
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 Wrist-Worn Device That Detects Depression!
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Fitness trackers are great—in some regards. There are things they do well, and things they do badly, and those things are not always the way around you might expect!
We wrote about this, here: What Your Fitness Tracker Is Best & Worst At
In that article, we mentioned that one of the things it’s best at is tracking and establishing patterns.
Can you guess where this is going today?
Actionable actigraphy
Researchers (Dr. Adile Nexha et al.) looked at whether actigraphy*-derived sleep and rest-activity rhythms are associated with relapse in major depressive disorder (MDD).
*actigraphy = activity as plotted on a graph
What they did: 93 adults in remission from MDD across Canada wore a research-grade wrist actigraphy device for 1–2 years, generating approximately 32,000 days of sleep and activity data.
And what did that data tell Dr. Nexha and her team?
In few words: people with more irregular sleep and weaker day–night activity contrast had about a twofold higher risk of depressive relapse, often detectable weeks to months before symptoms returned.
In more words:
- Most important factor: lower relative amplitude—meaning less difference between daytime activity and nighttime rest—remained predictive even after adjusting for concurrent Montgomery–Åsberg Depression Rating Scale scores.
- Other predictors: lower sleep regularity and sleep efficiency, higher wake after sleep onset, higher nighttime activity, and increasingly erratic sleep schedules before relapse.
This is a huge breakthrough because it shows that passive (easy!) continuous monitoring can flag risk earlier than symptom-based check-ins between appointments and could help people get the timely care they need.
Which is especially meaningful in cases of depression, where people struggling with depression are famously one of the hardest demographics to get to actively do something (including: tests).
You can find the paper itself, here: One-Year Actigraphy Study of Sleep and Rest-Activity Rhythms as Markers of Relapse in Depression
Another reason this is particularly important is that depression is sometimes astonishingly well-hidden. A person can be very very depressed, but they’re still switching into “performance mode” for things, sometimes even having a semblance of happiness while doing stuff in the company of others, but it’s all empty inside and lost in an instant once the mask can be allowed to slip, as it must, because keeping up appearances is very draining to someone who already doesn’t have a lot of energy due to the depression.
You can read more about that, here: How To Recognize Perfectly Hidden Depression
Want to learn more?
Some important reads:
- How To Stay Alive (When You Really Don’t Want To) ← this one’s about as serious as it can get, and we mean it.
- The Mental Health First-Aid That You’ll Hopefully Never Need ← no, we’re not going to ask you to name 5 things you can see and all that. That’s more to do with anxiety and disassociative disorders in any case. But what this article does have, is a lot of genuinely practical advice that actually works, and yes, even when your motivation is through the floor.
- Behavioral Activation Against Depression & Anxiety ← this one builds on the previous one, and can make use of your health tracker too 😎
Take care!
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Okra vs Zucchini – Which is Healthier?
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Our Verdict
When comparing okra to zucchini, we picked the okra.
Why?
In terms of macros, okra has nearly 2x the protein and more than 3x the fiber (for about 2x the carbs), so that’s an easy first-round win for okra.
When it comes to vitamins, things are also quite one-sided; okra has a lot more of vitamins A, B1, B3, B5, B6, B7, B9, C, E, and K, while zucchini has just a little more vitamin B2, yielding to okra a 10:1 win here.
Nor does the mineral situation make any compelling counterargument; okra has a lot more calcium, copper, iron, magnesium, manganese, phosphorus, potassium*, selenium, and zinc, while zucchini boasts only more sodium, which is not much of a boast. A third overwhelming win in a row for okra.
*Actually it’s only a little more potassium. But the rest are with big margins of difference.
In other considerations, both of these on-the-cusp-of-being-pungent vegetables have beneficial antioxidant polyphenols (especially various forms of quercetin), but okra has more, so that’s another round swung okra’s way.
Adding up the sections makes for a clear overall win for okra, but by all means do enjoy either or both, as diversity is best!
Want to learn more?
You might like:
21 Most Beneficial Polyphenols & What Foods Have Them
Enjoy!
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Nutrition To Combat Lymphedema & Lipedema
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Dr. Kelly Sturm is a rehab specialist (Doctor of Physical Therapy), and also a certified lymphedema therapist. Here’s what helps her patients with lymphedema and lipedema:
Don’t fan the flames
Lymphedema and lipedema are inflammatory lymphatic diseases affecting mostly women. As such, an anti-inflammatory diet will be important, but there are other factors too:
- Anti-inflammatory diet: this is to reduce the chronic inflammation associated with lymphatic diseases. This means eating plenty of fruit and vegetables, especially berries and leafy greens, and avoiding things like sugar, alcohol, caffeine, and processed foods. And of course, don’t smoke.
- Intermittent fasting: this also helps by giving the body a chance to correct itself; when the body isn’t digesting food, it has a lot more resources to devote to its favorite activity: maintenance. This results in lower inflammation, and better fat redistribution.
- Weight loss: not a bandwagon we often get on at 10almonds as it’s rarely the most important thing, but in this case it is of high importance (second only to dealing with the inflammation), as excess weight around the lymph nodes and vessels can lead to dysfunction and swelling. Thus, reducing the weight can ease that and allow the body to heal.
For more details on all of the above, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
- Eat To Beat Inflammation ← also some non-dietary advice in there too
- Ask Not What Your Lymphatic System Can Do For You…
- Lose Weight, But Healthily ← more useful than just trying to run a calorie deficit
Take care!
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Amphetamines: The Drug That Works Too Well?
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Developed to allow soldiers to continue fighting without sleeping; now mostly used for treating ADHD, amphetamines run the gamut from methamphetamines (potent, addictive), to non-methylated amphetamines (e.g. ADHD meds such as Adderall, Vyvanse, etc), as well as drugs generally considered quite different, like MDMA (“Ecstasy”).
So, what’s helpful and what’s dangerous?
Let’s get up to speed
In few words:
- How it works: it raises dopamine (motivation, excitement) and noradrenaline (alertness, focus); with these, it creates a state of “flow”, and also suppresses hunger, fatigue, and distractions.
- How it lasts: effects last 4–14 hours, longer than cocaine or most other stimulants.
- How it’s used: ADHD is the main reason people take it; off-label and illegal use is common in competitive fields and among college students for performance—especially amongst medical students who not only study famously long hours, but are also most likely to turn to medications to ease their problems.
- How it goes wrong: in the short term, problems can include hyperfocusing on the wrong tasks, anxiety, panic, irritability, dehydration, and insomnia, as well as crashes in mood and energy afterward. In the long term, regular use can result in tolerance (i.e., a higher dose is needed for the same effect), and it can can make users feel unable to function without it. There are some possible severe side effects, namely psychosis (hallucinations, paranoia, potential schizophrenia), and cardiovascular damage (high blood pressure, heart strain, strokes, heart attacks), but these are incredibly unlikely in someone with ADHD (where the medication was merely raising neurotransmitters to “normal” levels), still very unlikely in occasional use in someone with a “normal” brain, and most likely to cause problems in someone predisposed to psychosis, mania, etc.
In fewer words: amphetamines can enable productivity in the moment but don’t build lasting benefits; they’re a tool with noteworthy trade-offs. In terms of safety, low-dose medical use for ADHD appears safe; heavy or long-term use in others can cause problems. And if you are prone to psychosis and/or mania, then these are absolutely not good drugs for you.
For more on all of this, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like:
Wakefulness, Cognitive Enhancement, AND Improved Mood? ← this is about modafinil, which a) is usually prescribed for sleep disorders, though it enjoys widespread gray market off-label use, and b) works on the same systems as amphetamines, but purely as a reuptake inhibitor, giving it a much better safety profile, since it is less about increasing your neurotransmitter levels as high as possible, and more about not letting them sink beneath a certain level.
Take care!
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From eye exams to blood tests and surgery: how doctors use light to diagnose disease
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This is the next article in our ‘Light and health’ series, where we look at how light affects our physical and mental health in sometimes surprising ways. Read other articles in the series.
You’re not feeling well. You’ve had a pounding headache all week, dizzy spells and have vomited up your past few meals.
You visit your GP to get some answers and sit while they shine a light in your eyes, order a blood test and request some medical imaging.
Everything your GP just did relies on light. These are just some of the optical technologies that have had an enormous impact in how we diagnose disease.
megaflopp/Shutterstock 1. On-the-spot tests
Point-of-care diagnostics allow doctors to test patients on the spot and get answers in minutes, rather than sending samples to a lab for analysis.
The “flashlight” your GP uses to view the inside of your eye (known as an ophthalmoscope) is a great example. This allows doctors to detect abnormal blood flow in the eye, deformations of the cornea (the outermost clear layer of the eye), or swollen optical discs (a round section at the back of the eye where the nerve link to the brain begins). Swollen discs are a sign of elevated pressure inside your head (or in the worst case, a brain tumour) that could be causing your headaches.
The invention of lasers and LEDs has enabled many other miniaturised technologies to be provided at the bedside or clinic rather than in the lab.
Pulse oximetry is a famous example, where a clip attached to your finger reports how well your blood is oxygenated. It does this by measuring the different responses of oxygenated and de-oxygenated blood to different colours of light.
Pulse oximetry is used at hospitals (and sometimes at home) to monitor your respiratory and heart health. In hospitals, it is also a valuable tool for detecting heart defects in babies.
See that clip on the patient’s finger? That’s a pulse oximeter, which relies on light to monitor respiratory and heart health. CGN089/Shutterstock 2. Looking at molecules
Now, back to that blood test. Analysing a small amount of your blood can diagnose many different diseases.
A machine called an automated “full blood count analyser” tests for general markers of your health. This machine directs focused beams of light through blood samples held in small glass tubes. It counts the number of blood cells, determines their specific type, and reports the level of haemoglobin (the protein in red blood cells that distributes oxygen around your body). In minutes, this machine can provide a snapshot of your overall health.
For more specific disease markers, blood serum is separated from the heavier cells by spinning in a rotating instrument called a centrifuge. The serum is then exposed to special chemical stains and enzyme assays that change colour depending on whether specific molecules, which may be the sign of a disease, are present.
These colour changes can’t be detected with the naked eye. However, a light beam from an instrument called a spectrometer can detect tiny amounts of these substances in the blood and determine if the biomarkers for diseases are present, and at what levels.
Light shines through the blood sample and tells us whether biomarkers for disease are present. angellodeco/Shutterstock 3. Medical imaging
Let’s re-visit those medical images your GP ordered. The development of fibre-optic technology, made famous for transforming high-speed digital communications (such as the NBN), allows light to get inside the body. The result? High-resolution optical imaging.
A common example is an endoscope, where fibres with a tiny camera on the end are inserted into the body’s natural openings (such as your mouth or anus) to examine your gut or respiratory tracts.
Surgeons can insert the same technology through tiny cuts to view the inside of the body on a video screen during laparoscopic surgery (also known as keyhole surgery) to diagnose and treat disease.
Doctors can insert this flexible fibre-optic tube with a camera on the end into your body. Eduard Valentinov/Shutterstock How about the future?
Progress in nanotechnology and a better understanding of the interactions of light with our tissues are leading to new light-based tools to help diagnose disease. These include:
- nanomaterials (materials on an extremely small scale, many thousands of times smaller than the width of a human hair). These are being used in next-generation sensors and new diagnostic tests
- wearable optical biosensors the size of your fingernail can be included in devices such as watches, contact lenses or finger wraps. These devices allow non-invasive measurements of sweat, tears and saliva, in real time
- AI tools to analyse how blood serum scatters infrared light. This has allowed researchers to build a comprehensive database of scatter patterns to detect any cancer
- a type of non-invasive imaging called optical coherence tomography for more detailed imaging of the eye, heart and skin
- fibre optic technology to deliver a tiny microscope into the body on the tip of a needle.
So the next time you’re at the GP and they perform (or order) some tests, chances are that at least one of those tests depend on light to help diagnose disease.
Matthew Griffith, Associate Professor and ARC Future Fellow and Director, UniSA Microscopy and Microanalysis Facilities, University of South Australia
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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The Large-Scale Effects Of Mindful Eating
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We’ve written before about mindful eating; our first article on the topic was putting a spotlight on Dr. Rupy “The Kitchen Doctor” Aula, and his recommendations:
Interoception: Improving Our Awareness Of Body Cues
For the most part, mindful eating is thought of as a way to slow down our consumption of any given meal, and thus appreciate it more, as well as enjoying better digestion (and thus, better nutrient absorption—more on that at the end of today’s feature, in the “learn more” section).
Indeed, it’s often (rightly) touted as a way to Hack Your Hunger ← our article on same, for which mindful eating is one part
But what about the big picture?
What the French discovered
A French team of researchers (Dr. Pauline Paolassini-Guesnier et al.) investigated mindful eating on a large (n=13,768) scale.
Since this needs defining in order to do science to it, mindful eating was defined for the purposes of this study as being present, attentive, and non-judgmental during eating, responding to internal cues rather than external triggers. These items were measured by questionnaire, along with other factors such as hunger/satiety, and food journal recording what people actually ate.
Higher mindful eating scores correlated with:
- Increased adherence to healthy plant-based diets.
- Reduced intake of unhealthy plant-based foods, meat, and dairy.
- Higher likelihood of being vegetarian, pescatarian, or vegan.
Note: this study in no way promoted, suggested, or asked leading questions about, adherence to a healthy plant-based diet, or avoidance of animal products. These were simply observed results.
Interestingly, no comparable association was found between mindful eating and fish consumption (or lack thereof). There are two reasonable hypotheses to explain this:
- When it comes to health, there is more growing awareness about the harmful effects of various kinds of terrestrial meat (especially red meat, and pork which brings similar metabolic risks) and dairy, while fish is popularly still considered healthy in moderation (science broadly agrees).
- When it comes to ethical considerations, humans tend to empathize more with our fellow mammals than we do with fish, and this may also sway decisions about dietary choices.
We are a health science publication, not moral philosophy publication, so we’ve not written any ethical treatises here, but we have written on the topic of the health risks (and benefits) of animal products: Do We Need Animal Products To Be Healthy?
There were some limitations, most notably that the study sample over-represented health-conscious people, and the cross-sectional design on the study can’t confirm causality (i.e. it looks a lot like mindful eating promotes these healthier dietary patterns, but it could be that the healthier dietary patterns promote mindful eating, or both).
You can read the paper in full, here: Mindful eating is associated with a healthier plant-based diet in the NutriNet-Santé study
Want to learn more?
If you’d like to take up mindful eating, we wrote a step-by-step guide:
Mindful Eating: How To Get More Out Of What’s On Your Plate
Enjoy!
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