The 7 Approaches To Pain Management

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More Than One Way To Kill Pain

This is Dr. Deepak Ravindran (MD, FRCA. FFPMRCA, EDRA. FIPP, DMSMed). He has decades of experience and is a specialist in acute and chronic pain management, anesthesia, musculoskeletal medicine, and lifestyle medicine.

A quick catch-up, first:

We’ve written about chronic pain management before:

Managing Chronic Pain (Realistically!)

As well as:

Science-Based Alternative Pain Relief

Dr. Ravindran’s approach

Dr. Ravindran takes a “trauma-informed care” approach to his professional practice, and recommends the same for others.

In a nutshell, this means starting from a position of not “what’s wrong with you?”, but rather “what happened to you?”.

This seemingly subtle shift is important, because it means actually dealing with a person’s issues, instead of “take one of these and call my secretary next month”. Read more:

What is Trauma-Informed Care?

Pain itself can be something of a many-headed hydra. Dr. Ravindran’s approach is equally many-headed; specifically, he has a 7-point plan:

Medications

Dr. Ravindran sees painkillers (and a collection of other drugs, like antidepressants and muscle relaxants) as a potential means to an end worth exploring, but he doesn’t expect them to be the best choice for everyone, and nor does he expect them to be a cure-all. Neither should we. He also advises being mindful of the drawbacks and potential complications of these drugs, too.

Interventions

Sometimes, surgery is the right choice. Sometimes it isn’t. Often, it will change a life—one way or the other. Similar to with medications, Dr. Ravindran is very averse to a “one size fits all” approach here. See also:

The Insider’s Guide To Making Hospital As Comfortable As Possible

Neuroscience and stress management

Often a lot of the distress of pain is not just the pain itself, but the fear associated with it. Will it get worse if I move wrong or eat the wrong thing? How long will it last? Will it ever get better? Will it get worse if I do nothing?. Dr. Ravindran advises tackling this, with the same level of importance as the pain itself. Here’s a good start:

Stress, And Building Psychological Resilience

Diet and the microbiome

Many chronic illnesses are heavily influenced by this, and Dr. Ravindran’s respect for lifestyle medicine comes into play here. While diet might not fix all our ills, it certainly can stop things from being a lot worse. Beyond the obvious “eat healthily” (Mediterranean diet being a good starting point for most people), he also advises doing elimination tests where appropriate, to screen out potential flare-up triggers. You also might consider:

Four Ways To Upgrade The Mediterranean Diet

Sleep

“Get good sleep” is easy advice for those who are not in agonizing pain that sometimes gets worse from staying in the same position for too long. Nevertheless, it is important, and foundational to good health. So it’s important to explore—whatever limitations one might realistically have—what can be done to improve it.

If you can only sleep for a short while at a time, you may get benefit from this previous main feature of ours:

How To Nap Like A Pro (No More “Sleep Hangovers”!)

Exercise and movement

The trick here is to move little and often; without overdoing it, but without permitting loss of mobility either. See also:

The Doctor Who Wants Us To Exercise Less, And Move More

Therapies of the mind and body

This is about taking a holistic approach to one’s wellness. In Dr. Ravindran’s words:

❝Mind-body therapies are often an extremely sensitive topic about which people hold very strong opinions and sometimes irrational beliefs.

Some, like reiki and spiritual therapy and homeopathy, have hardly any scientific evidence to back them up, while others like yoga, hypnosis, and meditation/mindfulness are mainstream techniques with many studies showing the benefits, but they all work for certain patients.❞

In other words: evidence-based is surely the best starting point, but if you feel inclined to try something else and it works for you, then it works for you. And that’s a win.

Want to know more?

You might like his book…

The Pain-Free Mindset: 7 Steps to Taking Control and Overcoming Chronic Pain

He also has a blog and a podcast.

Take care!

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  • You, Happier – by Dr. Daniel Amen

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    The implicit question “what’s your brain type?” makes this book sound a little like a horoscope for science-enjoyers, but really, the “brain type” in question is simply a way of expressing which neurochemicals one’s brain makes most and/or least easily.

    That’s something that a) really does differ from one person to another b) isn’t necessarily fixed forever, but will tend to remain mostly the same most of the time for most people.

    And yes, the book does cover figuring out which neurotransmitter(s) it might be for you. On a secondary level, it also talks about more/less active parts of the brain for each of us, but the primary focus is on neurotransmitters.

    It’s easy to assume “everyone wants more [your favorite neurotransmitter here]” but in fact, most people most of the time have most of what they need.

    For those of us who don’t, those of us who perhaps have to work more to keep our level(s) of one or more neurotransmitters where they should be, this book is a great guide to optimizing aspects of our diet and lifestyle to compensate for what our brains might lack—potentially reducing the need to go for pharmaceutical approaches.

    The style of the book is very much pop-science, but it is all well-informed and well-referenced.

    Bottom line: if you sometimes (or often!) think “if only my brain would just make/acknowledge more [neurotransmitter], this book is for you.

    Click here to check out You, Happier, and discover a happier you!

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  • How Jumping Rope Changes The Human Body

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Most popularly enjoyed by professional boxers and six-year-old girls, jumping rope is one of the most metabolism-boosting exercises around:

    Just a hop, skip, and a jump away from good health

    Maybe you haven’t tried it since your age was in single digits, so, if you do…

    What benefits can you expect?

    • Improves cardiovascular fitness, equivalent to 30 minutes of running with just 10 minutes of jumping.
    • Increases bone density and boosts immunity by aiding the lymphatic system.
    • Enhances explosiveness in the lower body, agility, and stamina.
    • Improves shoulder endurance, coordination, and spatial awareness.

    What kind of rope is best for you?

    • Beginner ropes: licorice ropes (nylon/vinyl), beaded ropes for rhythm and durability.
    • Advanced ropes: speed ropes (denser, faster materials) for higher speeds and more difficult skills.
    • Weighted ropes: build upper body muscles (forearms, shoulders, chest, back).

    What length should you get?

    • Recommended rope length varies by height (8 ft for 5’0″–5’4″, 9 ft for 5’5″–5’11”, 10 ft for 6’0″ and above).
    • Beginners should start with longer ropes for clearance.

    What should you learn?

    • Initial jump rope skills: start with manageable daily jump totals, gradually increasing as ankles, calves, and feet adapt.
    • Further skills: learn the two-foot jump and then the boxer’s skip for efficient, longer sessions and advanced skills. Keep arms close and hands at waist level for a smooth swing.

    For more on all of this, enjoy:

    Click Here If The Embedded Video Doesn’t Load Automatically!

    Want to learn more?

    You might also like to read:

    How To Do High Intensity Interval Training (Without Wrecking Your Body)

    Take care!

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  • How To Reduce Chronic Stress

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Sunday Stress-Buster

    First, an important distinction:

    • Acute stress (for example, when stepping out of your comfort zone, engaging in competition, or otherwise focusing on something that requires your full attention for best performance) is generally a good thing. It helps you do you your best. It’s sometimes been called “eustress”, “good stress”.
    • Chronic stress (for example, when snowed under at work and you do not love it, when dealing with a serious illness, and/or faced with financial problems) is unequivocally a bad thing. Our body is simply not made to handle that much cortisol (the stress hormone) all the time.

    Know the dangers of too much cortisol

    We covered this as a main feature last month: Lower Your Cortisol! (Here’s Why & How)

    …but it bears mentioning again and for those who’ve joined us since then:

    A little spike of cortisol now and again can be helpful. Having it spiking all the time, or even a perpetual background low-to-moderate level, can be ruinous to the health in so many ways.

    The good news is, the physiological impact of stress on the body (which ranges from face-and-stomach fat deposits, to rapid aging), can be reversed—even the biological aging!

    Read: Biological age is increased by stress and restored upon recovery ← this study is so hot-of-the-press that it was published literally two days ago

    Focus on what you can control

    A lot of things that cause you stress may be outside of your control. Focus on what is within your control. Oftentimes, we are so preoccupied with the stress, that we employ coping strategies that don’t actually deal with the problem.

    That’s a maladaptive response to an evolutionary quirk—our bodies haven’t caught up with modern life, and on an evolutionary scale, are still priming us to deal with sabre-toothed tigers, not financial disputes, for example.

    But, how to deal with the body’s “wrong” response?

    First, deal with the tiger. There isn’t one, but your body doesn’t know that. Do some vigorous exercise, or if that’s not your thing, tense up your muscles strongly for a few seconds and then relax them, doing each part of your body. This is called progressive relaxation, and how it works is basically tricking your body into thinking you successfully fled the tiger, or fought the tiger and won.

    Next, examine what the actual problem is, that’s causing you stress. You’re probably heavily emotionally attached to the problem, or else it wouldn’t be stressing you. So, imagine what advice you would give to help a friend deal with the same problem, and then do that.

    Better yet: enlist an actual friend (or partner, family member, etc) to help you. We are evolved to live in a community, engaged in mutual support. That’s how we do well; that’s how we thrive best.

    By dealing with the problem—or sometimes even just having support and/or something like a plan—your stress will evaporate soon enough.

    The power of “…and then what?”

    Sometimes, things are entirely out of your control. Sometimes, bad things are entirely possible; perhaps even probable. Sometimes, they’re so bad, that it’s difficult to avoid stressing about the possible outcomes.

    If something seems entirely out of your control and/or inevitable, ask yourself:

    “…and then what?”

    Writer’s storytime: when I was a teenager, sometimes I would go out without a coat, and my mother would ask, pointedly, “But what will you do if it rains?!”

    I’d reply “I’ll get wet, of course”

    This attitude can go just the same for much more serious outcomes, up to and including death.

    So when you find yourself stressing about some possible bad outcome, ask yourself, “…and then what?”.

    • What if this is cancer? Well, it might be. And then what? You might seek cancer treatment.
    • What if I can’t get treatment, or it doesn’t work? Well, you might die. And then what?

    In Dialectic Behavior Therapy (DBT), this is called “radical acceptance” and acknowledges bad possible/probable/known outcomes, allows one to explore the feelings, and come up with a plan for managing the situation, or even just coming to terms with the fact that sometimes, suffering is inevitable and is part of the human condition.

    It’ll still be bad—but you won’t have added extra suffering in the form of stress.

    Breathe.

    Don’t underestimate the power of relaxed deep breathing to calm the rest of your body, including your brain.

    Also: we’ve shared this before, a few months ago, but this 8 minute soundscape was developed by sound technicians working with a team of psychologists and neurologists. It’s been clinically tested, and found to have a much more relaxing effect(in objective measures of lowering heart rate and lowering cortisol levels, as well as in subjective self-reports) than merely “relaxing music”.

    Try it and see for yourself:

    !

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  • The Brain Health Book – by Dr. John Randolph

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    The author, a clinical neuropsychologist and brain health consultant, brings his professional knowledge and understanding to bear on the questions of what works, what doesn’t, and why?

    In practical terms, the focus is mostly on maintaining/improving attention, memory, and executive functions. To that end, he covers what kinds of exercises to do (physical and mental!), and examines what strategies make the most difference—including the usual lifestyle considerations of course, but also more specifically than that, what to prioritize over what when it comes to daily choices.

    The style is easy pop-science, with an emphasis on being directly useful to the reader, rather than giving an overabundance of citations for everything as we go along. He does, however, explain the necessary science as we go, making the book educational without being academic.

    Bottom line: if you’d like to maintain/improve your brain, this book can certainly help with that, and as a bonus (unless you are already an expert) you’ll learn plenty about the brain as you go.

    Click here to check out The Brain Health Book, and use the power of neuroscience to improve your life!

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  • The Sun Exposure Dilemma

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    The Sun Exposure Dilemma

    Yesterday, we asked you about your policy on sun exposure, and got the above-pictured, below-described, set of answers:

    • A little over a third of respondents chose “I recognize the risks, but I think the benefits outweigh them”
    • A quarter of respondents chose “I am a creature of the shadows and I avoid the sun at all costs‍”
    • A little over a fifth of respondents chose “I recognize the benefits, but I think the risks outweigh them”
    • A little under a fifth of respondents chose “I’m a sun-lover! Give me that vitamin D and other benefits!”

    All in all, this is perhaps the most even spread of answers we’ve had for Friday mythbuster polls—though the sample size was smaller than it often is.

    Of those who added comments, common themes were to mention your local climate, and the importance of sunscreen and/or taking vitamin D supplements.

    One subscriber mentioned having lupus and living in Florida, which is a particularly unfortunate combination:

    Lupus Foundation | Lupus & UV exposure: What you need to know

    Another subscriber wrote:

    ❝Use a very good sunscreen with a high SPF all the time. Reapply after swimming or as needed! I also wear polarized sunglasses anytime I’m outside.❞

    …which are important things to note too, and a lot of people forget!

    See also: Who Screens The Sunscreens? (on fearing chemical dangers, vs the protection given)

    But, onto today’s science for the topic at hand…

    We need to get plenty of sun to get plenty of vitamin D: True or False?

    True or False, depending on so many factors—to the point that many people get it wildly wrong in either direction.

    Whether we are getting enough vitamin D depends on many circumstances, including:

    • The climate (and depending on latitude, time of year) where we live
    • Our genes, and especially (but not only) our skintone
    • The clothes we wear (or don’t)
    • Our diet (and not just “how much vitamin D do we consume”)
    • Chronic diseases that affect vitamin D metabolism and/or requirements and/or sensitivity to the sun

    For a rundown on these factors and more, check out:

    Should I be getting my vitamin D levels checked?

    Notably, on the topic of whether you should stay in the sun for longer to get more vitamin D…

    ❝The body can only produce a certain amount of vitamin D at the time, so staying in the sun any longer than needed (which could be just a few minutes, in a sunny climate) is not going to help increase your vitamin D levels, while it will increase your risk of skin cancer.❞

    Source: Dr. Elina Hypponen, professor of Nutritional Epidemiology, and director of the Australian Centre for Precision Health at the University of South Australia Cancer Research Institute.

    In contrast, she does also note:

    ❝During winter, catching enough sun can be difficult, especially if you spend your days confined indoors. Typically, the required exposure increases to two to three hours per week in winter. This is because sunlight exposure can only help produce vitamin D if the UVB rays reach us at the correct angle. So in winter we should regularly spend time outside in the middle of the day to get our dose of vitamin D.❞

    See also: Vitamin D & Calcium: Too Much Of A Good Thing?

    We can skip the sun and get our vitamin D from diet/supplements: True or False?

    True! However, vitamin D is not the only health benefit of sun exposure.

    Not only is sunlight-induced serotonin production important for many things ranging from mood to circadian rhythm (which in turn affects many other aspects of health), but also…

    While too much sun can cause skin cancer, too little sun could cause other kinds of cancer:

    Benefits of Sunlight: A Bright Spot for Human Health

    Additionally, according to new research, the circadian rhythm benefits we mentioned above may also have an impact on type 2 diabetes:

    Can catching some rays help you fight off type 2 diabetes?

    Which way to jump?

    A lot of it depends on who you are, ranging from the factors we mentioned earlier, to even such things as “having many moles” or “having blonde hair”.

    This latter item, blonde hair, is a dual thing: it’s a matter of genetic factors that align with being prone to being more sensitive to the sun, as well as being a lesser physical barrier to the sun’s rays than dark hair (that can block some UV rays).

    So for example, if two people have comparably gray hair now, but one of them used to have dark hair and the other blonde, there will still be a difference in how they suffer damage, or don’t—and yes, even if their skin is visually of the same approximate skintone.

    You probably already know for yourself whether you are more likely to burn or tan in the sun, and the former group are less resistant to the sun’s damage… But the latter group are more likely to spend longer in the sun, and accumulate more damage that way.

    If you’d like a very comprehensive downloadable, here are the guidelines issued by the UK’s National Institute for Health and Care Excellence:

    NICE Guidelines | Sunlight exposure: risks and benefits

    …and skip to “At risk groups”, if you don’t want to read the whole thing; “Skin type” is also an important subsection, which also uses your hair and eye color as indicators.

    Writer’s note: genetics are complicated and not everyone will fall neatly into categories, which is why it’s important to know the individual factors.

    For example, I am quite light-skinned with slightly graying dark hair and gray-blue eyes, and/but also have an obscure Sámi gene that means my skin makes vitamin D easily, while simultaneously being unusually resistant to burning (I just tan). Basically: built for the midnight sun of the Arctic circle.

    And yet! My hobbies include not getting skin cancer, so I tend to still be quite mindful of UV levels in different weathers and times of day, and make choices (schedule, clothing, sunscreen or not) accordingly.

    Bottom line:

    That big self-perpetuating nuclear explosion in the sky is responsible for many things, good and bad for our health, so be aware of your own risk factors, especially for vitamin D deficiency, and skin cancer.

    • If you have a predisposition to both, that’s unfortunate, but diet and supplementation at least can help with the vitamin D while getting modest amounts of sun at most.
    • Remember that you can only make so much vitamin D at once, so sunbathing for health benefits need only take a few minutes
    • Remember that sunlight is important for our circadian rhythm, which is important for many things.
    • That’s governed by specific photoreceptor cells, though, so we don’t need our skin to be exposed for that; we just need to be able to see sunlight.
    • If you’re going to be out in the sun, and not covered up, sunscreen is your friend, and yes, that goes for clear cold days under the winter sun too.
    • Most phone weather apps these days have a UV index score as part of the data they give. Get used to checking it as often as you’d check for rain.

    Stay safe, both ways around!

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  • 52 Small Changes – by Brett Blumenthal

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    We see a lot of books that exhort us to get a six-pack in a month, change our life in 7 days, learn Japanese in 24 hours. The reality is, things take time!

    Brett Blumenthal is more realistic while being just as motivational:

    The idea is simple… Make one small change per week for 52 weeks, and at the end of the year, you’ll be healthier and happier.

    At 10almonds, we’re big fans of small changes that add up (or rather: compound!) to make big differences, so this one’s absolutely our style!

    Best of all, she offers us not just “do this” advice, but also “and here’s the information and resources you’ll need to make this change work the best it can for you”

    The advices range in topic from nutrition to exercise to sleep to mental wellness to interpersonal stuff and more. The biggest focus is on personal health, though, with small changes to exercise and nutrition making up the lion’s share of the changes.

    Bottom line: this is a book you’ll want to grab once a week. Consider setting a reminder on your phone to check in with it each Sunday, for example!

    Take the first step and order “52 Small Changes” from Amazon today!

    Don’t Forget…

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    Learn to Age Gracefully

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