A Talk with Saloni Sharma, MD, author of The Pain Solution: 5 Steps to Relieve and Prevent Back Pain, Muscle Pain, and Joint Pain without Medication

SALONI SHARMA, MD, LAc, is double board-certified in pain management and rehabilitation medicine. She is the medical director and founder of the Orthopaedic Integrative Health Center at Rothman Orthopaedics and has treated thousands of patients. She is also cochair of Pain Management and Spine Rehabilitation for the American Academy of Physical Medicine and Rehabilitation. A popular speaker at Google and an award-winning clinical assistant professor at Thomas Jefferson University Hospital, she lives near Philadelphia. More information at www.salonisharmamd.com.

What are some of the top myths about orthopaedic pain? 

The tops myths are that nutrition, sleep, and stress do not affect orthopaedic pain. These factors matter! They feed or quell painful inflammation. Yet, most people are unaware of the huge impact these factors have on reducing pain and feeling better. Poor nutrition, poor sleep, and excessive stress create more inflammation which fuels more pain. Likewise, improving the food we eat, our sleep, and stress levels reduces pain and helps us heal. In fact, the American Academy of Orthopaedic Surgeons recommends better nutrition, sleep quality, and stress reduction to improve orthopaedic recovery. 

As opioid-related deaths have increased (especially during the pandemic) what does your book, The Pain Solution, offer as an alternative to opioids?

Unfortunately, opioid-related deaths and pain have skyrocketed during the pandemic. The Pain Solution offers a path to pain relief that does not rely on pills. The Relief-5R plan, explained in the book, not only reduces pain but builds lasting health and a better life. It teaches a simple system to improve health factors. The plan is based on small changes that make a big difference. I call these, microboosts, little steps that add up to big pain relief. If we use the tools in the book to reduce whole-body inflammation and pain, then we can avoid or minimize pain medications such as opioids.

What are the 5 modifiable life factors that contribute to pain and inflammation?

The five modifiable life factors that contribute to painful inflammation are nutrition, movement, sleep, stress, and relationships. It is easier to improve these factors if we have a practical plan to guide us such as the Relief-5R plan. While most orthopaedists do not write prescriptions for a pain-fighting food plan, better sleep, or stress reduction techniques (like mindfulness), these factors combined with typical treatments provide more lasting relief. Without improving these factors, our bodies and brains remained inflamed. This means standard treatments like medications only provide partial, temporary relief and we remain trapped in pain. We must address these global pain factors to feel better and stay better.

What is your Relief-5R plan? 

My Relief-5R plan 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. This is a practical plan to not only understand what lifestyle factors (food, activity, sleep, stress, relationships) matter but why they matter (the evidence) and how to easily add these microboosts to our busy days. The beauty of this plan is that it is concrete and customizable: the reader picks which microboosts work in their life and decides when and how to enact them. 

What is implementation intention and how does it fit into the Relief-5R plan? 

Implementation intention is creating a plan that specifies the who, what, why, when, where, and how of working towards your goal. It details the specifics so you can build a good habit and not rely on motivation alone. We know you (the who) want to crush painful inflammation (the what) to live better (the why). The microboosts recommended in this book show you the how. Deciding when and where you will implement your chosen microboosts builds a realistic, customized pain relief plan. For example, thinking, I should eat more vegetables is not a plan but a thought. But planning, I will fill half my plate with vegetables at dinner every weekday is a concrete plan. This practical method helps you reduce pain, limit inflammation, and live better.

Could you explain your mnemonic RELIEF and how it helps achieve goals?

I created the mnemonic RELIEF to use as a simple way to add microboosts to your day. It stands for Remove barriers, Eye level, Link to a specific activity, “I” declaration, Encourage progress by tracking, and Feel better! It is a strategy to seamlessly incorporate microboosts into a busy schedule and remove barriers. It is detailed in the book and is a straightforward, yet powerful, method to add small steps that improve our lives. 

What is a microboost and how do they help one get to a life with less pain?

Microboosts are small steps that move us toward ease and relief. Together they add up to big relief. Each microboost is a simple step that helps reduce inflammation and pain. They do so by tweaking our daily routine including food intake, activity level, sleep, stress, and relationships. The end of each core chapter lists a wide range of practical microboosts that have proved effective in reducing and preventing pain.

It is recommended that a reader pick two microboosts that work for them. 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 the RELIEF method for easily integrating them into your daily routine. This is the roadmap to less pain, more function, and a better life. 

What are the pain-relieving benefits of polyphenols – the micronutrients that naturally occur in plants?

Phytonutrients are plant’s superpowers. They are the chemicals that give plants their color, protection against diseases, and strength. For humans, phytonutrients act as antioxidants and anti-inflammatories. They boost health, charge the immune system, protect joints, and fight inflammation with no side effects and little cost! For example, the polyphenols found in berries, turmeric, and green tea help preserve our joints and limit arthritis damage. Studies have shown that an increased intake of polyphenol phytonutrients slows down joint and back degeneration, increases collagen production (important to skin and joint health), and decreases cell death. Since our bodies cannot produce these vital nutrients, we need to eat a variety of colorful plant foods to tame painful inflammation. 

How does a healthy gut microbiome help back pain?  

Our digestive tract is populated by more than a trillion tiny organisms, including bacteria, viruses, fungi, and yeast that are together called the gut microbiome. An optimal microbiome helps us digest food, absorb vitamins, fight infections, and lower painful inflammation. An unbalanced gut microbiome causes chaos, dysfunction, and pain. Studies have found that an unbalanced microbiome correlates with chronic musculoskeletal pain such as back, muscle, and joint pain. The Standard American Diet (SAD) directly affects the gut and leads to more swelling, more inflammation, more pain, and more dysfunction. If we want reduce orthopaedic pain and limit severe flare-ups, then we need a healthy gut microbiome.

You created a modified mindfulness tool for pain awareness and response with the mnemonic PAIN. Can you share how this works?

There are many well-established meditation tools to stop harmful thinking patterns, but pain comes with a special set of challenges. A mindfulness tool for compassion popularized by Tara Brach is RAIN (recognize, allow, investigate, nurture). I have created a modified version to disrupt negative pain thought spirals: PAIN (pause, accept, inquire, now decide). The first step is to pause and accept that this is what you are feeling in the moment. This enables you to recognize the feeling instead of fighting it. Next, inquire about what feelings and thoughts are contributing to the pain. The final step is deciding on what actions to take to reduce the pain. 

How does food affect back, muscle, and join pain?

Food and orthopaedic pain may not seem linked but they are intimately connected. The standard American diet (SAD) is more than sad; it breeds pain, inflammation, and disease.

It is composed of processed foods high in added sugar, added salt, and saturated fats, and low in nutrients. It lacks vegetables, fruits, and legumes. This processed, nutrient-poor diet increases pain and inflammation. If we do not address this major pain factor, we are missing a huge opportunity to reduce pain without pills.

What foods help reduce inflammation and pain?

We know the SAD results in more inflammation, pain, and dis-ease. A diet of unprocessed foods loaded with vegetables and fruits, helps reduce pain, restore gut balance, and decrease inflammation. A randomized controlled study reported in Pain Medicine found that adopting a low-carbohydrate diet (with leafy green vegetables and non-starchy vegetables) resulted in less pain, less inflammation, less oxidative stress, and more function in only twelve weeks. The authors suggested that dietary improvements might be a way to reduce opioid and other medication use. Additionally, a Mediterranean-style diet has been found in multiple studies to decrease pain and disability for people with joint pain. This type of diet, incorporating lots of fresh vegetables, fish and seafood, and small servings of lean meat, shifts the body to ease and relief. In the book, I share my guide to anti-inflammatory eating including five superfoods and powerhouse spices to reduce pain.

How does stress affect back, muscle, and join pain and what are the top 3 things one can do to decrease stress?

Conventional pain treatments focus on physical stress. Yet we know that mental and emotional stress worsen orthopaedic pain. Stress increases inflammation and can manifest as pain, spasms, and suffering. As an example, simply think about a corrupt politician, cutthroat coworker, or challenging family member. Picture the lines of their face, the sound of their voice, their negative words ringing in your ears, and the devastation caused by their actions. These thoughts may trigger tightness in your jaw, shoulders, or back. Your heart rate may quicken as your stress response flicks on. Thankfully, there are many microboosts we can use to decrease stress including practicing a mindfulness activity, taking an adult time-out (as explained in the book), and even looking at a favorite nature scene.

How does sleep affect back pain?

Pain and sleep difficulties are undeniably intertwined. Pain can disrupt sleep as a result of difficulties in finding a comfortable sleeping position or experiencing pain when rolling over. Sleep can also be affected by elevated stress hormones, anxiety, and depression. In a study of people sent to pain physicians, 70% described their sleep as poor and reported fewer sleep hours, greater disability, higher pain levels, less daytime activity, and higher depression and anxiety scores. Poor sleep is documented among people with arthritis, fibromyalgia, headaches, and other painful conditions. Even in people with and without diagnosed painful conditions, there is a clear connection between poor sleep and pain.

A study of more than seventeen thousand adults found that sleeping for five hours or less per night is associated with more musculoskeletal pain. Additionally, shorter sleep durations (less than six hours) are correlated with higher levels of inflammation and a lower pain tolerance. Sleep affects back pain in a multitude of ways.

How do relationships, both good and challenging ones, affect pain?

Poor relationships and loneliness are stressors just like poor food, lack of exercise, and disrupted sleep. Feeling isolated activates the stress response, raises cortisol, increases inflammation, increases defensiveness, and decreases sleep quality. A lack of support results in a greater risk of developing musculoskeletal problems. A systematic review found that poor social support could be used as a predictor of chronic low back pain. In addition, social isolation results in weight gain and may contribute to the development of inflammatory conditions such as diabetes as well as mental health issues. Good relationships and a sense of community help us reduce inflammation and better handle painful challenges.

The Pain Solution:

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

By Saloni Sharma, MD, FAAPMR, LAc * Foreword by Andrew Weil, MD

Category: Health & Well-Being * Pub Date: May 17, 2022

Price: $17.95 * Format: Trade Paperback

B & W Illustrations * Pages: 256 * ISBN: 978-1-60868-793-0

Also available as an ebook