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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The Kitchen Doctor
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Dr. Rupy Aujla: The Kitchen Doctor
This is Dr. Rupy Aujla, and he’s a medical doctor. He didn’t set out to become a “health influencer”.
But then, a significant heart condition changed his life. Having a stronger motivation to learn more about nutritional medicine, he did a deep dive into the scientific literature, because that’s what you do when your life is on the line, especially if you’re a doctor!
Using what he learned, he was able to reverse his condition using a food and lifestyle approach. Now, he devotes himself to sharing what he learned—and what he continues to learn as he goes along.
One important thing he learned because of what happened to him, was that he hadn’t been paying enough attention to what his body was trying to tell him.
He wants us to know about interoception—which isn’t a Chris Nolan movie. Rather, interoception is the sense of what is going on inside one’s own body.
The counterpart of this is exteroception: our ability to perceive the outside world by means of our various senses.
Interoception is still using the senses, but is sensing internal body sensations. Effectively, the brain interprets and integrates what happens in our organs.
When interoception goes wrong, researchers found, it can lead to a greater likelihood of mental health problems. Having an anxiety disorder, depression, mood disorder, or an eating disorder often comes with difficulties in sensing what is going on inside the body.
Improving our awareness of body cues
Those same researchers suggested therapies and strategies aimed at improving awareness of mind-body connections. For example, mindfulness-based stress reduction, yoga, meditation and movement-based treatments. They could improve awareness of body cues by attending to sensations of breathing, cognitions and other body states.
But where Dr. Aujla puts his focus is “the heart of the home”, the kitchen.
The pleasure of food
❝Eating is not simply ingesting a mixture of nutrients. Otherwise, we would all be eating astronaut food. But food is not only a tool for health. It’s also an important pleasure in life, allowing us to connect to others, the present moment and nature.❞
Dr. Rupy Aujla
Dr. Aujla wants to help shift any idea of a separation between health and pleasure, because he believes in food as a positive route to well-being, joy and health. For him, it starts with self-awareness and acceptance of the sensory pleasures of eating and nourishing our bodies, instead of focusing externally on avoiding perceived temptations.
Most importantly:
We can use the pleasure of food as an ally to healthy eating.
Instead of spending our time and energy fighting the urge to eat unhealthy things that may present a “quick fix” to some cravings but aren’t what our body actually wants, needs, Dr. Aujla advises us to pay just a little more attention, to make sure the body’s real needs are met.
His top tips for such are:
- Create an enjoyable relaxing eating environment
To help cultivate positive emotions around food and signal to the nervous system a shift to food-processing time. Try setting the table with nothing else on it beyond what’s relevant to the dinner, putting away distractions, using your favorite plates, tablecloth, etc.
- Take 3 deep abdominal breaths before eating
To help you relax and ground yourself in the present moment, which in turn is to prepare your digestive system to receive and digest food.
- Pay attention to the way you sit
Take some time to sit comfortably with your feet grounded on the floor, not slouching, to give your stomach space to digest the food.
- Appreciate what it took to bring this food to your plate
Who was involved in the growing process and production, the weather and soil it took to grow the food, and where in the world it came from.
- Enjoy the sensations
When you’re cooking, serving, and eating your food, be attentive to color, texture, aroma and even sound. Taste the individual ingredients and seasonings along the way, when safe and convenient to do so.
- Journal
If you like journaling, you can try adding a mindful eating section to that. Ask questions such as: “how did I feel before, during, and after the meal?”
In closing…
Remember that this is a process, not only on an individual level but as a society too.
Oftentimes it’s hard to eat healthily… We can be given to wonder even “what is healthy, after all?”, and we can be limited by what is available, what is affordable, and what we have time to prepare.
But if we make a conscious commitment to make the best choices we reasonably can as we go along, then small changes can soon add up.
Interested in what kind of recipes Dr. Aujla goes for?
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Vitamin C (Drinkable) vs Vitamin C (Chewable) – Which is Healthier?
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Our Verdict
When comparing vitamin C (drinkable) to vitamin C (chewable), we picked the drinkable.
Why?
First let’s look at what’s more or less the same in each:
- The usable vitamin C content is comparable
- The bioavailability is comparable
- The additives to hold it together are comparable
So what’s the difference?
With the drinkable, you also drink a glass of water
If you’d like to read more about how to get the most out of the vitamins you take, you can do so here:
Are You Wasting Your Vitamins? Maybe, But You Don’t Have To
If you’d like to get some of the drinkable vitamin C, here’s an example product on Amazon
Enjoy!
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Apples vs Bananas – Which is Healthier?
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Our Verdict
When comparing apples to bananas, we picked the bananas.
Why?
Both apples and bananas contain lots of vitamins, but bananas contain far more of Vitamins A, B, and C.
Apples beat bananas only for vitamins E and K.
This may seem like “well that’s 2 vs 3; that’s pretty close” until one remembers that vitamin B is actually eight vitamins in a trenchcoat. Bananas have more of vitamins B1, B2, B3, B5, B6, and B9.
If you’re wondering about the other numbers: neither fruit contains vitamins B7 (biotin) or B12 (cobalamins of various kinds). Vitamins B4, B8, B10, and B11 do not exist as such (due to changes in how vitamins are classified).
Both apples and bananas contain lots of minerals, but bananas contain far more of iron, magnesium, phosphorus, potassium, zinc, copper, manganese, and selenium.
Apples beat bananas only for calcium (and then, only very marginally)
Both apples and bananas have plenty of fiber.
Apples have marginally less sugar, but given the fiber content, this is pretty much moot when it comes to health considerations, and apples are higher in fructose in any case.
In short, both are wonderful fruits (and we encourage you to enjoy both!), and/but bananas beat apples healthwise in almost all measures.
PS: top tip if you find it challenging to get bananas at the right level of ripeness for eating… Try sun-dried! Not those hard chip kinds (those are mechanically and/or chemically dried, and usually have added sugar and preservatives), but sun-dried.
Here’s an example product on Amazon
Warning: since there aren’t many sun-dried bananas available on Amazon, double-check you haven’t been redirected to mechanically/chemically dried ones, as Amazon will try that sometimes!
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Hearing loss is twice as common in Australia’s lowest income groups, our research shows
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Around one in six Australians has some form of hearing loss, ranging from mild to complete hearing loss. That figure is expected to grow to one in four by 2050, due in a large part to the country’s ageing population.
Hearing loss affects communication and social engagement and limits educational and employment opportunities. Effective treatment for hearing loss is available in the form of communication training (for example, lipreading and auditory training), hearing aids and other devices.
But the uptake of treatment is low. In Australia, publicly subsidised hearing care is available predominantly only to children, young people and retirement-age people on a pension. Adults of working age are mostly not eligible for hearing health care under the government’s Hearing Services Program.
Our recent study published in the journal Ear and Hearing showed, for the first time, that working-age Australians from lower socioeconomic backgrounds are at much greater risk of hearing loss than those from higher socioeconomic backgrounds.
We believe the lack of socially subsidised hearing care for adults of working age results in poor detection and care for hearing loss among people from disadvantaged backgrounds. This in turn exacerbates social inequalities.
Population data shows hearing inequality
We analysed a large data set called the Household, Income and Labour Dynamics in Australia (HILDA) survey that collects information on various aspects of people’s lives, including health and hearing loss.
Using a HILDA sub-sample of 10,719 working-age Australians, we evaluated whether self-reported hearing loss was more common among people from lower socioeconomic backgrounds than for those from higher socioeconomic backgrounds between 2008 and 2018.
Relying on self-reported hearing data instead of information from hearing tests is one limitation of our paper. However, self-reported hearing tends to underestimate actual rates of hearing impairment, so the hearing loss rates we reported are likely an underestimate.
We also wanted to find out whether people from lower socioeconomic backgrounds were more likely to develop hearing loss in the long run.
Hearing care is publicly subsidised for children.
mady70/ShutterstockWe found people in the lowest income groups were more than twice as likely to have hearing loss than those in the highest income groups. Further, hearing loss was 1.5 times as common among people living in the most deprived neighbourhoods than in the most affluent areas.
For people reporting no hearing loss at the beginning of the study, after 11 years of follow up, those from a more deprived socioeconomic background were much more likely to develop hearing loss. For example, a lack of post secondary education was associated with a more than 1.5 times increased risk of developing hearing loss compared to those who achieved a bachelor’s degree or above.
Overall, men were more likely to have hearing loss than women. As seen in the figure below, this gap is largest for people of low socioeconomic status.
Why are disadvantaged groups more likely to experience hearing loss?
There are several possible reasons hearing loss is more common among people from low socioeconomic backgrounds. Noise exposure is one of the biggest risks for hearing loss and people from low socioeconomic backgrounds may be more likely to be exposed to damaging levels of noise in jobs in mining, construction, manufacturing, and agriculture.
Lifestyle factors which may be more prevalent in lower socioeconomic communities such as smoking, unhealthy diet, and a lack of regular exercise are also related to the risk of hearing loss.
Finally, people with lower incomes may face challenges in accessing timely hearing care, alongside competing health needs, which could lead to missed identification of treatable ear disease.
Why does this disparity in hearing loss matter?
We like to think of Australia as an egalitarian society – the land of the fair go. But nearly half of people in Australia with hearing loss are of working age and mostly ineligible for publicly funded hearing services.
Hearing aids with a private hearing care provider cost from around A$1,000 up to more than $4,000 for higher-end devices. Most people need two hearing aids.
Hearing loss might be more common in low income groups because they’re exposed to more noise at work.
Dmitry Kalinovsky/ShutterstockLack of access to affordable hearing care for working-age adults on low incomes comes with an economic as well as a social cost.
Previous economic analysis estimated hearing loss was responsible for financial costs of around $20 billion in 2019–20 in Australia. The largest component of these costs was productivity losses (unemployment, under-employment and Jobseeker social security payment costs) among working-age adults.
Providing affordable hearing care for all Australians
Lack of affordable hearing care for working-age adults from lower socioeconomic backgrounds may significantly exacerbate the impact of hearing loss among deprived communities and worsen social inequalities.
Recently, the federal government has been considering extending publicly subsidised hearing services to lower income working age Australians. We believe reforming the current government Hearing Services Program and expanding eligibility to this group could not only promote a more inclusive, fairer and healthier society but may also yield overall cost savings by reducing lost productivity.
All Australians should have access to affordable hearing care to have sufficient functional hearing to achieve their potential in life. That’s the land of the fair go.
Mohammad Nure Alam, PhD Candidate in Economics, Macquarie University; Kompal Sinha, Associate Professor, Department of Economics, Macquarie University, and Piers Dawes, Professor, School of Health and Rehabilitation Sciences, The University of Queensland
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Caramelized Caraway Cabbage
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Cabbage is an underrated vegetable for its many nutrients and its culinary potential—here’s a great way to make it a delectable starter or respectable side.
You will need
- 1 medium white cabbage, sliced into 1″ thick slabs
- 1 tbsp extra-virgin olive oil
- 1 tbsp caraway seeds
- 1 tsp black pepper
- ½ tsp turmeric
- ¼ tsp MSG or ½ tsp low-sodium salt
Method
(we suggest you read everything at least once before doing anything)
1) Preheat the oven to 400℉ / 200℃.
2) Combine the non-cabbage ingredients in a small bowl, whisking to mix thoroughly—with a tiny whisk if you have one, but a fork will work if necessary.
3) Arrange the cabbage slices on a lined baking tray and brush the seasoning-and-oil mixture over both sides of each slice.
4) Roast for 20–25 minutes until the cabbage is tender and beginning to caramelize.
5) Serve warm.
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Curcumin (Turmeric) is worth its weight in gold
- Black Pepper’s Impressive Anti-Cancer Arsenal (And More)
- Avocado Oil vs Olive Oil – Which is Healthier?
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Do You Know Which Supplements You Shouldn’t Take Together? (10 Pairs!)
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Dr. LeGrand Peterson wants us to get the most out of our supplements, so watch out for these…
Time to split up some pairs…
In most cases these are a matter of competing for absorption; sometimes to the detriment of both, sometimes to the detriment of one or the other, and sometimes, the problem is entirely different and they just interact in a way that could potentially cause other problems. Dr. Peterson advises as follows:
- Vitamin C and vitamin B12: taking these together can reduce the absorption of Vitamin B12, as vitamin C can overpower it.
- Vitamin C and copper: high amounts of vitamin C can decrease copper absorption, especially in those who are severely copper deficient.
- Magnesium and calcium: these two minerals compete for absorption in the intestines, potentially reducing the effectiveness of both.
- Calcium and iron: calcium can decrease iron absorption, so they should not be taken together, especially if you are iron deficient.
- Calcium and zinc: calcium also competes with zinc, reducing zinc absorption; they should be taken at different times.
- Zinc and copper: zinc and copper compete for absorption, so they should be taken at separate times.
- Iron and zinc: iron can decrease zinc absorption, and thus, they should not be taken together.
- Iron and green tea: perhaps a surprising one, but green tea can reduce iron absorption, so they should not be taken simultaneously.
- Vitamin E and vitamin K: vitamin E increases bleeding risk, while vitamin K promotes clotting, making them opposites and risky to take together.
- Fish oil and ginkgo biloba: both are anticoagulants and can increase the risk of bleeding, especially if taken with blood thinners like warfarin.
If you need to take supplements that compete (or conflict or otherwise potentially adversely interact) with each other, it’s recommended to separate them by at least 4 hours, or better yet, take one in the morning and the other at night. If in doubt, do speak with your pharmacist or doctor for personalized advice
You may be thinking: half my foods contain half of these nutrients! And yes, assuming you have a nutritionally dense diet, this is probably the case. Foods typically release nutrients more slowly than supplements, and unlike supplements, do not usually contain megadoses (although they can, such as the selenium content of Brazil nuts, or vitamin A in carrots). Basically, food is in most cases safer and gentler than supplements. If concerned, do speak with your nutritionist or doctor for personalized advice.
For more information on all of these, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
Do We Need Supplements, And Do They Work?
Take care!
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