What are the guidelines for approaching functional medicine (FM) therapies?

Guidelines for Approaching Functional Medicine Therapies

Functional medicine therapies should be implemented as part of a multidisciplinary approach that prioritizes evidence-based interventions while addressing the underlying causes of disease rather than just managing symptoms.

Core Principles of Functional Medicine Approach

• Functional medicine is a patient-centered approach that seeks to address underlying causes of disease rather than focusing solely on symptom management 1
• The approach should integrate strategies to address modifiable lifestyle factors including nutrition, sleep, stress management, and physical activity 2
• Functional medicine can serve as an adjunct to traditional medical care, not a replacement for evidence-based conventional treatments 2, 3

Evidence-Based Interventions in Functional Medicine

For Chronic Multisymptom Illness (CMI)

• Cognitive-behavioral therapy (CBT) or mindfulness-based therapy should be offered as first-line treatments for patients with chronic multisymptom illness 4
• Avoid opioid medications for pain related to CMI 4
• For patients with fibromyalgia syndrome (FMS) symptoms:
  • Consider yoga or tai chi as complementary interventions 4
  • Consider manual acupuncture as part of management 4
  • Physical exercise has demonstrated benefits in improving quality of life and reducing pain 4
  • Consider a trial of SNRIs or pregabalin for symptom management 4
  • Avoid NSAIDs for chronic pain related to CMI 4

For Functional Neurological Disorders (FND)

• Treatment should focus on activity-based (functional) rather than impairment-based goals and interventions 4
• Recognize and sensitively challenge unhelpful thoughts, beliefs, and behaviors 4
• Where possible, avoid use of compensatory aids and techniques in the acute phase or when undergoing active rehabilitation 4
• Avoid use of splints or devices that immobilize joints 4
• For functional movement symptoms:
  • Address unhelpful cognitions and movement patterns 4
  • Encourage optimal postural alignment at rest and within function 4
  • Promote normal movement techniques within functional activities 4

Nutrition Interventions

• A supervised elimination diet under the direction of a trained functional medicine dietitian can be effective for identifying food sensitivities 2, 5
• Elimination diets with functional medicine health coaching support have shown superior results in dietary compliance and improved health outcomes compared to self-guided approaches, particularly for those with greater symptomatology 5

Implementation Considerations

• Provide education about the diagnosis and the person's symptoms 4
• Involve significant others in education and treatment 4
• Use variability of symptoms positively in treatment 4
• Integrate specific treatment techniques into function and show the person how to carry these over independently 4
• Complete a relapse prevention and ongoing self-management plan as part of treatment 4

Quality Control and Evidence Concerns

• The complex functional medicine model posits multiple individualized diagnostic and therapeutic approaches, many of which have reasonable underlying science but have not been rigorously tested in research settings 6
• This can lead to non-rigorous thinking and sometimes uncritical acceptance of poorly documented diagnostic procedures and ineffective therapies 6
• Practitioners should prioritize interventions with stronger evidence bases and be transparent about limitations in evidence 6

Monitoring and Follow-up

• Regular evaluation by appropriate specialists during and after functional medicine interventions is recommended 4
• Booking follow-up appointments to review progress, troubleshoot issues, and reset goals is advised 4
• Document improvements in patient-reported outcomes such as quality of life, fatigue, and sleep quality to assess effectiveness 2, 5