Stopping Pain Without Drugs
As a non-surgeon practicing at the busiest orthopedic surgery hospital in the country, Dr. Vijay Vad stands out. Instead of sending his patients to surgery, his goal is to keep them out of it. A sports medicine specialist at New York’s Hospital for Special Surgery who regularly works with professional golfers and tennis players, Dr. Vad is a believer in the power of the mind-body connection and regularly prescribes yoga exercises and other alternative strategies for his patients. He is also the author of the new book “Stop Pain: Inflammation Relief for an Active Life,’’ which is packed with practical advice and self-care options to help chronic pain patients reduce their dependence on narcotics and avoid additional medical procedures.
I spoke with Dr. Vad recently about his new book and the problem of chronic pain. Here’s our conversation.
Why did you think there needed to be a book about pain?
I have seen a big explosion in chronic back pain and arthritis, and what I realized is that people have very limited self-help options. In the medical system, unfortunately, many health care providers do what they are trained to do. They push you into prescription medications which have side effects or suggest tons of medical procedures. Medical procedures like joint replacements and lumbar fusions have skyrocketed. I felt there was a need for people whose main focus is self help, giving them clinically proven options that will really help them improve their quality of life and minimize their dependence on narcotics and medical procedures as soon as possible.
What else can someone do to relieve pain besides take a prescription pain reliever or undergo a procedure?
There are so many self-help things you can do. Something as simple as trying to do 30 minutes of aerobic exercise can help. With pain, you’re in a vicious cycle – you take more narcotics, your REM sleep decreases, and then you’re tired and you don’t want to exercise. If you can get through the first week or two of extra pain by doing the proper exercise, like 30 minutes of walking daily, long term that’s going to have an impact. Most people give up on simple walking, but it can have a huge impact long term.
For people treating pain with exercise, do you have to be willing to get worse in order to get rid of pain eventually?
In the case of exercises, that’s true. If the pain goes up four-fold, you’re doing something wrong, but proper exercise will make you a little worse for a while before it makes you better. It’s a pain desensitization period. Think about if you have raw skin on your knuckle and you tap it. At first it hurts, but if you tap it more and more it will get desensitized. You’re doing the same to your chronic pain structure when you exercise. There is so much data on this with rehabilitation for back pain, for instance. You become pain desensitized by proper exercise with gradual increases in stress. The overall consensus for exercise therapy is that it has a positive impact. It can be something simple — it doesn’t have to be fancy machines or stretches.
Are other types of pain helped by exercise?
We see the same thing with arthritis. A gradual increase in load on an arthritic knee joint not only reduces pain, but there are data to show proper exercise therapy can slow down the loss of cartilage. Muscles are the shock absorbers, but they’re shut down by arthritic pain. You can reactivate those muscles gradually with proper exercise therapy.
Are there other self-help measures besides exercise?
That’s only one part of self help. There are topical treatments and supplements as well. When I started exploring this I used to think the topical thing is bogus. But there is a whole science behind topical pain relievers.
Are there food and diet options for treating chronic pain?
The whole book really establishes the link between inflammation and pain, and an anti-inflammatory diet is very important. The book talks about the fundamentals of diet, proper exercise and topicals and proper supplements that you may use to try to control your pain. I look at supplements with known data for certain problems, like glucosamine and chondroitin and vitamin D.
Do any of these treatments work for pain disorders like fibromyalgia or chronic fatigue syndrome?
I talk in my book about fibromyalgia. I have my own personal biases. Yes, it definitely exists, but I do think it’s over-diagnosed. I give an example of a woman who had been suffering from fibromyalgia for six or seven years. She couldn’t sleep, she was exhausted. I examined her and she didn’t have the classic fibromyalgia points. We talked, and she really had an irritated nerve in her neck that was causing pain in her shoulder blade. Literally, after one epidural and one proper pillow, she was night and day a different woman. But the book also talks about people who truly have fibromyalgia and other problems, and about the importance of aerobic exercise and how that can affect endorphin levels and how exercise increases REM sleep.
When should you use self help versus alternative treatment like acupuncture versus seeing a medical doctor?
If people have gone to a chiropractor or acupuncturist for back pain for six months with no relief, to me there are lots of red flags that there is something else going on. If you try things for a month or two and things haven’t improved, you really need to see a doctor. That doctor visit can rule out something very serious.
What are you hoping people get out of this book?
Whether you have a medical procedure or not, there are so many things you can do that are available right now. Every little thing adds up. Look at your mattress. Maybe the chair at work isn’t right. Maybe your computer setup isn’t perfect and is causing you neck pain.
What we’re trying to do here is add up six things you can do properly on your own, and it might have a huge impact on your quality of life. I’m trying to get people off using narcotics every time. Narcotics are a downward spiral. It’s a deal with the devil. I don’t know if you’ve seen anybody on heavy duty chronic pain medication, but it really affects how they live their life. And even with anti-inflammatory drugs, there are health issues. I’m trying to give people options that really don’t have a lot of downside.