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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  • The Spectrum of Hope – by Dr. Gayatri Devi

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    We’ve written before about Dr. Devi’s work (See: “Alzheimer’s: The Bad News And The Good“) but she has plenty more to say than we could fit in an article.

    The book is written for patients, family/carers, and clinicians—without getting deep into the science, which it is assumed clinicians will know. the general style of the book is pop-science, and it’s more about addressing the misconceptions around Alzheimer’s, rather than focusing on neurological features such as beta amyloid plaques and tau proteins and the like.

    Dr. Devi explains a lot about the experience of Alzheimer’s—what to expect, or rather, what to know about in advance. Because, as she explains, there are a lot of different manifestations of Alzheimer’s that are all lumped under the same umbrella.

    This means that a person could have negligible memory but perfect language and reasoning skills, or the other way around, or some other combination of symptoms showing up or not.

    Which means that any plan for managing one’s Alzheimer’s needs to be adaptable and personalized, which is something Dr. Devi talks us through, too.

    Bottom line: if you are a loved one has Alzheimer’s, or you just like to be prepared, this is a great book to prepare anybody for just that.

    Click here to check out The Spectrum of Hope, and hold onto that hope!

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  • The Teenage Brain – by Dr. Frances Jensen

    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 realize that we probably have more grandparents of teenagers than parents of teenagers here, but most of us have at least some teenage relative(s). Which makes this book interesting.

    There are a lot of myths about the teenage brain, and a lot of popular assumptions that usually have some basis in fact but are often misleading.

    Dr. Jensen gives us a strong foundational grounding in the neurophysiology of adolescence, from the obvious-but-often-unclear (such as the role of hormones) to less-known things like the teenage brain’s general lack of myelination. Not just “heightened neuroplasticity” but, if you imagine the brain as an electrical machine, then think of myelin as the insulation between the wires. Little wonder some wires may get crossed sometimes!

    She also talks about such things as the teenage circadian rhythm’s innate differences, the impact of success and failure on the brain, and harder topics such as addiction—and the adolescent cortisol functions that can lead to teenagers needing to seek something to relax in the first place.

    In criticism, we can only say that sometimes the author makes sweeping generalizations without acknowledging such, but that doesn’t detract from what she has to say on the topic of neurophysiology.

    Bottom line: if there’s a teenager in your life whose behavior and/or moods are sometimes baffling to you, and whose mysteries you’d like to unravel, this is a great book.

    Click here to check out the Teenage Brain, and better understand those around you!

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  • Lime-Charred Cauliflower Popcorn

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    Called “popcorn” for its appearance and tasty-snackness, this one otherwise bears little relation to the usual movie theater snack, and it’s both tastier and healthier. All that said, it can be eaten on its own as a snack (even with a movie, if you so wish), or served as one part of a many-dish banquet, or (this writer’s favorite) as a delicious appetizer that also puts down a healthy bed of fiber ready for the main course to follow it.

    You will need

    • 1 cauliflower, cut into small (popcorn-sized) florets
    • 2 tbsp extra virgin olive oil
    • 1 tbsp lime pickle
    • 1 tsp cumin seeds
    • 1 tsp smoked paprika
    • 1 tsp chili flakes
    • 1 tsp black pepper, coarse ground
    • ½ tsp ground turmeric

    Method

    (we suggest you read everything at least once before doing anything)

    1) Preheat your oven as hot as it will go

    2) Mix all the ingredients in a small bowl except the cauliflower, to form a marinade

    3) Drizzle the marinade over the cauliflower in a larger bowl (i.e. big enough for the cauliflower), and mix well until the cauliflower is entirely, or at least almost entirely, coated. Yes, it’s not a lot of marinade but unless you picked a truly huge cauliflower, the proportions we gave will be enough, and you want the end result to be crisp, not dripping.

    4) Spread the marinaded cauliflower florets out on a baking tray lined with baking paper. Put it in the oven on the middle shelf, so it doesn’t cook unevenly, but keeping the temperature as high as it goes.

    5) When it is charred and crispy golden, it’s done—this should take about 20 minutes, but we’ll say ±5 minutes depending on your oven, so do check on it periodically—and time to serve (it is best enjoyed warm).

    Enjoy!

    Want to learn more?

    For those interested in some of the science of what we have going on today:

    Take care!

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  • 7 Minutes, 30 Days, Honest Review: How Does The 7-Minute Workout Stack Up?

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    For those who don’t like exercising, “the 7-minute workout” (developed by exercise scientists Chris Jordan and Bret Klika) has a lot of allure. After all, it’s just 7 minutes and then you’re done! But how well does it stand up, outside of the lab?

    Down-to-Earth

    Business Insider’s Kelly Reilly is not a health guru, and here he reviews the workout for us, so that we can get a real view of what it’s really like in the real world. What does he want us to know?

    • It’s basically an optimized kind of circuit training, and can be done with no equipment aside from a floor, a wall, and a chair
    • It’s one exercise for 30 seconds, then 10 seconds rest, then onto the next exercise
    • He found it a lot easier to find the motivation to do this, than go to the gym. After all “it’s just 7 minutes” is less offputting than getting in the car, driving someplace, using public facilities, driving back, etc. Instead, it’s just him in the comfort of his home
    • The exercise did make him sweat and felt like a “real” workout in that regard
    • He didn’t like missing out on training his biceps, though, since there are no pulling movements
    • He lost a little weight over the course of the month, though that wasn’t his main goal (and indeed, he was not eating healthily)
    • He did feel better each day after working out, and at the end of the month, he enjoyed feeling self-confident in a tux that now fitted him better than it did before

    For more details, his own words, and down-to-earth visuals of what this looked like for him, enjoy:

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    Further reading

    Want to know more? Check out…

    Take care!

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  • How To Set Anxiety Aside

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    How To Set Anxiety Aside

    We’ve talked previously about how to use the “release” method to stop your racing mind.

    That’s a powerful technique, but sometimes we need to be calm enough to use it. So first…

    Breathe

    Obviously. But, don’t underestimate the immediate power of focusing on your breath, even just for a moment.

    There are many popular breathing exercises, but here’s one of the simplest and most effective, “4–4 breathing”:

    • Breathe in for a count of four
    • Hold for a count four
    • Breathe out for a count of four
    • Hold for a count of four
    • Repeat

    Depending on your lung capacity and what you’re used to, it may be that you need to count more quickly or slowly to make it feel right. Experiment with what feels comfortable for you, but the general goal should breathing deeply and slowly.

    Identify the thing that’s causing you anxiety

    We’ve also talked previously about how to use the RAIN technique to manage difficult emotions, and that’s good for handling anxiety too.

    Another powerful tool is journaling.

    Read: How To Use Journaling to Challenge Anxious Thoughts

    If you don’t want to use any of those (very effective!) methods, that’s fine too—journaling isn’t for everyone.

    You can leverage some of the same benefits by simply voicing your worries, even to yourself:

    There’s an old folk tradition of “worry dolls”; these are tiny little dolls so small they can be kept in a pocket-size drawstring purse. Last thing at night, the user whispers their worries to the dolls and puts them back in their bag, where they will work on the person’s problem overnight.

    We’re a health and productivity newsletter, not a dealer of magic and spells, but you can see how it works, right? It gets the worries out of one’s head, and brings about a helpful placebo effect too.

    Focus on what you can control

    • Most of what you worry about will not happen.
    • Some of what you worry about may happen.
    • Worrying about it will not help.

    In fact, in some cases it may bring about what you fear, by means of the nocebo effect (like the placebo effect, but bad). Additionally, worrying drains your body and makes you less able to deal with whatever life does throw at you.

    So while “don’t worry; be happy” may seem a flippant attitude, sometimes it can be best. However, don’t forget the other important part, which is actually focusing on what you can control.

    • You can’t control whether your car will need expensive maintenance…
      • …but you can control whether you budget for it.
    • You can’t control whether your social event will go well or ill…
      • …but you can control how you carry yourself.
    • You can’t control whether your loved one’s health will get better or worse…
      • …but you can control how you’re there for them, and you can help them take what sensible precautions they may.

    …and so forth.

    Look after your body as well!

    Your body and mind are deeply reliant on each other. In this case, just as anxiety can drain your body’s resources, keeping your body well-nourished, well-exercised, and well-rested and can help fortify you against anxiety. For example, when it comes to diet, exercise, and sleep:

    Don’t know where to start? How about the scientifically well-researched, evidence-based, 7-minute workout?

    Check Out the Seven Minute Workout App (Android and iOS

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  • Mediterranean Diet… In A Pill?

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    Does It Come In A Pill?

    For any as yet unfamiliar with the Mediterranean diet, you may be wondering what it involves, beyond a general expectation that it’s a diet popularly enjoyed in the Mediterranean. What image comes to mind?

    We’re willing to bet that tomatoes feature (great source of lycopene, by the way, and if you’re not getting lycopene, you’re missing out), but what else?

    • Salads, perhaps? Vegetables, olives? Olive oil, yea or nay?
    • Bread? Pasta? Prosciutto, salami? Cheese?
    • Pizza but only if it’s Romana style, not Chicago?
    • Pan-seared liver, with some fava beans and a nice Chianti?

    In fact, the Mediterranean diet is quite clear on all these questions, so to read about these and more (including a “this yes, that no” list), see:

    What Is The Mediterranean Diet, And What Is It Good For?

    So, how do we get that in a pill?

    A plucky band of researchers, Dr. Chiara de Lucia et al. (quite a lot of “et al.”; nine listed authors on the study), wondered to what extent the benefits of the Mediterranean diet come from the fact that the Mediterranean diet is very rich in polyphenols, and set about testing that, by putting the same polyphenols in capsule form, and running a randomized, double-blind, placebo-controlled, crossover clinical intervention trial.

    Now, polyphenols are not the only reason the Mediterranean diet is great; there are also other considerations, such as:

    • a great macronutrient balance with lots of fiber, healthy fats, moderate carbs, and protein from select sources
    • the absence or at least very low presence of a lot of harmful substances such as refined seed oils, added sugars, refined carbohydrates, and the like (“but pasta” yes pasta; in moderation and wholegrain and served with extra sources of fiber and healthy fats, all of which slow down the absorption of the carbs)

    …but polyphenols are admittedly very important too; we wrote about some common aspects of them here:

    Tasty Polyphenols: Enjoy Bitter Foods For Your Heart & Brain

    As for what Dr. de Lucia et al. put into the capsule, behold…

    The ingredients:

    1. Apple Extract 10.0%
    2. Pomegranate Extract 10.0%
    3. Tomato Powder 2.5%
    4. Beet, Spray Dried 2.5%
    5. Olive Extract 7.5%
    6. Rosemary Extract 7.5%
    7. Green Coffee Bean Extract (CA) 7.5%
    8. Kale, Freeze Dried 2.5%
    9. Onion Extract 10.0%
    10. Ginger Extract 10.0%
    11. Grapefruit Extract 2.5%
    12. Carrot, Air Dried 2.5%
    13. Grape Skin Extract 17.5%
    14. Blueberry Extract 2.5%
    15. Currant, Freeze Dried 2.5%
    16. Elderberry, Freeze Dried 2.5%

    And the relevant phytochemicals they contain:

    • Quercetin
    • Luteolin
    • Catechins
    • Punicalagins
    • Phloretin
    • Ellagic Acid
    • Naringin
    • Apigenin
    • Isorhamnetin
    • Chlorogenic Acids
    • Rosmarinic Acid
    • Anthocyanins
    • Kaempferol
    • Proanthocyanidins
    • Myricetin
    • Betanin

    And what, you may wonder, did they find? Well, first let’s briefly summarise the setup of the study:

    They took volunteers (n=30), average age 67, BMI >25, without serious health complaints, not taking other supplements, not vegetarian or vegan, not consuming >5 cups of coffee per day, and various other stipulations like that, to create a fairly homogenous study group who were expected to respond well to the intervention. In contrast, someone who takes antioxidant supplements, already eats many different color plants per day, and drinks 10 cups of coffee, probably already has a lot of antioxidant activity going on, and someone with a lower BMI will generally have lower resting levels of inflammatory markers, so it’s harder to see a change, proportionally.

    About those inflammatory markers: that’s what they were testing, to see whether the intervention “worked”; essentially, did the levels of inflammatory markers go up or down (up is bad; down is good).

    For more on inflammation, by the way, see:

    How to Prevent (or Reduce) Inflammation

    …which also explains what it actually is, and some important nuances about it.

    Back to the study…

    They gave half the participants the supplement for a week and the other half placebo; had a week’s gap as a “washout”, then repeated it, switching the groups, taking blood samples before and after each stage.

    What they found:

    The group taking the supplement had lower inflammatory markers after a week of taking it, while the group taking the placebo had relatively higher inflammatory markers after a week of taking it; this trend was preserved across both groups (i.e., when they switched roles for the second half).

    The results were very significant (p=0.01 or thereabouts), and yet at the same time, quite modest (i.e. the supplement made a very reliable, very small difference), probably because of the small dose (150mg) and small intervention period (1 week).

    What the researchers concluded from this

    The researchers concluded that this was a success; the study had been primarily to provide proof of principle, not to rock the world. Now they want the experiment to be repeated with larger sample sizes, greater heterogeneity, larger doses, and longer intervention periods.

    This is all very reasonable and good science.

    Read in full: A Randomised, Double-Blind, Placebo-Controlled, Cross-Over Clinical Trial to Evaluate the Biological Effects and Safety of a Polyphenol Supplement on Healthy Ageing

    What we conclude from this

    That ingredients list makes for a good shopping list!

    Well, not the extracts they listed, necessarily, but rather those actual fruits, vegetables, etc.

    If nine top scientists (anti-aging specialists, neurobiologists, pharmacologists, and at least one professor of applied statistics) came to the conclusion that to get the absolute most bang-for-buck possible, those are the plants to get the phytochemicals from, then we’re not going to ignore that.

    So, take another list above and ask yourself: how many of those 16 foods do you eat regularly, and could you work the others in?

    Want to make your Mediterranean diet even better?

    While the Mediterranean diet is a top-tier catch-all, it can be tweaked for specific areas of health, for example giving it an extra focus on heart health, or brain health, or being anti-inflammatory, or being especially gut healthy:

    Four Ways To Upgrade The Mediterranean

    Enjoy!

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