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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The 7-Minute Morning Routine That Eliminates Stiffness
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The video title says “65+”, but honestly, if you are younger than that, and wait until you are 65 to attend to such things as mobility maintenance, then you’ll wish you’d started a long time previously!
So, today is always a good day to start, whatever your age.
A good way to start the day
The exercises do not, in fact, include the forwards bend depicted in the thumbnail. Rather, they are:
Exercise 1: toe wiggles (1 minute):
- while lying in bed, open and close your toes to improve foot mobility.
- this may seem silly and/or trivial, but it’s vital for overall mobility as foot health impacts daily movement, and your toes are responsible for a surprising amount when it comes to your posture, gait, etc.
Exercise 2: calf and hamstring stretch (1 minute):
- use a rolled-up towel (or similar non-stretchy long thing) to pull one foot towards you while straightening your leg.
- hold the stretch for 30 seconds per leg to relieve tightness in the calf or hamstring.
Exercise 3: knee flexion (1 minute):
- bend your knee as much as possible and pull your shin towards you.
- perform for 30 seconds per leg, gently easing into stiffness if necessary to improve knee mobility (i.e. if this is difficult at first).
Exercise 4: knee extension (1 minute):
- straighten one leg on the bed and press your knee down while pulling the toes up.
- hold for 5 seconds, repeat six times per leg, improving knee extension and strengthening the quads.
Exercise 5: hip flexion mobilization (1 minute):
- with your knees bent, pull one knee towards your chest and release in a rhythmic motion (see video for differences from #3)
- do 30 seconds per leg to improve hip mobility and loosen stiffness, especially beneficial for those with hip arthritis.
exercise 6: cat-cow stretch (1 minute):
- on all fours, alternate between arching your back (cat) and dipping it (cow).
- improves mobility in the neck, mid-back, and lower back.
exercise 7: shoulder and upper back stretch (1 minute):
- stand facing a wall, place your hands on the wall, and hinge at the hips to drop your torso between your arms.
- stretches lats, shoulders, and the upper back; do two 30-second holds..
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like:
Over 50? Do These 3 Stretches Every Morning To Avoid Pain
Take care!
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Mythbusting Moldy Food
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Most Food Should Not Be Fuzzy
In yesterday’s newsletter, we asked you for your policy when it comes to mold on food (aside from intentional mold, e.g. blue cheese etc), and the responses were interesting:
- About 49% said “throw the whole thing away no matter what it is; it is dangerous”
- About 24% said “cut the mold off and eat the rest of whatever it is”
- The remainder were divided equally between “eat it all; keep the immune system on its toes” and “cut the mold off bread, but moldy animal products are dangerous”
So what does the science say?
Some molds are safe to eat: True or False?
True! We don’t think this is contentious so we’ll not spend much time on it, but just for the sake of being methodical: foods that are supposed to have mold on, including many kinds of cheese and even some kinds of cured meat (salami is an example; that powdery coating is mold).
We could give a big list of safe and unsafe molds, but that would be a list of names and let’s face it, they don’t introduce themselves by name.
However! The litmus test of “is it safe to eat” is:
Did you acquire it with this mold already in place and exactly as expected and advertised?
- If so, it is safe to eat (unless you have an allergy or such)
- If not, it is almost certainly not safe to eat
(more on why, later)
The “sniff test” is a good way to tell if moldy food is bad: True or False?
False. Very false. Because of how the sense of smell works.
You may feel like smell is a way of knowing about something at a distance, but the only way you can smell something is if particles of it are physically connecting with your olfactory receptors inside you. Yes, that has unfortunate implications about bathroom smells, but for now, let’s keep our attention in the kitchen.
If you sniff a moldy item of food, you will now have its mold spores inside your respiratory system. You absolutely do not want them there.
If we cut off the mold, the rest is safe to eat: True or False?
True or False, depending on what it is:
- Hard vegetables (e.g carrots, cabbage), and hard cheeses (e.g. Gruyère, Gouda) – cut off with an inch margin, and it should be safe
- Soft vegetables (e.g. tomatoes, and any vegetables that were hard but are now soft after cooking) – discard entirely; it is unsafe
- Anything else – discard entirely; it is unsafe
The reason for this is because in the case of the hard products mentioned, the mycelium roots of the mold cannot penetrate far.
In the case of the soft products mentioned, the surface mold is “the tip of the iceberg”, and the mycelium roots, which you will not usually be able to see, will penetrate the rest of it.
“Anything else” seems like quite a sweeping statement, but fruits, soft cheeses, yogurt, liquids, jams and jellies, cooked grains and pasta, meats, and yes, bread, are all things where the roots can penetrate deeply and easily. Regardless of you only being able to see a small amount, the whole thing is probably moldy.
The USDA has a handy downloadable factsheet:
Molds On Food: Are They Dangerous?
Eating a little mold is good for the immune system: True or False?
False, generally. There are of course countless types of mold, but not only are many of them pathogenic (mycotoxins), but also, a food that has mold will usually also have pathogenic bacteria along with the mold.
See for example: Occurrence, Toxicity, and Analysis of Major Mycotoxins in Food
Food poisoning will never make you healthier.
But penicillin is safe to eat: True or False?
False, and also penicillin is not the mold on your bread (or other foods).
Penicillin, an antibiotic* molecule, is produced by some species of Penicillium sp., a mold. There are hundreds of known species of Penicillium sp., and most of them are toxic, usually in multiple ways. Take for example:
Penicillium roqueforti PR toxin gene cluster characterization
*it is also not healthy to consume antibiotics unless it is seriously necessary. Antibiotics will wipe out most of your gut’s “good bacteria”, leaving you vulnerable. People have died from C. diff infections for this reason. So obviously, if you really need to take antibiotics, take them as directed, but if not, don’t.
See also: Four Ways Antibiotics Can Kill You
One last thing…
It may be that someone reading this is thinking “I’ve eaten plenty of mold, and I’m fine”. Or perhaps someone you tell about this will say that.
But there are two reasons this logic is flawed:
- Survivorship bias (like people who smoke and live to 102; we just didn’t hear from the 99.9% of people who smoke and die early)
- Being unaware of illness is not being absent of illness. Anyone who’s had an alarming diagnosis of something that started a while ago will know this, of course. It’s also possible to be “low-level ill” often and get used to it as a baseline for health. It doesn’t mean it’s not harmful for you.
Stay safe!
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JoyFull – by Radhi Devlukia-Shetty
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We haven’t done a recipe book in a little while, so here’s a good one!
The focus of this book is getting more plants and spices into your diet, and doing it deliciously.
Healthwise, there is nothing controversial here: the recipes are all plant-based, mostly whole-foods, and the items that aren’t whole foods are things like “vanilla extract”.
The recipes themselves (of which there are 125) are presented clearly and simply, one to a double-page (although sometimes there will be a suggested variation on the same double-page), ideal for use in a kitchen bookstand. For each recipe, there’s a clear photo of the end result, so you know what you’re working towards.
The ingredients are not too obscure, and can be acquired from more or less any large supermarket.
Bottom line: if you’re looking to expand your plant-based cooking repertoire in a way that’s not just substitutions, then this book provides an excellent variety.
Click here to check out JoyFull, and get a taste of Ayurvedic cooking!
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Lost Connections – by Johann Hari
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Johann Hari had a long journey through (and out of!) depression, and shares his personal findings, including his disappointment with medical options, and a focus on the external factors that lead to depression.
And that’s key to this book—while he acknowledges later in the book that there are physiological factors involved in depression, he wants to look past things we can’t change (like genes accounting for 37% of depression) or things that there may be unwanted side-effects to changing (as in the case of antidepressants, for many people), to things we genuinely can choose.
And no, it’s not a “think yourself happy” book either; rather, it looks at nine key external factorsthat a) influence depression b) can mostly be changed.
If the book has a downside, it’s that the author does tend to extrapolate his own experience a lot more than might be ideal. If SSRIs didn’t help him, they are useless, and also the only kind of antidepressant. If getting into a green space helped him, a Londoner, someone who lives in the countryside will not be depressed in the first place. And so forth. It can also be argued that he cherry-picked data to arrive at some of his pre-decided conclusions. He also misinterprets data sometimes; which is understandable; he is after all a journalist, not a scientist.
Nevertheless, he offers a fresh perspective with a lot of ideas, and whether or not we agree with them all, new ideas tend to be worth reading. And if even one of his nine ideas helps you, that’s a win.
Bottom line: if you’d like to explore the treatment of depression from a direction other than medicalization or psychotherapy, then this is will be a good book for you.
Click here to check out Lost Connections, and reforge yours!
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In the Realm of Hungry Ghosts – by Dr. Gabor Maté
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We’ve reviewed books by Dr. Maté before, and this one’s about addiction. We’ve reviewed books about addiction before too, so what makes this one different?
Wow, is this one so different. Most books about addiction are about “beating” it. Stop drinking, quit sugar, etc. And, that’s all well and good. It is definitely good to do those things. But this one’s about understanding it, deeply. Because, as Dr. Maté makes very clear, “there, but for the grace of epigenetics and environmental factors, go we”.
Indeed, most of us will have addictions; they’re (happily) just not too problematic for most of us, being either substances that are not too harmful (e.g. coffee), or behavioral addictions that aren’t terribly impacting our lives (e.g. Dr. Maté’s compulsion to keep buying more classical music, which he then tries to hide from his wife).
The book does also cover a lot of much more serious addictions, the kind that have ruined lives, and the kind that definitely didn’t need to, if people had been given the right kind of help—instead of, all too often, they got the opposite.
Perhaps the greatest value of this book is that; understanding what creates addiction in the first place, what maintains it, and what help people actually need.
Bottom line: if you’d like more insight into the human aspect of addiction without getting remotely wishy-washy, this book is probably the best one out there.
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Saffron For The Brain (& More)
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Saffron For The Brain (& More)
In yesterday’s edition of 10almonds, one of the items in the “health news from around the world” section was:
Clinical trial finds herbal medicine Sailuotong effective for brain health in older people
But, what is it?
❝SaiLuoTong (SLT) is a modern compound Chinese herbal medicine preparation in capsule form containing standardized extracts of Panax ginseng, Ginkgo biloba, and Crocus sativus L❞
We’ve written previously about ginseng and ginkgo biloba:
So, what’s this about Crocus sativus L.?
That is the plant better known as saffron. And, for all its wide availability (your local supermarket probably has at least a tiny amount in the spice section), there’s a reason we don’t see much of it:
❝Saffron blooms only once a year and should be collected within a very short duration. It is picked during 3–4 weeks in October-November. The method for the cultivation of saffron contributes greatly to its high price. According to some reports, this species is a sterile triploid and so does not produce fertile seeds. Germination can take 1–6 months at 18°C. It takes 3 years for plants to flower from seed.❞
Source: Crocus sativus L.: A comprehensive review
That’s fascinating, but what does it do for us?
Well, in the words of El Midaoui et al. (2022):
❝In the frame of a double-blind-placebo-controlled study, 30 mg per day supplementation with saffron for 16 weeks resulted in improved cognitive function in patients suffering from mild to moderate Alzheimer’s disease.
Moreover, the follow-up of this study in which the authors evaluated the effects of saffron (30 mg/day) for 22 weeks showed that saffron was as effective as donepezil in the treatment of mild-to-moderate Alzheimer’s disease❞
Read the full review: Saffron (Crocus sativus L.): A Source of Nutrients for Health and for the Treatment of Neuropsychiatric and Age-Related Diseases
Not just that, but it also has powerful antioxidant and anti-inflammatory properties beyond the brain (though the brain is where research has been most focused, due to its neuroprotective effects).
(this, too, is a full research review in its own right; we’re getting a lot of “bang for buck” on papers today)
And more?
Yes, and more. Lots more. To bullet-pointify even just the abstract from another research review:
- Saffron has been suggested to be effective in the treatment of a wide range of disorders including coronary artery diseases, hypertension, stomach disorders, dysmenorrhea and learning and memory impairments.
- In addition, different studies have indicated that saffron has anti-inflammatory, anti-atherosclerotic, antigenotoxic and cytotoxic activities. (This is all good; the cytotoxic activities are about killing cancer cells)
- Antitussive effects of stigmas and petals of C. sativus and its components, safranal and crocin have also been demonstrated.
- The anticonvulsant and anti-Alzheimer properties of saffron extract were shown in human and animal studies.
- The efficacy of C. sativus in the treatment of mild to moderate depression was also reported in clinical trial.
- Administration of C. sativus and its constituents increased glutamate and dopamine levels in the brain in a dose-dependent manner.
- It also interacts with the opioid system to reduce withdrawal syndrome.
- C. sativus and its components can be considered as promising agents in the treatment of nervous system disorders.
For more details on any of those items, see:
The effects of Crocus sativus (saffron) and its constituents on nervous system: a review
Is it safe?
The effective dose is 30mg/kg and the LD50 is more than 20g/kg, so yes, it’s very safe. Given the price of it, this also means that if you’re the size of this writer (a little over 70kg, or a little over 150lbs) to poison yourself effectively you’d need to consume about 1.4kg of saffron at a time, which would cost well over $6,000.
Where can I get it?
Your local supermarket probably has a tiny amount in the spice section, or you can get better prices buying it in “bulk” online. Here’s an example product on Amazon, for your convenience
Enjoy!
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