HOW NOT TO HURT Trailer for Dr. Greger’s New Book on Chronic Pain Relief

[music] >> One in five adults live in chronic pain. That's more than 50 million Americans reporting feeling pain on most or all days of the previous 3 months. Internationally, the prevalence may average more like 30% making chronic pain one of the most common elements in the world. In the US, the economic impact of pain has been estimated to be close to a a trillion dollars in direct medical costs, lost productivity, and disability. That's more than what's spent on heart disease, diabetes, and cancer combined. But the greatest cost is in human suffering. In surveys across the spectrum of chronic pain conditions, the pooled prevalence of past 2-week SI was 26%. SI stands for suicidal ideation. That means that around one in four individuals with chronic pain thought about killing themselves within the last 2 weeks. Pain, said Albert Schweitzer, is a more terrible lord of mankind than even death itself. The vast majority of patients with chronic pain are prescribed pain medications, but they may be unaware of the risks of taking even over-the-counter painkillers. For example, the liver toxicity of excessive consumption of acetaminophen, Tylenol. Opioids may contribute to the deaths of 75,000 people every year in the United States, but over-the-counter painkillers like ibuprofen may kill 50,000 Americans every year with ulcers, strokes, and heart attacks. Drugs can be dangerous, but we're willing to swallow the risks for effective treatments. The question is how effective are they? When a senior executive at drug giant GlaxoSmithKline admitted the dirty little secret that the vast majority of drugs in general don't work for most people. It set off a media firestorm. This is of course no news to doctors, the editorial of a leading medical journal wrote, acknowledging the open secret that most drugs are ineffective for most patients. And it's even worse in the field of pain management. The Cochrane Library, named after Archie Cochrane, the father of evidence-based medicine, has published hundreds of high-quality reviews on various interventions for pain. You know it's bad when the coordinating editor for this gold standard of science-backed medicine starts off their review on evidence-based pain management quoting Colonel Jessup from A Few Good Men. You can't handle [clears throat] the truth. From the hundreds of reviews, two clear facts seem to emerge. First, very few of the systematic reviews of interventions for acute pain, let alone even chronic pain, found that they could achieve on average even a one-point drop in pain level over placebo when patients were asked to rate their pain before and after on a scale from zero to 10. And the second takeaway is that even the very best responses in the field of pain management involved having pain levels in slightly more than half of patients compared to taking a sugar pill. And that was for acute distress when pain was tracked over just a few hours. The same poverty of evidence exists for effective interventions for chronic pain. The reviewers conclude, this may just be the uncomfortable truth that we have to handle. An analysis by the chair of a committee doing systematic reviews for the International Association of the Study of Pain detailed the sobering truth that failure is the norm. Failure rates of painkillers for osteoarthritis drugs ranged from 71 to 86% for chronic low back pain failure rates are from 82 to 87% for painful diabetic neuropathy from 70 to 87% and for chronic shingles pain 71 to 84% and fibromyalgia drugs failed 87 to 95% of the time to reduce pain by even 50% after months of treatment compared to taking placebo sugar pills. The analysis concluded that the field of pain medicine needs to confront its failings and acknowledge that drugs can't successfully treat more than that minority of people with painful condition. In rethinking chronic pain the editorial board of one of the most prestigious medical journals in the world concluded over reliance on drugs or devices may be spurred on by aggressive industry marketing and perverse financial incentives for shorter consultations, drug prescribing and invasive interventions. The desperation for effective treatments is reflected by a recourse to electroshock therapy, gamma knife surgery of the brain to control pain and electrodes implanted through the skull. Meanwhile, there are safe, simple, side effect free strategies that we may never hear of because they lack a corporate marketing budget. That's why I wrote how not to hurt. For example one of the success stories in pain medicine is the development in the 1990s of abortive therapies for migraine headaches. Drugs like sumatriptan sold as Imitrex only failed 57% of the time. Guess what was shown to work just as well in a double blind randomized placebo controlled clinical trial? Just an eighth of a teaspoon of ginger powder. You can hardly tell the ginger curve from the drug curve. In response to the billion-dollar blockbuster drug, 44% of patients were pain-free within 2 hours. In response to less than a penny's worth of the ground ginger you can buy in almost any store, 44% of the patients were pain-free within 2 hours. There was one significant difference, fewer side effects in the ginger group. Cinnamon may help prevent migraines in the first place. Based on a randomized double-blind placebo-controlled trial that found that quarter teaspoon doses could significantly decrease migraine frequency, severity, and duration. In the placebo group, their pain level dropped from an eight out of 10 down to a seven. Whereas in the group secretly slipped some cinnamon hidden in capsules, their pain dropped from an eight out of 10 down to a three. And no, the study wasn't funded by Big Bark. Prescription drugs kill more than 100,000 Americans every year, making medications a leading cause of death. That's why doctors are rightly resistant to change their clinical practice based on a single new suggestive study. But when it comes to something as safe, simple, and side effect free as cinnamon, what's the downside to tell patients to give it a try? Uh many probably have it sitting in their pantry right now. Even if the cinnamon study was a total fluke, what's the worst that can happen? Taste to your oatmeal? This is just one of many examples you'll find throughout my book of simple foods to eat or avoid, treatments that are safer, cheaper, and sometimes even more effective than drugs. The most likely reason your doctor hasn't said anything about these natural remedies is probably because they've never even heard of them. Uh the clinical trials were published in the peer-reviewed medical literature, but more than a million papers are published every year. Which of those million do you think your doctor hears about? The ones with corporate budgets driving their promotion. The one the drug reps tell them about over their {quote} free lunch. Plants aren't profitable because plants aren't patentable. The latest migraine drugs can cost more than a hundred dollars per pill and don't even work as well as the common migraine medication sumatriptan. Patients at risk pay more for less effective drugs because they're safer. Triptan drugs have artery constricting effects and make triple one's odds of having a heart attack or stroke. Ground ginger would be expected to work just as well without the drugs risks and be literally a thousand times cheaper. But that's the problem. There's no money to be made. No company is going to thrill their stockholders selling something that costs less than a penny per day. >> [snorts] >> There isn't much margin on mint, dividends on dates, rose hip returns, no windfalls for wheat germ. >> [snorts] >> No wonder most doctors have never heard about the studies I've covered and share throughout my book. I certainly hadn't. But that's what we do at nutritionfacts.org. My team and I comb through tens of thousands of studies so you and your doctors don't have to. Billions of dollars are spent on unproven remedies and modalities that can sometimes make matters worse. My goal in writing How Not to Hurt was to create the most definitive evidence-based guide on natural approaches to pain management and relief reviewing every non-invasive, non-pharmacological intervention proven in randomized controlled trials to work but may otherwise remain in obscurity due to a lack of profitability. I jump right in to cover all the major sources of chronic pain, back pain, joint pain, migraines, irritable bowel, fibromyalgia, endometriosis, fibroids, gout, tennis elbow, and more. I go through conventional and alternative therapies and take the deepest dive into any and all diet and lifestyle approaches shown to relieve pain or even better, treat the underlying cause. If you or a loved one is suffering from any of these conditions, I support the natural impulse to jump straight to that chapter. There are, however, important concepts, cautions, theories, and therapies I introduce throughout the book that may bear on your personal situation. For example, in the back pain chapter, I cover the new research suggesting that treating acute pain with anti-inflammatory drugs like ibuprofen may actually prevent healing and make chronic pain worse. Uh the finding that led to proclamations like how we currently treat pain could be wrong. Uh that's relevant to a wide variety of pain problems, not just back pain, but I only cover it once to avoid redundancy. Uh so, I encourage affected readers to at least skim the rest of the chapters beyond their narrow focus. In the osteoarthritis chapter, topics of broad interest include a discussion of the adverse effects of over-the-counter NSAID drugs like ibuprofen and naproxen, and why we may not want to take them with food. I cover topical NSAIDs, platelet-rich plasma, quote unquote regenerative medicine, and urtication, intentionally stinging yourself with nettles. Also, the chapter includes four important concepts, MCID, what it means to achieve a minimal clinically important difference when it comes to pain, regression to the mean, a concept that is at once so trivial that it is blindingly obvious and so deep that many scientists spend their whole career being fooled by it. The healthy user effect, which can make supplements appear more useful than they are, and the placebo effect, how real it is, and how surprisingly common it is for doctors to use it to effectively deceive patients. In the rheumatoid arthritis chapter, I cover traditional Chinese medicine, introduce elimination diets including fasting, and explore three overlooked sources of inflammation, new 5G C, endotoxins, and sodium versus potassium intake. In the back pain chapter, I also cover acupuncture, dry needling, cupping, chiropractic spinal manipulation. Spoiler alert, it's not all it's cracked up to be. TENS, transcutaneous electrical nerve stimulation, and the undue influence of medical device companies. I get into the healing power of empathy, psychological and mind-body approaches, the efficacy paradox, and the adverse effects of Tylenol, including its purported links to autism. I also cover everything there is to say about back pain. These are just some of the things that can apply across conditions. In the shoulder pain chapter, I consider the shocking fact that surgeons often recommend patients get procedures that they wouldn't have performed on themselves. You'd think surgeons would be the most enthusiastic, which they are for surgeries for their livelihood, but not for their lives. In the neck pain chapter, I explore the research showing that even just being labeled as sick can make us act and feel sicker. The foot pain chapter, I explore post-hoc bias, which is said to expose a core weakness around intuitions in healthcare. And in the fibromyalgia chapter, I cover the concept of nocebo plastic pain. Detail the four rules of sleep hygiene and conditioning, and explore what may be the oldest known method for relieving pain, music. >> [snorts] >> In the migraine headaches chapter, I cover zinc and melatonin, caution about alpha-lipoic acid supplements, and address yoga, green light therapy, and neuromodulation, how pain can sometimes inhibit pain. In the irritable bowel syndrome chapter, I explore the mystery of open-label placebos, atypical food allergies like alpha-gal syndrome, and food sensitivities like gluten, as well as covering the gut microbiome, including fecal transplants, FODMAP diets, and glutamine supplements. In the inflammatory bowel disease chapter, I cover berberine supplements and biologic drugs like Humira, in addition to everything else you need to know about Crohn's disease and ulcerative colitis. In the nerve pain chapter, I relay concerns about gabapentin-type drugs, fighting fire with fire with the chili pepper compound capsaicin, the pros and cons of cannabis, acetyl-l-carnitine supplements, the importance of butyrate, how to prevent withdrawal symptoms when stopping antidepressants, instances where evidence-based medicine can lead us astray, and critiques of both sides of the vaccine efficacy debate. In the ischemic pain chapter, I convey Dr. Cass's parable of the tiny parachute to explain why some randomized controlled trials require a double take, and in the pelvic pain chapter, I cover caveats about fistural supplements, which again is applicable to other pain conditions. And each one of the thousands of scientific sources in How Not to Hurt will be searchable and hyperlinked on nutritionfacts.org. >> [snorts] >> What if there isn't a chapter on your condition? There are literally thousands of conditions for which pain is a core symptom. I was only able to cover some of the most common, or maybe your doctor doesn't have a diagnosis for why you're in pain at all. That's where the Soothing Seven comes in. There There certain foods, mostly spices, that came up in study after study, chapter after chapter, offering broad pain relief for a variety of disparate afflictions. Specifically, there are seven that have been shown to help with three or more different diseases. So, may offer the best hopes for helping across the board. I'll talk about the dosing for each, their beneficial side effects, and the caveats. Now, throughout the book, I identify dozens of different foods and beverages shown to help with specific conditions and note when they were tried but failed. In most cases, though, they just haven't been tested more extensively. Most foods haven't even been tested at all. So, maybe they belong in an effective eight, a numbing nine, or tranquilizing 10. You tell me. The nice thing about side effect free solutions is that you can just give them a try and see if they help. You have nothing to lose but your pains. So, check out How Not to Hurt from your local public library. If you do end up buying it, know that all proceeds I receive from the sales of this book and all the books I've ever written, every penny, all donated directly to charity. I just hope I can lessen some of your suffering. >> [music]