The Pain Solution: 5 Steps to Relieve and Prevent Back Pain, Muscle Pain, and Joint Pain without Medication

Praise for The Pain Solution

Absolutely brilliant! A must-read for all Americans with ongoing pain — an essential yet practical guide to solving your pain problems.

— Robin Raju, DO, assistant professor, orthopaedics and rehabilitation, Yale School of Medicine

A remarkable book, full of empathy and empowerment for those suffering from chronic pain. Dr. Sharma’s Relief-5R plan informs and supports us to make clear and reachable steps to markedly reduce pain and enhance health!

— Erik Ensrud, MD, professor of physiatry and neurology, University of Kansas

Dr. Sharma’s book empowers the patient, illuminates nondrug remedies, and revives practitioners’ treatment repertoires. It is a great resource for those confronting pain.

— Ronnen Abramov, DO, pain medicine specialist, Princeton Medical Center

This book is a critical read for anyone suffering from chronic pain and in need of tangible, concrete strategies to get back to a more normal life, one less reliant on medications and instead more focused on centering activities that improve overall wellness. It’s so timely, given the havoc the Covid-19 pandemic has wreaked on many individuals suffering with chronic pain and addiction disorders.

— Vin Gupta, MD, MPA, professor and health policy expert; senior principal, health, at Amazon; and medical analyst at NBC News

Dr. Saloni Sharma’s book provides empathic, sound clinical advice to the millions of patients experiencing and managing chronic back pain. Dr. Sharma’s Relief-5R plan is a helpful approach that enables patients to set small goals toward creating lasting habits. I love how she describes them as ‘microboosts’ — ‘little steps that boost you toward ease and relief.’ I know my patients will benefit from Dr. Sharma’s guidance and techniques.

— Deborah A. Venesy, MD, senior staff, Cleveland Clinic Center for Spine Health

"The Pain Solution offers what the title promises. You can, by reading this book, discover your best self and be free of the pains of your past. Read, learn, and be guided to a more comfortable life, and let the healing begin!"

— Bernie Siegel, MD, New York Times bestselling author of Love, Medicine & Miracles and No Endings, Only Beginnings

Dr. Sharma offers a simple framework and reasonable strategies to navigate an often complicated and daunting path to optimal health. I will wholeheartedly recommend this book to my patients, friends, and family.

— John Vasudevan, MD, CAQSM, associate professor, University of Pennsylvania, and medical director, Rock ‘n’ Roll Philadelphia Half Marathon

"Chronic pain is arguably the most soul-sapping, joy-gutting adversity an ever-increasing portion of our population — our loved ones, colleagues, selves — struggles with every day. Dr. Sharma’s groundbreaking and scientifically solid book upshifts us from victims to healers. The Pain Solution equips us with a potent and vital blend of self-efficacy, action, hope, and control. This is the book you will want to give to anyone and everyone who is in pain and suffering."

— Paul G. Stoltz, PhD, globally bestselling author of Adversity Quotient and GRIT and founder and CEO of PEAK Learning, Inc.

Dr. Sharma has outlined a tremendous process that will help all people who suffer from chronic pain. Her five-step solution applies to anyone with any type of chronic pain and is a great series of options that patients can use in the comfort of their own homes to relieve (or prevent the occurrence of) pain. Dr. Sharma is an incredible colleague who is world-renowned for her conservative and effective treatment options for patients with chronic pain, and it is no surprise that she has written a seminal work on this topic.

— Ameet Nagpal, MD, MS, MEd, division chief, physical medicine and rehabilitation, Medical University of South Carolina

As a physician who sees patients in pain on a daily basis, Dr. Sharma has written a must-read book for all who have ever had debilitating pain to learn how to regain control of their lives and pursue the version of themselves they can only dream of now. This is the most comprehensive but approachable guide to why we hurt and what we can do about it. It starts with a self-assessment that allows us to identify opportunities for growth and improvement, then shows us how to achieve them. For those of us currently hurting, she helps us understand how we got to where we are — and how to get out of there!

— Ai Mukai, MD, faculty, Dell Medical School, University of Texas at Austin, and pain management specialist, Texas Orthopedics Sports and Rehabilitation, OrthoLoneStar, Austin

Copyright © 2022 by Saloni Sharma, MD

All rights reserved. This book may not be reproduced in whole or in part, stored in a retrieval system, or transmitted in any form or by any means — electronic, mechanical, or other — without written permission from the publisher, except by a reviewer, who may quote brief passages in a review.

The material in this book is intended for education. No expressed or implied guarantee of the effects of the use of the recommendations can be given or liability taken. It is not meant to take the place of diagnosis and treatment by a qualified medical practitioner or therapist. Some names have been changed to protect privacy. Neither the publisher nor author is rendering medical advice or services to the individual reader. This book is not a substitute for a medical consultation with your physician, and all changes regarding your health require supervision by your own physician. Neither the author nor publisher shall be liable for any damage or loss allegedly coming from information or recommendations in this book.

Text design by Tona Pearce Myers

Library of Congress Cataloging-in-Publication Data

Names: Sharma, Saloni, author.

Title: The pain solution : 5 steps to relieve and prevent back pain, muscle pain, and joint pain without medication / Saloni Sharma, MD, FAAPMR, LAc ; foreword by Andrew Weil, MD.

Description: Novato, California : New World Library, [2022] | Includes bibliographical references and index. | Summary: A patient-proven approach to pain prevention, relief, and eradication without medication, surgery, or special equipment—Provided by publisher.

Identifiers: LCCN 2022000218 (print) | LCCN 2022000219 (ebook) | ISBN 9781608687930 (paperback) | ISBN 9781608687947 (epub)

Subjects: LCSH: Pain—Alternative treatment. | Backache—Alternative treatment. | Myalgia—Alternative treatment. | Joints—Diseases—Alternative treatment.

Classification: LCC RB127 .S46 2022 (print) | LCC RB127 (ebook) | DDC 616/.0472—dc23/eng/20220126

LC record available at https://lccn.loc.gov/2022000218

LC ebook record available at https://lccn.loc.gov/2022000219

First printing, May 2022

ISBN 978-1-60868-793-0

Ebook ISBN 978-1-60868-794-7

Printed in Canada on 100% postconsumer-waste recycled paper

10 9 8 7 6 5 4 3 2 1

To all the people searching for relief, ease, and joy

To all the patients I have had the honor of treating

To my colleagues making a difference in a fractured system

And to my loves, for their unwavering support, love, and belief: MW, LW, MW, Dad, Mom, MS, and PS

A bird slams into the glass.

A bird slams into the glass.

A bird slams into the glass.

Over and over again, headfirst,

determined to defeat its own reflection.

A head butt of bravado.

I watched it, time and time again.

From the inside, I studied the dozens of oily streaks

smeared across the window.

After a few minutes, the bird would fly away — sore or distracted

from its battle with itself.

It would be comical if it weren’t painful.

Like the bird, we repeatedly bash ourselves against

invisible constraints:

eat poorly, sleep less, move less, enjoy less human connection,

take on more responsibilities, build stress, and suffer more.

It is time to stop beating ourselves against the glass.

To pause and to be mindful.

To see who we are.

To decide who we are becoming,

what our body is becoming,

and what our life is becoming.

Let’s stop ramming into the glass.

Let’s stop suffering.

Let’s ease pain.

Let’s live better.

SALONI SHARMA, MD

Contents

Foreword by Andrew Weil, MD

Introduction

1: The Pain Problem

2: The Relief-5R Plan

3: Refuel

4: Revitalize

5: Recharge

6: Refresh

7: Relate

8: The Path

Acknowledgments

List of Illustrations

Notes

Index

About the Author

Foreword

We have a big problem. More people are suffering from pain than ever before — with devastating consequences. More than one in every five Americans report ongoing pain, especially back, joint, and muscle pain. For decades the pharmaceutical industry has pushed medications as the primary treatment for pain — anti-inflammatories, muscle relaxers, and dangerous opioids. These medications are not solutions, merely ways to temporarily dampen symptoms. Worse, they often have adverse effects and such unintended consequences as organ damage, bleeding ulcers, brain fogginess, constipation, breathing abnormalities, addiction, and even death. The painful conditions they are used for would be better treated by improving eating patterns, activity levels, sleep habits, and stress levels. A true pain solution must go to the source of the problem and address the whole person. This book offers a true pain solution. As you read it, you will discover that lasting pain relief is not found in pill bottles but rests on building a healthy lifestyle, pain resiliency, and preventative measures. It is time to take charge of our own pain care. It is time to stop suffering.

Although the United States is a beacon of scientific achievement and medical innovation, compared to other nations it has one of the highest rates of people in pain. Low back pain is the number one cause of disability in our country. Because of our nation’s pharmaceutical-driven medical approach, we lead the world in opioid use and are fighting an opioid crisis. Unfortunately, physicians in training are not typically taught other ways to treat pain, and many patients are not aware of evidence-based, nonpharmacological treatments.

In my role as director of the Andrew Weil University of Arizona Center for Integrative Medicine, I have taught thousands of physicians, allied health professionals, and students about other ways to treat pain. One example is dietary change. When I develop a treatment program for a patient, my first step considers ways to change eating patterns that can help. An anti-inflammatory eating plan can calm pain. There is excellent evidence that supports this, and Dr. Sharma skillfully explains the data while providing practical recommendations on how to take advantage of it. Another possibility is mind-body medicine, making use of mindfulness, meditation, breathing exercises, guided imagery, and visualization. Patients often experience remarkable pain relief with these methods. This book not only reveals the evidence behind these methods but shares a novel approach for comprehensive pain relief.

Dr. Sharma is a double board-certified pain physician, a national leader in pain management, medical director of the Orthopaedic Integrative Health Center, an acupuncturist, and a graduate fellow in integrative medicine at the University of Arizona. This book is a culmination of her years of work managing orthopaedic pain with both conventional and integrative treatments. The Pain Solution fills an urgent need. It is what we have been searching for to understand and implement better pain care. This is the future of medicine — treating the whole person, not just the symptom. In this integrative approach, we all play an active role in our care, build wellness, improve resiliency, and live better.

Congratulations on starting the journey to a better life with less pain!

ANDREW WEIL, MD

Tucson, Arizona

Introduction

Two metal rods ran the length of my spine. A third metal rod emerged from the plastic that encased my abdomen, lay across my breastbone, and met the other rods to form a ring around my neck like a metal dog collar. Little screws on the back of the brace tore out strands of my hair. I was eleven years old, and this was the treatment for a curved spine. From this experience, I learned what it meant to live with orthopaedic pain long before I became a physician certified in treating people with pain. Experiencing orthopaedic pain inspired my mission to help people live better and with less pain.

Fortunately, most people do not spend years encased in metal restraints, but an estimated 80 percent of Americans experience back pain at some point in their lives. This statistic does not take into account other types of orthopaedic pain, including muscle sprains, arthritis pain, joint pain, and neck pain. While orthopaedic pain may seem inevitable for most people, we can lessen its impact on our daily lives. We can reduce its intensity and duration, protect ourselves against future pain, and stop suffering by making small changes in the way we live. These small steps move us toward ease and relief. I call them microboosts.

My Relief-5R plan, based on more than a decade of practice as a pain physician, consists of many microboosts that add up to big pain relief. The plan gets its name from its five pillars of pain relief: refuel, revitalize, recharge, refresh, and relate. Chapters 3–7 of the book discuss each of these pillars in depth and offer a wide range of microboosts that have proved effective in reducing and preventing pain. Level 1 microboosts are small, simple changes that you can implement right away; level 2 microboosts may require a little more time, effort, or commitment. To help these microboosts stick, each chapter contains practical advice for easily integrating them into your routine. This is the road map to less pain, more function, and a better life.

Does pain limit you now? Do you want to prevent pain from hijacking your life? The questionnaire below identifies key risk factors for chronic pain and suffering. Thankfully, we can eliminate most of these risk factors and reduce others; only a few are part of our history. And even though we cannot change that history, we can change our view of it so that we are not shackled by pain.

It may be helpful to complete this questionnaire once before you begin the Relief-5R plan and again after you have followed it for four weeks. This is a living experiment: test out the plan and see if it works for you. After all, you have nothing to lose but pain and suffering.

Risk Factors for Chronic Pain: Questionnaire

Respond to these questions on a scale from 0 to 5, where 0 means no or never, and 5 means yes or always.

1. Do you have recurring pain?

2. Are you overweight?

3. Do you eat processed foods and sugary foods more than twice a day? (This includes packaged foods with more than five ingredients and foods with more than ten grams of added sugar.)

4. Do you have a low intake of vegetables, fruits, nuts, and fish?

5. Do you consume sugary beverages, including soda, fruit juice, or coffee or tea with sugar daily ?

6. Do you drink less than four glasses of water a day?

7. Are you sedentary for most of the day?

8. Do you walk for less than twenty minutes a day?

9. Do you take anti-inflammatory medications (e.g., ibuprofen, naproxen) daily or nearly every day?

10. Do you smoke?

11. Do you drink alcohol daily?

12. Do you spend limited time outside daily?

13. Do you sleep for less than seven hours a night?

14. Do you have trouble sleeping?

15. Do you have any inflammatory conditions, such as diabetes, prediabetes, heart disease, or high blood pressure?

16. Do you have family members with chronic pain?

17. Do you have a history of adverse childhood experiences (trauma, abuse, neglect)?

18. Do you have trouble coping with change?

19. Are you under stress?

20. Do you find it difficult to deal with stress?

21. Are you no longer learning something new or challenging yourself?

22. Do you feel lonely?

23. Are you surrounded by negative people who bring you down?

24. Do you have a pessimistic outlook?

25. Do you have days when you experience no joy?

Add up your numerical responses to all the questions. If your score is higher than 30, then you may have a higher risk of chronic pain and suffering. The good news is that many of these factors can be modified with little tweaks to your daily routine. The Relief-5R plan provides simple steps to reduce and prevent pain. The following pages will explain how to put it into practice. As with all health and wellness changes, please clear all changes with your own physician before you begin.

Congratulations on starting a path to a better life!

CHAPTER 1

The Pain Problem

The way modern medicine operates is like trying to diagnose what’s wrong with your car by listening to the noises it makes instead of looking under the hood. … We must learn to treat the person, not the disease; the system, not just the symptoms.

— MARK HYMAN, MD

If you are the kind of person who believes in treating the root cause of pain instead of relying on temporary Band-aids, then this is the book for you. We can calm pain, build resilience, and stop suffering without medications. True relief comes from identifying and treating the source of pain. Think about the last time you felt good, living your life with joy and without pain, your body well, and your mind calm. Can you see it? Can you feel it? It is possible to feel that way again. We can design our lives to help us feel better, be better, and live better.

You may want to prevent severe pain, or you may have struggled with crippling pain for days, months, or years, with little relief provided by conventional remedies. But painful suffering is not your destiny. Failed treatments are not your fault. There is a lot of misinformation and impractical advice out there, often spread by those with ulterior motives. Continued