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.
Woman sits on exercise ball and uses stretchy band
Pain education is central. Monkey Business Images/Shutterstock

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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  • Holistic Approach To Resculpting A Face Affected By Hypothyroidism, PCOS, Or Menopause

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Mila Magnani has PCOS and hypothyroidism, but the principles are the same for menopause because both menopause and PCOS are a case of a hormone imbalance resulting in androgenic effects, so there’s a large amount of overlap.

    Obviously, a portion of the difference in the thumbnail is a matter of angle and make-up, but as you can see in the video itself, there’s also a lot of genuine change underneath, too:

    Stress-free method

    Firstly, she bids us get lab tests and work with a knowledgeable doctor to address potential thyroid, hormonal, or nutrient imbalances. Perhaps we already know at least part of what is causing our problems, but even if so, it doesn’t hurt to take steps to rule the others out. Imagine spending ages unsuccessfully battling PCOS or menopause, only to discover it was a thyroid issue, and you were fighting the wrong battle!

    Magnani used a natural route to manage her PCOS and hypothyroidism, while acknowledging that medication is fine too; it’s usually cheaper and more convenient—and there’s a lot more standardization for medications than there is for supplements, which makes it a lot easier to navigate, find what works, and keep getting the exact same thing once it does work.

    Other things she recommends include:

    • Lymphatic drainage: addressing the lymphatic system to reduce puffiness. Techniques include lymphatic drainage massage, stretching, rebounding (trampoline), and dry brushing. She emphasizes that for facial de-puffing, it’s important to treat the whole upper body, not just the face.
    • Low-impact exercise: she switched from high-intensity workouts to low-impact exercises like nature walking and gentle stretching to reduce stress and improve health.
    • Nervous system regulation: she worked on nervous system regulation by means of journaling, breathwork, and stimulating the vagus nerve, which improved sleep and reduced stress and anxiety. These things, of course, have knock-on benefits for almost every part of health.
    • Diet: she adopted a low-glycemic diet, reduced salt intake, and cooked at home to avoid water retention caused by high sodium in restaurant meals.
    • Natural diuretics: she uses teas like hibiscus and chamomile to reduce puffiness after consuming high-sodium foods.
    • Sauna and sweating: consider a sauna mat or hot baths to detox and reduce swelling; that’s what she uses in lieu of a convenient sauna.

    You may be wondering how quickly you can expect results: it took 3–6 months of daily effort to see significant changes, and she now maintains the routine less frequently (every 2–3 days, instead of daily).

    For more on all this, enjoy:

    Click Here If The Embedded Video Doesn’t Load Automatically!

    Want to learn more?

    You might also like to read:

    Take care!

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  • HIIT, But Make It HIRT

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    This May HIRT A Bit

    This is Ingrid Clay. She’s a professional athlete, personal trainer, chef*, and science writer.

    *A vegan bodybuilding chef, no less:

    Click Here If The Embedded Video Doesn’t Load Automatically!

    For those who prefer reading…

    This writer does too 😉

    We’ve previously reviewed her book, “Science of HIIT”, and we’re going to be talking a bit about High Intensity Interval Training today.

    If you’d like to know a little more about the woman herself first, then…

    Centr | Meet Ingrid: Your HIIT HIRT trainer

    Yes, that is Centr, as in Chris Hemsworth’s personal training app, where Clay is the resident HIIT & HIRT expert & trainer.

    What’s this HIIT & HIRT?

    HIIT” is High Intensity Interval Training, which we’ve written about before:

    How To Do HIIT (Without Wrecking Your Body)

    Basically, it’s a super-efficient way of working out, that gets better results than working out for longer with other methods, especially because of how it raises the metabolism for a couple of hours after training (this effect is called EPOC, by the way—Excessive Post-exercise Oxygen Consumption), and is a good thing.

    You can read more about the science of it, in the above-linked main feature.

    And HIRT?

    HIRT” is High Intensity Resistance Training, and is resistance training performed with HIIT principles.

    See also: Chris Hemsworth’s Trainer Ingrid Clay Explains HIRT

    An example is doing 10 reps of a resistance exercise (e.g., a dumbbell press) every minute on odd-numbered minutes, and 10 reps of a different resistance exercise (e.g. dumbbell squats) on even-numbered minutes.

    If dumbbells aren’t your thing, it could be resistance bands, or even the floor (press-ups are a resistance exercise!)

    For HIRT that’s not also a cardio exercise, gaps between different exercises can be quite minimal, as we only need to confuse the muscles, not the heart. So, effectively, it becomes a specially focused kind of circuit training!

    If doing planks though, you might want to check out Clay’s troubleshooting guide:

    Expert trainer Ingrid Clay identifies the mistakes many people make when doing the plank, and how to correct them.

    Want more from Clay?

    Here she gives a full 20-minute full-body HIIT HIRT workout:

    Click Here If The Embedded Video Doesn’t Load Automatically!

    Enjoy!

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  • What’s the difference between ‘strep throat’ and a sore throat? We’re developing a vaccine for one of them

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    What’s the difference? is a new editorial product that explains the similarities and differences between commonly confused health and medical terms, and why they matter.


    It’s the time of the year for coughs, colds and sore throats. So you might have heard people talk about having a “strep throat”.

    But what is that? Is it just a bad sore throat that goes away by itself in a day or two? Should you be worried?

    Here’s what we know about the similarities and differences between strep throat and a sore throat, and why they matter.

    Prostock-studio/Shutterstock

    How are they similar?

    It’s difficult to tell the difference between a sore throat and strep throat as they look and feel similar.

    People usually have a fever, a bright red throat and sometimes painful lumps in the neck (swollen lymph nodes). A throat swab can help diagnose strep throat, but the results can take a few days.

    Thankfully, both types of sore throat usually get better by themselves.

    How are they different?

    Most sore throats are caused by viruses such as common cold viruses, the flu (influenza virus), or the virus that causes glandular fever (Epstein-Barr virus).

    These viral sore throats can occur at any age. Antibiotics don’t work against viruses so if you have a viral sore throat, you won’t get better faster if you take antibiotics. You might even have some unwanted antibiotic side-effects.

    But strep throat is caused by Streptococcus pyogenes bacteria, also known as strep A. Strep throat is most common in school-aged children, but can affect other age groups. In some cases, you may need antibiotics to avoid some rare but serious complications.

    In fact, the potential for complications is one key difference between a viral sore throat and strep throat.

    Generally, a viral sore throat is very unlikely to cause complications (one exception is those caused by Epstein-Barr virus which has been associated with illnesses such as chronic fatigue syndrome, multiple sclerosis and certain cancers).

    But strep A can cause invasive disease, a rare but serious complication. This is when bacteria living somewhere on the body (usually the skin or throat) get into another part of the body where there shouldn’t be bacteria, such as the bloodstream. This can make people extremely sick.

    Invasive strep A infections and deaths have been rising in recent years around the world, especially in young children and older adults. This may be due to a number of factors such as increased social mixing at this stage of the COVID pandemic and an increase in circulating common cold viruses. But overall the reasons behind the increase in invasive strep A infections are not clear.

    Another rare but serious side effect of strep A is autoimmune disease. This is when the body’s immune system makes antibodies that react against its own cells.

    The most common example is rheumatic heart disease. This is when the body’s immune system damages the heart valves a few weeks or months after a strep throat or skin infection.

    Around the world more than 40 million people live with rheumatic heart disease and more than 300,000 die from its complications every year, mostly in developing countries.

    However, parts of Australia have some of the highest rates of rheumatic heart disease in the world. More than 5,300 Indigenous Australians live with it.

    Streptococcus pyogenes
    Strep throat is caused by Streptococcus bacteria and can be treated with antibiotics if needed. Kateryna Kon/Shutterstock

    Why do some people get sicker than others?

    We know strep A infections and rheumatic heart disease are more common in low socioeconomic communities where poverty and overcrowding lead to increased strep A transmission and disease.

    However, we don’t fully understand why some people only get a mild infection with strep throat while others get very sick with invasive disease.

    We also don’t understand why some people get rheumatic heart disease after strep A infections when most others don’t. Our research team is trying to find out.

    How about a vaccine for strep A?

    There is no strep A vaccine but many groups in Australia, New Zealand and worldwide are working towards one.

    For instance, Murdoch Children’s Research Institute and Telethon Kids Institute have formed the Australian Strep A Vaccine Initiative to develop strep A vaccines. There’s also a global consortium working towards the same goal.

    Companies such as Vaxcyte and GlaxoSmithKline have also been developing strep A vaccines.

    What if I have a sore throat?

    Most sore throats will get better by themselves. But if yours doesn’t get better in a few days or you have ongoing fever, see your GP.

    Your GP can examine you, consider running some tests and help you decide if you need antibiotics.

    Kim Davis, General paediatrician and paediatric infectious diseases specialist, Murdoch Children’s Research Institute; Alma Fulurija, Immunologist and the Australian Strep A Vaccine Initiative project lead, Telethon Kids Institute, and Myra Hardy, Postdoctoral Researcher, Infection, Immunity and Global Health, Murdoch Children’s Research Institute

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    This week in health news…

    Do not go gentle into that good night

    As wildfires rage in California, snow is falling from Texas to Georgia, meaning that a lot of people are facing weather they’re not accustomed to, in houses that were not built for it. And that’s the lucky ones; there are many thousands of people who are homeless, of whom many will die.

    Hopefully all our readers are safe, but it pays to watch out for the signs of hypothermia as it is a condition that really sneaks up on people and, in the process, takes away their ability to notice the hypothermia. You and your loved ones are not immune to this, so it’s good to keep an eye on each other, looking out for:

    • Shivering, first ← when this stops, assuming it’s not because the temperature has risen, it is often a sign of hypothermia entering a later stage, in which the body is no longer responding appropriately to the cold
    • Slurred speech or mumbling
    • Slow, shallow breathing
    • A weak pulse
    • Clumsiness or lack of coordination
    • Drowsiness or very low energy
    • Confusion or memory loss
    • Loss of consciousness
    • In infants, bright red, cold skin

    How cold is too cold? It doesn’t even have to be sub-zero. According to the CDC, temperatures of 4℃ (40℉) can be low enough to cause hypothermia.

    Read in full: The warning signs to notice if someone has hypothermia

    Related: Cold Weather Health Risks

    Lethal lottery of pathogens

    In Minnesota, hospital emergency room waiting times have skyrocketed since yesterday (at time of writing), with 40% of Minnesota’s 1,763 flu-related hospitalizations this fall and winter occurring in the same week, according to yesterday’s report. To put it further into perspective, 17 out of 20 of this season’s flu outbreaks have occurred in the past two weeks.

    And that’s just the flu, without considering COVID, RSV, and Norovirus, which are also all running rampant in MN right now.

    The advice presently is:

    ❝Go to the ER if you are super-sick. If you are not super-sick, go to urgent care, go to your clinic, schedule a virtual appointment.❞

    And if you’re not in Minneapolis? These stats won’t apply, but definitely consider, before going to the hospital, whether you might leave sicker than you arrived, and plan accordingly, making use of telehealth where reasonably possible.

    Read in full: Minnesota ERs stressed by “quad-demic” of COVID, flu, RSV, norovirus

    Related: Move over, COVID and Flu! We Have “Hybrid Viruses” To Contend With Now

    Sleep, but at what cost?

    This was a study looking at the effects of sleeping pills on the brain, specifically zolpidem (most well-known by its brand name of Ambien).

    What they found is that while it does indeed effectively induce sleep, part of how it does that is suppressing norepinephrine oscillations (which might otherwise potentially wake you up, though in healthy people these oscillations and the micro-arousals that they cause shouldn’t disrupt sleep at all, and are just considered part of our normal sleep cycles), which oscillations are necessary to generate the pumping action required to move cerebrospinal fluid through the glymphatic system while asleep.

    This is a big problem, because the glymphatic system is almost entirely responsible for keeping the brain free from waste products such as beta-amyloids (whose build-up is associated with Alzheimer’s disease and is considered to be a significant part of Alzheimer’s pathogensesis) and alpha-synuclein (same but for Parkinson’s disease), amongst others:

    Read in full: Common sleeping pill may pave way for disorders like Alzheimer’s

    Related: How To Clean Your Brain (Glymphatic Health Primer)

    Take care!

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  • Policosanol: A Rival To Statins, Without The Side Effects?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Policosanol (which can be extracted from various sources, but is mostly made from sugar cane extract) is marketed as lipid-lowering agent for improving cholesterol levels, but its research history has not been without controversy:

    2001: it works!

    After a lot of research in the 1990s, it came out of the gate strong in 2001, with:

    ❝Policosanol (5 and 10 mg/day) significantly decreased LDL-cholesterol (17.3% and 26.7%, respectively), total cholesterol (12.9% and 19.5%), as well as the ratios of LDL-cholesterol to high-density lipoprotein (HDL)-cholesterol (17.2% and 26.5%) and total cholesterol to HDL-cholesterol (16.3% and 21.0%) compared with baseline and placebo❞

    This, by the way, is comparable in efficacy to the most powerful statins, but without the adverse side effects.

    Source: Efficacy and tolerability of policosanol in hypercholesterolemic postmenopausal women

    Furthermore, its effects were not limited to postmenopausal women, and additionally, it was found that 20mg/day was sufficient for optimal effects; 40mg worked exactly the same as 20mg:

    Read: Effects of policosanol 20 versus 40 mg/day in the treatment of patients with type II hypercholesterolemia: a 6-month double-blind study

    2006–2010: we do not trust the Cubans!

    After it had been marketed and used in much of the world for some years, extra scrutiny was brought upon it, because the initial studies had been performed by the same lab in Cuba, a commercial lab that had tested them for a private interest (i.e., a company selling the supplement):

    Heart Beat: Policosanol: A sweet nothing for high cholesterol

    And furthermore, US-based labs were unable to replicate the results:

    Policosanols as Nutraceuticals: Fact or Fiction

    The Cuban researchers countered that the composition of policosanol as produced in their lab was different than the composition of the policosanol as produced in the US labs, because of the purity of the ingredients used in the Cuban lab.

    Which, on the face of it, could be true or could just be the claim of a commercial lab with an association with a company selling a product.

    Of course, importing Cuban ingredients to test them in the US was not a reasonably accessible option for the US-based labs, because of the US’s embargo of Cuba. In principle it could be done, but unless there is already a huge clear profit incentive, research scientists are usually on their hands and knees begging for grants already, so getting extra funding for specially-important Cuban ingredients was not going to be likely.

    2012: never mind, it does work after all!

    An American meta-analysis of 4596 patients from 52 eligible studies (from around the world, so many of them not affected by the US’s embargo; some were from within the US using non-Cuban ingredients, though), found:

    ❝policosanol is more effective than plant sterols and stanols for LDL level reduction and more favorably alters the lipid profile, approaching antilipemic drug efficacy❞

    Those last words there, to be clear, mean “yes, the original claim of being on a par with statins is at least more or less true”.

    Source: Meta-Analysis of Natural Therapies for Hyperlipidemia: Plant Sterols and Stanols versus Policosanol

    2018: also yes, the Cuban kind does get those extra-effective results, even when tested outside of Cuba

    A Korean research team verified this; it’s quite straightforward so for brevity we’ll just drop links:

    Mystery resolved!

    Want to try some?

    We don’t sell it, but here for your convenience is an example product on Amazon—it’s not the Cuban kind, because the US’s trade embargo makes it difficult for the US to import even things that are theoretically now exempt from the embargo such as food and medicines. In principle they can now be imported, but in practice, the extra regulations added to Cuban imports make it nearly impossible, especially for small sellers.

    Still, it’s 40mg/tablet policosanol from sugar cane extract, and 3rd party lab tested, so it’s the next best thing 😎

    Enjoy!

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  • Live Long, Die Short – by Dr. Roger Landry

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    First know: “die short” is not about your height—although on average, short people do live longer, partly because insulin-like growth factor (IGF-1) promotes both tallness and accelerated DNA damage (thus, aging and cancer), and partly because if someone is very tall, it can cause circulatory problems, and without a nice easy flow of blood through the brain, bad things happen (such as accumulation of harmful detritus in the brain, and increased stroke risk too).

    Next know: “die short” is, in this book, actually about shortening the decline at the end of life. Sometimes people say “I don’t want to live 10 years longer; they’ll be the 10 most miserable years”, but in fact if we look after our health, we will be healthy for perhaps >9.5 of our last 10 years, while an unhealthy person may just get their expected “10 most miserable years” 10 or 20 years earlier (and then die).

    So, in short (so to speak), it’s about increasing healthspan.

    To enjoy the longest and healthiest healthspan, Dr. Landry offers 10 tips. We’ll not keep them a secret; they are:

    1. Use it or lose it
    2. Keep moving
    3. Challenge your brain
    4. Stay connected
    5. Lower your risks
    6. Never act your age
    7. Wherever you are, be fully there
    8. Find your purpose
    9. Have children in your life
    10. Laugh to a better life

    Each of these has a chapter devoted to them, in section 2 of the book (section 1 is about what we know about healthy aging, and section 3 is about where we go from here).

    You’ll notice that one item not generally found on such lists is “have children in your life”; to be clear, they don’t have to be your children, and/but they do have to be actual current children; any now-grown-up progeny aren’t what’s being talked about here (wonderful as they may be, any support role they may play gets filed under “stay connected” instead).

    The style is mostly impersonal pop-science with occasional personal anecdotes, and the book’s formatting (many subheadings within chapters) makes it easy to read a bit at a time, if that’s your preference. There’s a modest, but extant, bibliography.

    Bottom line: if you’d like to stay younger as you get older, this book goes into a lot of detail about 10 ways to do just that.

    Click here to check out Live Long, Die Short, and live long, die short!

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