This is Dr. Christiane Wolf. Is than an MD or a PhD, you ask? The answer is: yes (it is both; the latter being in psychosomatic medicine).

She also teaches Mindfulness-Based Stress Reduction, which as you may recall is pretty much the most well-evidenced* form of meditation there is, in terms of benefits:

No-Frills, Evidence-Based Mindfulness

*which is not to claim it is necessarily the best (although it also could be); rather, this means that it is the form of meditation that’s accumulated the most scientific backing in total. If another equal or better form of meditation enjoyed less scientific scrutiny, then there could an alternative out there languishing with only two and a half scientific papers to its name. However, we at 10almonds are not research scientists, and thus can only comment on the body of evidence that has been published.

In any case, today is going to be about pain.

What does she want us to know?

Your mind does matter

It’s easy to think that anything you can do with your mind is going to be quite small comfort when your nerves feel like they’re on fire.

However, Dr. Wolf makes the case for pain consisting of three components:

• the physical sensation(s)
• the emotions we have about those
• the meaning we give to such (or “the story” that we use to describe it)

To clarify, let’s give an example:

• the physical sensations of burning, searing, and occasionally stabbing pains in the lower back
• the emotions of anguish, anger, despair, self-pity
• the story of “this pain has ruined my life, is making it unbearable, will almost certainly continue, and may get worse”

We are not going to tell you to throw any of those out of the window for now (and, would that you could throw the first line out, of course).

The first thing Dr. Wolf wants us to do to make this more manageable is to break it down.

Because presently, all three of those things are lumped together in a single box labelled “pain”.

If each of those items is at a “10” on the scale of pain, then this is 10×10×10=1000.

If our pain is at 1000/10, that’s a lot. We want to leave the pain in the box, not look at it, and try to distract ourselves. That is one possible strategy, by the way, and it’s not always bad when it comes to giving oneself a short-term reprieve. We balanced it against meditation, here:

Managing Chronic Pain (Realistically)

However, back to the box analogy, if we open that box and take out each of those items to examine them, then even without changing anything, even with them all still at 10, they can each be managed for what they are individually, so it’s now 10+10+10=30.

If our pain is at 30/10, that’s still a lot, but it’s a lot more manageable than 1000/10.

On rating pain, by the way, see:

Get The Right Help For Your Pain

Dealing with the separate parts

It would be nice, of course, for each of those separate parts to not be at 10.

With regard to the physical side of pain, this is not Dr. Wolf’s specialty, but we have some good resources here at 10almonds:

• The 7 Approaches To Pain Management
• 10 Tips To Reduce Morning Pain & Stiffness With Arthritis
• Science-Based Alternative Pain Relief: When Painkillers Aren’t Helping, These Things Might

When it comes to emotions associated with pain, Dr. Wolf (who incidentally is a Buddhist and also a teacher of same, and runs meditation retreats for such), recommends (of course) mindfulness, and what in Dialectical Behavior Therapy (DBT) is called “radical acceptance” (in Buddhism, it may be referred to as being at one with things). We’ve written about this here:

“Hello, Emotions”: Radical Acceptance In CBT & DBT

Once again, the aim here is still not to throw the (often perfectly valid) emotions out of the window (unless you want to), but rather, to neutrally note and acknowledge the emotions as they arrive, á la “Hello, despair. Depression, my old foe, we meet again. Hello again, resentment.” …and so on.

The reason this helps is because emotions, much like the physical sensations of pain, are first and foremost messengers, and sometimes (as in the case of chronic pain) they get broken and keep delivering the message beyond necessity. Acknowledging the message helps your brain (and all that is attached to it) realize “ok, this message has been delivered now; we can chill about it a little”.

Having done that, if you can reasonably tweak any of the emotions (for example, perhaps that self-pity we mentioned could be turned into self-compassion, which is more useful), that’s great. If not, at least you know what’s on the battlefield now.

When we examine the story of our pain, lastly, Dr. Wolf invites us to look at how one of the biggest drivers of distress under pain is the uncertainty of how long the pain will last, whether it will get worse, whether what we are doing will make it worse, and so forth. See for example:

How long does back pain last? And how can learning about pain increase the chance of recovery?

And of course, many things we do specifically in response to pain can indeed make our pain worse, and spread:

How To Stop Pain Spreading

Dr. Wolf’s perspective says:

1. Life involves pain
2. Pain invariably has a cause
3. What has a cause, can have an end
4. We just need to go through that process

This may seem like small comfort when we are in the middle of the pain, but if we’ve broken it down into parts with Dr. Wolf’s “box method”, and dealt with the first two parts (the sensations and the emotions) as well as reasonably possible, then we can tackle the third one (the story) a little more easily than we could if we were trying to come at it with no preparation.

What used to be:

“This pain has ruined my life, is making it unbearable, will almost certainly continue, and may get worse”

…can now become:

“This pain is a big challenge, but since I’m here for it whether I want to be or not, I will suffer as I must, while calmly looking for ways to reduce that suffering as I go.”

In short: you cannot “think healing thoughts” and expect your pain to go away. But you can do a lot more than you might (if you left it unexamined) expect.

Want to know more from Dr. Wolf?

We reviewed a book of hers recently, which you might enjoy:

Outsmart Your Pain – by Dr. Christiane Wolf

Take care!

What You Should Have Been Told About Menopause Beforehand

This is Dr. Jen Gunter. She’s a gynecologist, specializing in chronic pain and vulvovaginal disorders. She’s also a woman on a mission to demystify things that popular culture, especially in the US, would rather not talk about.

When was the last time you remember the menopause being referenced in a movie or TV show? If you can think of one at all, was it just played for laughs?

And of course, the human body can be funny, so that’s not necessarily the problem, but it sure would be nice if that weren’t all that there is!

So, what does Dr. Gunter want us to know?

It’s a time of changes, not an end

The name “menopause” is misleading. It’s not a “pause”, and those menses aren’t coming back.

And yet, to call it a “menostop” would be differently misleading, because there’s a lot more going on than a simple cessation of menstruation.

Estrogen levels will drop a lot, testosterone levels may rise slightly, mood and sleep and appetite and sex drive will probably be affected (progesterone can improve all these things!) and not to mention but we’re going to mention: vaginal atrophy, which is very normal and very treatable with a topical estrogen cream. Untreated menopause can also bring a whole lot of increased health risks (for example, heart disease, osteoporosis, and, counterintuitively given the lower estrogen levels, breast cancer).

However, with a little awareness and appropriate management, all these things can usually be navigated with minimal adverse health outcomes.

Dr Gunter, for this reason, refers to it interchangeably as “the menopausal transition”. She describes it as being less like a cliff edge we fall off, and more like a bridge we cross.

Bridges can be dangerous to cross! But they can also get us safely where we’re going.

Ok, so how do we manage those things?

Dr. Gunter is a big fan of evidence-based medicine, so we’ll not be seeing any yonic crystals or jade eggs. Or “goop”.

See also: Meet Goop’s Number One Enemy

For most people, she recommends Menopausal Hormone Therapy (MHT), which falls under the more general category of Hormone Replacement Therapy (HRT).

This is the most well-evidenced, science-based way to avoid most of the risks associated with menopause.

Nevertheless, there are scare-stories out there, ranging from painful recommencement of bleeding, to (once again) increased risk of breast cancer. However, most of these are either misunderstandings, or unrelated to menopause and MHT, and are rather signs of other problems that should not be ignored.

To get a good grounding in this, you might want to read her Hormone Therapy Guide, freely available as a standalone section on her website. This series of posts is dedicated to hormone therapy. It starts with some basics and builds on that knowledge with each post:

Dr. Gunter’s Guide To The Hormone Menoverse

What about natural therapies?

There are some non-hormonal things that work, but these are mostly things that:

• give a statistically significant reduction in symptoms
• give the same statistically significant reduction in symptoms as placebo

As Dr. Gunter puts it:

❝While most of the studies of prescription medications for hot flashes have an appropriate placebo arm, this is rarely the case with so-called alternative therapies.

In fact, the studies here are almost always low quality, so it’s often not possible to conclude much.

Many reviews that look at these studies often end with a line that goes something like, “Randomized trials with a placebo arm, a low risk of bias, and adequate sample sizes are urgently needed.”

You should interpret this kind of conclusion as the polite way of saying, “We need studies that aren’t BS to say something constructive.”❞

~ Gunter, 2023

However, if it works, it works, whatever its mechanism. It’s just good, when making medical decisions, to do so with the full facts!

For that matter, even Dr. Gunter acknowledges that while MHT can be lifechanging (in a positive way) for many, it’s not for everyone:

Informed Decisions: When Menopause Hormone Therapy Isn’t Recommended

Want to know more?

Dr. Gunter also has an assortment of books available, including The Menopause Manifesto (which we’ve reviewed previously), and some others that we haven’t, such as “Blood” and “The Vagina Bible”.

Enjoy!