Managing Chronic Pain (Realistically!)
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Realistic chronic pain management
We’ve had a number of requests to do a main feature on managing chronic pain, so here it is!
A quick (but important) note before we begin:
Obviously, not all chronic pain is created equal. Furthermore, we know that you, dear reader with chronic pain, have been managing yours for however long you have, learning as you go. You also doubtlessly know your individual condition inside out.
We also know that people with chronic health conditions in general are constantly beset by well-meaning unsolicited advice from friends and family, asking if you’ve heard about [thing you heard about 20 years ago] that will surely change your life and cure you overnight.
It’s frustrating, and we’re going to try to avoid doing that here, while still offering the advice that was asked for. We ask you, therefore, to kindly overlook whatever you already knew, and if you already knew it all, well, we salute you and will not be surprised if that’s the case for at least some readers. Chronic pain’s a… Well, it’s a chronic pain.
All that said, let’s dive in…
How are you treating your body right now?
Are you hydrated; have you eaten; are you standing/sitting/lying in a position that at least should be comfortable for you in principle?
The first two things affect pain perception; the latter can throw a spanner in the works if something’s not quite right.
Move your body (gently!)
You know your abilities, so think about the range of motion that you have, especially in the parts of your body that hurt (if that’s “everywhere”, then, our sympathies, and we hope you find the same advice applies). Think about your specific muscles and joints as applicable, and what the range of motion is “supposed” to be for each. Exercise your range of motion as best you can (gently!) to the point of its limit(s) and/or pain.
- If you take it past that limit, there is a good chance you will make it worse. You don’t want that.
- If you don’t take it to the limit, there is a good chance your range of movement will deteriorate, and your “safe zone” (i.e., body positions that are relatively free from pain) will diminish. You definitely don’t want that, either.
Again, moderation is key. Yes, annoying as the suggestion may be, such things as yoga etc can help, if done carefully and gently. You know your limits; work with those, get rest between, and do what you can.
For most people this will at least help keep the pain from getting worse.
Hot & Cold
Both of these things could ease your pain… Or make it worse. There is an element of “try it and see”, but here’s a good general guide:
Here’s How to Choose Between Using Ice or Heat for Pain
Meditation… Or Distraction
Meditating really does help a lot of people. In the case of pain, it can be counterintuitively helpful to focus for a while on the sensation of the pain… But in a calm, detached fashion. Without judgement.
“Yes, I am experiencing pain. Yes, it feels like I’m being stabbed with hot knives. Yes, this is tortuous; wow, I feel miserable. This truly sucks.”
…it doesn’t sound like a good experience, does it? And it’s not, but paying it attention this way can paradoxically help ease things. Pain is, after all, a messenger. And in the case of chronic pain, it’s in some ways a broken messenger, but what a messenger most needs is to be heard.
The above approach a) is good b) may have a limit in how long you can sustain it at a time, though. So…
The opposite is a can be a good (again, short-term) approach too. Call a friend, watch your favorite movie, play a video game if that’s your thing. It won’t cure anything, but it can give you a little respite.
Massage
Unless you already know this makes your pain worse, this is a good thing to try. It doesn’t have to be a fancy spa; if the nature of your pain and condition permits, you can do self-massage. If you have a partner or close friend who can commit to helping, it can be very worth them learning to give a good massage. There are often local courses available, and failing that, there is also YouTube.
Here’s an example of a good video for myofascial release massage, which can ease a lot of common kinds of chronic pain:
Some quick final things to remember:
- If you find something helps, then it helps, do that.
- That goes for mobility aids and other disability aids too, even if it was designed for a different disability. If it helps, it helps. You’re not stealing anyone’s thunder (or resources) by using something that makes your life easier. We’re not in this life to suffer!
- There is no such thing as “this pain is not too much”. The correct amount of pain is zero. Maybe your body won’t let you reach zero, but more than that is “too much” already.
- You don’t have to be suffering off the scale to deserve relief from pain
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Reversing Alzheimer’s – by Dr. Heather Sandison
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The title here is bold, isn’t it? But, if the studies so far are anything to go by, she is, indeed, reversing Alzheimer’s. By this we mean: her Alzheimer’s patients have enjoyed a measurable reversal of the symptoms of cognitive decline (this is not something that usually happens).
The science here is actually new, and/but references are given aplenty, including Dr. Sandison’s own research and others—there’s a bibliography of several hundred papers, which we love to see.
Dr. Sandison’s approach is of course multivector, but is far more lifestyle medicine than pills, with diet in particular playing a critical role. Indeed, it’s worth mentioning that she is a naturopathic doctor (not an MD), so that is her focus—though she’s had a lot of MDs looking in on her work too, as you may see in the book. She has found best results in a diet low in carbs, high in healthy fats—and it bears emphasizing, healthy ones. Many other factors are also built in, but this is a book review, not a book summary.
Nor does the book look at diet in isolation; other aspects of lifestyle are also taken into account, as well as various medical pathways, and how to draw up a personalized plan to deal with those.
The book is written with the general assumption that the reader is someone with increased Alzheimer’s risk wishing to reduce that risk, or the relative of someone with Alzheimer’s disease already. However, the information within is beneficial to all.
The style is on the hard end of pop-science; it’s written for the lay reader, but will (appropriately enough) require active engagement to read effectively.
Bottom line: if Alzheimer’s is something that affects or is likely to affect you (directly, or per a loved one), then this is a very good book to have read
Click here top check out Reversing Alzheimer’s, and learn how to do it!
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Healthy Chocolate Fudge Energy Bites
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While these are quite high-calorie, they’re also high in protein, and the fiber and healthy fats flatten the blood sugar curve:
You will need
- 1 cup peanut butter
- 4 oz dark chocolate, melted (try to get dark chocolate with >80% cocoa, if you can; 85% is very respectable and 90% is perfect)
- ⅓ cup maple syrup (you can safely reduce this, or even omit it, if you prefer less sweetness)
- ¼ cup hazelnuts
- ¼ cup almond milk (or your preferred milk, but we recommend almond for taste and health)
- 1 tsp vanilla extract
- Topping: ¼ cup hazelnuts, roughly chopped
Method
(we suggest you read everything at least once before doing anything)
1) Combine all the ingredients (except the topping) in a food processor, and blend until smooth.
2) Line a container (5″x7″ is a good size) with baking paper and spread the mixture evenly into it, pressing down gently.
3) Sprinkle the topping onto it, press that even more gently into it.
4) Refrigerate overnight (or chill it for 2hrs in the freezer).
5) Cut into cubes to serve; they can be served frozen or thawed, per your preference:
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Eating For Energy (In Ways That Actually Work)
- “Let Them Eat Cake”, She Said…
- Why You Should Diversify Your Nuts!
- Plant-Based Milks—What’s Best?
- Chocolate & Health: Fact or Fiction?
Take care!
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The Cough Doctor
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The Cough Doctor
This is Dr. Peter Small, who worked in epidemiology since the beginning of HIV epidemic. He became a pioneer in the field of molecular epidemiology. As such, his work was a guiding beacon for the public health response to the resurgence of tuberculosis. He’s travelled the world spending years in various institutions studying all manner of respiratory illnesses…. These have ranged from tuberculosis to pneumonia to lung cancer and (back to epidemiology) Covid-19.
He’s now the Chief Medical Officer at…
Hyfe
Hyfe, a medical AI company, was founded in 2020. Its objective: to build acoustic tools for respiratory diagnostics and monitoring.
In other words: it records coughs and collects data about coughing.
❝It’s ironic how much people focus on counting steps while ignoring cough, which is far more consequential. Hyfe is a science-driven company with the technology to make cough count. Particularly now, with increased awareness of cough and the rapid growth of digital health driven by Covid-19, this technology can improve the lives of patients, the care provided by doctors, and the efficiency of health systems.❞
~ Dr. Peter Small, CMO, Hyfe
How does it do it?
Hyfe’s AI monitors the number of times a person coughs and the sound of the cough through any smartphone or other smart device.
This data collected over time provides increasingly more reliable information than a single visit to the doctor! By constantly listening and analyzing, it can detect patterns that might otherwise go unnoticed.
How big is this “big data” effort?
Hyfe maintains the largest cough dataset in the world. This means it can compare the sound of a patient’s cough with more than 400 million cough-like sounds from 83 countries across all continents.
The human brain doesn’t handle big numbers well. So, just to illustrate: if the average cough is 1 second long, that means it’d take more than 12 years to listen to them all.
Hyfe, meanwhile, can:
- listen to many things simultaneously
- index them all against user and location,
- use its ever-growing neural net to detect and illustrate patterns.
It’s so attentive, that it can learn to distinguish between different people’s coughs in the same household.
❝Companies like Google Health see even basic information such as getting an accurate count of the number of times a person coughs a day as a useful resource, and part of a larger need to collect and chronicle more health information to refine the way doctors diagnose disease and manage treatments in the future.❞
What are the public health implications?
The most obvious application is to note when there’s a spike in coughing, and see how such spikes grow and spread (if they do), to inform of contagion risks.
Another is to cross-reference it with data about local environmental allergens. Knowing how things like pollution and even pollen affect individuals differently could be helpful in identifying (and managing) chronic conditions like asthma.
What are the private health implications?
❝It’s going to transform the whole clinical approach for this common and chronic symptom. Patients will come in, have the data on how much they are coughing, and the physician can suggest a treatment based on that information to see if it makes the coughs better❞
~ Dr. Peter Small
Dr. Small’s colleague Dr. Cai, speaking for Google Health on this project, sees even more utility for diagnostics:
❝When I was in medical school, never ever did they teach us that we could listen to somebody cough and identify whether that person has TB (tuberculosis), COPD, or a tumor. But I keep seeing more and more studies of people coughing into a microphone, and an algorithm can detect whether somebody has TB with 95% specificity and sensitivity, or if someone has pneumonia or an exacerbation of COPD❞
~ Dr. Lawrence Cai
And the privacy implications?
Perhaps you don’t quite fancy the idea of not being able to cough without Google knowing about it. Hyfe’s software is currently opt-in, but…
If you cough near someone else’s Hyfe app, their app will recognize you’re not the app’s user, and start building a profile for you. Of course, that won’t be linked to your name, email address, or other IDs, as it would if you were the app’s user.
Hyfe will ask to connect to your social media, to collect more information about you and your friends.
Whether you’d like to try this or perhaps you’re just curious to learn more about this fascinating project, you can check out:
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Fitness Walking and Bodyweight Exercises – by Frank S. Ring
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A lot of exercise manuals assume that the reader has a “basic” body (nothing Olympian, but nothing damaged either). As we get older, increasingly few of us fall into the “but nothing damaged either” category!
Here’s where Ring brings to bear his decades of experience as a coach and educator, and also his personal recovery from a serious back injury.
The book covers direct, actionable exercise advice (with all manner of detail), and also offers mental health tips he’s learned along the way.
Ring, like us, is a big fan of keeping things simple, so he focusses on “the core four” of bodyweight exercises:
- Pushups
- Squats
- Lunges
- Planks
These four exercises get a whole chapter devoted to them, though! Because there are ways to make each exercise easier or harder, or have different benefits. For example, adjustments include:
- Body angle
- Points of contact
- Speed
- Pausing
- Range of motion
This, in effect, makes a few square meters of floor (and perhaps a chair or bench) your fully-equipped gym.
As for walking? Ring enjoys and extols the health benefits, and/but also uses his walks a lot for assorted mental exercises, and recommends we try them too.
A fine book for anyone who wants to gain and/or maintain good health, but doesn’t pressingly want to join a gym or start pumping iron!
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Addiction Myths That Are Hard To Quit
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Which Addiction-Quitting Methods Work Best?
In Tuesday’s newsletter we asked you what, in your opinion, is the best way to cure an addiction. We got the above-depicted, below-described, interesting distribution of responses:
- About 29% said: “Addiction cannot be cured; once an addict, always an addict”
- About 26% said “Cold turkey (stop 100% and don’t look back)”
- About 17% said “Gradually reduce usage over an extended period of time”
- About 11% said “A healthier, but somewhat like-for-like, substitution”
- About 9% said “Therapy (whether mainstream, like CBT, or alternative, like hypnosis)”
- About 6% said “Peer support programs and/or community efforts (e.g. church etc)”
- About 3% said “Another method (mention it in the comment field)” and then did not mention it in the comment field
So what does the science say?
Addiction cannot be cured; once an addict, always an addict: True or False?
False, which some of the people who voted for it seemed to know, as some went on to add in the comment field what they thought was the best way to overcome the addiction.
The widespread belief that “once an addict, always an addict” is a “popular truism” in the same sense as “once a cheater, always a cheater”. It’s an observation of behavioral probability phrased as a strong generalization, but it’s not actually any kind of special unbreakable law of the universe.
And, certainly the notion that one cannot be cured keeps membership in many 12-step programs and similar going—because if you’re never cured, then you need to stick around.
However…
❝What is the definition of addiction?
Addiction is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences.
Prevention efforts and treatment approaches for addiction are generally as successful as those for other chronic diseases.❞
~ American Society of Addiction Medicine
Or if we want peer-reviewed source science, rather than appeal to mere authority as above, then:
❝What is drug addiction?
Addiction is defined as a chronic, relapsing disorder characterized by compulsive drug seeking and use despite adverse consequences. It is considered a brain disorder, because it involves functional changes to brain circuits involved in reward, stress, and self-control. Those changes may last a long time after a person has stopped taking drugs.
Addiction is a lot like other diseases, such as heart disease. Both disrupt the normal, healthy functioning of an organ in the body, both have serious harmful effects, and both are, in many cases, preventable and treatable.❞
~ Nora D. Volkow (Director, National Institute of Drug Abuse)
Read more: Drugs, Brains, and Behavior: The Science of Addiction
In short: part of the definition of addiction is the continued use; if the effects of the substance are no longer active in your physiology, and you are no longer using, then you are not addicted.
Just because you would probably become addicted again if you used again does not make you addicted when neither the substance nor its after-effects are remaining in your body. Otherwise, we could define all people as addicted to all things based on “well if they use in the future they will probably become addicted”.
This means: the effects of addiction can and often will last for long after cessation of use, but ultimately, addiction can be treated and cured.
(yes, you should still abstain from the thing to which you were formerly addicted though, or you indeed most probably will become addicted again)
Cold turkey is best: True or False?
True if and only if certain conditions are met, and then only for certain addictions. For all other situations… False.
To decide whether cold turkey is a safe approach (before even considering “effective”), the first thing to check is how dangerous the withdrawal symptoms are. In some cases (e.g. alcohol, cocaine, heroin, and others), the withdrawal symptoms can kill.
That doesn’t mean they will kill, so knowing (or being!) someone who quit this way does not refute this science by counterexample. The mortality rates that we saw while researching varied from 8% to 37%, so most people did not die, but do you really want (yourself or a loved one) to play those odds unnecessarily?
See also: Detoxification and Substance Abuse Treatment
Even in those cases where it is considered completely safe for most people to quit cold turkey, such as smoking, it is only effective when the quitter has appropriate reliable medical support, e.g.
- Without support: 3–5% success rate
- With support: 22% success rate
And yes, that 22% was for the “abrupt cessation” group; the “gradual cessation” group had a success rate of 15.5%. On which note…
Gradual reduction is the best approach: True or False?
False based on the above data, in the case of addictions where abrupt cessation is safe. True in other cases where abrupt cessation is not safe.
Because if you quit abruptly and then die from the withdrawal symptoms, then well, technically you did stay off the substance for the rest of your life, but we can’t really claim that as a success!
A healthier, but somewhat like-for-like substitution is best: True or False?
True where such is possible!
This is why, for example, medical institutions recommend the use of buprenorphine (e.g. Naloxone) in the case of opioid addiction. It’s a partial opioid receptor agonist, meaning it does some of the job of opioids, while being less dangerous:
It’s also why vaping—despite itself being a health hazard—is recommended as a method of quitting smoking:
Similarly, “zero alcohol drinks that seem like alcohol” are a popular way to stop drinking alcohol, alongside other methods:
This is also why it’s recommended that if you have multiple addictions, to quit one thing at a time, unless for example multiple doctors are telling you otherwise for some specific-to-your-situation reason.
Take care!
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Pneumonia: Prevention Is Better Than Cure
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Pneumonia: What We Can & Can’t Do About It
Pneumonia is a significant killer of persons over the age of 65, with the risk increasing with age after that, rising very sharply around the age of 85:
While pneumonia is treatable, especially in young healthy adults, the risks get more severe in the older age brackets, and it’s often the case that someone goes into hospital with one thing, then develops pneumonia, which the person was already not in good physical shape to fight, because of whatever hospitalized them in the first place:
American Lung Association | Pneumonia Treatment and Recovery
Other risk factors besides age
There are a lot of things that can increase our risk factor for pneumonia; they mainly fall into the following categories:
- Autoimmune diseases
- Other diseases of the immune system (e.g. HIV)
- Medication-mediated immunosuppression (e.g. after an organ transplant)
- Chronic lung diseases (e.g. asthma, COPD, Long Covid, emphysema, etc)
- Other serious health conditions ← we know this one’s broad, but it encompasses such things as diabetes, heart disease, and cancer
See also:
Why Chronic Obstructive Pulmonary Disease (COPD) Is More Likely Than You Think
Things we can do about it
When it comes to risks, we can’t do much about our age and some of the other above factors, but there are other things we can do to reduce our risk, including:
- Get vaccinated against pneumonia if you are over 65 and/or have one of the aforementioned risk factors. This is not perfect (it only reduces the risk for certain kinds of infection) and may not be advisable for everyone (like most vaccines, it can put the body through its paces a bit after taking it), so speak with your own doctor about this, of course.
- See also: Vaccine Mythbusting
- Avoid contagion. While pneumonia itself is not spread person-to-person, it is caused by bacteria or viruses (there are numerous kinds) that are opportunistic and often become a secondary infection when the immune system is already busy with the first one. So, if possible avoid being in confined spaces with many people, and do wash your hands regularly (as a lot of germs are transferred that way and can get into the respiratory tract because you touched your face or such).
- See also: The Truth About Handwashing
- If you have a cold, or flu, or other respiratory infection, take it seriously, rest well, drink fluids, get good immune-boosting nutrients. There’s no such thing as “just a cold”; not anymore.
- Look after your general health too—health doesn’t exist in a vacuum, and nor does disease. Every part of us affects every other part of us, so anything that can be in good order, you want to be in good order.
This last one, by the way? It’s an important reminder that while some diseases (such as some of the respiratory infections that can precede pneumonia) are seasonal, good health isn’t.
We need to take care of our health as best we can every day along the way, because we never know when something could change.
Want to do more?
Check out: Seven Things To Do For Good Lung Health!
Take care!
Don’t Forget…
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