Feel Better In 5 – by Dr. Rangan Chatterjee
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We’ve featured Dr. Rangan Chatterjee before, and here’s a great book of his.
The premise is a realistic twist on a classic, the classic being “such-and-such, in just 5 minutes per day!”
In this case, Dr. Chatterjee offers many lifestyle interventions that each take just 5 minutes, with the idea that you implement 3 of them per day (your choice which and when), and thus gradually build up healthy habits. Of course, once things take as habits, you’ll start adding in more, and before you know it, half your lifestyle has changed for the better.
Which, you may be thinking “my lifestyle’s not that bad”, but if you improve the health outcomes of, say, 20 areas of your life by just a few percent each, you know much better health that adds up to? We’ll give you a clue: it doesn’t add up, it compounds, because each improves the other too, for no part of the body works entirely in isolation.
And Dr. Chatterjee does tackle the body systematically, by the way; interventions for the gut, heart, brain, and so on.
As for what these interventions look like; it is very varied. One might be a physical exercise; another, a mental exercise; another, a “make this health 5-minute thing in the kitchen”, etc, etc.
Bottom line: this is the most supremely easy of easy-ins to healthier living, whatever your starting point—because even if you’re doing half of these interventions, chances are you aren’t doing the other half, and the idea is to pick and choose how and when you adopt them in any case, just picking three 5-minute interventions each day with no restrictions. In short, a lot of value to had here when it comes to real changes to one’s serious measurable health.
Click here to check out Feel Better In 5, and indeed feel better in 5!
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Parents are increasingly saying their child is ‘dysregulated’. What does that actually mean?
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Welcome aboard the roller coaster of parenthood, where emotions run wild, tantrums reign supreme and love flows deep.
As children reach toddlerhood and beyond, parents adapt to manage their child’s big emotions and meltdowns. Parenting terminology has adapted too, with more parents describing their child as “dysregulated”.
But what does this actually mean?
ShUStudio/Shutterstock More than an emotion
Emotional dysregulation refers to challenges a child faces in recognising and expressing emotions, and managing emotional reactions in social settings.
This may involve either suppressing emotions or displaying exaggerated and intense emotional responses that get in the way of the child doing what they want or need to do.
“Dysregulation” is more than just feeling an emotion. An emotion is a signal, or cue, that can give us important insights to ourselves and our preferences, desires and goals.
An emotionally dysregulated brain is overwhelmed and overloaded (often, with distressing emotions like frustration, disappointment and fear) and is ready to fight, flight or freeze.
Developing emotional regulation
Emotion regulation is a skill that develops across childhood and is influenced by factors such as the child’s temperament and the emotional environment in which they are raised.
In the stage of emotional development where emotion regulation is a primary goal (around 3–5 years old), children begin exploring their surroundings and asserting their desires more actively.
A child’s temperament and upbringing affect how they regulate emotions. bluedog studio/Shutterstock It’s typical for them to experience emotional dysregulation when their initiatives are thwarted or criticised, leading to occasional tantrums or outbursts.
A typically developing child will see these types of outbursts reduce as their cognitive abilities become more sophisticated, usually around the age they start school.
Express, don’t suppress
Expressing emotions in childhood is crucial for social and emotional development. It involves the ability to convey feelings verbally and through facial expressions and body language.
When children struggle with emotional expression, it can manifest in various ways, such as difficulty in being understood, flat facial expressions even in emotionally charged situations, challenges in forming close relationships, and indecisiveness.
Several factors, including anxiety, attention-deficit hyperactivity disorder (ADHD), autism, giftedness, rigidity and both mild and significant trauma experiences, can contribute to these issues.
Common mistakes parents can make is dismissing emotions, or distracting children away from how they feel.
These strategies don’t work and increase feelings of overwhelm. In the long term, they fail to equip children with the skills to identify, express and communicate their emotions, making them vulnerable to future emotional difficulties.
We need to help children move compassionately towards their difficulties, rather than away from them. Parents need to do this for themselves too.
Caregiving and skill modelling
Parents are responsible for creating an emotional climate that facilitates the development of emotion regulation skills.
Parents’ own modelling of emotion regulation when they feel distressed. The way they respond to the expression of emotions in their children, contributes to how children understand and regulate their own emotions.
Children are hardwired to be attuned to their caregivers’ emotions, moods, and coping as this is integral to their survival. In fact, their biggest threat to a child is their caregiver not being OK.
Unsafe, unpredictable, or chaotic home environments rarely give children exposure to healthy emotion expression and regulation. Children who go through maltreatment have a harder time controlling their emotions, needing more brainpower for tasks that involve managing feelings. This struggle could lead to more problems with emotions later on, like feeling anxious and hypervigilant to potential threats.
Recognising and addressing these challenges early on is essential for supporting children’s emotional wellbeing and development.
A dysregulated brain and body
When kids enter “fight or flight” mode, they often struggle to cope or listen to reason. When children experience acute stress, they may respond instinctively without pausing to consider strategies or logic.
If your child is in fight mode, you might observe behaviours such as crying , clenching fists or jaw, kicking, punching, biting, swearing, spitting or screaming.
In flight mode, they may appear restless, have darting eyes, exhibit excessive fidgeting, breathe rapidly, or try to run away.
A shut-down response may look like fainting or a panic attack.
When a child feels threatened, their brain’s frontal lobe, responsible for rational thinking and problem-solving, essentially goes offline.
The amygdala, shown here in red, triggers survival mode. pikovit/Shutterstock This happens when the amygdala, the brain’s alarm system, sends out a false alarm, triggering the survival instinct.
In this state, a child may not be able to access higher functions like reasoning or decision-making.
While our instinct might be to immediately fix the problem, staying present with our child during these moments is more effective. It’s about providing support and understanding until they feel safe enough to engage their higher brain functions again.
Reframe your thinking so you see your child as having a problem – not being the problem.
Tips for parents
Take turns discussing the highs and lows of the day at meal times. This is a chance for you to be curious, acknowledge and label feelings, and model that you, too, experience a range of emotions that require you to put into practice skills to cope and has shown evidence in numerous physical, social-emotional, academic and behavioural benefits.
Talk about your day over dinner. Monkey Business Images/Shutterstock Spending even small amounts (five minutes a day!) of quality one-on-one time with your child is an investment in your child’s emotional wellbeing. Let them pick the activity, do your best to follow their lead, and try to notice and comment on the things they do well, like creative ideas, persevering when things are difficult, and being gentle or kind.
Take a tip from parents of children with neurodiversity: learn about your unique child. Approaching your child’s emotions, temperament, and behaviours with curiosity can help you to help them develop emotion regulation skills.
When to get help
If emotion dysregulation is a persistent issue that is getting in the way of your child feeling happy, calm, or confident – or interfering with learning or important relationships with family members or peers – talk to their GP about engaging with a mental health professional.
Many families have found parenting programs helpful in creating a climate where emotions can be safely expressed and shared.
Remember, you can’t pour from an empty cup. Parenting requires you to be your best self and tend to your needs first to see your child flourish.
Cher McGillivray, Assistant Professor Psychology Department, Bond University and Shawna Mastro Campbell, Assistant Professor Psychology, Bond University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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These Top Few Things Make The Biggest Difference To Health
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The Best Few Interventions For The Best Health
Writer’s note: I was going to do something completely different for today (so that can go out another week now), but when reflecting on my own “what should I focus on in the new year?” (in terms of my own personal health goals and such) it occured to me that I should look back on the year’s articles, to take our own advice myself, and see what most important things I should make sure to focus on.
In so doing for myself, it occured to me that you, our subscribers who like condensed information and simple interventions for big positive effects, might also find value in a similar once-over. And so, today’s main feature was born!
Sometimes at 10almonds we talk about “those five things that affect everything”. They are:
- Good diet
- Good exercise
- Good sleep
- Not drinking
- Not smoking
If we were to add a sixth in terms of things that make a huge difference, it would be “manage stress effectively” and a seventh, beyond the scope of our newsletter, would be “don’t be socioeconomically disadvantaged” (e.g. poor, and/or part of some disprivileged minority group).
But as for those five we listed, it still leaves the question: what are the few most effective things we can do to improve them? Where can we invest our time/energy/effort for greatest effect?
Good diet
Best current science consistently recommends the Mediterranean Diet:
The Mediterranean Diet: What Is It Good For?
But it can be tweaked for specific desired health considerations:
Four Ways To Upgrade The Mediterranean Diet
Other most-effective dietary tweaks that impact a lot of other areas of health include looking after your gut health and looking after your blood sugars:
Making Friends With Your Gut (You Can Thank Us Later)
and
“Let Them Eat Cake”, She Said (10 Ways To Balance Blood Sugars)
Good exercise
Most exercise is good, but two of the most beneficial things that are (for most people) easy to implement are walking, and High-Intensity Interval Training:
How To Do HIIT (Without Wrecking Your Body)
Good sleep
This means quality and quantity! We cannot skimp on either and expect good health:
Why You Probably Need More Sleep
and as for quality,
The Head-To-Head Of Google and Apple’s Top Apps For Getting Your Head Down
Not drinking
According to the World Health Organization, the only safe amount of alcohol is zero.
See also:
Can We Drink To Good Health? (e.g. Red Wine & Heart Health)
and
Not smoking
We haven’t done a main feature on this! It’s probably not really necessary, as it’s not very contentious to say “smoking is bad for everything”.
WHO | Tobacco kills up to half its users who don’t quit
However, as a side-note, while cannabis is generally recognised as not as harmful as tobacco-based products, it has some fairly major drawbacks too. For some people, the benefits (e.g. pain relief) may outweigh the risks, though:
Final thoughts
Not sure where to start? We suggest this order of priorities, unless you have a major health condition that makes something else a higher priority:
- If you smoke, stop
- If you drink, reduce, or ideally stop
- Improve your diet
About that diet…
- Worry less about what to exclude, and instead focus on adding more variety of fruit/veg
- See also: Level-Up Your Fiber Intake! (Without Difficulty Or Discomfort)
- That said, if you’re looking for things to cut, sugar is a top candidate (and red meat is in clear second place albeit some way below)
When it comes to exercise, get your 10,000 daily steps in (actually, science says 8,000 steps is fine), and consider adding HIIT per our above article, when you feel like adding that in. As for that about the steps:
When it comes to sleep, if you’re taking care of the above things, and set a regular early wake-up time that you do not deviate from, then this will probably take care of itself, if you don’t have a sleep-inconvenient lifestyle (e.g. shift work, just had a baby, etc) or a sleep disorder.
For further pointers, see: 10 Tips for Better Sleep: Starting In The Morning
Take care!
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Stop Pain Spreading
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Put Your Back Into It (Or Don’t)!
We’ve written before about Managing Chronic Pain (Realistically!), and today we’re going to tackle a particular aspect of chronic pain management.
- It’s a thing where the advice is going to be “don’t do this”
- And if you have chronic pain, you will probably respond “yep, I do that”
However, it’s definitely a case of “when knowing isn’t the problem”, or at the very least, it’s not the whole problem.
Stop overcompensating and address the thing directly
We all do it, whether in chronic pain, or just a transient injury. But we all need to do less of it, because it causes a lot of harm.
Example: you have pain in your right knee, so you sit, stand, walk slightly differently to try to ease that pain. It works, albeit marginally, at least for a while, but now you also have pain in your left hip and your lumbar vertebrae, because of how you leaned a certain way. You adjust how you sit, stand, walk, to try to ease both sets of pain, and before you know it, now your neck also hurts, you have a headache, and you’re sure your digestion isn’t doing what it should and you feel dizzy when you stand. The process continues, and before long, what started off as a pain in one knee has now turned your whole body into a twisted aching wreck.
What has happened: the overcompensation due to the original pain has unduly stressed a connected part of the body, which we then overcompensate for somewhere else, bringing down the whole body like a set of dominoes.
For more on this: Understanding How Pain Can Spread
“Ok, but how? I can’t walk normally on that knee!”
We’re keeping the knee as an example here, but please bear in mind it could be any chronic pain and resultant disability.
Note: if you found the word “disability” offputting, please remember: if it adversely affects your abilities, it is a disability. Disabilities are not something that only happen to other people! They will happen to most of us at some point!
Ask yourself: what can you do, and what can’t you do?
For example:
- maybe you can walk, but not normally
- maybe you can walk normally, but not without great pain
- maybe you can walk normally, but not at your usual walking pace
First challenge: accept your limitations. If you can’t walk at your usual walking pace without great pain and/or throwing your posture to the dogs, then walk more slowly. To Hell with societal expectations that it shouldn’t take so long to walk from A to B. Take the time you need.
Second challenge: accept help. It doesn’t have to be help from another person (although it could be). It might be accepting the help of a cane, or maybe even a wheelchair for “flare-up” days. Society, especially American society which is built on ideas of self-sufficiency, has framed a lot of such options as “giving up”, but if they help you get about your day while minimizing doing further harm to your body, then they can be good and even health-preserving things. Same goes for painkillers if they help you from doing more harm to your body by balling up tension in a part of your body in a way that ends up spreading out and laying ruin to your whole body.
Speaking of which:
How Much Does It Hurt? Get The Right Help For Your Pain
After which, you might want to check out:
The 7 Approaches To Pain Management
and
Science-Based Alternative Pain Relief
Third challenge: deserves its own section, so…
Do what you can
If you have chronic pain (or any chronic illness, really), you are probably fed up of hearing how this latest diet will fix you, or yoga will fix you, and so on. But, while these things may not be miracle cures…
- A generally better diet really will lessen symptoms and avoid flare-ups (a low-inflammation diet is a great start for lessening the symptoms of a lot of chronic illnesses)
- Doing what exercise you can, being mindful of your limitations yes but still keeping moving as much as possible, will also prevent (or at least slow) deterioration. Consider consulting a physiotherapist for guidance (a doctor will more likely just say “rest, take it easy”, whereas a physiotherapist will be able to give more practical advice).
- Getting good sleep may be a nightmare in the case of chronic pain (or other chronic illnesses! Here’s to those late night hyperglycemia incidents for Type 1 Diabetics that then need monitoring for the next few hours while taking insulin and hoping it goes back down) but whatever you can do to prioritize it, do it.
Want to read more?
We reviewed a little while ago a great book about this; the title sounds like a lot of woo, but we promise the content is extremely well-referenced science:
…and if your issue is back pain specifically, we highly recommend:
Healing Back Pain: The Mind-Body Connection – by Dr. John Sarno
Take care!
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Oral retinoids can harm unborn babies. But many women taking them for acne may not be using contraception
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Oral retinoids are a type of medicine used to treat severe acne. They’re sold under the brand name Roaccutane, among others.
While oral retinoids are very effective, they can have harmful effects if taken during pregnancy. These medicines can cause miscarriages and major congenital abnormalities (harm to unborn babies) including in the brain, heart and face. At least 30% of children exposed to oral retinoids in pregnancy have severe congenital abnormalities.
Neurodevelopmental problems (in learning, reading, social skills, memory and attention) are also common.
Because of these risks, the Australasian College of Dermatologists advises oral retinoids should not be prescribed a month before or during pregnancy under any circumstances. Dermatologists are instructed to make sure a woman isn’t pregnant before starting this treatment, and discuss the risks with women of childbearing age.
But despite this, and warnings on the medicines’ packaging, pregnancies exposed to oral retinoids continue to be reported in Australia and around the world.
In a study published this month, we wanted to find out what proportion of Australian women of reproductive age were taking oral retinoids, and how many of these women were using contraception.
Our results suggest a high proportion of women are not using effective contraception while on these drugs, indicating Australia needs a strategy to reduce the risk oral retinoids pose to unborn babies.
Contraception options
Using birth control to avoid pregnancy during oral retinoid treatment is essential for women who are sexually active. Some contraception methods, however, are more reliable than others.
Long-acting-reversible contraceptives include intrauterine devices (IUDs) inserted into the womb (such as Mirena, Kyleena, or copper devices) and implants under the skin (such as Implanon). These “set and forget” methods are more than 99% effective.
Oral retinoids taken during pregnancy can cause complications in babies. Gorodenkoff/Shutterstock The effectiveness of oral contraceptive pills among “perfect” users (following the directions, with no missed or late pills) is similarly more than 99%. But in typical users, this can fall as low as 91%.
Condoms, when used as the sole method of contraception, have higher failure rates. Their effectiveness can be as low as 82% in typical users.
Oral retinoid use over time
For our study, we analysed medicine dispensing data among women aged 15–44 from Australia’s Pharmaceutical Benefit Scheme (PBS) between 2013 and 2021.
We found the dispensing rate for oral retinoids doubled from one in every 71 women in 2013, to one in every 36 in 2021. The increase occurred across all ages but was most notable in young women.
Most women were not dispensed contraception at the same time they were using the oral retinoids. To be sure we weren’t missing any contraception that was supplied before the oral retinoids, we looked back in the data. For example, for an IUD that lasts five years, we looked back five years before the oral retinoid prescription.
Our analysis showed only one in four women provided oral retinoids were dispensed contraception simultaneously. This was even lower for 15- to 19-year-olds, where only about one in eight women who filled a prescription for oral retinoids were dispensed contraception.
A recent study found 43% of Australian year 10 and 69% of year 12 students are sexually active, so we can’t assume this younger age group largely had no need for contraception.
One limitation of our study is that it may underestimate contraception coverage, because not all contraceptive options are listed on the PBS. Those options not listed include male and female sterilisation, contraceptive rings, condoms, copper IUDs, and certain oral contraceptive pills.
But even if we presume some of the women in our study were using forms of contraception not listed on the PBS, we’re still left with a significant portion without evidence of contraception.
What are the solutions?
Other countries such as the United States and countries in Europe have pregnancy prevention programs for women taking oral retinoids. These programs include contraception requirements, risk acknowledgement forms and regular pregnancy tests. Despite these programs, unintended pregnancies among women using oral retinoids still occur in these countries.
But Australia has no official strategy for preventing pregnancies exposed to oral retinoids. Currently oral retinoids are prescribed by dermatologists, and most contraception is prescribed by GPs. Women therefore need to see two different doctors, which adds costs and burden.
Preventing pregnancy during oral retinoid treatment is essential. Krakenimages.com/Shutterstock Rather than a single fix, there are likely to be multiple solutions to this problem. Some dermatologists may not feel confident discussing sex or contraception with patients, so educating dermatologists about contraception is important. Education for women is equally important.
A clinical pathway is needed for reproductive-aged women to obtain both oral retinoids and effective contraception. Options may include GPs prescribing both medications, or dermatologists only prescribing oral retinoids when there’s a contraception plan already in place.
Some women may initially not be sexually active, but change their sexual behaviour while taking oral retinoids, so constant reminders and education are likely to be required.
Further, contraception access needs to be improved in Australia. Teenagers and young women in particular face barriers to accessing contraception, including costs, stigma and lack of knowledge.
Many doctors and women are doing the right thing. But every woman should have an effective contraception plan in place well before starting oral retinoids. Only if this happens can we reduce unintended pregnancies among women taking these medicines, and thereby reduce the risk of harm to unborn babies.
Dr Laura Gerhardy from NSW Health contributed to this article.
Antonia Shand, Research Fellow, Obstetrician, University of Sydney and Natasha Nassar, Professor of Paediatric and Perinatal Epidemiology and Chair in Translational Childhood Medicine, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Beetroot vs Pumpkin – Which is Healthier?
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Our Verdict
When comparing beetroot to pumpkin, we picked the beetroot.
Why?
It was close! And an argument could be made for either.
In terms of macros, beetroot has about 3x more protein and about 3x more fiber, as well as about 2x more carbs, making it the “more food per food” option. While both have a low glycemic index, we picked the beetroot here for its better numbers overall.
In the category of vitamins, beetroot has more of vitamins B6 and B9, while pumpkin has more of vitamins A, B2, B3, B5, E, and K. So, a fair win for pumpkin this time.
When it comes to minerals, though, beetroot has more calcium, iron, magnesium, manganese, phosphorus, potassium, selenium, and zinc, while pumpkin has a tiny bit more copper. An easy win for beetroot here.
In short, both are great, and although pumpkin shines in the vitamin category, beetroot wins on overall nutritional density.
Want to learn more?
You might like to read:
No, beetroot isn’t vegetable Viagra. But here’s what it can do
Take care!
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Pain Doesn’t Belong on a Scale of Zero to 10
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Over the past two years, a simple but baffling request has preceded most of my encounters with medical professionals: “Rate your pain on a scale of zero to 10.”
I trained as a physician and have asked patients the very same question thousands of times, so I think hard about how to quantify the sum of the sore hips, the prickly thighs, and the numbing, itchy pain near my left shoulder blade. I pause and then, mostly arbitrarily, choose a number. “Three or four?” I venture, knowing the real answer is long, complicated, and not measurable in this one-dimensional way.
Pain is a squirrely thing. It’s sometimes burning, sometimes drilling, sometimes a deep-in-the-muscles clenching ache. Mine can depend on my mood or how much attention I afford it and can recede nearly entirely if I’m engrossed in a film or a task. Pain can also be disabling enough to cancel vacations, or so overwhelming that it leads people to opioid addiction. Even 10+ pain can be bearable when it’s endured for good reason, like giving birth to a child. But what’s the purpose of the pains I have now, the lingering effects of a head injury?
The concept of reducing these shades of pain to a single number dates to the 1970s. But the zero-to-10 scale is ubiquitous today because of what was called a “pain revolution” in the ’90s, when intense new attention to addressing pain — primarily with opioids — was framed as progress. Doctors today have a fuller understanding of treating pain, as well as the terrible consequences of prescribing opioids so readily. What they are learning only now is how to better measure pain and treat its many forms.
About 30 years ago, physicians who championed the use of opioids gave robust new life to what had been a niche specialty: pain management. They started pushing the idea that pain should be measured at every appointment as a “fifth vital sign.” The American Pain Society went as far as copyrighting the phrase. But unlike the other vital signs — blood pressure, temperature, heart rate, and breathing rate — pain had no objective scale. How to measure the unmeasurable? The society encouraged doctors and nurses to use the zero-to-10 rating system. Around that time, the FDA approved OxyContin, a slow-release opioid painkiller made by Purdue Pharma. The drugmaker itself encouraged doctors to routinely record and treat pain, and aggressively marketed opioids as an obvious solution.
To be fair, in an era when pain was too often ignored or undertreated, the zero-to-10 rating system could be regarded as an advance. Morphine pumps were not available for those cancer patients I saw in the ’80s, even those in agonizing pain from cancer in their bones; doctors regarded pain as an inevitable part of disease. In the emergency room where I practiced in the early ’90s, prescribing even a few opioid pills was a hassle: It required asking the head nurse to unlock a special prescription pad and making a copy for the state agency that tracked prescribing patterns. Regulators (rightly) worried that handing out narcotics would lead to addiction. As a result, some patients in need of relief likely went without.
After pain doctors and opioid manufacturers campaigned for broader use of opioids — claiming that newer forms were not addictive, or much less so than previous incarnations — prescribing the drugs became far easier and were promoted for all kinds of pain, whether from knee arthritis or back problems. As a young doctor joining the “pain revolution,” I probably asked patients thousands of times to rate their pain on a scale of zero to 10 and wrote many scripts each week for pain medication, as monitoring “the fifth vital sign” quickly became routine in the medical system. In time, a zero-to-10 pain measurement became a necessary box to fill in electronic medical records. The Joint Commission on the Accreditation of Healthcare Organizations made regularly assessing pain a prerequisite for medical centers receiving federal health care dollars. Medical groups added treatment of pain to their list of patient rights, and satisfaction with pain treatment became a component of post-visit patient surveys. (A poor showing could mean lower reimbursement from some insurers.)
But this approach to pain management had clear drawbacks. Studies accumulated showing that measuring patients’ pain didn’t result in better pain control. Doctors showed little interest in or didn’t know how to respond to the recorded answer. And patients’ satisfaction with their doctors’ discussion of pain didn’t necessarily mean they got adequate treatment. At the same time, the drugs were fueling the growing opioid epidemic. Research showed that an estimated 3% to 19% of people who received a prescription for pain medication from a doctor developed an addiction.
Doctors who wanted to treat pain had few other options, though. “We had a good sense that these drugs weren’t the only way to manage pain,” Linda Porter, director of the National Institutes of Health’s Office of Pain Policy and Planning, told me. “But we didn’t have a good understanding of the complexity or alternatives.” The enthusiasm for narcotics left many varietals of pain underexplored and undertreated for years. Only in 2018, a year when nearly 50,000 Americans died of an overdose, did Congress start funding a program — the Early Phase Pain Investigation Clinical Network, or EPPIC-Net — designed to explore types of pain and find better solutions. The network connects specialists at 12 academic specialized clinical centers and is meant to jump-start new research in the field and find bespoke solutions for different kinds of pain.
A zero-to-10 scale may make sense in certain situations, such as when a nurse uses it to adjust a medication dose for a patient hospitalized after surgery or an accident. And researchers and pain specialists have tried to create better rating tools — dozens, in fact, none of which was adequate to capture pain’s complexity, a European panel of experts concluded. The Veterans Health Administration, for instance, created one that had supplemental questions and visual prompts: A rating of 5 correlated with a frown and a pain level that “interrupts some activities.” The survey took much longer to administer and produced results that were no better than the zero-to-10 system. By the 2010s, many medical organizations, including the American Medical Association and the American Academy of Family Physicians, were rejecting not just the zero-to-10 scale but the entire notion that pain could be meaningfully self-reported numerically by a patient.
In the years that opioids had dominated pain remedies, a few drugs — such as gabapentin and pregabalin for neuropathy, and lidocaine patches and creams for musculoskeletal aches — had become available. “There was a growing awareness of the incredible complexity of pain — that you would have to find the right drugs for the right patients,” Rebecca Hommer, EPPIC-Net’s interim director, told me. Researchers are now looking for biomarkers associated with different kinds of pain so that drug studies can use more objective measures to assess the medications’ effect. A better understanding of the neural pathways and neurotransmitters that create different types of pain could also help researchers design drugs to interrupt and tame them.
Any treatments that come out of this research are unlikely to be blockbusters like opioids; by design, they will be useful to fewer people. That also makes them less appealing prospects to drug companies. So EPPIC-Net is helping small drug companies, academics, and even individual doctors design and conduct early-stage trials to test the safety and efficacy of promising pain-taming molecules. That information will be handed over to drug manufacturers for late-stage trials, all with the aim of getting new drugs approved by the FDA more quickly.
The first EPPIC-Net trials are just getting underway. Finding better treatments will be no easy task, because the nervous system is a largely unexplored universe of molecules, cells, and electronic connections that interact in countless ways. The 2021 Nobel Prize in Physiology or Medicine went to scientists who discovered the mechanisms that allow us to feel the most basic sensations: cold and hot. In comparison, pain is a hydra. A simple number might feel definitive. But it’s not helping anyone make the pain go away.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Subscribe to KFF Health News’ free Morning Briefing.
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