The Relief-5R Plan

The Relief-5R Plan
An Excerpt from The Pain Solution by Saloni Sharma, MD

In many cases, the outcome you want will continue
to elude you — even if you try harder. But it may be possible if you try differently.
Can your current choices carry you to your desired future? If not, something has to change. You can’t get there from here.
You have to get on a different trajectory.
— James Clear

Modern life brims with little and big stressors, from never-ending phone notifications and late nights to the loss of a job or a devastating injury. These physical, mental, and emotional stressors intensify orthopaedic pain. They tighten our muscles, constrict blood vessels, and pinch nerves. When we are stressed, we become smaller, self-focused, and limited. Our bodies crumple into a ball of tension, inflammation, and pain, sometimes so bad that we have trouble standing up straight or walking.

The tools in this book can help you reduce painful inflammation and chronic stress in order to function and live better. What we fuel our bodies with today determines our future level of painful inflammation. Each bite of food, each movement, each response to stress, each sleep decision, and each social relationship can tip the balance toward or away from painful inflammation. Small, simple changes can add up to a big reduction in overall pain and inflammation, and a big increase in wellness. To understand how and why they work, let’s look at some of the root causes of pain and the ways our body and brain send and interpret pain signals.

Lower Back Pain and Arthritis (Joint) Pain
More than 60 million Americans have had a recent bout of back pain. The leading causes of back pain include muscle sprains, spasms, degenerative disc disease, disc herniations, nerve root pinching, spinal stenosis (arthritis), facet joint spondylosis (arthritis), bony misalignments, abnormal spinal curvatures, and fractures. Disc herniations are a common cause of back pain. Spinal discs act as rubbery shock absorbers between the vertebrae (the bones of the spine). We can think of them as being like jelly donuts, with thicker outer layers and gelatinous middles. If there is a tear in the outer layer, some of the gelatinous substance may leak out: this is called a herniation. If this rupture occurs near a nerve, it may irritate the nerve and cause symptoms such as leg pain, weakness, and numbness. Arthritic bone spurs and cysts can also pinch nerves and cause similar symptoms.

Other common sources of back pain are sacroiliac joint pain, bursitis, hip pain, piriformis syndrome, inflammatory arthritis, and widespread pain conditions like fibromyalgia. Some of these conditions can occur in combination. Other, less common forms of pain are related to conditions such as infection or cancer (and this is the reason that any ongoing pain must be evaluated by your physician).

With age, everybody develops some arthritic joint changes as a result of wear and tear, but these can be aggravated by physical stressors, injuries, obesity, and genetics. Another risk factor is metabolic syndrome, which is a cluster of inflammatory abnormalities, including abdominal obesity, high blood sugar, high cholesterol, and high blood pressure. As these risk factors increase, so do inflammatory levels. Inflammation leads to cartilage breakdown and bony overgrowth in the joints and spine. But typical
degenerative joint changes do not result in severe, debilitating pain for everybody, so what accounts for the difference? The answer is a combination of fuel and genetics. We cannot control aging or fully control our genetic risk factors, but we can control how we fuel our bodies.

Lumbar degenerative disc disease (wear and tear on the discs between our vertebrae) is one of the most commonly diagnosed causes of back pain and one for which treatment options are limited and often ineffective. Even the diagnosis of this pain is difficult, since it can be caused by multiple factors, including aging, injury, poor healing, and ongoing cellular stress. As with arthritis, certain risk factors are known to accelerate disc degeneration, such as physical trauma, carrying extra weight, smoking, infections, inflammation, metabolic conditions, and genetics. While most adults experience some disc degeneration, the extent of and, more important, the pain associated with this nearly universal phenomenon vary greatly. In particular, the degree of inflammation in the tissues surrounding the disc often determines the level of pain.

Furthermore, chronic painful inflammation changes our brains. It makes us more sensitive to pain: we are liable to feel pain even in response to light touch and to feel it beyond the injured area. Like a wildfire, painful inflammation can spread and grow stronger if it is left unchecked.

Fortunately, some of the risk factors for orthopaedic pain and inflammation are within our control, including daily food intake, activity level, sleep quality, mental stressors, and emotional stressors. To improve spine health and reduce pain, we must opt for real food, move more, use good ergonomics, sleep better, reduce stress, and focus on positive relationships. We can make these changes in bite-sized chunks and without time-consuming workouts, personal yoga instructors, or other costly or disruptive lifestyle changes.

Conventional pain treatment focuses on physical stress. Yet we know that mental and emotional stress worsen pain. Even without a definitive physical injury, mental and emotional stress 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.

Now take a big breath in and a longer breath out. Do this three more times. Then let out an audible, teenage-angst sigh. Now picture somebody you love — a family member, friend, mentor, or pet. Remember how you feel in their presence, the sound of their voice, and their warmth. You may notice some of the tightness melt away. This experience reminds us that the mind and body are not separate entities: what happens in the mind manifests in the body and vice versa. Simply put, all forms of stress contribute to inflammation and pain.

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

Excerpted from the book The Pain Solution: 5 Steps to Relieve and Prevent Back Pain, Muscle Pain, and Joint Pain. Copyright ©2022 by Saloni Sharma, MD. Printed with permission from New World Library.