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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Eat Move Sleep – by Tom Rath
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The subtitle of this book, “how small choices lead to big changes“, is very much the idea that a lot of what we do here at 10almonds is about.
And the title itself, “Eat Move Sleep”? Well, that’s 3/5 of The Usual Five Things™ that we promote here (the other two being: reduce or eliminate alcohol, and don’t smoke). So, naturally this book got our attention.
One of the key ideas that Rath presents is that every action we take leads to a net gain or loss in health. The question then is: what are the biggest point-swingers? In other words, what are the places in our life where the smallest changes can make the biggest difference?
Rath looks at what parts of diet make the biggest difference to our health, and the findings there alone probably make reading the book worthwhile.
When it comes to movement, he actually flips this! For Rath, it’s less about how much exercise you get, and more about minimizing how long we spend not moving… And especially, minimizing how long we spend sitting. So, lots of little tweaks for that.
In the category of sleep: a key idea is that quality is as important as quantity, and there’s an aspect of bringing together as a synergistic routine. To finish off a productive day with good rest, and power up ready for the next morning.
In short: tying these items together—and focusing on the smallest choices that lead to the biggest changes—makes for quite a manifesto that we could describe as “Atomic Habits, for health specifically”.
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Avoiding/Managing Osteoarthritis
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Avoiding/Managing Osteoarthritis
Arthritis is the umbrella term for a cluster of joint diseases involving inflammation of the joints, hence “arthr-” (joint) “-itis” (suffix used to denote inflammation).
Inflammatory vs Non-Inflammatory Arthritis
Arthritis is broadly divided into inflammatory arthritis and non-inflammatory arthritis.
Some forms, such as rheumatoid arthritis, are of the inflammatory kind. We wrote about that previously:
See: Avoiding/Managing Rheumatoid Arthritis
You may be wondering: how does one get non-inflammatory inflammation of the joints?
The answer is, in “non-inflammatory” arthritis, such as osteoarthritis, the damage comes first (by general wear-and-tear) and inflammation generally follows as part of the symptoms, rather than the cause.
So the name can be a little confusing. In the case of osteo- and other “non-inflammatory” forms of arthritis, you definitely still want to keep your inflammation at bay as best you can; it’s just not the prime focus.
So, what should we focus on?
First and foremost: avoiding wear-and-tear if possible. Naturally, we all must live our lives, and sometimes that means taking a few knocks, and definitely it means using our joints. An unused joint would suffer just as much as an abused one. But, we can take care of our joints!
We wrote on that previously, too:
See: How To Really Look After Your Joints
New osteoarthritis medication (hot off the press!)
At 10almonds, we try to keep on top of new developments, and here’s a shiny new one from this month:
- Methotrexate to treat hand osteoarthritis with synovitis (12th Oct, clinical trial)
- New research has found an existing drug could help many people with painful hand osteoarthritis (24th Oct, pop-science article about the above, but still written by one of the study authors!)
Note also that Dr. Flavia Cicuttini there talks about what we talked about above—that calling it non-inflammatory arthritis is a little misleading, as the inflammation still occurs.
And finally…
You might consider other lifestyle adjustments to manage your symptoms. These include:
- Exercise—gently, though!
- Rest—while keeping mobility going.
- Mobility aids—if it helps, it helps.
- Go easy on the use of braces, splints, etc—these can offer short-term relief, but at a long term cost of loss of mobility.
- Only you can decide where to draw the line when it comes to that trade-off.
You can also check out our previous article:
See: Managing Chronic Pain (Realistically!)
Take good care of yourself!
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Yoga Safety: Simple Guidelines
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It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝I was wondering whether there were very simple, clear bullet points or instructions on things to be wary of in Yoga.❞
That’s quite a large topic, and not one that lends itself well to being conveyed in bullet points, but first we’ll share the article you sent us when sending this question:
Tips for Avoiding Yoga Injuries
…and next we’ll recommend the YouTube channel @livinleggings, whose videos we feature here from time to time. She (Liv) has a lot of good videos on problems/mistakes/injuries to avoid.
Here’s a great one to get you started:
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Semaglutide’s Surprisingly Unexamined Effects
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Semaglutide’s Surprisingly Big Research Gap
GLP-1 receptor agonists like Ozempic, Wegovy, and other semaglutide drugs. are fast becoming a health industry standard go-to tool in the weight loss toolbox. When it comes to recommending that patients lose weight, “Have you considered Ozempic?” is the common refrain.
Sometimes, this may be a mere case of kicking the can down the road with regard to some other treatment that it can be argued (sometimes even truthfully) would go better after some weight loss:
How weight bias in health care can harm patients with obesity: Research
…which we also covered in fewer words in the second-to-last item here:
But GLP-1 agonists work, right?
Yes, albeit there’s a litany of caveats, top of which are usually:
- there are often adverse gastrointestinal side effects
- if you stop taking them, weight regain generally ensues promptly
For more details on these and more, see:
…but now there’s another thing that’s come to light:
The dark side of semaglutide’s weight loss
In academia, “dark” is often used to describe “stuff we don’t have much (or in some cases, any) direct empirical evidence of, but for reasons of surrounding things, we know it’s there”.
Well-known examples include “dark matter” in physics and the Dark Ages in (European) history.
In the case of semaglutide and weight loss, a review by a team of researchers (Drs. Sandra Christenen, Katie Robinson, Sara Thomas, and Dominique Williams) has discovered how little research has been done into a certain aspect of GLP-1 agonist’s weight loss effects, namely…
Dietary changes!
There’s been a lot of popular talk about “people taking semaglutide eat less”, but it’s mostly anecdotal and/or presumed based on parts of the mechanism of action (increasing insulin production, reducing glucagon secretions, modulating dietary cravings).
Where studies have looked at dietary changes, it’s almost exclusively been a matter of looking at caloric intake (which has been found to be a 16–39% reduction), and observations-in-passing that patients reported reduction in cravings for fatty and sweet foods.
This reduction in caloric intake, by the way, is not significantly different to the reduction brought about by counselling alone (head-to-head studies have been done; these are also discussed in the research review).
However! It gets worse. Very few studies of good quality have been done, even fewer (two studies) actually had a registered dietitian nutritionist on the team, and only one of them used the “gold standard” of nutritional research, the 24-hour dietary recall test. Which, in case you’re curious, you can read about what that is here:
Dietary Assessment Methods: What Is A 24-Hour Recall?
Of the four studies that actually looked at the macros (unlike most studies), they found that on average, protein intake decreased by 17.1%. Which is a big deal!
It’s an especially big deal, because while protein’s obviously important for everyone, it’s especially important for anyone trying to lose weight, because muscle mass is a major factor in metabolic base rate—which in turn is much important for fat loss/maintenance than exercise, when it comes to how many calories we burn by simply existing.
A reasonable hypothesis, therefore, is that one of the numerous reasons people who quit GLP-1 agonists immediately put fat back on, is because they probably lost muscle mass in amongst their weight loss, meaning that their metabolic base rate will have decreased, meaning that they end up more disposed to put on fat than before.
And, that’s just a hypothesis and it’s a hypothesis based on very few studies, so it’s not something to necessarily take as any kind of definitive proof of anything, but it is to say—as the researchers of this review do loudly say—more research needs to be done into this, because this has been a major gap in research so far!
Any other bad news?
While we’re talking research gaps, guess how many studies looked into micronutrient intake changes in people taking GLP-1 agonists?
If you guessed zero, you guessed correctly.
You can find the paper itself here:
What’s the main take-away here?
On a broad, scoping level: we need more research!
On a “what this means for individuals who want to lose weight” level: maybe we should be more wary of this still relatively new (less than 10 years old) “wonder drug”. And for most of those 10 years it’s only been for diabetics, with weight loss use really being in just the past few years (2021 onwards).
In other words: not necessarily any need to panic, but caution is probably not a bad idea, and natural weight loss methods remain very reasonable options for most people.
See also: How To Lose Weight (Healthily!)
Take care!
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Little Treatments, Big Effects – by Dr. Jessica Schleider
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The author, a clinical psychologist, discusses how mental healthcare has come a very long way, yet still has a long way to go. While advocating for top-down reforms, she does have a stopgap solution:
Find ways to significantly improve people’s mental health in a single-session intervention.
This seems like a tall order, but her method is based on good science, and also, most people will agree from experience that big changes can happen to someone in the space of moments, at pivotal turning points in life—they just have to be the right moments.
Dr. Schleider recommends that therapists train in (and then offer) this method, but she does also give comprehensive advice for self-therapy of this kind too.
These self-therapy directions, ways to induce those life-pivoting moments for the better, are perhaps the greatest value that the book gives us.
Bottom line: if you’d like a lot of the benefits of therapy without getting therapy, this book can definitely point you in the right direction, in a manner that won’t be a drain on your time or your wallet.
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Rewire Your OCD Brain – by Dr. Catherine Pittman & Dr. William Youngs
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OCD is just as misrepresented in popular media as many other disorders, and in this case, it’s typically not “being a neat freak” or needing to alphabetize things, so much as having uncontrollable obsessive intrusive thoughts, and often in response to those, unwanted compulsions. This can come from unchecked spiralling anxiety, and/or PTSD, for example.
What Drs. Pittman & Young offer is an applicable set of solutions, to literally rewire the brain (insofar as synapses can be considered neural wires). Leveraging neuroplasticity to work with us rather than against us, the authors talk us through picking apart the crossed wires, and putting them back in more helpful ways.
This is not, by the way, a book of CBT, though it does touch on that too.
Mostly, the book explains—clearly and simply and sometimes with illustrations—what is going wrong for us neurologically, and how to neurologically change that.
Bottom line: whether you have OCD or suffer from anxiety or just need help dealing with obsessive thoughts, this book can help a lot in, as the title suggests, rewiring that.
Click here to check out Rewire Your OCD Brain, and banish obsessive thoughts!
Don’t Forget…
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