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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I’ve recovered from a cold but I still have a hoarse voice. What should I do?
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Cold, flu, COVID and RSV have been circulating across Australia this winter. Many of us have caught and recovered from one of these common upper respiratory tract infections.
But for some people their impact is ongoing. Even if your throat isn’t sore anymore, your voice may still be hoarse or croaky.
So what happens to the voice when we get a virus? And what happens after?
Here’s what you should know if your voice is still hoarse for days – or even weeks – after your other symptoms have resolved.
Why does my voice get croaky during a cold?
A healthy voice is normally clear and strong. It’s powered by the lungs, which push air past the vocal cords to make them vibrate. These vibrations are amplified in the throat and mouth, creating the voice we hear.
The vocal cords are two elastic muscles situated in your throat, around the level of your laryngeal prominence, or Adam’s apple. (Although everyone has one, it tends to be more pronounced in males.) The vocal cords are small and delicate – around the size of your fingernail. Any small change in their structure will affect how the voice sounds.
When the vocal cords become inflamed – known as laryngitis – your voice will sound different. Laryngitis is a common part of upper respiratory tract infections, but can also be caused through misuse.
Viruses such as the common cold can inflame the vocal cords. Pepermpron/Shutterstock Catching a virus triggers the body’s defence mechanisms. White blood cells are recruited to kill the virus and heal the tissues in the vocal cords. They become inflamed, but also stiffer. It’s harder for them to vibrate, so the voice comes out hoarse and croaky.
In some instances, you may find it hard to speak in a loud voice or have a reduced pitch range, meaning you can’t go as high or loud as normal. You may even “lose” your voice altogether.
Coughing can also make things worse. It is the body’s way of trying to clear the airways of irritation, including your own mucus dripping onto your throat (post-nasal drip). But coughing slams the vocal cords together with force.
Chronic coughing can lead to persistent inflammation and even thicken the vocal cords. This thickening is the body trying to protect itself, similar to developing a callus when a pair of new shoes rubs.
Thickening on your vocal cords can lead to physical changes in the vocal cords – such as developing a growth or “nodule” – and further deterioration of your voice quality.
Coughing and exertion can cause inflamed vocal cords to thicken and develop nodules. Pepermpron/Shutterstock How can you care for your voice during infection?
People who use their voices a lot professionally – such as teachers, call centre workers and singers – are often desperate to resume their vocal activities. They are more at risk of forcing their voice before it’s ready.
The good news is most viral infections resolve themselves. Your voice is usually restored within five to ten days of recovering from a cold.
Occasionally, your pharmacist or doctor may prescribe cough suppressants to limit additional damage to the vocal cords (among other reasons) or mucolytics, which break down mucus. But the most effective treatments for viral upper respiratory tract infections are hydration and rest.
Drink plenty of water, avoid alcohol and exposure to cigarette smoke. Inhaling steam by making yourself a cup of hot water will also help clear blocked noses and hydrate your vocal cords.
Rest your voice by talking as little as possible. If you do need to talk, don’t whisper – this strains the muscles.
Instead, consider using “confidential voice”. This is a soft voice – not a whisper – that gently vibrates your vocal cords but puts less strain on your voice than normal speech. Think of the voice you use when communicating with someone close by.
During the first five to ten days of your infection, it is important not to push through. Exerting the voice by talking a lot or loudly will only exacerbate the situation. Once you’ve recovered from your cold, you can speak as you would normally.
What should you do if your voice is still hoarse after recovery?
If your voice hasn’t returned to normal after two to three weeks, you should seek medical attention from your doctor, who may refer you to an ear nose and throat specialist.
If you’ve developed a nodule, the specialist would likely refer you to a speech pathologist who will show you how to take care of your voice. Many nodules can be treated with voice therapy and don’t require surgery.
You may have also developed a habit of straining your vocal cords, if you forced yourself to speak or sing while they were inflamed. This can be a reason why some people continue to have a hoarse voice even when they’ve recovered from the cold.
In those cases, a speech pathologist may play a valuable role. They may teach you to exercises that make voicing more efficient. For example, lip trills (blowing raspberries) are a fun and easy way you can learn to relax the voice. This can help break the habit of straining your voice you may have developed during infection.
Yeptain Leung, Postdoctoral Research and Lecturer of Speech Pathology, School of Health Sciences, The University of Melbourne
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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The Joy of Saying No – by Natalie Lue
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Superficially, this seems an odd topic for an entire book. “Just say no”, after all, surely! But it’s not so simple as that, is it?
Lue looks into what underpins people-pleasing, first. Then, she breaks it down into five distinct styles of people-pleasing that each come from slightly different motivations and ways of perceiving how we interact with those around us.
Lest this seem overly complicated, those five styles are what she calls: gooding, efforting, avoiding, saving, suffering.
She then looks out how to have a healthier relationship with our yes/no decisions; first by observing, then by creating healthy boundaries. “Healthy” is key here; this isn’t about being a jerk to everyone! Quite the contrary, it involves being honest about what we can and cannot reasonably take on.
The last section is about improving and troubleshooting this process, and constitutes a lot of the greatest value of the book, since this is where people tend to err the most.
Bottom line: this book is informative, clear, and helpful. And far from disappointing everyone with “no”, we can learn to really de-stress our relationships with others—and ourselves.
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Plant vs Animal Protein
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Plant vs Animal Protein: Head to Head
Some people will obviously have strong ideological opinions here—for vegetarians and vegans, it’s no question, and for meat-eaters, it’s easy to be reactive to that and double-down on the bacon. But, we’re a health and productivity newsletter, so we’ll be sticking to the science.
Which is better, healthwise?
First, it depends how you go about it. Consider these options:
- A piece of salmon
- A steak
- A hot dog
- A hot dog, but plant-based
- Textured soy protein (no additives)
- Edamame (young soy) beans
Three animal-based protein sources, three plant-based. We could render the competition simple (but very unfair) by pitting the hotdog against the edamame beans, or the plant-based hot dog against the piece of salmon. So let’s kick this off by saying:
- There are good and bad animal-based protein sources
- There are good and bad plant-based protein sources
Whatever you choose, keep that in mind while you do. Less processed is better in either case. And if you do go for red meat, less is better, period.
Picking the healthiest from each, how do the nutritional profiles look?
They look good in both cases! One factor of importance is that in either case, our bodies will reduce the proteins we consume to their constituent amino acids, and then rebuild them into the specific proteins we actually need. Our bodies will do that regardless of the source, because we are neither a salmon nor a soy bean, for example.
We need 20 specific amino acids, for our bodies to make the proteins we will use in our bodies.
Animal protein sources contain all 20 of those. Plant based sources often don’t, individually, but by eating soy for example (which does contain all 20) and/or getting multiple sources of protein from different plants, the 20 can be covered quite easily with little thought, just by having a varied diet.
Meats are #1!
- They’re number 1 for nutritional density
- They’re number 1 for health risks, too
So while plant-based diet adherents may need to consume more varied things to get all the nutrients necessary, meat-eaters won’t have that problem.
Meat-eaters will instead have a different problem, of more diet-related health risks, e.g.
- Cardiovascular disease
- Metabolic disorders
- Cancers
So again, if eating (especially processed and/or red) meat, moderation is good. The Mediterranean Diet that we so often recommend, by default contains small amounts of lean animal protein.
Which is better for building muscle?
Assuming a broadly healthy balanced diet, and getting sufficient protein from your chosen source, they’re pretty equal:
- Vegan and Omnivorous High Protein Diets Support Comparable Daily Myofibrillar Protein Synthesis Rates and Skeletal Muscle Hypertrophy in Young Adults
- A mycoprotein-based high-protein vegan diet supports equivalent daily myofibrillar protein synthesis rates compared with an isonitrogenous omnivorous diet in older adults: a randomised controlled trial
(both studies showed that both dietary approaches yielded results that showed no difference in muscle synthesis between the two)
The bottom line is…
Healthwise, what’s more important than whether you get your protein from animals or plants is that you eat foods that aren’t processed, and are varied.
And if you want to do a suped-up Mediterranean Diet with less red meat, you might want to try:
A Pesco-Mediterranean Diet With Intermittent Fasting: JACC Review Topic of the Week
^This is from a review in the Journal of the American College of Cardiology, and in few words, they recommend it very highly
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Tips For Avoiding/Managing Rheumatoid Arthritis
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Avoiding/Managing Rheumatoid Arthritis
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). These are mostly, but not all, autoimmune diseases, in which the body’s immune system mistakenly attacks our own joints.
Inflammatory vs Non-Inflammatory Arthritis
Arthritis is broadly divided into inflammatory arthritis and non-inflammatory 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, but it’s not as absolutely critical a deal as it is for “inflammatory” forms of arthritis.
We’ll tackle the beast that is osteoarthritis another day, however.
Today we’re going to focus on…
Rheumatoid Arthritis
This is the most common of the autoimmune forms of arthritis. Some quick facts:
- It affects a little under 1% of the global population, but the older we get, the more likely it becomes
- Early onset of rheumatoid arthritis is most likely to show up around the age of 50 (but it can show up at any age)
- However, incidence (not onset) of rheumatoid arthritis peaks in the 70s age bracket
- It is 2–4 times more common in women than in men
- Approximately one third of people stop work within two years of its onset, and this increases thereafter.
Well, that sounds gloomy.
Indeed it’s not fun. There’s a lot of stiffness and aching of joints (often with swelling too), loss of joint function can be common, and then there are knock-on effects like fatigue, weakness, and loss of appetite.
Beyond that it’s an autoimmune disorder, its cause is not known, and there is no known cure.
Is there any good news?
If you don’t have rheumatoid arthritis at the present time, you can reduce your risk factors in several ways:
- Having an anti-inflammatory diet. Get plenty of fiber, greens, and berries. Fatty fish is great too, as are oily nuts. On the other side of things, high consumption of salt, sugar, alcohol, and red meat are associated with a greater risk of developing rheumatoid arthritis.
- Not smoking. Smoking is bad for pretty much everything, including your chances of developing rheumatoid arthritis.
- Not being obese. This one may be more a matter of correlation than causation, because of the dietary factors (if one eats an anti-inflammatory diet, obesity is less likely), but the association is there.
There are other risk factors that are harder to control, such as genetics, age, sex, and having a mother who smoked.
See: Genetic and environmental risk factors for rheumatoid arthritis
What if I already have rheumatoid arthritis?
If you already have rheumatoid arthritis, it becomes a matter of symptom management.
First, reduce inflammation any (reasonable) way you can. We did a main feature on this before, so we’ll just drop that again here:
Next, consider the available medications. Your doctor may or may not have discussed all of the options with you, so be aware that there are more things available than just pain relief. To talk about them all would require a whole main feature, so instead, here’s a really well-compiled list, along with explanations about each of them, up to date as of this year:
Rheumatoid Arthritis Medication List (And What They Do, And How)
Finally, consider other lifestyle adjustments to manage your symptoms. These include:
- Exercise—gently, though! You do not want to provoke a flare-up, but you do want to maintain your mobility as best you can. There’s a use-it-or-lose-it factor here. Swimming and yoga are great options, as is tai chi. You may want to avoid exercises that involve repetitive impacts to your joints, like running.
- Rest—while keeping mobility going. Get good sleep at night (this is important), but don’t make your bed your new home, or your mobility will quickly deteriorate.
- Hot & cold—both can help, and alternating them can reduce inflammation and stiffness by improving your body’s ability to respond appropriately to these stimuli rather than getting stuck in an inappropriate-response state of inflammation.
- Mobility aids—if it helps, it helps. Maybe you only need something during a flare-up, but when that’s the case, you want to be as gentle on your body as possible while keeping moving, so if crutches, handrails etc help, then by all means get them and use them.
- 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:
Managing Chronic Pain (Realistically!)
Take good care of yourself!
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Breakfasting For Health?
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Breakfast Time!
In yesterday’s newsletter, we asked you for your health-related opinions on the timings of meals.
But what does the science say?
Quick recap on intermittent fasting first:
Today’s article will rely somewhat on at least a basic knowledge of intermittent fasting, what it is, and how and why it works.
Armed with that knowledge, we can look at when it is good to break the fast (i.e. breakfast) and when it is good to begin the fast (i.e. eat the last meal of the day).
So, if you’d like a quick refresher on intermittent fasting, here it is:
Intermittent Fasting: We Sort The Science From The Hype
And now, onwards!
One should eat breakfast first thing: True or False?
True! Give or take one’s definition of “first thing”. We did a main feature about this previously, and you can read a lot about the science of it, and see links to studies:
The Circadian Rhythm: Far More Than Most People Know
In case you don’t have time to read that now, we’ll summarize the most relevant-to-today’s-article conclusion:
The optimal time to breakfast is around 10am (this is based on getting sunlight around 8:30am, so adjust if this is different for you)
It doesn’t matter when we eat; calories are calories & nutrients are nutrients: True or False?
Broadly False, for practical purposes. Because, indeed calories are calories and nutrients are nutrients at any hour, but the body will do different things with them depending on where we are in the circadian cycle.
For example, this study in the Journal of Nutrition found…
❝Our results suggest that in relatively healthy adults, eating less frequently, no snacking, consuming breakfast, and eating the largest meal in the morning may be effective methods for preventing long-term weight gain.
Eating breakfast and lunch 5-6 h apart and making the overnight fast last 18-19 h may be a useful practical strategy.❞
Read in full: Meal Frequency and Timing Are Associated with Changes in Body Mass Index
We should avoid eating too late at night: True or False?
False per se, True in the context of the above. Allow us to clarify:
There is nothing inherently bad about eating late at night; there is no “bonus calorie happy hour” before bed.
However…
If we are eating late at night, that makes it difficult to breakfast in the morning (as is ideal) and still maintain a >16hr fasting window as is optimal, per:
❝the effects of the main forms of fasting, activating the metabolic switch from glucose to fat and ketones (G-to-K), starting 12-16 h after cessation or strong reduction of food intake❞
~ Dr. Françoise Wilhelmi de Toledo et al.
So in other words: since the benefits of intermittent fasting start at 12 hours into the fast, you’re not going to get them if you’re breakfasting at 10am and also eating in the evening.
Summary:
- It is best to eat breakfast around 10am, generally (ideally after some sunlight and exercise)
- While there’s nothing wrong with eating in the evening per se, doing so means that a 10am breakfast will eliminate any fasting benefits you might otherwise get
- If a “one meal a day, and that meal is breakfast” lifestyle doesn’t suit you, then one possible good compromise is to have a large breakfast, and then a smaller meal in the late afternoon / early evening.
One last tip: the above is good, science-based information. Use it (or don’t), as you see fit. We’re not the boss of you:
- Maybe you care most about getting the best circadian rhythm benefits, in which case, prioritizing breakfast being a) in the morning and b) the largest meal of the day, is key
- Maybe you care most about getting the best intermittent fasting benefits, in which case, for many people’s lifestyle, a fine option is skipping eating in the morning, and having one meal in the late afternoon / early evening.
Take care!
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You can’t reverse the ageing process but these 5 things can help you live longer
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At this time of year many of us resolve to prioritise our health. So it is no surprise there’s a roaring trade of products purporting to guarantee you live longer, be healthier and look more youthful.
While an estimated 25% of longevity is determined by our genes, the rest is determined by what we do, day to day.
There are no quick fixes or short cuts to living longer and healthier lives, but the science is clear on the key principles. Here are five things you can do to extend your lifespan and improve your health.
1. Eat a predominantly plant-based diet
What you eat has a huge impact on your health. The evidence overwhelmingly shows eating a diet high in plant-based foods is associated with health and longevity.
If you eat more plant-based foods and less meat, processed foods, sugar and salt, you reduce your risk of a range of illnesses that shorten our lives, including heart disease and cancer.
Plant-based foods are rich in nutrients, phytochemicals, antioxidants and fibre. They’re also anti-inflammatory. All of this protects against damage to our cells as we age, which helps prevent disease.
No particular diet is right for everyone but one of the most studied and healthiest is the Mediterranean diet. It’s based on the eating patterns of people who live in countries around the Mediterranean Sea and emphases vegetables, fruits, wholegrains, legumes, nuts and seeds, fish and seafood, and olive oil.
2. Aim for a healthy weight
Another important way you can be healthier is to try and achieve a healthy weight, as obesity increases the risk of a number of health problems that shorten our lives.
Obesity puts strain on all of our body systems and has a whole myriad of physiological effects including causing inflammation and hormonal disturbances. These increase your chances of a number of diseases, including heart disease, stroke, high blood pressure, diabetes and a number of cancers.
In addition to affecting us physically, obesity is also associated with poorer psychological health. It’s linked to depression, low self-esteem and stress.
One of the biggest challenges we face in the developed world is that we live in an environment that promotes obesity. The ubiquitous marketing and the easy availability of high-calorie foods our bodies are hard-wired to crave mean it’s easy to consume too many calories.
3. Exercise regularly
We all know that exercise is good for us – the most common resolution we make this time of year is to do more exercise and to get fitter. Regular exercise protects against chronic illness, lowers your stress and improves your mental health.
While one of the ways exercising helps you is by supporting you to control your weight and lowering your body fat levels, the effects are broader and include improving your glucose (blood sugar) use, lowering your blood pressure, reducing inflammation and improving blood flow and heart function.
While it’s easy to get caught up in all of the hype about different exercise strategies, the evidence suggests that any way you can include physical activity in your day has health benefits. You don’t have to run marathons or go to the gym for hours every day. Build movement into your day in any way that you can and do things that you enjoy.
4. Don’t smoke
If you want to be healthier and live longer then don’t smoke or vape.
Smoking cigarettes affects almost every organ in the body and is associated with both a shorter and lower quality of life. There is no safe level of smoking – every cigarette increases your chances of developing a range of cancers, heart disease and diabetes.
Even if you have been smoking for years, by giving up smoking at any age you can experience health benefits almost immediately, and you can reverse many of the harmful effects of smoking.
If you’re thinking of switching to vapes as a healthy long term option, think again. The long term health effects of vaping are not fully understood and they come with their own health risks.
5. Prioritise social connection
When we talk about living healthier and longer, we tend to focus on what we do to our physical bodies. But one of the most important discoveries over the past decade has been the recognition of the importance of spiritual and psychological health.
People who are lonely and socially isolated have a much higher risk of dying early and are more likely to suffer from heart disease, stroke, dementia as well as anxiety and depression.
Although we don’t fully understand the mechanisms, it’s likely due to both behavioural and biological factors. While people who are more socially connected are more likely to engage in healthy behaviours, there also seems to be a more direct physiological effect of loneliness on the body.
So if you want to be healthier and live longer, build and maintain your connections to others.
Hassan Vally, Associate Professor, Epidemiology, Deakin University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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