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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Going for a bushwalk? 3 handy foods to have in your backpack (including muesli bars)
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This time of year, many of us love to get out and spend time in nature. This may include hiking through Australia’s many beautiful national parks.
Walking in nature is a wonderful activity, supporting both physical and mental health. But there can be risks and it’s important to be prepared.
You may have read the news about hiker, Hadi Nazari, who was recently found alive after spending 13 days lost in Kosciuszko National Park.
He reportedly survived for almost two weeks in the Snowy Mountains region of New South Wales by drinking fresh water from creeks, and eating foraged berries and two muesli bars.
So next time you’re heading out for a day of hiking, what foods should you pack?
Here are my three top foods to carry on a bushwalk that are dense in nutrients and energy, lightweight and available from the local grocery store.
Leah-Anne Thompson/Shutterstock 1. Muesli bars
Nazari reportedly ate two muesli bars he found in a mountain hut. Whoever left the muesli bars there made a great choice.
Muesli bars come individually wrapped, which helps them last longer and makes them easy to transport.
They are also a good source of energy. Muesli bars typically contain about 1,500–1,900 kilojoules per 100 grams. The average energy content for a 35g bar is about 614kJ.
This may be a fraction of what you’d usually need in a day. However, the energy from muesli bars is released at a slow to moderate pace, which will help keep you going for longer.
Muesli bars are also packed with nutrients. They contain all three macronutrients (carbohydrate, protein and fat) that our body needs to function. They’re a good source of carbohydrates, in particular, which are a key energy source. An average Australian muesli bar contains 14g of whole grains, which provide carbohydrates and dietary fibre for long-lasting energy.
Muesli bars that contain nuts are typically higher in fat (19.9g per 100g) and protein (9.4g per 100g) than those without.
Fat and protein are helpful for slowing down the release of energy from foods and the protein will help keep you feeling full for longer.
There are many different types of muesli bars to choose from. I recommend looking for those with whole grains, higher dietary fibre and higher protein content.
2. Nuts
Nuts are nature’s savoury snack and are also a great source of energy. Cashews, pistachios and peanuts contain about 2,300-2,400kJ per 100g while Brazil nuts, pecans and macadamias contain about 2,700-3,000kJ per 100g. So a 30g serving of nuts will provide about 700-900kJ depending on the type of nut.
Just like muesli bars, the energy from nuts is released slowly. So even a relatively small quantity will keep you powering on.
Nuts are also full of nutrients, such as protein, fat and fibre, which will help to stave off hunger and keep you moving for longer.
When choosing which nuts to pack, almost any type of nut is going to be great.
Peanuts are often the best value for money, or go for something like walnuts that are high in omega-3 fatty acids, or a nut mix.
Whichever nut you choose, go for the unsalted natural or roasted varieties. Salted nuts will make you thirsty.
Nut bars are also a great option and have the added benefit of coming in pre-packed serves (although nuts can also be easily packed into re-usable containers).
If you’re allergic to nuts, roasted chickpeas are another option. Just try to avoid those with added salt.
Nuts are nature’s savoury snack and are also a great source of energy. Eakrat/Shutterstock 3. Dried fruit
If nuts are nature’s savoury snack, fruit is nature’s candy. Fresh fruits (such as grapes, frozen in advance) are wonderfully refreshing and perfect as an everyday snack, although can add a bit of weight to your hiking pack.
So if you’re looking to reduce the weight you’re carrying, go for dried fruit. It’s lighter and will withstand various conditions better than fresh fruit, so is less likely to spoil or bruise on the journey.
There are lots of varieties of dried fruits, such as sultanas, dried mango, dried apricots and dried apple slices.
These are good sources of sugar for energy, fibre for fullness and healthy digestion, and contain lots of vitamins and minerals. So choose one (or a combination) that works for you.
Don’t forget water
Next time you head out hiking for the day, you’re all set with these easily available, lightweight, energy- and nutrient-dense snacks.
This is not the time to be overly concerned about limiting your sugar or fat intake. Hiking, particularly in rough terrain, places demands on your body and energy needs. For instance, an adult hiking in rough terrain can burn upwards of about 2,000kJ per hour.
And of course, don’t forget to take plenty of water.
Having access to even limited food, and plenty of fresh water, will not only make your hike more pleasurable, it can save your life.
Margaret Murray, Senior Lecturer, Nutrition, Swinburne University of Technology
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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How To Boost Your Memory Immediately (Without Supplements)
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How To Boost Your Memory (Without Supplements)
While we do recommend having a good diet and taking advantage of various supplements that have been found to help memory, that only gets so much mileage. With that in mind…
First, how good is your memory? Take This 2-Minute Online Test
Now, that was a test of short term memory, which tends to be the most impactful in our everyday life.
It’s the difference between “I remember the address of the house where I grew up” (long-term memory) and “what did I come to this room to do?” (short-term memory / working memory)
First tip:
When you want to remember something, take a moment to notice the details. You can’t have a madeleine moment years later if you wolfed down the madeleines so urgently they barely touched the sides.
This goes for more than just food, of course. And when facing the prospect of age-related memory loss in particular, people tend to be afraid not of forgetting their PIN code, but their cherished memories of loved ones. So… Cherish them, now! You’ll struggle to cherish them later if you don’t cherish them now. Notice the little details as though you were a painter looking at a scene for painting. Involve more senses than just sight, too!
If it’s important, relive it. Relive it now, relive it tomorrow. Rehearsal is important to memory, and each time you relive a memory, the deeper it gets written into your long-term memory until it becomes indelible to all but literal brain damage.
Second tip:
Tell the story of it to someone else. Or imagine telling it to someone else! (You brain can’t tell the difference)
And you know how it goes… Once you’ve told a story a few times, you’ll never forget it later. Isn’t your life a story worth telling?
Many people approach memory like they’re studying for a test. Don’t. Approach it like you’re preparing to tell a story, or give a performance. We are storytelling creatures at heart, whether or not we realize it.
What do you do when you find yourself in a room and wonder why you went there? (We’ve all been there!) You might look around for clues, but if that doesn’t immediately serve, your fallback will be retracing your steps. Literally, physically, if needs be, but at least mentally. The story of how you got there is easier to remember than the smallest bit of pure information.
What about when there’s no real story to tell, but we still need to remember something?
Make up a story. Did you ever play the game “My granny went to market” as a child?
If not, it’s a collaborative memory game in which players take turns adding items to a list, “My granny went to market and bought eggs”, My granny went to market and bought eggs and milk”, “my granny went to market and bought eggs and milk and flour” (is she making a cake?), “my granny went to market and bought eggs and milk and flour and shoe polish” (what image came to mind? Use that) “my granny went to market and bought eggs and milk and flour and shoe polish and tea” (continue building the story in your head), and so on.
When we actually go shopping, if we don’t have a written list we may rely on the simple story of “what I’m going to cook for dinner” and walking ourselves through that story to ensure we get the things we need.
This is because our memory thrives (and depends!) on connections. Literal synapse connections in the brain, and conceptual contextual connections in your mind. The more connections, the better the memory.
Now imagine a story: “I went to Stonehenge, but in the background was a twin-peaked mountain blue. I packed a red suitcase, placing a conch shell inside it, when suddenly I heard a trombone, and…” Ring any bells? These are example items from the memory test earlier, though of course you may have seen different things in a different order.
So next time you want to remember things, don’t study as though for a test. Prepare to tell a story!
Try going through the test again, but this time, ignore their instructions because we’re going to use the test differently than intended (we’re rebels like that). Don’t rush, and don’t worry about the score this time (or even whether or not you saw a given image previously), but instead, build a story as you go. We’re willing to bet that after it, you can probably recite most of the images you saw in their correct order with fair confidence.
Here’s the link again: Take The Same Test, But This Time Make It Story-Worthy!
Again, ignore what it says about your score this time, because we weren’t doing that this time around. Instead, list the things you saw.
What you were just able to list was the result of you doing story-telling with random zero-context images while under time pressure.
Imagine what you can do with actual meaningful memories of your ongoing life, people you meet, conversations you have!
Just… Take the time to smell the roses, then rehearse the story you’ll tell about them. That memory will swiftly become as strong as any memory can be, and quickly get worked into your long-term memory for the rest of your days.
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Escape From The Clutches Of Shame
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We’ve written before about managing various emotions, including “negative” ones. We put that in “scare quotes” because they also all have positive aspects, that are just generally overshadowed by the fact that the emotions themselves are not pleasant. But for example…
We evolved our emotions, including the “negative” ones, for our own benefit as a species:
- Stress keeps us safe by making sure we take important situations seriously
- Anger keeps us safe by protecting us from threats
- Disgust keeps us safe by helping us to avoid things that might cause disease
- Anxiety keeps us safe by ensuring we don’t get complacent
- Guilt keeps us safe by ensuring we can function as a community
- Sadness keeps us safe by ensuring we value things that are important to us, and learn to become averse to losing them
- …and so on
You can read more about how to turn these off (or rather, at least pause them) when they’re misfiring and/or just plain not convenient, here:
While it’s generally considered good to process feelings instead of putting them aside, the fact is that sometimes we have to hold it together while we do something, such that we can later have an emotional breakdown at a convenient time and place, instead of the supermarket or bank or office or airport or while entertaining houseguests or… etc.
Today, though, we’re not putting things aside, for the most part (though we will get to that too).
We’ll be dealing with shame, which is closely linked to the guilt we mentioned in that list there.
See also: Reconsidering the Differences Between Shame and Guilt
Shame’s purpose
Shame’s purpose is to help us (as a community) avoid anti-social behavior for which we might be shamed, and thus exiled from the in-group. It helps us all function better together, which is how we thrive as a species.
Shame, therefore, is often assumed to be something we can (and possibly should) use to ensure that we (ourselves and/or others) “do the right thing”.
But there’s a catch…
Shame only works negatively
You may be thinking “well duh, it’s a negative emotion”, but this isn’t about negativity in the subjective sense, but rather, positive vs negative motivation:
- Positive motivation: motivation that encourages us to do a given thing
- Negative motivation: motivation that encourages us to specifically not do a given thing
Shame is only useful as a negative motivation, i.e., encouraging us to specifically not do a given thing.
Examples:
- You cannot (in any way that sticks, at least) shame somebody into doing more housework.
- You can, however, shame somebody out of drinking and driving.
This distinction matters a lot when it comes to how we are with our children, or with our employees (or those placed under us in a management structure), or with people who otherwise look to us as leaders.
It also matters when it comes to how we are with ourselves.
Here’s a paper about this, by the way, with assorted real-world examples:
The negative side of motivation: the role of shame
From those examples, we can see that attempts to shame someone (including oneself) into doing something positive will generally not only fail, they will actively backfire, and people (including oneself) will often perform worse than pre-shaming.
Looking inwards: healthy vs unhealthy shame
Alcoholics Anonymous and similar programs use a degree of pro-social shame to help members abstain from the the act being shamed.
Rather than the unhelpful shame of exiling a person from a group for doing a shameful thing, however, they take an approach of laying out the shame for all to see, feeling the worst of it and moving past it, which many report as being quite freeing emotionally while still [negatively] motivational to not use the substance in question in the future (and similar for activity-based addictions/compulsions, such as gambling, for example).
As such, if you are trying to avoid doing a thing, shame can be a useful motivator. So by all means, if it’s appropriate to your goals, tell your friends/family about how you are now quitting this or that (be it an addiction, or just something generally unhealthy that you’d like to strike off your regular consumption/activity list).
You will still be tempted! But the knowledge of the shame you would feel as a result will help keep you from straying into that temptation.
If you are trying to do a thing, however, (even something thought of in a negative frame, such as “lose weight”), then shame is not helpful and you will do best to set it aside.
You can shame yourself out of drinking sodas (if that’s your plan), but you can’t shame yourself into eating healthy meals. And even if your plan is just shaming yourself out of eating unhealthy food… Without a clear active positive replacement to focus on instead, all you’ll do there is give yourself an eating disorder. You’ll eat nothing when people are looking, and then either a) also eat next to nothing in private or else b) binge in secret, and feel terrible about yourself, neither of which are any good for you whatsoever.
Similarly, you can shame yourself out of bed, but you can’t shame yourself into the gym:
Let it go
There are some cases, especially those where shame has a large crossover with guilt, that it serves no purpose whatsoever, and is best processed and then put aside.
For example, if you did something that you are ashamed of many years ago, and/or feel guilty about something that you did many years ago, but this is not an ongoing thing for you (i.e., it was a one-off bad decision, or a bad habit that have now long since dropped), then feeling shame and/or guilt about that does not benefit you or anyone else.
As to how to process it and put it aside, if your thing harmed someone else, you could see if there’s a way to try to make amends (even if without confessing ill, such as by acting anonymously to benefit the person/group you harmed).
And then, forgive yourself. Regardless of whether you feel like you deserve it. Make the useful choice, that better benefits you, and by extension those around you.
If you are religious, you may find that of help here too. We’re a health science publication not a theological one, but for example: Buddhism preaches compassion including for oneself. Judaism preaches atonement. Christianity, absolution. For Islam, mercy is one of the holiest ideals of the religion, along with forgiveness. So while religion isn’t everyone’s thing, for those for whom it is, it can be an asset in this regard.
For a more worldly approach:
To Err Is Human; To Forgive, Healthy (Here’s How To Do It) ← this goes for when the forgiveness in question is for yourself, too—and we do write about that there (and how)!
Take care!
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These Top Few Things Make The Biggest Difference To Health
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The Best Few Interventions For The Best Health
Writer’s note: I was going to do something completely different for today (so that can go out another week now), but when reflecting on my own “what should I focus on in the new year?” (in terms of my own personal health goals and such) it occured to me that I should look back on the year’s articles, to take our own advice myself, and see what most important things I should make sure to focus on.
In so doing for myself, it occured to me that you, our subscribers who like condensed information and simple interventions for big positive effects, might also find value in a similar once-over. And so, today’s main feature was born!
Sometimes at 10almonds we talk about “those five things that affect everything”. They are:
- Good diet
- Good exercise
- Good sleep
- Not drinking
- Not smoking
If we were to add a sixth in terms of things that make a huge difference, it would be “manage stress effectively” and a seventh, beyond the scope of our newsletter, would be “don’t be socioeconomically disadvantaged” (e.g. poor, and/or part of some disprivileged minority group).
But as for those five we listed, it still leaves the question: what are the few most effective things we can do to improve them? Where can we invest our time/energy/effort for greatest effect?
Good diet
Best current science consistently recommends the Mediterranean Diet:
The Mediterranean Diet: What Is It Good For?
But it can be tweaked for specific desired health considerations:
Four Ways To Upgrade The Mediterranean Diet
Other most-effective dietary tweaks that impact a lot of other areas of health include looking after your gut health and looking after your blood sugars:
Making Friends With Your Gut (You Can Thank Us Later)
and
“Let Them Eat Cake”, She Said (10 Ways To Balance Blood Sugars)
Good exercise
Most exercise is good, but two of the most beneficial things that are (for most people) easy to implement are walking, and High-Intensity Interval Training:
How To Do HIIT (Without Wrecking Your Body)
Good sleep
This means quality and quantity! We cannot skimp on either and expect good health:
Why You Probably Need More Sleep
and as for quality,
The Head-To-Head Of Google and Apple’s Top Apps For Getting Your Head Down
Not drinking
According to the World Health Organization, the only safe amount of alcohol is zero.
See also:
Can We Drink To Good Health? (e.g. Red Wine & Heart Health)
and
Not smoking
We haven’t done a main feature on this! It’s probably not really necessary, as it’s not very contentious to say “smoking is bad for everything”.
WHO | Tobacco kills up to half its users who don’t quit
However, as a side-note, while cannabis is generally recognised as not as harmful as tobacco-based products, it has some fairly major drawbacks too. For some people, the benefits (e.g. pain relief) may outweigh the risks, though:
Final thoughts
Not sure where to start? We suggest this order of priorities, unless you have a major health condition that makes something else a higher priority:
- If you smoke, stop
- If you drink, reduce, or ideally stop
- Improve your diet
About that diet…
- Worry less about what to exclude, and instead focus on adding more variety of fruit/veg
- See also: Level-Up Your Fiber Intake! (Without Difficulty Or Discomfort)
- That said, if you’re looking for things to cut, sugar is a top candidate (and red meat is in clear second place albeit some way below)
When it comes to exercise, get your 10,000 daily steps in (actually, science says 8,000 steps is fine), and consider adding HIIT per our above article, when you feel like adding that in. As for that about the steps:
When it comes to sleep, if you’re taking care of the above things, and set a regular early wake-up time that you do not deviate from, then this will probably take care of itself, if you don’t have a sleep-inconvenient lifestyle (e.g. shift work, just had a baby, etc) or a sleep disorder.
For further pointers, see: 10 Tips for Better Sleep: Starting In The Morning
Take care!
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What’s Missing from Medicine – by Dr. Saray Stancic
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Another from the ranks of “doctors who got a serious illness and it completely changed how they view the treatment of serious illness”, Dr. Stancic was diagnosed with multiple sclerosis, and wasn’t impressed with the treatments presented.
Taking an evidence-based lifestyle medicine approach, she was able to not only manage her illness sufficiently to resume her normal activities, but even when so far as to run a marathon, and today boasts a symptom-free, active life.
The subtitular six lifestyle changes are not too shocking, and include a plants-centric diet, good exercise, good sleep, stress management, avoidance of substance abuses, and a fostering of social connections, but the value here is in what she has to say about each, especially the ones that aren’t so self-explanatory and/or can even cause harm if done incorrectly (such as exercise, for example).
The style is on the academic end of pop-science, of the kind that has frequent data tables, lots of statistics, and an extensive bibliography, but is still very readable.
Bottom line: if you are faced with a chronic disease, or even just an increased risk of some chronic disease, or simply like to not take chances, then this is a high-value book for you.
Click here to check out What’s Missing From Medicine, and enjoy chronic good health!
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Salmon vs Tuna – Which is Healthier?
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Our Verdict
When comparing salmon to tuna, we picked the tuna.
Why?
It’s close, and there are merits and drawbacks to both!
In terms of macros, tuna is higher in protein, while salmon is higher in fats. How healthy are the fats, you ask? Well, it’s a mix, because while there are plenty of “good” fats in salmon, salmon is also 10x higher in saturated fat and 150% higher in cholesterol.
So when it comes to fats, if you want to eat fish and have the healthiest fats, one option is to skip the salmon, and instead serve tuna with some extra virgin olive oil.
We’ll call this section a clear win for tuna.
On the vitamin front, they are close to equal. Salmon has more of some vitamins, tuna has more of others; all in all we’d say the balance is in salmon’s favor, but by the time a portion of salmon is giving you 350% of your daily requirement, does it really matter that the same portion of tuna is “only” giving you 294% of the daily requirement? It goes like that for a lot of the vitamins they both contain.
Still, we’ll call this section a nominal win for salmon.
In the category of minerals, tuna is much higher in iron while salmon is higher in calcium. The rest of the minerals they both have, tuna is comfortably higher—and since the “% of RDA in a portion” figures are double-digit here rather than triple, those margins are relevant this time.
We’ll call this section a moderate win for tuna.
Both fish carry a risk of mercury poisoning, but this varies more by location than by fish, so it hasn’t been a consideration in this head-to-head.
Totting up the sections, this a modest but clear win for tuna.
Want to learn more?
You might like to read:
Farmed Fish vs Wild-Caught: Important Differences!
Take care!
Don’t Forget…
Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!
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