Surgery won’t fix my chronic back pain, so what will?
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This week’s ABC Four Corners episode Pain Factory highlighted that our health system is failing Australians with chronic pain. Patients are receiving costly, ineffective and risky care instead of effective, low-risk treatments for chronic pain.
The challenge is considering how we might reimagine health-care delivery so the effective and safe treatments for chronic pain are available to millions of Australians who suffer from chronic pain.
One in five Australians aged 45 and over have chronic pain (pain lasting three or more months). This costs an estimated A$139 billion a year, including $12 billion in direct health-care costs.
The most common complaint among people with chronic pain is low back pain. So what treatments do – and don’t – work?
Opioids and invasive procedures
Treatments offered to people with chronic pain include strong pain medicines such as opioids and invasive procedures such as spinal cord stimulators or spinal fusion surgery. Unfortunately, these treatments have little if any benefit and are associated with a risk of significant harm.
Spinal fusion surgery and spinal cord stimulators are also extremely costly procedures, costing tens of thousands of dollars each to the health system as well as incurring costs to the individual.
Addressing the contributors to pain
Recommendations from the latest Australian and World Health Organization clinical guidelines for low back pain focus on alternatives to drug and surgical treatments such as:
- education
- advice
- structured exercise programs
- physical, psychological or multidisciplinary interventions that address the physical or psychological contributors to ongoing pain.
Two recent Australian trials support these recommendations and have found that interventions that address each person’s physical and psychological contributors to pain produce large and sustained improvements in pain and function in people with chronic low back pain.
The interventions have minimal side effects and are cost-effective.
In the RESOLVE trial, the intervention consists of pain education and graded sensory and movement “retraining” aimed to help people understand that it’s safe to move.
In the RESTORE trial, the intervention (cognitive functional therapy) involves assisting the person to understand the range of physical and psychological contributing factors related to their condition. It guides patients to relearn how to move and to build confidence in their back, without over-protecting it.
Why isn’t everyone with chronic pain getting this care?
While these trials provide new hope for people with chronic low back pain, and effective alternatives to spinal surgery and opioids, a barrier for implementation is the out-of-pocket costs. The interventions take up to 12 sessions, lasting up to 26 weeks. One physiotherapy session can cost $90–$150.
In contrast, Medicare provides rebates for just five allied health visits (such as physiotherapists or exercise physiologists) for eligible patients per year, to be used for all chronic conditions.
Private health insurers also limit access to reimbursement for these services by typically only covering a proportion of the cost and providing a cap on annual benefits. So even those with private health insurance would usually have substantial out-of-pocket costs.
Access to trained clinicians is another barrier. This problem is particularly evident in regional and rural Australia, where access to allied health services, pain specialists and multidisciplinary pain clinics is limited.
Higher costs and lack of access are associated with the increased use of available and subsidised treatments, such as pain medicines, even if they are ineffective and harmful. The rate of opioid use, for example, is higher in regional Australia and in areas of socioeconomic disadvantage than metropolitan centres and affluent areas.
So what can we do about it?
We need to reform Australia’s health system, private and public, to improve access to effective treatments for chronic pain, while removing access to ineffective, costly and high-risk treatments.
Better training of the clinical workforce, and using technology such as telehealth and artificial intelligence to train clinicians or deliver treatment may also improve access to effective treatments. A recent Australian trial, for example, found telehealth delivered via video conferencing was as effective as in-person physiotherapy consultations for improving pain and function in people with chronic knee pain.
Advocacy and improving the public’s understanding of effective treatments for chronic pain may also be helpful. Our hope is that coordinated efforts will promote the uptake of effective treatments and improve the care of patients with chronic pain.
Christine Lin, Professor, University of Sydney; Christopher Maher, Professor, Sydney School of Public Health, University of Sydney; Fiona Blyth, Professor, University of Sydney; James Mcauley, Professor of Psychology, UNSW Sydney, and Mark Hancock, Professor of Physiotherapy, Macquarie University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Junk Food Turns Public Villain as Power Shifts in Washington
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The new Trump administration could be coming for your snacks.
For years, the federal government has steered clear of regulating junk food, fast food, and ultra-processed food.
Now attitudes are changing. Some members of President-elect Donald Trump’s inner circle are gearing up to battle “Big Food,” or the companies that make most of the food and beverages consumed in the United States. Nominees for top health agencies are taking aim at ultra-processed foods that account for an estimated 70% of the nation’s food supply. Based on recent statements, a variety of potential politically charged policy options to regulate ultra-processed food may land on the Trump team menu, including warning labels, changes to agribusiness subsidies, and limits on which products consumers can buy with government food aid.
The push to reform the American diet is being driven largely by conservatives who have taken up the cause that has long been a darling of the left. Trump supporters such as Robert F. Kennedy Jr., whose controversial nomination to lead the Department of Health and Human Services still faces Senate confirmation, are embracing a concept that champions natural foods and alternative medicine. It’s a movement they’ve dubbed “MAHA,” or Make America Healthy Again. Their interest has created momentum because their goals have fairly broad bipartisan support even amid a bitterly divided Congress in which lawmakers from both sides of the aisle focused on the issue last year.
It’s likely to be a pitched battle because the food industry wields immense political influence and has successfully thwarted previous efforts to regulate its products or marketing. The category of “food processing and sales companies,” which includes Tyson Foods and Nestle SA, tallied $26.7 million in spending on lobbying in 2024, according to OpenSecrets. That’s up from almost $10 million in 1998.
“They have been absolutely instrumental and highly, highly successful at delaying any regulatory effectiveness in America,” said Laura Schmidt, a health policy professor at the University of California-San Francisco. “It really does feel like there needs to be a moment of reckoning here where people start asking the question, ‘Why do we have to live like this?’”
“Ultra-processed food” is a widely used term that means different things to different people and is used to describe items ranging from sodas to many frozen meals. These products often contain added fats, starches, and sugars, among other things. Researchers say consumption of ultra-processed foods is linked — in varying levels of intensity — to chronic conditions like diabetes, cancer, mental health problems, and early death.
Nutrition and health leaders are optimistic that a reckoning is already underway. Kennedy has pledged to remove processed foods from school lunches, restrict certain food additives such as dyes in cereal, and shift federal agricultural subsidies away from commodity crops widely used in ultra-processed foods.
The intensifying focus in Washington has triggered a new level of interest on the legal front as lawyers explore cases to take on major foodmakers for selling products they say result in chronic disease.
Bryce Martinez, now 18, filed a lawsuit in December against almost a dozen foodmakers such as Kraft Heinz, The Coca-Cola Co., and Nestle USA. He developed diabetes and non-alcoholic fatty liver disease by age 16, and is seeking to hold them accountable for his illnesses. According to the suit, filed in the Philadelphia Court of Common Pleas, the companies knew or should have known ultra-processed foods were harmful and addictive.
The lawsuit noted that Martinez grew up eating heavily advertised, brand-name foods that are staples of the American diet — sugary soft drinks, Cheerios and Lucky Charms, Skittles and Snickers, frozen and packaged dinners, just to name a few.
Nestle, Coca-Cola, and Kraft Heinz didn’t return emails seeking comment for this article. The Consumer Brands Association, a trade association for makers of consumer packaged goods, disputed the allegations.
“Attempting to classify foods as unhealthy simply because they are processed, or demonizing food by ignoring its full nutrient content, misleads consumers and exacerbates health disparities,” said Sarah Gallo, senior vice president of product policy, in a statement.
Other law firms are on the hunt for children or adults who believe they were harmed by consuming ultra-processed foods, increasing the likelihood of lawsuits.
One Indiana personal injury firm says on its website that “we are actively investigating ultra processed food (UPF) cases.” Trial attorneys in Texas also are looking into possible legal action against the federal regulators they say have failed to police ultra-processed foods.
“If you or your child have suffered health problems that your doctor has linked directly to the consumption of ultra-processed foods, we want to hear your story,” they say on their website.
Meanwhile, the FDA on Jan. 14 announced it is proposing to require a front-of-package label to appear on most packaged foods to make information about a food’s saturated fat, sodium, and added sugar content easily visible to consumers.
And on Capitol Hill, Sens. Bernie Sanders (I-Vt.), Ron Johnson (R-Wis.), and Cory Booker (D-N.J.) are sounding the alarm over ultra-processed food. Sanders introduced legislation in 2024 that could lead to a federal ban on junk food advertising to children, a national education campaign, and labels on ultra-processed foods that say the products aren’t recommended for children. Booker cosigned the legislation along with Sens. Peter Welch (D-Vt.) and John Hickenlooper (D-Colo.).
The Senate Committee on Health, Education, Labor and Pensions held a December hearing examining links between ultra-processed food and chronic disease during which FDA Commissioner Robert Califf called for more funding for research.
Food companies have tapped into “the same neural circuits that are involved in opioid addiction,” Califf said at the hearing.
Sanders, who presided over the hearing, said there’s “growing evidence” that “these foods are deliberately designed to be addictive,” and he asserted that ultra-processed foods have driven epidemics of diabetes and obesity, and hundreds of billions of dollars in medical expenses.
Research on food and addiction “has accumulated to the point where it’s reached a critical mass,” said Kelly Brownell, an emeritus professor at Stanford who is one of the editors of a scholarly handbook on the subject.
Attacks from three sides — lawyers, Congress, and the incoming Trump administration, all seemingly interested in taking up the fight — could lead to enough pressure to challenge Big Food and possibly spur better health outcomes in the U.S., which has the lowest life expectancy among high-income countries.
“Maybe getting rid of highly processed foods in some things could actually flip the switch pretty quickly in changing the percentage of the American public that are obese,” said Robert Redfield, a virologist who led the Centers for Disease Control and Prevention during the previous Trump administration, in remarks at a December event hosted by the Heritage Foundation, a conservative think tank.
Claims that Big Food knowingly manufactured and sold addictive and harmful products resemble the claims leveled against Big Tobacco before the landmark $206 billion settlement was reached in 1998.
“These companies allegedly use the tobacco industry’s playbook to target children, especially Black and Hispanic children, with integrated marketing tie-ins with cartoons, toys, and games, along with social media advertising,” Rene Rocha, one of the lawyers at Morgan & Morgan representing Martinez, told KFF Health News.
The 148-page Martinez lawsuit against foodmakers draws from documents made public in litigation against tobacco companies that owned some of the biggest brands in the food industry.
Similar allegations were made against opioid manufacturers, distributors, and retailers before they agreed to pay tens of billions of dollars in a 2021 settlement with states.
The FDA ultimately put restrictions on the labeling and marketing of tobacco, and the opioid epidemic led to legislation that increased access to lifesaving medications to treat addiction.
But the Trump administration’s zeal in taking on Big Food may face unique challenges.
The ability of the FDA to impose regulation is hampered in part by funding. While the agency’s drug division collects industry user fees, its division of food relies on a more limited budget determined by Congress.
Change can take time because the agency moves at what some critics call a glacial pace. Last year, the FDA revoked a regulation allowing brominated vegetable oil in food products. The agency determined in 1970 that the additive was not generally recognized as safe.
Efforts to curtail the marketing of ultra-processed food could spur lawsuits alleging that any restrictions violate commercial speech protected by the First Amendment. And Kennedy — if he is confirmed as HHS secretary — may struggle to get support from a Republican-led Congress that champions less federal regulation and a president-elect who during his previous term served fast food in the White House.
“The question is, will RFK be able to make a difference?” said David L. Katz, a doctor who founded True Health Initiative, a nonprofit group that combats public health misinformation. “No prior administration has done much in this space, and RFK is linked to a particularly anti-regulatory administration.”
Meanwhile, the U.S. population is recognized as among the most obese in the world and has the highest rate of people with multiple chronic conditions among high-income countries.
“There is a big grassroots effort out there because of how sick we are,” said Jerold Mande, who served as deputy undersecretary for food safety at the Department of Agriculture from 2009 to 2011. “A big part of it is people shouldn’t be this sick this young in their lives. You’re lucky if you get to 18 without a chronic disease. It’s remarkable.”
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Subscribe to KFF Health News’ free Morning Briefing.
This article first appeared on KFF Health News and is republished here under a Creative Commons license.
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What the Most Successful People Do Before Breakfast – by Laura Vanderkram
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First, what this is not:this is not a rehash of “The 5AM Club”, and nor is it a rehash of “The Seven Habits of Highly Effective People”.
What it is: packed with tips about time management for real people operating here in the real world. The kind of people who have non-negotiable time-specific responsibilities, and frequent unavoidable interruptions. The kind of people who have partners, families, and personal goals and aspirations too.
The “two other short guides” mentioned in the subtitle are her other books, whose titles start the same but instead of “…before Breakfast”, substitute:
- …on the Weekend
- …at Work
However, if you’re retired (we know many of our subscribers are), this still applies to you:
- The “weekend” book is about getting the most out of one’s leisure time, and we hope you have that too!
- The “work” book is about not getting lost in the nitty-gritty of the daily grind, and instead making sure to keep track of the big picture. You probably have this in your personal projects, too!
Bottom line: if, in the mornings, it sometimes seems like your get-up-and-go has got up and gone without you, then you will surely benefit from this book that outstrips its competitors in usefulness and applicability.
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Jackfruit vs Durian – Which is Healthier?
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Our Verdict
When comparing jackfruit to durian, we picked the durian.
Why?
Durian may look and smell like it has come directly from Hell, but there’s a lot of goodness in there!
First, let’s talk macros: jackfruit and durian are both unusually high in protein, for fruits. That said, jackfruit does have slightly more protein—but durian has more than 2x the fiber, for only slightly more carbs, so we call this section a win for durian.
Like most fruits, these two are an abundance source of vitamins; jackfruit has more of vitamins A and E, while durian has more of vitamins B1, B2, B3, B9, and C. Another win for durian.
When it comes to minerals, jackfruit has more calcium, while durian has more copper, iron, manganese, phosphorus, and zinc. We don’t usually measure this one as there’s not much in most foods (unless added in artificially), but durian is also high in sulfur, specifically in “volatile sulfur compounds”, which account for some of its smell, and are—notwithstanding the alarming name—harmless. In any case, mineral content is another win for durian.
These three things add up to one big win for durian.
There is one thing to watch out for, though: durian inhibits aldehyde dehydrogenase, which the body uses to metabolize alcohol. So, we recommend you don’t drink-and-durian, as it can increase the risk of alcohol poisoning, and even if alcohol consumption is moderate, it’ll simply stay in your system for longer, doing more damage while it’s there. Of course, it is best to simply avoid drinking alcohol regardless, durian or no durian, but the above is good to know for those who do imbibe.
A final word on durians: if you haven’t had it before, or had it and it was terrible, then know: much like a banana or an avocado, durian has a rather brief “ideal ripeness” phase for eating. It should be of moderate firmness; neither tough nor squishy. It should not have discolored spikes, nor should it have little holes in, nor be leaking fluid, and it should not smell of sweat and vinegar, although it should smell like sulfurous eggs, onions, and cheese. Basically, if it smells like a cheese-and-onion omelette made in Hell, it’s probably good. If it smells like something that died and then was kept warm in someone’s armpit for a day, it’s probably not. The best way to have a good first experience with a durian is to enjoy one with someone who knows and enjoys durians, as they will be able to pick one that’s right, and will know if it’s not (durian-sellers may not necessarily have your best interests at heart, and may seek to palm off over-ripe durians on people who don’t know better).
Enjoy!
Want to learn more?
You might like to read:
What’s Your Plant Diversity Score?
Take care!
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Red Lentils vs Oats – Which is Healthier?
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Our Verdict
When comparing red lentils to oats, we picked the oats.
Why?
In terms of macros, oats have more protein, carbs, fiber, and even a little fat—mostly healthy mono- and polyunsaturated fats, thus making them the more nutritionally dense. That said, red lentils have the lower glycemic index, (low GI compared to oats’ medium GI) which offsets that, so we’ll call this category a tie.
In the category of vitamins, red lentils have more of vitamins B6, B9, and choline, while oats have more of vitamins B1, B2, and B5. Another tie!
When it comes to minerals, however, we have a tiebreaker category: red lentils have more selenium, while oats have more calcium, copper, iron, magnesium, manganese, phosphorus, potassium, and zinc. An easy win for oats this time!
So, thanks to the minerals, oats are the clear winner in total. But by all means, enjoy either or both; diversity is good!
Want to learn more?
You might like to read:
The Best Kind Of Fiber For Overall Health? ← it’s β-glucan, the kind find in oats!
Enjoy!
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Watch Out For Lipedema
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Lipedema occurs mostly in women, mostly in times of hormonal change, with increasing risk as time goes by (so for example, puberty yields a lower risk than pregnancy, which yields a lower risk than menopause).
Its name literally means “fat swelling”, and can easily be mistaken for obesity or, in its earlier stages, just pain old cellulite.
Cellulite, by the way, is completely harmless and is also not, per se, an indicator of bad health. But if you have it and don’t like it, you can reduce it:
Obesity is more of a complex matter, and one that we’ve covered here:
Lipedema is actively harmful
Lipedema can become a big problem, because lifestyle change does not reduce lipedema fat, the fat is painful, can lead to obesity if one was not already obese, causes gait and joint abnormalities, causes fatigue, can lead to lymphedema (beyond the scope of today’s article—perhaps another time!) and very much psychosocial distress.
Like many conditions that mostly affect women, the science is… Well, here’s a recent example review that was conducted and published:
Fun fact: in Romanian there is an expression “one eye is laughing; the other is crying”, and it seems appropriate here.
Spot the signs
Because it’s most readily mistaken for cellulite in first presentation, let’s look at the differences between them:
- Cellulite is characterized by dimpled, bumpy, or even skin; lipedema is the same but with swelling too.
- Cellulite is a connective tissue condition; lipedema is too (at least in part), but also involves the abnormal accumulation and deposition of fat cells, rather than just pulling some down a bit.
- Cellulite has no additional symptoms; lipedema soon also brings swollen limbs, joint pain, and/or skin that’s “spongy” and easily bruised.
What to do about it
First, get it checked out by a doctor.
If the doctor says it is just cellulite or obesity, ask them what difference(s) they are basing that on, and ask that they confirm in writing having dismissed your concerns (having this will be handy later if it turns out to be lipedema after all).
If it is lipedema, you will want to catch it early; there is no known cure, but advanced symptoms are a lot easier to keep at bay than they are to reverse once they’ve shown up.
Weight maintenance, skin care (including good hydration), and compression therapy have all been shown to help slow the progression.
If it is allowed to progress unhindered, that’s when a lot more fat accumulation and joint pain is likely to occur. Liposuction and surgery are options, but even they are only a temporary solution, and are obviously not fun things to have to go through.
Prevention is, as ever, much better than
curetreatment ← because there is no known cureOne last thing
Lipedema’s main risk factor is genetic. The bad news is, there’s not much that can be done about that for now, but the good news is, you can at least get the heads-up about whether you are at increased risk or not, and be especially vigilant if you’re in the increased risk group. See also:
One Test, Many Warnings: The Real Benefit Of Genetic Testing
Take care!
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Acid Reflux After Meals? Here’s How To Stop It Naturally
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Harvard-trained gastroenterologist Dr. Saurabh Sethi advises:
Calming it down
First of all, what it actually is and how it happens: acid reflux occurs when the lower esophageal sphincter (LES) doesn’t close properly, allowing stomach acid to flow back into the esophagus. Chronic acid reflux is known as gastroesophageal reflux disease (GERD). Symptoms can include heartburn, an acid taste in the mouth, belching, bloating, sore throat, and a persistent cough—but most people do not get all of the symptoms, usually just some.
Things that help it acutely (as in, you can do them today and they will help today): consider skipping certain foods/substances like peppermint, tomatoes, chocolate, alcohol, and caffeine, which can worsen acid reflux. Eating smaller, more frequent meals instead of large ones and leaving a gap of 3–4 hours before lying down after meals can also help manage symptoms.
Things that can help it chronically (as in, you do them in an ongoing fashion and they will help in an ongoing fashion): lifestyle changes like quitting smoking, reducing alcohol intake, and wearing loose clothing can strengthen the LES. Maintaining a healthy weight and avoiding large meals, especially close to bedtime, can also reduce symptoms. Elevating the upper body while sleeping (using a wedge pillow or raising the bed by 10–20°) can make a big difference.
Medications to avoid, if possible, include: aspirin, ibuprofen, and calcium channel blockers.
Some drinks you can enjoy that will help: drinking water can quickly dilute stomach acid and provide relief. Herbal teas like basil tea, fennel tea, and ginger tea are also effective. But notably: not peppermint tea! Since, as mentioned earlier, peppermint is a known trigger for acid reflux (despite peppermint’s usual digestion-improving properties).
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 to read:
Coughing/Wheezing After Dinner? Here’s How To Fix It ← this is about acid reflux and more
Take care!
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