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 Longevity Diet – by Dr. Valter Longo
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Another book with “The New Science” in its subtitle, so, is this one a new science?
Yes and no; some findings are new, many are not, what really sets this book apart from many of its genre though is that rather than focusing on fighting aging, it focuses on retaining youth. While this may seem like one and the same thing, there is a substantive difference beyond the ideological, which is: while anti-aging research focuses on what causes people to suffer age-related decline and fights each of those things, Dr. Longo’s research focuses on what is predominant in youthful bodies, cells, DNA, and looks to have more of that. Looking in a slightly different place means finding slightly different things, and knowledge is power indeed.
Dr. Longo bases his research and focus on his “5 pillars of longevity”. We’ll not keep them a mystery; they are:
- Juventology research
- Epidemiology
- Clinical studies
- Centenarian studies
- Study of complex systems
The first there (juventology research) may sound like needless jargon, but it is the counterpoint of the field of gerontology, and is otherwise something that didn’t have an established name.
You may wonder why “clinical studies” gets a separate item when the others already include studies; this is because many studies when it comes to aging and related topics are population-based studies, cohort studies, observational studies, or (as is often the case) multiple of the above at once.
Of course, all this discussion of academia is not itself practical information for the reader (unless we happen to work in the field), but it is interesting and does give confidence in the conclusions upon which the practical parts of the book are based.
And what are they? As the title suggests, it’s about diet, and specifically, it’s about Dr. Longo’s “fast-mimicking diet”, which boasts the benefits of intermittent fasting without intermittent fasting. This hinges, of course, on avoiding metabolic overload, which can be achieved with a fairly simple diet governed by the principles outlined in this book, based on the research referenced.
In the category of subjective criticism, there is quite a bit of fluff, much of it self-indulgently autobiographical and very complimentary, but its presence does not take anything away from the excellent content contained in the book.
Bottom line: if you’d like a fresh perspective on regaining/retaining youthfulness, then this is a great book to read.
Click here to check out The Longevity Diet, and stay younger!
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Soap vs Sanitizer – Which is Healthier?
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Our Verdict
When comparing soap to sanitizer, we picked the soap.
Why?
Both are good at killing bacteria / inactivating viruses, but there are several things that set them apart:
- Soap doesn’t just kill them; it slides them off and away down the drain. That means that any it failed to kill are also off and down the drain, not still on your hands. This is assuming good handwashing technique, of course!
- Sanitizer gel kills them, but can take up to 4 minutes of contact to do so. Given that people find 20 seconds of handwashing laborious, 240 seconds of sanitizer gel use seems too much to hope for.
Both can be dehydrating for the hands; both can have ingredients added to try to mitigate that.
We recommend a good (separate) moisturizer in either case, but the point is, the dehydration factor doesn’t swing it far either way.
So, we’ll go with the one that gets rid of the germs the most quickly: the soap
10almonds tip: splash out on the extra-nice hand-soaps for your home—this will make you and others more likely to wash your hands more often! Sometimes, making something a more pleasant experience makes all the difference.
Want to know more?
Check out:
Take care!
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Creamy Zucchini, Edamame, & Asparagus Linguine
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Protein, fiber, and polyphenols are the dish of the day here:
You will need
- 1½ cups milk (your choice what kind; we recommend soy for its neutral taste, though hazelnut’s nutty flavor would also work in this recipe)
- 6 oz wholegrain linguine (or your pasta of choice)
- 2 zucchini, thinly sliced
- 5 oz edamame beans (frozen is fine)
- 5 oz asparagus tips, cut into 2″ lengths
- ½ bulb garlic, crushed
- 1 tbsp chia seeds
- 1 small handful arugula
- 1 small handful parsley, chopped
- A few mint leaves, chopped
- Juice of ½ lemon
- 2 tsp black pepper, coarse ground
- ½ tsp MSG or 1 tsp low-sodium salt
- Extra virgin olive oil
Method
(we suggest you read everything at least once before doing anything)
1) Heat some oil in a sauté pan or similar, over a low to medium heat. Add the zucchini and cook for 5 minutes until they start to soften.
2) Add the garlic and continue cooking for 1 minute, stirring gently.
3) Add the milk, bring to the boil, and add the past, chia seeds (the resistant starch from the pasta will help thicken the sauce, as will the chia seeds), and MSG or salt.
4) Reduce the heat, cover, and simmer for 8 minutes.
5) Add the edamame beans and asparagus, and cook for a further 2 minutes, or until the pasta is cooked but still firm to the bite. The sauce should be quite thick now.
6) Stir in the remaining ingredients and serve, adding a garnish if you wish.
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- The Many Health Benefits Of Garlic
- Black Pepper’s Impressive Anti-Cancer Arsenal (And More)
- If You’re Not Taking Chia, You’re Missing Out
Take care!
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The Stress-Proof Brain – by Dr. Melanie Greenberg
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The premise of the book is as stated in the subtitle: using mindfulness and neuroplasticity to manage our stress response.
As such, it’s divided into three parts:
- Understanding your stress (and different types of stressors)
- Calming your amygdalae (thus, dealing with your stress response while the stressor is stressing you)
- Moving forward with your prefrontal cortex (and thus, gradually improving automatic stress responses over time, as we learn new, better responses to do automatically)
The content ranges from the neurophysiological to “therapist’s couch” stuff; Dr. Greenberg having her PhD in psychology has prepared her to write both of those different-but-touching fields with equal competence. In-line citations are given throughout, for those who want to look up studies.
The style is direct and informative, with little to no attention given to making it an entertaining read. As a result, it’s information dense (which is good), and/but not necessarily a “couldn’t put it down” page-turner.
Bottom line: if you’d like to improve your ability to deal with stress, this book is as good as any.
Click here to check out The Stress-Proof Brain, and stress-proof yours!
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10 Ways To Balance Blood Sugars
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“Let Them Eat Cake”, She Said…
This is Jessie Inchauspé, a French biochemist and author. She’s most known for her best-selling “Glucose Revolution: The Life-Changing Power Of Balancing Your Blood Sugar”.
It’s a great book (which we reviewed recently) and you absolutely should read it, but meanwhile, we’re going to distill at least the most critical core ideas, 10almonds style. In this case, her “ten hacks”:
Eat foods in the right order
The order is:
- Fiber first
- Protein and fat second
- Starches and sugars last
What happens here is… the fiber perks up the gut bacteria, the protein and fat will then be better-digested next, and the starches and sugars will try to jump the line, but they can’t because the fiber is a physical speedbump and the proteins and fats are taking the prime place for being digested. So instead, the starches and sugars—usually responsible for blood sugar spikes—get processed much more gradually, resulting in a nice even curve.
Add a green starter to all your meals
We know what you’re thinking: “that’s just the first one again”, but no. This is an extra starter, before you get to that. If you’re the cook of the household, this can absolutely simply mean snacking on green ingredients while cooking.
Stop counting calories
Especially, she advises: stop worrying about extra calories from fats, such as if doing an oil-and-vinegar dressing for salad—which she also recommends, because all three components (the oil, the vinegar, and the salad) help even out blood sugar levels.
Flatten your breakfast curve
For many, breakfast is the starchiest meal of the day, if not the sugariest. Inchauspé recommends flipping this (ideally) or softening it (if you really must have a carb-based breakfast):
- Top choices include: a warm vegetable salad, fish, or eggs (or tofu if you don’t do animal products).
- Next-best include: if you must have toast, make sure to have butter (and/or the aforementioned egg/tofu, for example) to give your digestion an extra thing to do.
- Also: she recommends skipping the juice in favour of home-made breakfast smoothies. That way, instead of basically just sugar with some vitamins, you’re getting a range of nutrients that, if you stack it right, can constitute a balanced meal itself, with fiber + protein + fat + carbs.
Have any type of sugar—they’re all the same
They’re technically not, but the point is that your body will immediately take them apart and then they will be just the same. Whether it’s the cheapest white sugar or the most expensive organic lovingly hand-reared free-range agave nectar, your body is going to immediately give it the chop-shop treatment (a process so quick as to be practically instantaneous) and say “this is now glucose”.
Pick a dessert over a sweet snack
Remember that about the right order for foods? A dessert, when your body is already digesting dinner, is going to make much less of a glucose spike than, say, a blueberry muffin when all you’ve had this morning is coffee and juice.
Reach for the vinegar before you eat
We recently did a whole main feature about this, so we’ll not double up today!
After you eat, move
The glucose you eat will be used to replace lost muscle glycogen, before any left over is stored as fat… and, while it’s waiting to be stored as fat, just sitting in your bloodstream being high blood sugars. So, this whole thing will go a lot better if you are actively using muscle glycogen (by moving your body).
Inchauspé gives a metaphor: imagine a steam train worker, shoveling coal into the furnace. Meanwhile, other workers are bringing more coal. If the train is moving quickly, the coal can be shoveled into the furnace and burned and won’t build up so quickly. But if the train is moving slowly or not at all, that coal is just going to build up and build up, until the worker can shovel no more because of being neck-deep in coal.
Same with your blood sugars!
If you want to snack, go low-sugar
In the category of advice that will shock nobody: sugary snacks aren’t good for avoiding blood sugar spikes! This one probably didn’t need a chapter devoted to it, but anyway: low sugar is indeed the way to go for snacks.
Put some clothes on your carbs
This is about olive oil on pasta, butter on potatoes, and so forth. Basically, anything starchy is going to be broken down quickly to sugar and sent straight into the bloodstream, if there’s nothing to slow it down. If you’re wondering what to do with rice: adding a tablespoon of chia seeds to the rice while cooking (so they’re cooked together) will add very healthy fats to your rice, and (because they’ve been cooked) will not seem like eating seeds, by the way. In terms of texture and appearance, it’ll be as though you threw some black pepper in*
*which you should also do for many reasons, but that’s beyond the scope of this “about blood sugars” feature!
Wanting to know more about the science of this?
We’ve done all we have room for here today, but Inchauspé is, as ever, happy to explain it herself:
Prefer text? Check out:
The Science Behind Glucose GoddessDon’t Forget…
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Minimize Aging’s Metabolic Slump
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
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 know that metabolism slows with age, are there any waypoints or things to look out for? I don’t know whether I should be eating less, or doing less, or taking some other approach entirely. What’s recommended?❞
Age and sex count for a lot with this one! As metabolism is in large part directed by hormones:
- For men, declining testosterone (often from around 45 onwards) can result in a metabolic slump
- For women, declining estrogen with the menopause does have an effect, but progesterone is the bigger factor for metabolism in the sense you are talking about.
In both cases, simply taking more of those hormones can often help, but please of course speak with an endocrinologist if that seems like a possible option for you, as your circumstances (and physiology) may vary.
If you’d like to go to that conversation well-armed with information, here are some good starting points, by the way:
- The Testosterone Drop, & Topping Up Testosterone
- Menopausal HRT: Bioidentical vs Animal (It Makes A Difference!)
And if you’re wondering about the natural vs pharmaceutical approaches…
- What Does “Balance Your Hormones” Even Mean?
- What You Should Have Been Told About The Menopause Beforehand
About your metabolic base rate
We tend to think of “fast metabolism good, slow metabolism bad”, and that’s a reasonable general premise… but it’s not necessarily always so.
After all, if you could double your metabolism and keep it there all the time, without changing anything else, well… You’ve heard the phrase “burning the candle at both ends”? So, having at least some downtime is important too.
See for example: Sleep Deprivation & Diabetes Risk
What’s critical, when it comes to base metabolic rate, is that your body must be capable of adequately processing what you are putting into it. Because if your body can’t keep up with the input, it’ll just start storing the excess chemical energy in the quickest and easiest way possible.
…which is a fast track to metabolic disorder in general and type 2 diabetes in particular. For more on the science and mechanics of this, see:
How To Prevent And Reverse Type 2 Diabetes
As for portion sizes…
Your body knows what you need, so listen to it. There is no external source of knowledge that can tell you how much food you need better than your own body itself can tell you.
You may be wondering “how exactly do I listen to my body, though?”, in which case, check out:
The Kitchen Doctor: Interoception & Mindful Eating
As for exercise…
When you exercise, your metabolic rate temporarily increases. After most kinds of exercise, your metabolism slumps again afterwards to compensate.
There are two ways to avoid this:
- Exercise Less, Move More ← it’s about maximizing time spent not sitting still
- High Intensity Interval Training ← a special kind of exercise, the only one known to keep the metabolism running high for a couple of hours afterwards, with no counter-slump
…which makes it pretty effective indeed
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