Table 4.

Clinical Decision-Making Within the Initial Integrative Consult

Refer to PT when

Pain co-occurs with kinesiophobia

There are multiple pain sites

Myofascial trigger points are present

Patient is deconditioned

Joints are hypermobile

Recommend therapeutic movement (rather than or in addition to PT) when:

Patient demonstrates self-motivation

Patient is deconditioned without acute pathology

Patient has completed PT

Patient is in maintenance phase of treatment

Refer to acupuncture when patient symptoms:

Include pain, digestive issues, and/or fatigue

Prevent engagement in movement or psychologic therapy

Refer to massage therapy when patients:

Have myofascial pain

Need support in learning to relax in their body/breath

Need to improve their mind–body connection

Refer to health psychologist when

Medical condition impacts level of function

Medical condition impacts quality of life

Patient lacks coping skills for self-management of his or her medical condition

Patient's relationship to the pain and/or the medical condition is suboptimal

Psychologic factors are interfering with patient's ability to effectively cope with symptoms

Patient is unable to participate in groups due to acute distress or other individual-level factors

Refer to group psychotherapy and/or mind–body treatment groups when patients need

Self-regulatory or coping skills

Pain education

Socialization

Note: Avoid referral when patient is suicidal, emotionally unstable, or psychotic

Consider mind and body therapies

Nutrition counseling

Biofeedback

Aromatherapy

Health coaching

Other services with NP/MD/PhD

NP, nurse practitioner; PT, physical therapy.