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:
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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Debate over tongue tie procedures in babies continues. Here’s why it can be beneficial for some infants
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There is increasing media interest about surgical procedures on new babies for tongue tie. Some hail it as a miracle cure, others view it as barbaric treatment, though adverse outcomes are rare.
Tongue tie occurs when the tissue under the tongue is attached to the lower gum or floor of the mouth in a way that can restrict the movement or range of the tongue. This can impact early breastfeeding in babies. It affects an estimated 8% of children under one year of age.
While there has been an increase in tongue tie releases (also called division or frenotomy), it’s important to keep this in perspective relative to the increase in breastfeeding rates.
The World Health Organization recommends exclusive breastfeeding for the first six months of life, with breastfeeding recommended into the second year of life and beyond for the health of mother and baby as well as optimal growth. Global rates of breastfeeding infants for the first six months have increased from 38% to 48% over the past decade. So, it is not surprising there is also an increase in the number of babies being referred globally with breastfeeding challenges and potential tongue tie.
An Australian study published in 2023 showed that despite a 25% increase in referrals for tongue tie division between 2014 and 2018, there was no increase in the number of tongue tie divisions performed. Tongue tie surgery rates increased in Australia in the decade from 2006 to 2016 (from 1.22 per 1,000 population to 6.35) for 0 to 4 year olds. There is no data on surgery rates in Australia over the last eight years.
Tongue tie division isn’t always appropriate but it can make a big difference to the babies who need it. More referrals doesn’t necessarily mean more procedures are performed.
chomplearn/Shutterstock How tongue tie can affect babies
When tongue tie (ankyloglossia) restricts the movement of the tongue, it can make it more difficult for a baby to latch onto the mother’s breast and painlessly breastfeed.
Earlier this month, the International Consortium of oral Ankylofrenula Professionals released a tongue tie position statement and practice guideline. Written by a range of health professionals, the guidelines define tongue tie as a functional diagnosis that can impact breastfeeding, eating, drinking and speech. The guidelines provide health professionals and families with information on the assessment and management of tongue tie.
Tongue tie release has been shown to improve latch during breastfeeding, reduce nipple pain and improve breast and bottle feeding. Early assessment and treatment are important to help mothers breastfeed for longer and address any potential functional problems.
The frenulum is a band of tissue under the tongue that is attached to the gumline base of the mouth. Akkalak Aiempradit/Shutterstock Where to get advice
If feeding isn’t going well, it may cause pain for the mother or there may be signs the baby isn’t attaching properly to the breast or not getting enough milk. Parents can seek skilled help and assessment from a certified lactation consultant or International Board-Certified Lactation Consultant who can be found via online registry.
Alternatively, a health professional with training and skills in tongue tie assessment and division can assist families. This may include a doctor, midwife, speech pathologist or dentist with extended skills, training and experience in treating babies with tongue tie.
When access to advice or treatment is delayed, it can lead to unnecessary supplementation with bottle feeds, early weaning from breastfeeding and increased parental anxiety.
Getting a tongue tie assessment
During assessment, a qualified health professional will collect a thorough case history, including pregnancy and birth details, do a structural and functional assessment, and conduct a comprehensive breastfeeding or feeding assessment.
They will view and thoroughly examine the mouth, including the tongue’s movement and lift. The appearance of where the tissue attaches to the underside of the tongue, the ability of the tongue to move and how the baby can suck also needs to be properly assessed.
Treatment decisions should focus on the concerns of the mother and baby and the impact of current feeding issues. Tongue tie division as a baby is not recommended for the sole purpose of avoiding speech problems in later life if there are no feeding concerns for the baby.
A properly qualified lactation consultant can help with positioning and attachment. HarryKiiM Stock/Shutterstock Treatment options
The Australian Dental Association’s 2020 guidelines provide a management pathway for babies diagnosed with tongue tie.
Once feeding issues are identified and if a tongue tie is diagnosed, non-surgical management to optimise positioning, latch and education for parents should be the first-line approach.
If feeding issues persist during follow-up assessment after non-surgical management, a tongue tie division may be considered. Tongue tie release may be one option to address functional challenges associated with breastfeeding problems in babies.
There are risks associated with any procedure, including tongue tie release, such as bleeding. These risks should be discussed with the treating practitioner before conducting any laser, scissor or scalpel tongue tie procedure.
Post-release support by a certified lactation consultant or feeding specialist is necessary after a tongue tie division. A post-release treatment plan should be developed by a team of health professionals including advice and support for breastfeeding to address both the mother and baby’s individual needs.
We would like to acknowledge the contribution of Raymond J. Tseng, DDS, PhD, (Paediatric Dentist) to the writing of this article.
Sharon Smart, Lecturer and Researcher (Speech Pathology) – School of Allied Health, Curtin University; David Todd, Associate Professor, Neonatology, ANU Medical School, Australian National University, and Monica J. Hogan, PhD student, ANU School of Medicine and Psychology, Australian National University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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7 Kinds Of Rest When Sleep Is Not Enough
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Taking Rest Seriously (More Than Just Sleep)
This is Dr. Matthew Edlund. He has 44 years experience as a psychiatrist, and is also a sleep specialist. He has a holistic view of health, which is reflected in his practice; he advocates for “a more complete health: physical, mental, social, and spiritual well-being”.
What does he want us to know?
Sleep, yes
Sleep cannot do all things for us in terms of rest, but it can do a lot, and it is critical. It is, in short, a necessary-but-not-sufficient condition for being well-rested.
See also: Why You Probably Need More Sleep
Rest actively
Rest is generally thought of as a passive activity, if you’ll pardon the oxymoron. Popular thinking is that it’s not something defined by what we do, so much what we stop doing.
In contrast, Dr. Edlund argues that to take rest seriously, we need do restful things.
Rest is as important as eating, and we wouldn’t want for that to “just happen”, would we?
Dr. Edlund advocates for restful activities such as going to the garden (or a nearby park) to relax. He also suggests we not underestimate the power of sex as an actively restful activity—this one is generally safer in the privacy of one’s home, though!
Rest physically
This is about actively relaxing our body—yoga is a great option here, practised in a way that is not physically taxing, but is physically rejuvenating; gentle stretches are key. Without such things, our body will keep tension, and that is not restful.
For the absolute most restful yogic practice? Check out:
Non-Sleep Deep Rest: A Neurobiologist’s Take
this is about yoga nidra!
Rest mentally
The flipside of the above is that we do need to rest our mind also. When we try to rest from a mental activity by taking on a different mental activity that uses the same faculties of the brain, it is not restful.
Writer’s example: as a writer, I could not rest from my writing by writing recreationally, or even by reading. An accountant, however, could absolutely rest from accounting by picking up a good book, should they feel so inclined.
Rest socially
While we all have our preferences when it comes to how much or how little social interaction we like in our lives, humans are fundamentally social creatures, and it is hardwired into us by evolution to function at our best in a community.
This doesn’t mean you have to go out partying every night, but it does mean you should take care to spend at least a little time with friends, even if just once or twice per week, and yes, even if it’s just a videocall (in person is best, but not everyone lives close by!)
If your social life is feeling a little thin on the ground these days, that’s a very common thing—not only as we get older, but also as many social institutions took a dive in functionality on account of the pandemic, and many are still floundering. Nevertheless, there are more options than you probably realize; yes, even for the naturally reclusive:
How To Beat Loneliness & Isolation
Rest spiritually
Be we religious or not, there are scientifically well-evidenced benefits to religious practices—some are because of the social aspect, and follow on from what we talked about just above. Other benefits come from activities such as prayer or meditation (which means that having some kind of faith, while beneficial, is not actually a requirement for spiritual rest—comparable practices without faith are fine too).
We discussed the overlapping practices of prayer and meditation, here:
The Science Of Mantra Meditation
Rest at home
Obviously, most people sleep at home. But…
Busy family homes can sometimes need a bit of conscious effort to create a restful environment, even if just for a while. A family dinner together is one great way to achieve this, and also ties in with the social element we mentioned before!
A different challenge faced by a lot of older people without live-in families, on the other hand, is the feeling of too much opportunity for rest—and then a feeling of shame for taking it. The view is commonly held that, for example, taking an afternoon nap is a sign of weakness.
On the contrary: taking an afternoon nap can be a good source of strength! Check out:
How To Nap Like A Pro (No More “Sleep Hangovers”!)
Rest at work
Our readership has a lot of retirees, but we know that’s not the case for everyone. How then, to rest while at work? Ideally we have breaks, of course, but most workplaces do not exactly have an amusement arcade in the break room. Nevertheless, there are some quick resets that can be done easily, anywhere, and (almost) any time:
Meditation Games: Meditation That You’ll Actually Enjoy
Want to know more?
You might also like:
How To Rest More Efficiently (Yes, Really)
Take care!
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Anti-Inflammatory Diet 101 (What to Eat to Fight Inflammation)
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Chronic inflammation is a cause and/or exacerbating factor in very many diseases. Arthritis, diabetes, and heart disease are probably top of the list, but there are lots more where they came from. And, it’s good to avoid those things. So, how to eat to avoid inflammation?
Let food be thy medicine
The key things to keep in mind, the “guiding principles” are to prioritize whole, minimally-processed foods, and enjoy foods with plenty of antioxidants. Getting a healthy balance of omega fatty acids is also important, which for most people means getting more omega-3 and less omega-6.
Shopping list (foods to prioritize) includes:
- fruits and vegetables in a variety of colors (e.g. berries, leafy greens, beats)
- whole grains, going for the most fiber-rich options (e.g. quinoa, brown rice, oats)
- healthy fats (e.g. avocados, nuts, seeds)
- fatty fish (e.g. salmon, mackerel, sardines) ← don’t worry about this if you’re vegetarian/vegan though, as the previous category can already cover it
- herbs and spices (e.g. turmeric, garlic, ginger)
Noping list (foods to avoid) includes:
- refined carbohydrates
- highly processed and/or fried foods
- red meats and/or processed meats (yes, that does mean that organic grass-fed farmers’ pinky-promise-certified holistically-raised beef is also off the menu)
- dairy products, especially if unfermented
For more information on each of these, plus advice on transitioning away from an inflammatory diet, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
How to Prevent (or Reduce) Inflammation
Take care!
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How To Get Your First Pull-Up
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Pull-ups are a great compound exercise that works most of the upper body. However, it can be frustrating for many, if unable to do more than dangle and struggle while not going anywhere. That’s not actually bad, by the way! Of course it’s not great athletic performance, but in terms of exercise, “dangling and struggling while not going anywhere” is an isometric exercise that has plenty of benefits of its own. However, for those who would rather go up in the world, personal trainer Meg Gallagher shows the way:
The Only Way Is Up?
Gallagher offers a few methods; the first is simply an improvement on the “dangling and struggling while not going anywhere” method, but doing it with good form. It’s called the…
Hollow body hold:
- Hang from the bar with legs and feet together.
- Maintain a posterior pelvic tilt (i.e. don’t let your hips roll forwards, and don’t let your butt stick out more than is necessary by mere virtue of having a butt)
- Engage your core by shortening the space between your ribs and pelvis.
- Turn on your abs and lats, with your head slightly behind the bar.
- Practice the hollow body hang instead of dead hangs to build grip and core strength.
Another method is now moving on from the hollow body hold, and shows that in fact, up is not the only way. It’s called…
Negative pull-ups:
- Jump up to get your chin over the bar, then slowly lower yourself in a controlled manner.
- Prioritize negative pull-ups over other exercises to build strength.
- You can use modifications like resistance bands or feet assistance if necessary to extend the duration of your negative pull-up, but these are “crutches”, so try to move on from them as soon as you reasonably can—same if your gym has an “assisted pull-up” machine, consisting of a moving platform with a variable counterweight, mimicking how a pull-up would feel if your body were lighter.
- Practice resisting throughout the entire range of motion.
To give a sense of direction, Gallagher offers the following program:
- On day 1, test how long you can resist the negative pull-up (e.g., 10 seconds).
- For each session, multiply your time by 2 (e.g., 10 seconds × 2 = 20 seconds total).
- Break the total volume into as many sets as needed (e.g., 2 sets of 10 seconds or 4 sets of 5 seconds).
- After each session, add 2 seconds to the total volume for the next session.
- Aim for 3 sessions per week for 3–4 weeks, increasing by 2 seconds each session.
- When you reach about 25 seconds, you should be close to performing your first pull-up.
For more on all of this, plus a few other things to try, plus visual demonstrations, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
Take care!
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What Happens To Your Body When You Do Squats Every Day-Not Just For Legs!
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Squat Every Day? Yes, Please!
It’s back to basics with this video (below). Passion for Health’s video, “What Happens To Your Body When You Do Squats Every Day-Not Just For Legs!” really brings home how squats aren’t just a one-trick pony for your legs.
The humble bodyweight squat is shown to contribute to everything from bolstering all-around lower body strength to bettering bone density and increasing metabolism.
Indeed, squats are so powerful that we reviewed a whole book that focuses just on the topic of squatting. Other, broader books on exercise also focus on the positive impacts that squatting can make.
A proper squat goes beyond your legs, engaging your core, enhancing joint health, and, some argue, can lead to improved balance and circulation.
(Plus, they’re easy to execute, given they can be done anywhere, without any equipment).
This is probably why Luigi Fontana and Dr Rangan Chatterjee have spoken about the benefits of squatting.
How Should We Start?
The video goes beyond the ‘why’ and delves into the ‘how’, offering step-by-step squatting techniques.
It answers the burning question: should you really be doing squats every day?
(Hint: the answer is most likely “yes”).
Of course, some of us may not be able to squat, and for those, we’ll feature alternatives in a future article.
For beginners, the advice is to start slow, aiming for 10 repetitions. You can gradually increase that count as you feel your muscles strengthen. Experienced gym-goers might push for 20 or more reps, adding variations like jump squats for an extra challenge.
The key takeaway is to listen to your body and ensure rest days for muscle recovery.
At the end of the day, Passion for Health’s video is a treasure trove for squat lovers, from novices to the seasoned, and insists on the importance of form, frequency, and listening to one’s body.
How did you find that video? If you’ve discovered any great videos yourself that you’d like to share with fellow 10almonds readers, then please do email them to us!
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The Bitter Truth About Coffee (or is it?)
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The Bitter Truth About Coffee (or is it?)
Yesterday, we asked you for your (health-related) views on coffee. The results were clear: if we assume the responses to be representative, we’re a large group of coffee-enthusiasts!
One subscriber who voted for “Coffee is a healthy stimulant, hydrating, and full of antioxidants” wrote:
❝Not so sure about how hydrating it is! Like most food and drink, moderation is key. More than 2 or 3 cups make me buzz! Just too much.❞
And that fine point brings us to our first potential myth:
Coffee is dehydrating: True or False?
False. With caveats…
Coffee, in whatever form we drink it, is wet. This may not come as a startling revelation, but it’s an important starting point. It’s mostly water. Water itself is not dehydrating.
Caffeine, however, is a diuretic—meaning you will tend to pee more. It achieves its diuretic effect by increasing blood flow to your kidneys, which prompts them to release more water through urination.
See: Effect of caffeine on bladder function in patients with overactive bladder symptoms
How much caffeine is required to have a diuretic effect? About 4.5 mg/kg.
What this means in practical terms: if you weigh 70kg (a little over 150lbs), 4.5×70 gives us 315.
315mg is about how much caffeine might be in six shots of espresso. We say “might” because while dosage calculations are an exact science, the actual amount in your shot of espresso can vary depending on many factors, including:
- The kind of coffee bean
- How and when it was roasted
- How and when it was ground
- The water used to make the espresso
- The pressure and temperature of the water
…and that’s all without looking at the most obvious factor: “is the coffee decaffeinated?”
If it doesn’t contain caffeine, it’s not diuretic. Decaffeinated coffee does usually contain tiny amounts of caffeine still, but with nearer 3mg than 300mg, it’s orders of magnitude away from having a diuretic effect.
If it does contain caffeine, then the next question becomes: “and how much water?”
For example, an Americano (espresso, with hot water added to make it a long drink) will be more hydrating than a ristretto (espresso, stopped halfway through pushing, meaning it is shorter and stronger than a normal espresso).
A subscriber who voted for “Coffee messes with sleep, creates dependency, is bad for the heart and gut, and is dehydrating too” wrote:
❝Coffee causes tachycardia for me so staying away is best. People with colon cancer are urged to stay away from coffee completely.❞
These are great points! It brings us to our next potential myth:
Coffee is bad for the heart: True or False?
False… For most people.
Some people, like our subscriber above, have an adverse reaction to caffeine, such as tachycardia. An important reason (beyond basic decency) for anyone providing coffee to honor requests for decaff.
For most people, caffeine is “heart neutral”. It doesn’t provide direct benefits or cause direct harm, provided it is enjoyed in moderation.
See also: Can you overdose on caffeine?
Some quick extra notes…
That’s all we have time for in myth-busting, but it’s worth noting before we close that coffee has a lot of health benefits; we didn’t cover them today because they’re not contentious, but they are interesting nevertheless:
- Coffee is the world’s biggest source of antioxidants
- 65% reduced risk of Alzheimer’s for coffee-drinkers
- 67% reduced risk of type 2 diabetes for coffee-drinkers
- 43% reduced risk of liver cancer for coffee-drinkers
- 53% reduced suicide risk for coffee-drinkers
Enjoy!
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