive thoughts, emotions, or actions associated with those symptoms, it’s known as somatic symptom disorder. Many somatic problems, such as pain, weakness, difficulty moving, headaches, dizziness, excessive fatigue, changes in vision or hearing, itching, numbness, odd movements, stomach pain, and nausea, are often reported by patients after a brain injury. These symptoms illustrate how neurological impairment may materialize as pervasive physical dysfunction by reflecting the disturbed connection between the brain and many bodily systems. chop+1

The Brain-Body Connection and Head Injury

The human nervous system operates through an intricate network that connects the brain to every organ, muscle, and tissue in the body. This communication highway relies on precise signaling between the central nervous system (brain and spinal cord) and the peripheral nervous system (nerves throughout the body). When head trauma occurs, this delicate communication system can become disrupted at multiple levels, affecting both somatic (voluntary) and autonomic (involuntary) nervous system functions.

According to Dr. Alexander Jimenez, a board-certified Family Practice Nurse Practitioner and Doctor of Chiropractic in El Paso, Texas, the spine houses the spinal cord, which acts as the communication superhighway between the brain and body. Any misalignment in the spine can disrupt the nervous system’s signals, and for traumatic brain injury patients, this connection becomes crucial. Dr. Jimenez explains that misalignment caused by the injury itself or associated whiplash can worsen symptoms like headaches, brain fog, and balance issues, emphasizing the importance of addressing both cranial and spinal components in recovery. northwestfloridaphysiciansgroup

The brain-body disconnect following trauma manifests as disrupted somatic sensory processing, encompassing vestibular (balance) and somatosensory (touch, pressure, temperature) processing. These sensory systems are primarily concerned with survival and safety, given the potential consequences of impaired balance or diminished awareness of physical threats. Following a head injury, trauma-related symptoms are conceptualized to be grounded in brainstem-level somatic sensory processing dysfunction and its cascading influences on physiological arousal modulation, affect regulation, and higher-order capacities. pmc.ncbi.nlm.nih

Research has identified that traumatic conditions may manifest as disrupted vertical integration, in which the balance between lower brain regions and higher cortical areas becomes dysregulated, particularly within the midline neural circuitry responsible for generating a primordial sense of a bodily and affective self as a coherent and stable entity in relation to the environment. This alteration has a cascading impact on the horizontal integration of cortical brain structures, meaning that different regions of the brain may be structurally intact yet lack fluid communication. pmc.ncbi.nlm.nih

Autonomic Dysfunction After Head Injury

One of the most significant yet underappreciated consequences of head injury is autonomic nervous system dysfunction. The autonomic nervous system controls involuntary bodily functions, including heart rate, blood pressure, digestion, breathing, and temperature regulation. Following moderate-to-severe traumatic brain injury, patients often experience significant autonomic dysfunction affecting both sympathetic (fight-or-flight) and parasympathetic (rest-and-digest) branches of this critical system. neurologyopen.bmj

Studies have demonstrated that patients with severe traumatic brain injury can experience sympathetic hyperactivity in the acute stages. More importantly, autonomic dysfunction persists in many patients for months or even years after their initial injury, affecting fully ambulant patients whom many might assume to be fully recovered. This persistent dysfunction occurs through various mechanisms, with the hallmark of moderate-to-severe traumatic brain injury being white matter injury caused by axonal shearing due to injury forces, continuing due to inflammation and delayed axonal degeneration in the chronic period, resulting in network disruption. neurologyopen.bmj

Autonomic dysfunction may occur due to injury to regions of the central autonomic network or their connecting white matter tracts. Brainstem nuclei and white matter connections to and from thalamic and basal ganglia regions may be particularly vulnerable to damage, underlying dysfunction that contributes to cognitive impairment post-traumatic brain injury. Given the importance of brainstem, thalamic, and basal ganglia circuits to autonomic function, injury to these white matter tracts may cause centrally mediated autonomic dysfunction. neurologyopen.bmj

The clinical manifestations of autonomic dysfunction after head injury are diverse and often debilitating. Many classic symptoms following concussion are, at least in part, likely a result of injury to the autonomic nervous system. Cognitive difficulties seen after mild traumatic brain injury may be related to autonomic dysregulation, specifically impaired cerebral blood flow. The presence of autonomic dysfunction has been shown to correlate with increased morbidity and mortality in moderate and severe traumatic brain injury, with perturbations of the autonomic nervous system consisting of either increased sympathetic or reduced vagal activity, potentially resulting in serious cardiac complications. health+1

Dr. Jimenez’s clinical practice emphasizes the importance of recognizing autonomic dysfunction in patients recovering from head injuries. His functional medicine approach includes detailed health assessments evaluating lifestyle, environmental exposures, and psychological factors to understand the root causes of chronic disorders and treat patients holistically. This comprehensive evaluation is particularly important for identifying autonomic dysfunction, which may manifest as dizziness, balance problems, temperature dysregulation, digestive issues, and cardiovascular irregularities.

Environmental Factors Affecting Brain Activity and the Body

Environmental factors play a critical role in shaping brain structure and function, as well as the development of mental and physical health conditions. The macroenvironment encompasses immediate factors such as air, noise, and light pollution; proximal factors, including regional socioeconomic characteristics; and distal factors, such as urbanization, natural spaces, and climate. These environmental exposures are mostly modifiable, presenting opportunities for interventions and strategies to promote the structural and functional integrity of the brain and mitigate the burden of illness following head injury. nature

  • Air pollution has emerged as a significant concern for brain health, particularly following traumatic brain injury, when the brain is already vulnerable. Studies have demonstrated that air pollution may increase vulnerability to mood dysfunction and potentially inhibit an appropriate stress response. Prolonged exposure to fine particulate matter (PM2.5 and PM10) has been associated with negative stress-related brain activation in the prefrontal cortex, frontoinsular cortex, limbic system, inferior parietal cortex, and cingulate regions. Magnetic resonance imaging studies reveal that increased exposure to PM2.5 is associated with changes in brain structure in older adults, including brain atrophy, that occur before the onset of dementia. environmentalhealth.ucdavis+1
  • Noise pollution, originating from urban traffic, airports, industries, and construction sites, can evoke negative emotions and disrupt recovery following head injury. Prolonged exposure to disruptive noise induces brain alterations through mechanisms such as sleep disturbances, which create a pro-oxidative environment that predisposes to neuroinflammation and heightened hypothalamic-pituitary-adrenal axis reactivity, contributing to mental and physical health problems. For individuals recovering from head trauma, protecting against excessive noise exposure becomes particularly important as the injured brain requires optimal conditions for healing. nature
  • Light pollution and exposure to artificial light at night have become increasingly prevalent, especially in urban areas, disrupting natural darkness and circadian rhythms. Light is detected by the retina and transmitted through intrinsically photosensitive retinal ganglion cells to the suprachiasmatic nucleus in the hypothalamus and other brain regions involved in regulating circadian rhythms and sleep-wake cycles. Circadian rhythm disruptions have been linked to elevated risk of mood disorders, bipolar disorders, and heightened mood instability, potentially mediated by oscillations in clock gene expression responsive to light-dark transitions. nature
  • Following traumatic brain injury, circadian rhythm disruptions become even more pronounced. Research has documented that traumatic brain injury can lead to decreased melatonin release, causing circadian rhythm delays. Studies using animal models have revealed that acute subdural hematoma resulted in dysregulation of circadian gene expression and rhythmic changes in body temperature during the first 48 hours post-injury. The regulation of biological rhythms through changes in core body temperature, pineal gland melatonin secretion, and blood cortisol levels becomes disrupted, affecting the body’s ability to anticipate and adapt to environmental changes. practicalneurology+1

Minor traumatic brain injury contributes to the emergence of circadian rhythm sleep disorders, with research identifying two distinct types: delayed sleep phase syndrome and irregular sleep-wake pattern. These disorders differ in subjective questionnaire scores and have distinct profiles of melatonin and temperature circadian rhythms. The alteration in the circadian timing system partially accounts for the presence of post-traumatic brain injury sleep-wake disturbances, which changes in sleep architecture alone cannot fully explain. pubmed.ncbi.nlm.nih+1

Understanding Long-Lasting Injuries- Video

How Head Injuries Affect Daily Tasks and Routines

The impact of head injuries extends far beyond the initial trauma, profoundly affecting an individual’s ability to perform everyday activities and maintain normal routines. The disruption to brain-body communication creates challenges across multiple domains of daily functioning, from basic self-care tasks to complex cognitive and social activities. Understanding these impacts helps patients, families, and healthcare providers develop realistic expectations and appropriate support strategies during recovery.

  • Cognitive fatigue represents one of the most disabling consequences of traumatic brain injury, affecting 21-73% of patients regardless of injury severity or time since injury. Fatigue has been identified as the main cause of disability after traumatic brain injury, negatively affecting social, physical, and cognitive functions as well as participation in daily activities and social life. At the neural level, patients with fatigue following head injury exhibit significant disruption of global resting-state alpha-band functional connectivity between cortical midline structures and the rest of the brain. Furthermore, individuals with fatigue show reduced overall brain activation during cognitive tasks, without time-on-task effects. academic.oup
  • Adults with a history of even mild traumatic brain injury report significantly greater fatigue and cognitive impairment than those with no history of head trauma, with symptoms becoming more profound with greater injury severity. This persistent fatigue affects the ability to maintain attention, concentrate on tasks, process information efficiently, and sustain mental effort throughout the day. Patients frequently report that activities requiring cognitive engagement become increasingly difficult as the day progresses, leading to a pattern of morning productivity followed by afternoon exhaustion. pubmed.ncbi.nlm.nih+1
  • Memory difficulties present another significant challenge affecting daily functioning after a head injury. Patients may struggle with both short-term working memory (holding information in mind while using it) and long-term memory formation (creating new lasting memories). These memory challenges affect practical tasks such as remembering appointments, following multi-step instructions, recalling conversations, and learning new information or skills. The impact extends to occupational functioning, with studies finding a correlation between higher levels of mental fatigue and lower employment status following traumatic brain injury. headway+1
  • Executive function impairments following head injury affect planning, organization, decision-making, problem-solving, and behavioral regulation. These higher-order cognitive processes are essential for managing daily responsibilities, from planning meals and organizing household tasks to managing finances and making important life decisions. Patients may find themselves struggling with tasks that previously seemed automatic, requiring conscious effort and external supports to maintain daily routines. headway
  • Sensory processing alterations create additional challenges for daily functioning. The vestibular system, which contributes to balance, spatial processing, arousal modulation, first-person perspective, and social cognition, becomes particularly vulnerable following head trauma. Disturbed temporal binding of sensory information creates perceptual chaos and lack of coherence, which may lead to bodily disconnect and states of hypervigilance. Patients describe feeling disconnected from their bodies, experiencing the world as if through a fog, or feeling constantly on guard against potential threats. pmc.ncbi.nlm.nih
  • Balance and coordination problems stemming from vestibular dysfunction affect mobility and safety in daily activities. Simple tasks like walking on uneven surfaces, turning the head while moving, or navigating busy environments become challenging and potentially dangerous. Many patients report increased anxiety about falling, leading to activity restriction and social withdrawal. Over one-third of adults over 40 will experience vestibular dysfunction at some point in their lives, and when it occurs, whether by injury, aging, or disease, individuals can experience vertigo, nauseating dizziness, vision and balance problems affecting every area of life. neuroinjurycare+1

Dr. Jimenez’s practice in El Paso focuses extensively on helping patients restore function and return to daily activities following head injuries. His integrated approach combines chiropractic care, functional medicine, and rehabilitation therapies to address the multiple systems affected by head trauma. By evaluating the connections between physical, nutritional, and emotional factors, Dr. Jimenez develops personalized care plans that recognize the complex ways head injuries disrupt daily functioning and quality of life.

Overlapping Risk Profiles and Symptoms Associated With Head Injuries

Head injuries create overlapping risk profiles affecting multiple body systems simultaneously, leading to complex symptom presentations that can challenge both patients and healthcare providers. Understanding these interconnected risk factors and symptoms is essential for comprehensive assessment and treatment planning. Individuals who sustain head injuries develop an increased risk for somatic symptom disorder, with early illness beliefs playing a significant predictive role. Specifically, believing that mild traumatic brain injury has serious life consequences and causes distress in the weeks following injury is associated with later development of somatic symptom disorder. Patients with somatic symptom disorder after head injury report more pain and post-concussion symptoms and are significantly more likely to have comorbid major depressive disorder and anxiety disorders compared to those without this condition. neurologyopen.bmj

  • The systematic review examining the relationship between somatic symptoms and related disorders and mild traumatic brain injury found that the majority of acceptable evidence supported a relationship between these conditions. Nine studies reported associations between functional seizures and a history of mild traumatic brain injury, while 31 studies assessed relationships between questionnaires measuring somatic symptom disorder burden and mild traumatic brain injury. Three studies investigated healthcare practitioners’ diagnosis of somatic symptoms and related disorders and post-mild traumatic brain injury symptom burden, collectively demonstrating the strong connection between head trauma and subsequent development of somatic complaints. foundationhealth
  • Cardiovascular complications represent another significant overlapping risk following head injury. Research demonstrates that individuals with moderate-to-severe traumatic brain injury have increased rates of self-reported hypertension and stroke but lower rates of myocardial infarction and congestive heart failure than uninjured adults. The findings highlight the importance of early screening for and management of cardiovascular risk factors in individuals with chronic traumatic brain injury, particularly those of younger age, not typically thought to be at risk for these conditions. ahajournals
  • The relationship between blood pressure and traumatic brain injury follows a complex U-shaped pattern, with both hypotension and hypertension associated with worse outcomes. Early hypotension has been linked with poor outcomes following severe traumatic brain injury, but recent data suggest that arterial hypertension after injury is also associated with poor outcomes. The initial catecholamine response and resulting systemic hypertension may be protective to a point by maintaining cerebral perfusion pressure in the setting of impaired cerebral autoregulation after injury, yet catecholamine-induced hypertension may also cause secondary brain damage by aggravation of vasogenic edema and intracranial hypertension. pmc.ncbi.nlm.nih
  • Post-traumatic headaches affect approximately 40% of individuals who experience concussions, representing one of the most common and persistent symptoms following head injury. Patients can experience tension headaches, migraine headaches, and cervicogenic headaches (radiating from the neck) all at once, making treatment particularly challenging. Ninety-five percent of people with a concussion experience headache associated with that injury, and among those with headache, about two-thirds have migraine features. Individuals with a family history of migraine or preexisting headache disorders face a higher risk of developing post-traumatic headache. wexnermedical.osu+1
  • Sleep disturbances cluster with other post-traumatic brain injury symptoms, creating compounding difficulties for recovery. Changes in sleep architecture following injury cannot fully explain the extent and intensity of sleep-wake disturbances reported by patients. The current literature supports cognitive-behavioral therapy and sleep hygiene education, light therapy, and certain pharmacologic interventions for treating sleep disturbances in patients with brain injury, with early screening and individualized approaches prioritized to improve sleep and, consequently, speed recovery. pubmed.ncbi.nlm.nih
  • Exercise intolerance commonly results from a concussion, often limiting return to activities and quality of life. The reviewed studies support clinical suspicion of autonomic dysfunction as an important component of exercise intolerance, though specific mechanisms of impairment and relationships to symptoms and recovery require additional investigation. Post-concussive exercise intolerance has been linked to a reduction in cerebral blood flow, theoretically prolonging the effects of the metabolic energy crisis associated with injury. pmc.ncbi.nlm.nih
  • Mental health complications, including anxiety, depression, post-traumatic stress disorder, and behavioral changes, frequently develop following head injury. Brain injuries, no matter how severe, commonly cause emotional and behavioral changes, including emotional lability with extreme mood swings, anxiety disorders, depression, impulsive behaviors, flat affect causing a lack of emotional expression, and a lack of empathy and social skills. These psychological changes can cause unnecessary suffering and, in cases of severe depression and anxiety, can even halt physical recovery progress. flintrehab

Non-Surgical Treatments to Improve Somatovisceral Function

Fortunately, numerous non-surgical treatment approaches have demonstrated effectiveness in improving somatovisceral function and promoting recovery following head injuries. These interventions work through various mechanisms to restore proper communication between the brain and the body, balance the autonomic nervous system, and support the brain’s natural healing processes. Dr. Jimenez’s clinical practice emphasizes comprehensive non-invasive protocols, prioritizing natural recovery and avoiding unnecessary surgeries or medications.

A Questionnaire Example of TBI Symptoms

Chiropractic Care and Spinal Adjustments

Chiropractic care focuses on the spine and nervous system, recognizing that the spine houses the spinal cord, which acts as the communication superhighway between the brain and body. For traumatic brain injury patients, proper spinal alignment becomes crucial because misalignment caused by the injury itself or associated whiplash can worsen symptoms like headaches, brain fog, and balance issues. Chiropractic care aims to restore proper alignment, thereby improving nervous system function and supporting the brain’s ability to heal. northwestfloridaphysiciansgroup Chiropractic adjustments help alleviate post-traumatic brain injury symptoms by releasing pressure on irritated nerves and improving joint function. For many patients, this results in improved comfort and reduced reliance on pain medication. Proper spinal alignment promotes better blood flow to the brain, and since the brain requires oxygen-rich blood to heal and function, improved circulation directly supports recovery from traumatic brain injury while reducing dizziness and fatigue. northwestfloridaphysiciansgroup

Research demonstrates that chiropractic intervention can modify proprioceptive input from more functional spinal joints, helping restore this input to the brain’s multisensory integration centers. Studies of patients receiving chiropractic care in neurorehabilitation hospitals have shown that spinal manipulation influences pain through complex mechanisms in the central nervous system. A case study documenting concussion treatment using massage and manipulation techniques showed diminished concussion symptoms and regained ease in cervical range of motion, highlighting the potential importance of manual therapy work to reduce headache, dizziness, and nausea in concussion recovery. pmc.ncbi.nlm.nih+2 Dr. Jimenez explains that by realigning the spine through chiropractic adjustments, treatment reduces nerve interference, optimizing mind-body communication, and enhancing overall function. The adjustments improve cerebral blood flow and reduce inflammation, thereby accelerating recovery from head injury. With enhanced nervous system function comes improved mental clarity, including reduced brain fog, sharper focus, and better memory, while also promoting stress relief and alleviating irritability and emotional strain often linked to head injuries. zakerchiropractic

Vestibular Rehabilitation

Vestibular rehabilitation is a specialized form of physical therapy that focuses on strengthening the connections between the brain, eyes, inner ear, muscles, and nerves. This treatment approach proves particularly valuable for post-concussion patients experiencing dizziness, vertigo, balance problems, and spatial impairment. According to a review in the British Journal of Medicine, vestibular therapy reduced symptoms in patients with sports-related concussions faster, with patients three times as likely to return to play within eight weeks of therapy compared to those who didn’t receive treatment. denverphysicalmedicine+1 Vestibular rehabilitation therapy involves exercises designed to improve the functioning between the inner ear, brain, eyes, muscles, and nerves. These exercises help minimize balance issues and treat dizziness, vertigo, and spatial orientation deficits caused by vestibular impairments that some individuals experience after brain injury. The therapy addresses issues in the inner ear through specific exercises designed to improve balance and coordination. biausa

The Epley Maneuver represents a simple yet effective exercise to treat benign paroxysmal positional vertigo, a very specific form of vertigo quite common after traumatic brain injury. During vestibular rehabilitation, benign paroxysmal positional vertigo generally responds well to the Epley Maneuver, and patients learn to perform the movement at home to alleviate symptoms as they arise. Studies have shown that vestibular rehabilitation is an effective modality for managing dizziness, vertigo, and imbalance following concussion, though careful consideration of the injury’s acuity and effective management of co-morbid conditions will optimize results. pubmed.ncbi.nlm.nih+1 Co-morbidities, including cognitive and behavioral issues, visual-perceptual dysfunction, metabolic dysfunction, and autonomic dysfunction, may hamper the effectiveness of traditional vestibular rehabilitation approaches. Working closely with other disciplines well-versed in treating these co-morbid issues helps individuals obtain optimal recovery. Dr. Jimenez’s integrated practice model exemplifies this multidisciplinary approach, bringing together chiropractic care, functional medicine, physical therapy, and other specialties to provide comprehensive treatment for patients with vestibular dysfunction following head injuries. pubmed.ncbi.nlm.nih

Physical Therapy and Exercise Rehabilitation

Physical therapy plays a pivotal role in optimizing recovery and enhancing functional independence after brain injury. Therapeutic approaches include gait training to improve walking patterns, balance activities to enhance stability and prevent falls, strength training to rebuild muscle mass and function, coordination exercises to improve fine and gross motor skills, and range-of-motion exercises to maintain flexibility. biausa In some cases, physical therapists recommend body-weight-supported treadmill training to help patients safely relearn walking patterns. Family and caregiver training proves extremely important and helpful, as loved ones can gain an understanding of how the brain works and the specific nature of the injury, supporting the rehabilitation process. biausa

Available evidence demonstrates the potential of exercise in improving cognitive impairment, mood disorders, and post-concussion syndrome following traumatic brain injury. Exercise rehabilitation has been shown to attenuate cognitive deficits in animal models by stimulating cerebral signaling pathways, with treadmill exercise improving memory by modulating neurotransmitter systems and neurotrophic factors. High-intensity interval training helps regulate the autonomic nervous system while boosting brain-derived neurotrophic factor, thereby promoting neuroplasticity, an essential factor for recovery. sciencedirect+1 However, exercise prescription following head injury requires careful consideration, as exercise intolerance commonly results from concussion and autonomic dysfunction. Graded exercise testing while monitoring symptoms and heart rate helps guide a safe return to physical activity. Current clinical practice involves careful assessment to determine appropriate exercise intensity and duration, gradually progressing as autonomic function improves. pmc.ncbi.nlm.nih

Acupuncture and Neuroplasticity Enhancement

Acupuncture has gained widespread recognition as an effective, low-cost treatment for neurological rehabilitation with minimal adverse effects. Clinical and experimental evidence documents the potential of acupuncture to ameliorate injury-induced neurological deficits, particularly sequelae such as dyskinesia, spasticity, cognitive impairment, and dysphagia. These effects relate to acupuncture’s ability to promote spontaneous neuroplasticity after injury. pmc.ncbi.nlm.nih+1 Specifically, acupuncture can stimulate neurogenesis, activate axonal regeneration and sprouting, and improve the structure and function of synapses. These processes modify the neural network and the function of the damaged brain area, leading to improvements in various skills and adaptability. Astrocytes and microglia may be involved in acupuncture-induced regulation of neuroplasticity, for example, by producing and releasing various neurotrophic factors, including brain-derived neurotrophic factor and nerve growth factor. pmc.ncbi.nlm.nih

Studies have shown that acupuncture reduces neuroinflammation after brain injury, with research published in The Journal of Neuroinflammation finding that acupuncture significantly reduced neuroinflammation and improved cognitive function in animal models of brain injury. By modulating inflammatory pathways, acupuncture helps reduce the production of pro-inflammatory cytokines, promoting brain healing and reducing symptoms such as headaches and dizziness. betsygordonacupuncture Acupuncture enhances neuroplasticity, which is crucial for recovery after brain injury, promoting improvements in memory, learning, and overall cognitive function. Research in Neural Regeneration highlighted that acupuncture promotes neuroplasticity, which is essential for rehabilitation. Studies demonstrate that acupuncture improves cognitive performance and reduces anxiety and depression in patients recovering from brain injuries. betsygordonacupuncture+1 Dr. Jimenez’s functional medicine practice incorporates acupuncture and electro-acupuncture as part of comprehensive care plans for patients recovering from head injuries. His team uses these modalities in combination with other therapies to create customized treatment approaches that promote natural healing, mobility, and long-term wellness.

Nutritional Interventions and Functional Medicine

Nutrition plays a positive role during acute traumatic brain injury recovery, with patient needs being unique and requiring individualized approaches. Following mild traumatic brain injury, patients who consumed enough food to meet calorie and macronutrient (particularly protein) needs specific to their injury severity and sex within 96 hours post-injury had reduced length of hospital stay. Patients receiving nutrients and non-nutrient support within 24-96 hours post-injury had positive recovery outcomes, including omega-3 fatty acids, vitamin D, magnesium oxide, N-acetyl cysteine, and hyperosmolar sodium lactate. frontiersin Traumatic brain injury contributes to extensive dysbiosis of the gastrointestinal system, leading to worsened outcomes, making nutritional support essential. Early nutrition supports preservation of muscle mass, decreases infection complications, promotes cerebral homeostasis, and improves recovery outcomes. The human brain consumes 20% of total resting energy, despite accounting for only 2% of total body mass, underscoring the critical role of adequate nutrition for healing. xiahepublishing

A recent clinical trial demonstrated that dietary changes significantly reduce persistent post-traumatic headaches, a common and debilitating consequence of traumatic brain injury. Researchers found that increasing omega-3 fatty acids (commonly found in fatty fish) while reducing omega-6 fatty acids (abundant in seed oils) led to fewer and less severe headaches. Participants assigned to the intervention diet experienced approximately two fewer headache days per month and a 30% reduction in daily headache pain intensity compared to the control diet group. med.unc Supplementing with omega-3 fatty acids can reduce inflammation and oxidative stress, promote brain-cell survival, and help the brain recover from injury. Vitamins D and E, niacin, zinc, and magnesium have neuroprotective benefits, and supplementing with these vitamins and minerals has been shown to improve recovery, especially in patients who are deficient. An energy-balanced, anti-inflammatory diet with adequate sources of omega-3 fats and appropriate vitamin D supplementation proves especially important for patients with a history of traumatic brain injury. consultant360

Dr. Jimenez’s practice embraces Functional Integrative Medicine, a patient-focused approach that treats the whole person rather than just symptoms. His team offers detailed health assessments that evaluate genetics, lifestyle, environmental exposures, and psychological factors to create comprehensive health profiles. By combining Institute for Functional Medicine programs with personalized nutrition plans, Dr. Jimenez helps patients address chronic conditions and optimize brain health following head injuries.

Massage Therapy and Manual Techniques

Massage therapy provides valuable support in brain injury rehabilitation, offering benefits for physical, mental, and emotional well-being. Massage significantly improves blood circulation, ensuring that essential nutrients and oxygen are efficiently delivered to brain cells. By increasing circulation, the brain’s healing process is expedited, promoting cellular regeneration and reducing the risk of secondary complications. Improved blood flow also helps reduce swelling and inflammation, common challenges following brain injury. neuropraxisrehab Post-brain injury pain can be debilitating and hinder recovery, but massage therapy helps alleviate pain by targeting tense muscles and releasing built-up tension. Through gentle manipulation, massage therapists can improve muscle flexibility and joint mobility, relieving discomfort and enhancing overall physical comfort. Brain injuries often lead to muscle stiffness and reduced range of motion, but massage therapy techniques such as stretching and kneading help improve flexibility by breaking down scar tissue and adhesions. neuropraxisrehab

Specific massage modalities show promise for traumatic brain injury recovery. Manual Lymphatic Drainage uses light massage to stimulate the flow of lymphatic fluid, potentially increasing the lymphatic system’s ability to clear waste products from the brain. A case study combining Manual Lymphatic Drainage with craniosacral therapy and glymphatic system techniques resulted in an 87% reduction of concussion symptoms after three months of treatment. concussionalliance A case study documenting massage intervention for post-concussion treatment demonstrated complete return to pre-concussion activities and function with no continued symptoms following a short and specific massage series. The treatment focused on restoring ideal alignment of the atlanto-occipital joint, resulting in reduced pain, muscle hypertonicity, headaches, reduced medication use, and improved balance, posture, cervical range of motion, mental focus, and physical activity. pmc.ncbi.nlm.nih

Dr. Jimenez’s comprehensive approach includes specialized massage and manual therapy techniques, integrated with chiropractic care and other modalities. His team focuses particularly on neck and shoulder areas to reduce effects patients experience after traumatic brain injuries, with goals including improved neck mobility, reduction of headaches and nerve pain, and addressing balance, dizziness, and vertigo issues through specific therapeutic techniques. newapproachescenter

Cognitive Behavioral Therapy and Psychological Support

Cognitive Behavioral Therapy has been demonstrated to be effective by over 1,000 studies involving 10,000 patients, making it one of the most scientifically verified psychotherapy treatments available. CBT has been successfully used on a variety of disorders, including traumatic brain injury patients with post-concussional symptoms and secondary effects such as anxiety and fatigue. The therapy focuses on the relationship between thoughts, feelings, and behaviors, built around three core principles: beliefs create feelings, feelings dictate behavior, and behavior reinforces beliefs. flintrehab A new meta-analysis found substantial evidence for the use of cognitive behavioral therapy in managing anxiety and depression in patients with traumatic brain injury. Researchers identified that CBT interventions had immediate effects of reducing depression and anxiety, with effects sustained for depression at the three-month follow-up. Effects were greater in groups that received individualized CBT than in those that received group-based CBT. headway

CBT proves particularly valuable for addressing recovery expectations and perceived consequences of traumatic brain injury. Behavioral techniques such as relaxation, behavioral activation, and stress management help patients manage the anxiety, depressive symptoms, and insomnia that can be present following injury. In the acute phase of recovery, brief psychoeducational and cognitive behavioral interventions have consistently been shown to result in improvement in managing cognitive and psychological symptoms for brain injury survivors. abct For patients with cognitive impairment, CBT can be adapted with modifications including simplified concepts, concrete behavioral examples, pictorial handouts and cues, considerable repetition, and booster sessions. Studies found that adapted CBT was able to reduce anxiety and depression in patients who suffered moderate to severe traumatic brain injury. CBT helps patients identify and challenge unhelpful or inaccurate thoughts that can arise or intensify after injury, while focusing on behavioral activation and engaging in meaningful, important activities, which can boost mood and decrease isolation. cbtdenver+1

Mind-Body Therapies and Somatic Approaches

Mind-body therapies have gained recognition for their effectiveness in treating trauma-related symptoms and supporting nervous system regulation. More than 80% of specialized programs to treat post-traumatic stress disorder offer some form of mind-body therapy, including yoga, relaxation, tai chi, guided imagery, and mindfulness practices. These approaches prove particularly valuable for individuals experiencing somatic symptoms following head injuries. research.va Somatic therapy helps individuals reconnect with their bodies through awareness of physical sensations and their relationship to emotional experiences. For patients with head injuries who may feel disconnected from their bodies or experience persistent physical symptoms, somatic approaches provide pathways for healing by working through sensations in safe and supportive environments. Techniques such as grounding exercises, deep breathing, mindful observation of physical sensations, and guided movement empower individuals to explore how trauma manifests physically and provide avenues for release. pacmh

Yoga as a whole significantly reduced post-traumatic stress disorder symptoms in research studies, with a positive impact comparable to that of psychotherapeutic and psychopharmacologic approaches. Yoga may improve the functioning of traumatized people by helping them tolerate physical and sensory experiences associated with fear and helplessness, and increasing emotional awareness and affect tolerance. For individuals recovering from head injuries, gentle yoga practices adapted to their current functional abilities can support both physical and psychological healing. research.va Polyvagal theory provides a powerful framework for understanding how trauma affects the nervous system and pathways for healing. The theory centers on the autonomic nervous system as a key component in trauma recovery, emphasizing the role of the vagus nerve in regulating physiological and emotional states. Basic somatic exercises can bring the nervous system out of dysfunction, beginning to retrain safety and social cues. This proves particularly helpful for individuals with head injuries who experience autonomic dysregulation and hypervigilance. pyramid-healthcare

Breathing Practices and Vagal Tone Restoration

Voluntary regulated breathing practices offer accessible and effective means to support autonomic nervous system regulation and restore vagal tone. These practices draw on both modern scientific studies and ancient concepts, with applications ranging from clinical anxiety treatment to stress reactivity reduction. Effective breathing interventions support greater parasympathetic tone, which can counterbalance the high sympathetic activity intrinsic to stress and dysfunction following head injury. pmc.ncbi.nlm.nih The physiological sigh is a simple yet powerful breathing technique that involves two nose inhales, followed by a long exhale through the mouth. This technique rapidly reduces stress and calms the nervous system by leveraging the interaction between the sympathetic (arousing) and parasympathetic (calming) branches of the autonomic nervous system to control heart rate and promote calm. Studies have shown that this breathing pattern effectively reduces arousal and returns the body to baseline functioning. hubermanlab+1

Deep, slow breathing benefits vagal outflow, with evidence suggesting particular benefits for older adults in restoring vagal tone. One session of deep and slow breathing can produce measurable improvements in heart rate variability metrics associated with parasympathetic activity. Regular practice of paced breathing at approximately six cycles per minute, significantly lower than the standard respiratory rate of 12 to 20 breaths per minute, can enhance vagal tone and improve overall autonomic regulation. pmc.ncbi.nlm.nih+1 Heart rate variability biofeedback is an innovative, non-invasive, evidence-based technique that enhances vagal nerve activity by combining slow-paced breathing with real-time feedback. The practice proves simple to implement, cost-effective, and carries minimal risk, making it an accessible tool for various health interventions. HRV biofeedback likely modulates neuroplasticity in autonomic control centers, enhancing parasympathetic tone and improving cardiac efficiency, reducing sympathetic overactivation, and lowering systemic inflammation. pmc.ncbi.nlm.nih

Improving Central Nervous System Function and Communication

The comprehensive non-surgical treatments described work synergistically to improve central nervous system function and restore proper communication between the brain and body. These approaches target multiple aspects of neurological health, from cellular-level processes to whole-system integration, supporting the brain’s remarkable capacity for adaptation and healing known as neuroplasticity. Neuroplasticity represents the brain’s ability to reorganize and form new neural connections throughout life, enabling recovery from injury by creating alternative pathways when original circuits become damaged. Following a brain injury, neuroplasticity’s ability to adapt becomes crucial, as these injuries frequently result in severe impairments. Rehabilitation strategies exploit neuroplasticity, leveraging the brain’s plasticity to promote healing through approaches ranging from constraint-induced movement therapy to virtual reality and brain-computer interfaces. pmc.ncbi.nlm.nih

The integration of multiple treatment modalities enhances neuroplastic responses and accelerates recovery. Combining chiropractic care with vestibular rehabilitation, for example, addresses both spinal alignment and sensory integration, creating synergistic effects that amplify benefits beyond what either treatment could achieve alone. Similarly, pairing nutritional interventions with physical therapy provides both the structural building blocks and functional stimulation necessary for optimal neural repair and reorganization. frontiersin+4 Dr. Jimenez’s practice exemplifies this integrated approach, combining specialized chiropractic protocols with wellness programs, functional and integrative nutrition, agility and mobility fitness training, and rehabilitation systems for all ages. The team has taken great pride in providing patients with only clinically proven treatment protocols, using an integrated approach to create personalized care plans that often include functional medicine, acupuncture, electro-acupuncture, and sports medicine principles. The goal is to relieve pain naturally by restoring the body’s health and function through holistic wellness as a lifestyle.

Restoring Vagal Tone and Autonomic Balance

The vagus nerve, as the main neural component of the parasympathetic nervous system, plays a crucial role in maintaining physiological homeostasis. The vagus nerve starts in the brain and ends in the abdomen, and it is responsible for the involuntary functions of the heart, lungs, digestive system, liver, and kidneys. Following a head injury, vagal tone frequently becomes diminished, contributing to autonomic dysfunction and associated symptoms. pmc.ncbi.nlm.nih+3 Heart rate variability serves as a non-invasive biomarker of vagal tone and autonomic flexibility, with reduced HRV associated with cardiovascular diseases, hypertension, inflammation, and mental health disorders. Non-invasive vagal neuromodulation through HRV biofeedback and similar interventions could potentially serve as rehabilitative strategies to restore autonomic balance, mitigate post-injury fatigue, and improve cardiovascular function. pmc.ncbi.nlm.nih

Practices such as breathwork, cold exposure, exercise, meditation, taking probiotics, laughter, singing, massages, and relaxation exercises help improve vagal tone. These accessible interventions provide multiple pathways for patients to actively participate in their recovery, building resilience and enhancing the body’s natural regulatory capacities. High vagal tone is associated with greater resilience to stress, promoting activation of the parasympathetic nervous system and reducing physiological symptoms of stress, such as increased heart rate and muscle tension. neurodivergentinsights+1 The Safe and Sound Protocol represents another non-invasive approach engaging the ventral vagal complex via auditory-motor pathways, facilitating neuroplasticity and enhancing emotional regulation. This protocol may function by modulating the prefrontal cortex’s influence on autonomic outflow, thereby promoting a shift toward parasympathetic dominance. Combined with heart rate variability biofeedback, these approaches offer promising avenues for restoring vagal tone and autonomic balance following head injury. pmc.ncbi.nlm.nih

Enhancing Communication Between Brain and Body

Effective treatment of head injuries requires addressing the fundamental disruption in communication between the brain and body that occurs following trauma. The somatovisceral response, characterized by intricate interactions between somatic (bodily) and visceral (organ) systems, depends on intact nerve signal transmission for proper function. When head injuries disrupt these communication pathways, comprehensive interventions targeting multiple levels of the nervous system become necessary. foundationhealth

  • Chiropractic care directly addresses communication disruption by restoring proper spinal alignment, reducing nerve interference, and optimizing signal transmission between the brain and body. Research demonstrates that chiropractic adjustments can improve brain function by supporting proper cerebrospinal fluid flow and blood circulation, which are crucial for healing after traumatic brain injuries. By facilitating a return to the preferred anatomical form through therapy, function is restored, allowing a complete return to pre-injury activities. hmlfunctionalcare+2
  • Vestibular rehabilitation specifically targets multisensory integration, recognizing that the vestibular system plays a role in multisensory binding, giving rise to a unified multisensory experience underlying self-representation and bodily self-awareness. By addressing vestibular dysfunction through targeted exercises, therapy helps restore temporal binding of sensory information, reducing perceptual chaos and improving coherence of bodily experience. pmc.ncbi.nlm.nih
  • Acupuncture enhances brain-body communication through multiple mechanisms, including stimulation of neuroplasticity, modulation of neurotransmitter systems, and regulation of inflammatory processes. The effect of acupuncture begins with the stimulation of acupoints, which converts physical or chemical information into electrical activity that sends signals along afferent fibers to the spinal cord and brain. This modulation of neural structure and function supports restoration of proper communication throughout the nervous system. pmc.ncbi.nlm.nih
  • Functional medicine approaches recognize that optimal brain-body communication requires addressing multiple factors, including nutrition, inflammation, gut health, hormone balance, and detoxification. Dr. Jimenez’s practice uses detailed Institute for Functional Medicine Collaborative Assessment Programs focused on Integrative Treatment Protocols, thoroughly evaluating personal history, current nutrition, activity behaviors, environmental exposures to toxic elements, and psychological and emotional factors. This comprehensive approach addresses the root causes of chronic disorders, treating the person holistically rather than just managing symptoms.

Improving Somatic and Autonomic Systems

The ultimate goal of comprehensive treatment for head injuries is to restore balance and proper function to both the somatic (voluntary) and the autonomic (involuntary) nervous systems. The somatic nervous system connects to most senses and helps control voluntary muscle movements, while the autonomic nervous system regulates involuntary bodily functions, including heart rate, blood pressure, digestion, and breathing. clevelandclinic Following a head injury, both systems frequently become dysregulated, leading to wide-ranging symptoms affecting physical function, cognitive abilities, and emotional well-being. Addressing this dysregulation requires integrated approaches that simultaneously target physical alignment, sensory processing, autonomic balance, and neuroplasticity. pmc.ncbi.nlm.nih+1

  • Physical therapy, including vestibular rehabilitation and gait training, directly addresses somatic system function by retraining movement patterns, improving balance and coordination, and rebuilding strength and endurance. These interventions leverage neuroplasticity to establish new motor programs and compensatory strategies, supporting functional recovery even when some neural damage persists. pmc.ncbi.nlm.nih+1
  • Autonomic system restoration requires approaches specifically targeting vagal tone and parasympathetic activation. Heart rate variability biofeedback, breathing practices, massage therapy, and acupuncture all support enhanced parasympathetic tone, helping shift the nervous system from states of hyperarousal toward balanced regulation. Dr. Jimenez emphasizes that, by focusing on flexibility, agility, and strength through tailored programs, his practice helps patients of all ages thrive despite health challenges. massgeneral+3
  • Nutritional interventions support both somatic and autonomic function by providing essential building blocks for neural repair, reducing inflammation, supporting mitochondrial function, and optimizing neurotransmitter production. Omega-3 fatty acids, for example, reduce inflammation and oxidative stress while promoting brain cell survival, supporting both structural repair and functional optimization. xiahepublishing+2
  • Cognitive-behavioral therapy and mind-body approaches address the psychological and emotional factors that influence both somatic and autonomic function. By helping patients reframe unhelpful thoughts, manage anxiety and depression, and develop healthy coping strategies, these interventions support overall nervous system regulation and functional recovery. pacmh+3

The Path Forward: Integrative Care for Head Injury Recovery

Recovery from head injuries represents a complex journey requiring patience, persistence, and comprehensive support. The disruption to brain-body communication and development of somatovisceral disorders following head trauma creates challenges that cannot be addressed through single-modality treatments. Instead, the most effective approach involves integrated care that simultaneously addresses physical alignment, sensory processing, autonomic regulation, nutrition, psychological well-being, and neuroplasticity enhancement. Dr. Jimenez’s practice in El Paso exemplifies this integrative model, bringing together chiropractic care, functional medicine, physical therapy, acupuncture, and other evidence-based approaches to provide comprehensive treatment tailored to each patient’s unique needs. His philosophy recognizes that the body has an innate healing capacity when provided with proper support, emphasizing natural recovery methods over invasive procedures or addictive medications. The evidence reviewed throughout this article demonstrates that non-surgical treatments can effectively improve somatovisceral function, restore vagal tone, enhance brain-body communication, and support recovery of both somatic and autonomic nervous systems. These approaches work synergistically, creating conditions that support the brain’s remarkable capacity for adaptation and healing through neuroplasticity. pubmed.ncbi.nlm.nih+6

For individuals recovering from head injuries, seeking comprehensive evaluation and integrated treatment early in the recovery process offers the best opportunity for optimal outcomes. Dr. Jimenez emphasizes that early identification of at-risk patients appears feasible, with somatic symptom disorder potentially serving as a useful framework for conceptualizing poor outcomes from mild traumatic brain injury in patients with prominent psychological distress and guiding rehabilitation. neurologyopen.bmj The future of head injury treatment lies in continued refinement of these integrated approaches, with ongoing research exploring optimal combinations of interventions, timing of treatment initiation, and personalization based on individual patient characteristics. As understanding of brain-body connections deepens and evidence for non-surgical treatments continues to accumulate, patients have increasing reason for hope that recovery is possible with the right comprehensive support. frontiersin

Conclusion

Head traumas cause serious problems with the complex communication systems that link the brain and body. This may lead to somatovisceral illnesses that affect multiple bodily systems simultaneously. To develop effective treatments, it’s important to understand how environmental influences affect brain activity, how symptoms overlap and cluster, and how everyday functioning might be affected. The extensive evidence examined indicates that non-surgical interventions, such as chiropractic care, vestibular rehabilitation, physical therapy, acupuncture, nutritional modifications, massage therapy, cognitive-behavioral therapy, and mind-body techniques, can successfully restore function after head injuries. These treatments increase the function of the central nervous system, restore vagal tone and autonomic balance, and improve communication between the brain and the body. In the end, they help both the somatic and autonomic systems heal.

Dr. Alexander Jimenez’s clinical observations and integrative treatment strategy in El Paso, Texas, demonstrate how integrating evidence-based modalities into individualized care regimens can facilitate optimal patient recovery. This all-encompassing approach gives hope to those who are recovering from head traumas and have somatovisceral problems by concentrating on the body’s inherent ability to heal and treating the fundamental causes instead of merely the symptoms. To get well, you need to be patient, keep going, and get the right help. Integrated care, on the other hand, may help people regain function, lessen symptoms, and enhance their quality of life by treating all areas of health. As research continues to improve our knowledge of how the brain and body work together and how successful treatments are, the future looks bright for even better ways to help people recover from head injuries.

References