Current pain treatments and their deficiencies

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

The U.S. health care system is designed to handle emergencies. It manages life-threatening heart attacks and acute fractures well. Thankfully, it saves lives. But most ongoing medical conditions are not life-threatening, they are life draining. They chip away at joy. Ongoing painful conditions such as spine and arthritis pain steal people’s daily lives. They limit the ability to stand up at a wedding, watch a child’s soccer game from the sidelines, and even fetch the mail. Unfortunately, the medical system usually offers no lasting solutions.

Chronic painful conditions often have complex, interrelated causes. Conventional health care is modeled around identifying and “fixing” an immediate and dangerous problem, not diagnosing and alleviating chronic painful conditions. If your pain continues beyond an “expected” course, or you want to avoid pain medications, or your pain occurs without a triggering event, then the current model fails. It fails to consider the whole person. It fails to address the imbalances fueling pain and dysfunction.

Insurance companies, hospital systems, and administrators push for algorithms to treat patients in a cookie-cutter way. This approach has some benefits. Standardized checklists and guidelines for treatment, for instance, help ensure that nothing is overlooked. Measuring outcomes helps assess the effectiveness of treatments. Standardization also identifies opportunities to save money and increase efficiency. But strict adherence to these algorithms, with little consideration of a person’s unique medical history, lifestyle factors, and environment, results in subpar pain care. To minimize pain, eliminate suffering, and enable a person to function better, clinicians must see the whole person, reviewing their daily habits, activities, and environment alongside their medical history, physical exam, and diagnostic tests. These individual factors influence pain, disease, unease, and wellness.

In the current health care system, time and financial constraints have led to a divide-and-conquer attitude. Well-meaning physicians are allotted only ten to fifteen minutes for office visits, forcing them to focus on one issue and refer the patient to specialists to address additional concerns. A person with pain may be sent to a psychiatrist for depression, a lung doctor to assess sleep problems, and a cardiologist to treat high blood pressure. These specialists play an important role, but we need to remember that these conditions are interconnected. We must consider the big picture: the whole, interconnected person.

Many prescription medication commercials tell us, “When diet and exercise fail, you can take this pill!” Ironically, this is an admission by the pharmaceutical industry that changes to our lifestyle (such as diet and exercise) are the first step to feeling better! It’s also an admission that these changes can make medications unnecessary. Yet more than 68 percent of Americans receive at least one prescription medication every year. Ninety percent of Americans over age 65 take prescription medications, and almost 40 percent take more than five prescription medications.

While some medications are life-saving and necessary, the unintended effects of this smorgasbord of medications on multiple organ systems and the gut microbiome (discussed in chapter 3),

in addition to known side effects, drug interactions, and cost, are mind-blowing. Many of these lab-synthesized chemicals may contribute to whole-body inflammation, stress, hormonal imbalances, gut damage, and impaired cognition, in addition to causing side effects that require many columns of small print to disclose. Yet medications are often considered the go-to treatment for both pain and inflammation. While pain and inflammation are undeniably linked — as inflammation levels rise, pain increases — medications are not the answer. They do not provide lasting relief.

Many of us can reduce the number and quantity of prescription medications we need by caring for our bodies. Research has shown that diet and other lifestyle changes could prevent 80 percent of inflammatory conditions such as diabetes, stroke, and premature heart disease. Inflammation drives these conditions and drives ongoing pain. To stop ongoing pain, we must reduce painful inflammation.

For decades, my colleagues and I have seen different people with the same MRI findings of severe back arthritis (severe stenosis). One person may have acute, piercing pain and have difficulty even walking to the bathroom. Another may have only mild pain and be surprised to learn that they have severe stenosis. Why does the same diagnosis produce such different symptoms? The differences arise from each person’s unique combination of genetics, medical history, and fuel. Fuel refers not only to what we eat and drink but also to behavioral factors that feed into our well-being, such as exercise, sleep, stressors, and relationships. This combination determines an individual’s overall level of painful inflammation. The good news is that some of these factors are within our control.

We become what we consume — and what we do. If we are stuck in a pattern of eating foods, practicing behaviors, and living in an environment that aggravates inflammation, then our body turns into a house of pain. If we break free of these patterns and improve our fuel, behaviors, and environment, we quell that inflammation. We can control our future with the choices we make today. For example, even if we have a strong family history of an inflammatory condition such as type 2 diabetes, we are not inevitably destined to have the disease. Our fuel, behaviors, and environment also play a role in determining whether we travel down a path of inflammation. These choices determine whether we become the best possible version of ourselves. We must fuel well to feel well and be well.

The Holy Grail of medicine used to be increasing lifespan: now the goal is increasing healthspan, the number of years lived in good health with the ability to participate in life. Isn’t this what we really want? Eighty years is a long lifespan, but if it is burdened by forty years of disease, a poor quality of life, and limited function, then the result is a short healthspan. Low back pain, neck pain, musculoskeletal disorders, and arthritis decrease healthspan.

Diet and lifestyle factors affect healthspan. A 2020 study published in the Journal of the American Medical Association found that maintaining a healthy weight, being physically active, not smoking, and limiting alcohol intake increased healthy years. Nutritious foods help extend our healthspan, as do improvements in physical activity, sleep, resilience, and healthy relationships.

In my medical training, we were taught five ways to treat pain: lifestyle modifications, physical therapy, medications, injections, and surgery. Lifestyle modifications are positive changes in diet, exercise, sleep, and stress levels. This is the first-line treatment for painful inflammation. Yet we tend to overlook this option in favor of tools that produce quicker results. Passive treatments (medications, injections, some surgeries) can relieve acute pain or nerve damage but do not always provide lasting relief for ongoing or recurring pain. And even these passive treatments work better when coupled with lifestyle changes. To decrease chronic pain, we must consider what we consume. Better fuel reduces inflammation, improves function, and restores balance.

Lifestyle medicine doctors like to say, “Diet and exercise rarely fail us, but we fail them.” While this is true in theory, the reality is not so simple. In the modern world, there are endless pressures, professional obligations, and personal responsibilities that seem to block the pursuit of wellness. These obstacles sink us into a painful quicksand, leaving us unsure how to escape.

Freedom lies in taking little steps. By integrating small wellness changes into our chaotic days, we can stop suffering. The keys are discovering what would help, why these wellness choices matter, and how to incorporate them into a busy life. Understanding the why and the how are critical to living a life with less pain.

Saloni Sharma is a pain management and rehabilitation medicine physician and author of The Pain Solution: 5 Steps to Relieve and Prevent Back Pain, Muscle Pain, and Joint Pain without Medication.