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 Salt Fix – by Dr. James DiNicolantonio

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    This book has a bold premise: high salt consumption is not, as global scientific consensus holds, a serious health risk, but rather, as the title suggests, a health fix.

    Dr. DiNicolantonio, a pharmacist, explains how “our ancestors crawled out of the sea millions of years ago and we still crave that salt”, giving this as a reason why we should consume salt ad libitum, aiming for 8–10g per day, and thereafter a fair portion of the book is given over to discussing how many health conditions are caused/exacerbated by sugar, and that therefore we have demonized the wrong white crystal (scientific consensus is that there are many white crystals that can cause us harm).

    Indeed, sugar can be a big health problem, but reading it at such length felt a lot like when all a politician can talk about is how their political rival is worse.

    A lot of the studies the author cites to support the idea of healthy higher salt consumption rates were on non-human animals, and it’s always a lottery as to whether those results translate to humans or not. Also, many of the studies he’s citing are old and have methodological flaws, while others we could not find when we looked them up.

    One of the sources cited is “my friend Jose tried this and it worked for him”.

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    Click here to check out The Salt Fix for yourself! It’s a fascinating book.

    (Usually, if we do not approve of a book, we simply do not review it. We like to keep things positive. However, this one came up in Q&A, so it seemed appropriate to share our review. Also, the occasional negative review may reassure you, dear readers, that when we praise a book, we mean it)

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  • Widen the Window – by Dr. Elizabeth Stanley

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    Firstly, about the title… That “window” that the author bids us “widen” is not a flowery metaphor, but rather, is referring to the window of exhibited resilience to stress/trauma; the “window” in question looks like an “inverted U” bell-curve on the graph.

    In other words: Dr. Stanley’s main premise here is that we respond best to moderate stress (i.e: in that window, the area under the curve!), but if there is too little or too much, we don’t do so well. The key, she argues, is widening that middle part (expanding the area under the curve) in which we perform optimally. That way, we can still function in a motivated fashion without extrinsic threats, and we also don’t collapse under the weight of overwhelm, either.

    The main strength of this book, however, lies in its practical exercises to accomplish that—and more.

    “And more”, because the subtitle also promised recovery from trauma, and the author delivers in that regard too. In this case, it’s about widening that same window, but this time to allow one’s parasympathetic nervous system to recognize that the traumatic event is behind us, and no longer a threat; we are safe now.

    Bottom line: if you would like to respond better to stress, and/or recover from trauma, this book is a very good tool.

    Click here to check out Widen the Window, and widen yours!

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  • Fatigue? Unexplained weight gain and dry skin? Could it be Hashimoto’s disease?

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    Maybe you feel worn out. Perhaps you’re also having trouble losing weight. Generally, you just don’t feel 100%.

    Could it be Hashimoto’s disease? This common autoimmune thyroid disorder is when your immune system (which fights off viruses and bacteria), mistakenly attacks a part of your body. In this case, it’s your thyroid – a gland located at the base of your neck – and can cause low thyroid hormones levels (hypothyroidism).

    Hypothyroidism affects one in 33 Australians and Hashimoto’s is one of the most common thyroid conditions in first-world countries.

    While symptoms can be subtle, untreated Hashimoto’s can cause long-term problems with your heart, memory and fertility. Here is what you need to know.

    What happens when you have Hashimoto’s?

    Your thyroid gland is a butterfly-shaped gland in the neck. It is essential in regulating things like muscle function, digestion, metabolism, the heart and lungs. In children, thyroid hormones are also needed for normal growth and development.

    Hashimoto’s thyroid disease, named after the Japanese doctor who discovered it in 1912, is also known as Hashimoto’s thyroiditis or chronic lymphocytic thyroiditis. The disease can cause the immune system to mistakenly produce proteins called antibodies (thyroid peroxidase and thyroglobulin). These can cause inflammation and long-term damage to the thyroid gland. Over time, as thyroid tissue is inflamed and/or destroyed, there can be a decrease in the production of thyroid hormones (hypothyroidism).

    Hashimoto’s can present subtly at first. If you only have antibodies with no change in thyroid levels, it is likely you won’t have any symptoms.

    However, as the disease progresses, you may experience fatigue, weight gain (or difficulty losing weight), increased sensitivity to the cold, constipation, dry skin, muscle aches, irregular or heavy menstrual cycles, enlarged thyroid (goitre) and occasionally hair loss, including at the ends of your eyebrows.

    What causes Hashimoto’s thyroid disease?

    Several risk factors can contribute to the development of Hashimoto’s including:

    What are the long-term risks?

    Long-term, untreated Hashimoto’s thyroiditis can cause heart issues, higher cholesterol levels, nerve damage (peripheral neuropathy), reduced cognition and infertility.

    In pregnancy, Hashimoto’s has a higher risk of pre-eclampsia (high blood pressure affecting several organs), premature birth, placental abruption (when the placenta separates from the inner wall of the uterus before birth) and, in severe cases, pregnancy loss.

    The disease has also been linked with an increased risk (but low incidence) of the lymphocytes of the thyroid turning into cancer cells to cause thyroid lymphoma.

    How is Hashimoto’s diagnosed?

    Diagnosis can be confirmed with a blood test to check thyroid levels and antibodies.

    Thyroid peroxidase antibodies are commonly present but about 5% of patients test antibody-negative. In those people, diagnosis depends on the thyroid levels, clinical presentation and ultrasound appearance of general inflammation. An ultrasound may not be required though, especially if the diagnosis is obvious.

    Three hormone levels are tested to determine if you have Hashimoto’s.

    Thyroid stimulating hormone (TSH) is produced by the brain to speak to the thyroid, telling it to produce two types of thyroid hormones – T3 and T4.

    If you have either relative or absolute thyroid hormone deficiency, a test will show the stimulating hormones as high because the brain is trying to get the thyroid to work harder.

    microscopic slide of cells in pink stain
    Hashimoto’s thyroiditis under the microscope. Antibodies against thyroid peroxidase and thyroglobulin were elevated.
    Patho/Wikimedia Commons, CC BY-SA

    Can it be treated?

    The management of Hashimoto’s depends on the severity of the thyroid levels. Up to 20% of the population can have antibodies but normal thyroid levels. This is still Hashimoto’s thyroid disease, but it is very mild and does not require treatment. There is no current treatment to reduce antibody levels alone.

    Because thyroid peroxidase antibodies increase the risk of abnormal thyroid levels in the future, regular thyroid testing is recommended.

    When the thyroid stimulating hormone is high with normal thyroid hormone levels it is termed “subclinical hypothyroidism”. When it is paired with low hormone levels it is called “overt hypothyroidism”. The first is a mild form of the disease and treatment depends on the degree of stimulating hormone elevation.

    Overt hypothyroidism warrants treatment. The main form of this is thyroid hormone replacement therapy (levothyroxine) with the dose of the drug adjusted until thyroid levels are within the normal range. This is usually a lifelong treatment but, once the dose is optimised, hormone levels usually remain relatively stable.

    In some people with very enlarged thyroid glands causing compressive symptoms (such as difficulty swallowing or breathing), thyroidectomy (surgical removal of the thyroid) is considered.

    Hashimoto’s thyroiditis is a common condition caused by your body’s immune system incorrectly damaging to your thyroid and can go undetected. Long-term, untreated, it can cause issues with your heart, cognition, and fertility. It can be diagnosed with a simple blood test. Speak to your doctor if you have any concerns as early diagnosis and treatment can help prevent complications.The Conversation

    Aakansha Zala, The University of Queensland

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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    Our Verdict

    When comparing Puritan’s Pride Resveratrol to Life Extension Resveratrol, we picked the Life Extension Resveratrol.

    Why?

    It contains not only more resveratrol per serving (250mg compared to Puritan’s Pride’s 100mg), but also contains other goodies too. Specifically, each capsule also contains:

    Whereas the Puritan’s Pride softgels? The other top ingredients are soybean oil and gelatin.

    Want to check out the products for yourself? Here they are:

    Puritan’s Pride Resveratrol | Life Extension Resveratrol

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    Enjoy!

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  • Is Dairy Scary?

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    Is Dairy Scary?

    Milk and milk products are popularly enjoyed as a good source of calcium and vitamin D.

    In contrast, critics of dairy products (for medical reasons, rather than ethical, which is another matter entirely and beyond the scope of this article) point to risks of cancer, heart disease, and—counterintuitively—osteoporosis. We’ll focus more on the former, but touch on the latter two before closing.

    Dairy & Cancer

    Evidence is highly conflicting. There are so many studies with so many different results. This is partially explicable by noting that not only is cancer a many-headed beast that comes in more than a hundred different forms and all or any of them may be affected one way or another by a given dietary element, but also… Not all milk is created equal, either!

    Joanna Lampe, of the Public Health Sciences division, Fred Hutchinson Cancer Research Center in Seattle, writes:

    ❝Dairy products are a complex group of foods and composition varies by region, which makes evaluation of their association with disease risk difficult. For most cancers, associations between cancer risk and intake of milk and dairy products have been examined only in a small number of cohort studies, and data are inconsistent or lacking❞

    In her systematic review of studies, she noted, for example, that:

    • Milk and dairy products contain micronutrients and several bioactive constituents that may influence cancer risk and progression
    • There’s probable association between milk intake and lower risk of colorectal cancer
    • There’s a probable association between diets high in calcium and increased risk of prostate cancer
    • Some studies show an inverse association between intake of cultured dairy products and bladder cancer (i.e., if you eat yogurt you’re less likely to get bladder cancer)

    Since that systemic review was undertaken, more research has been conducted, and the results are… Not conclusive, but converging towards a conclusion:

    • Dairy products can increase or decrease cancer risk
    • The increase in cancer risk seems strongest when milk is consumed in quantities that result in too much calcium. When it comes to calcium, you can absolutely have too much of a good thing—just ask your arteries!
    • The decrease in cancer seems to be mostly, if not exclusively, from fermented dairy products. This usually means yogurts. The benefit here is not from the milk itself, but rather from the gut-friendly bacteria.

    You may be wondering: “Hardened arteries, gut microbiome health? I thought we were talking about cancer?” and yes we are. No part of your health is an island unrelated to other parts of your health. One thing can lead to another. Sometimes we know how and why, sometimes we don’t, but it’s best to not ignore the data.

    The bottom line on dairy products and cancer is:

    • Consuming dairy products in general is probably fine
    • Yogurt, specifically, is probably beneficial

    Dairy and Heart Disease

    The reason for the concern is clear enough: it’s largely assumed to be a matter of saturated fat intake.

    The best combination of “large” and “recent” that we found was a three-cohort longitudinal study in 2019, which pretty much confirms what was found in smaller or less recent studies:

    • There is some evidence to suggest that consumption of dairy can increase all-cause mortality in general, and death from (cancer and) cardiovascular disease in particular
    • The evidence is not, however, overwhelming. It is marginal.

    Dairy and Osteoporosis

    Does dairy cause osteoporosis? Research here tends to fall into one of two categories when it comes to conclusions, so we’ll give an example of each:

    1. “Results are conflicting, saying yes/no/maybe, and basically we just don’t know”
    2. “Results are conflicting, but look: cross-sectional and case-control studies say yes; cohort studies say maybe or no; we prefer the cohort studies”

    See them for yourself:

    1. Osteoporosis: Is milk a kindness or a curse?
    2. Consumption of milk and dairy products and risk of osteoporosis and hip fracture

    Conclusion: really, the jury is very much still out on this one

    Summary:

    • Moderate consumption of dairy products is almost certainly fine
    • More specifically: it probably has some (small) pros and some (small) cons
    • Yogurt is almost certainly healthier than other dairy products, and is almost universally considered a healthy food (assuming not being full of added sugar etc, of course)
    • If you’re going to have non-dairy alternatives to milk, choose wisely!

    That’s all we have time for today, but perhaps in a future edition we’ll do a run-down of the pros and cons of various dairy alternatives!

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  • Remember – by Dr. Lisa Genova

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    Memory is often viewed as one thing—either you have a good memory, or you don’t. At best, a lot of people have a vague idea of selective memory. But, the reality is much more complex—and much more interesting.

    Dr. Genova lays out clearly and simply the various different kinds of memory, how they work, and how they fail. Some of these kinds of memory operate on completely different principles than others, and/or in different parts of the brain. And, it’s not just “a memory for faces” or a “memory for names”, nor even “short term vs long term”. There’s working memory, explicit and implicit memory, semantic memory, episodic memory, muscle memory, and more.

    However, this is not just an interesting book—it’s also a useful one. Dr. Genova also looks at how we can guard against failing memory in later years, and how we can expand and grow the kinds of memory that are most important to us.

    The style of the book is very conversational, and not at all textbook-like. It’s certainly very accessible, and pleasant to read too.

    Bottom line: memory is a weird and wonderful thing, and this book shines a clear light on many aspects of it—including how to improve the various different kinds of memory.

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    Learn to Age Gracefully

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