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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Want to sleep longer? Adding mini-bursts of exercise to your evening routine can help – new study
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Exercising before bed has long been discouraged as the body doesn’t have time to wind down before the lights go out.
But new research has found breaking up a quiet, sedentary evening of watching television with short bursts of resistance exercise can lead to longer periods of sleep.
Adults spend almost one third of the 24-hour day sleeping. But the quality and length of sleep can affect long-term health. Sleeping too little or waking often in the night is associated with an increased risk of heart disease and diabetes.
Physical activity during the day can help improve sleep. However, current recommendations discourage intense exercise before going to bed as it can increase a person’s heart rate and core temperature, which can ultimately disrupt sleep.
Nighttime habits
For many, the longest period of uninterrupted sitting happens at home in the evening. People also usually consume their largest meal during this time (or snack throughout the evening).
Insulin (the hormone that helps to remove sugar from the blood stream) tends to be at a lower level in the evening than in the morning.
Together these factors promote elevated blood sugar levels, which over the long term can be bad for a person’s health.
Our previous research found interrupting evening sitting every 30 minutes with three minutes of resistance exercise reduces the amount of sugar in the bloodstream after eating a meal.
But because sleep guidelines currently discourage exercising in the hours before going to sleep, we wanted to know if frequently performing these short bursts of light activity in the evening would affect sleep.
Activity breaks for better sleep
In our latest research, we asked 30 adults to complete two sessions based in a laboratory.
During one session the adults sat continuously for a four-hour period while watching streaming services. During the other session, they interrupted sitting by performing three minutes of body-weight resistance exercises (squats, calf raises and hip extensions) every 30 minutes.
After these sessions, participants went home to their normal life routines. Their sleep that evening was measured using a wrist monitor.
Our research found the quality of sleep (measured by how many times they woke in the night and the length of these awakenings) was the same after the two sessions. But the night after the participants did the exercise “activity breaks” they slept for almost 30 minutes longer.
Identifying the biological reasons for the extended sleep in our study requires further research.
But regardless of the reason, if activity breaks can extend sleep duration, then getting up and moving at regular intervals in the evening is likely to have clear health benefits.
Time to revisit guidelines
These results add to earlier work suggesting current sleep guidelines, which discourage evening exercise before bed, may need to be reviewed.
As the activity breaks were performed in a highly controlled laboratory environment, future research should explore how activity breaks performed in real life affect peoples sleep.
We selected simple, body-weight exercises to use in this study as they don’t require people to interrupt the show they may be watching, and don’t require a large space or equipment.
If people wanted to incorporate activity breaks in their own evening routines, they could probably get the same benefit from other types of exercise. For example, marching on the spot, walking up and down stairs, or even dancing in the living room.
The key is to frequently interrupt evening sitting time, with a little bit of whole-body movement at regular intervals.
In the long run, performing activity breaks may improve health by improving sleep and post-meal blood sugar levels. The most important thing is to get up frequently and move the body, in a way the works best for a person’s individual household.
Jennifer Gale, PhD candidate, Department of Human Nutrition, University of Otago and Meredith Peddie, Senior Lecturer, Department of Human Nutrition, University of Otago
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Why it’s a bad idea to mix alcohol with some medications
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Anyone who has drunk alcohol will be familiar with how easily it can lower your social inhibitions and let you do things you wouldn’t normally do.
But you may not be aware that mixing certain medicines with alcohol can increase the effects and put you at risk.
When you mix alcohol with medicines, whether prescription or over-the-counter, the medicines can increase the effects of the alcohol or the alcohol can increase the side-effects of the drug. Sometimes it can also result in all new side-effects.
How alcohol and medicines interact
The chemicals in your brain maintain a delicate balance between excitation and inhibition. Too much excitation can lead to convulsions. Too much inhibition and you will experience effects like sedation and depression.
Alcohol works by increasing the amount of inhibition in the brain. You might recognise this as a sense of relaxation and a lowering of social inhibitions when you’ve had a couple of alcoholic drinks.
With even more alcohol, you will notice you can’t coordinate your muscles as well, you might slur your speech, become dizzy, forget things that have happened, and even fall asleep.
Alcohol can affect the way a medicine works.
Jonathan Kemper/UnsplashMedications can interact with alcohol to produce different or increased effects. Alcohol can interfere with the way a medicine works in the body, or it can interfere with the way a medicine is absorbed from the stomach. If your medicine has similar side-effects as being drunk, those effects can be compounded.
Not all the side-effects need to be alcohol-like. Mixing alcohol with the ADHD medicine ritalin, for example, can increase the drug’s effect on the heart, increasing your heart rate and the risk of a heart attack.
Combining alcohol with ibuprofen can lead to a higher risk of stomach upsets and stomach bleeds.
Alcohol can increase the break-down of certain medicines, such as opioids, cannabis, seizures, and even ritalin. This can make the medicine less effective. Alcohol can also alter the pathway of how a medicine is broken down, potentially creating toxic chemicals that can cause serious liver complications. This is a particular problem with paracetamol.
At its worst, the consequences of mixing alcohol and medicines can be fatal. Combining a medicine that acts on the brain with alcohol may make driving a car or operating heavy machinery difficult and lead to a serious accident.
Who is at most risk?
The effects of mixing alcohol and medicine are not the same for everyone. Those most at risk of an interaction are older people, women and people with a smaller body size.
Older people do not break down medicines as quickly as younger people, and are often on more than one medication.
Older people also are more sensitive to the effects of medications acting on the brain and will experience more side-effects, such as dizziness and falls.
Smaller and older people are often more affected.
Alfonso Scarpa/UnsplashWomen and people with smaller body size tend to have a higher blood alcohol concentration when they consume the same amount of alcohol as someone larger. This is because there is less water in their bodies that can mix with the alcohol.
What drugs can’t you mix with alcohol?
You’ll know if you can’t take alcohol because there will be a prominent warning on the box. Your pharmacist should also counsel you on your medicine when you pick up your script.
The most common alcohol-interacting prescription medicines are benzodiazepines (for anxiety, insomnia, or seizures), opioids for pain, antidepressants, antipsychotics, and some antibiotics, like metronidazole and tinidazole.
Medicines will carry a warning if you shouldn’t take them with alcohol.
Nial WheateIt’s not just prescription medicines that shouldn’t be mixed with alcohol. Some over-the-counter medicines that you shouldn’t combine with alcohol include medicines for sleeping, travel sickness, cold and flu, allergy, and pain.
Next time you pick up a medicine from your pharmacist or buy one from the local supermarket, check the packaging and ask for advice about whether you can consume alcohol while taking it.
If you do want to drink alcohol while being on medication, discuss it with your doctor or pharmacist first.
Nial Wheate, Associate Professor of the School of Pharmacy, University of Sydney; Jasmine Lee, Pharmacist and PhD Candidate, University of Sydney; Kellie Charles, Associate Professor in Pharmacology, University of Sydney, and Tina Hinton, Associate Professor of Pharmacology, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Chocolate & Health
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Chocolate & Health: Fact or Fiction?
“Chocolate Is Good For The Heart”
“When making chocolate chip cookies, you don’t measure using cups, you measure by heart”
…but how good is chocolate when it comes to heart health?
First, what is heart health?
A healthy heart typically has a low resting pulse rate and a strong, steady beat. This is affected strongly by exercise habits, and diet plays only a support role (can’t exercise without energy from food!).
It is also important to have blood pressure within a healthy range (with high blood pressure being a more common problem than low, so things that lower blood pressure are generally considered good).
- Flavanols, flavonoids, and polyphenols in chocolate contribute to lower blood pressure
- Dark chocolate is best for these, as milk chocolate contains much less cocoa solids and more unhelpful fats
- White chocolate contains no cocoa solids and is useless for this
- Some of the fats in most commercial chocolate can contribute to atherosclerosis which raises blood pressure and ultimately can cause heart attacks.
- If you’re diabetic, you will probably not get the usual heart-related benefits from chocolate (sorry)
The Verdict: dark chocolate, in moderation, can support good heart health.
“Chocolate Is Good For The Brain”
Chocolate has been considered a “brain food”… why?
- The brain uses more calories than any other organ (chocolate has many calories)
- The heart benefits we listed above mean improved blood flow—including to your brain
- Chocolate contains phenylethylamine, a powerful chemical that has a similar effect to amphetamines… But it’s metabolized in digestion and never makes it to the central nervous system (so basically, this one’s a miss; we had a good run with the other two, though!)
The Verdict: dark chocolate, in moderation, can support good brain health
“Chocolate Is An Aphrodisiac”
“If chocolate be the food of love, pass me that cocoa; I’m starving”
Most excitingly, chocolate contains phenylethylamine, the “molecule of love” or, more accurately, lust. It has an effect similar to amphetamines, and while we can synthesize it in the body, we can also get it from certain foods. But…
Our body is so keen to get it that most of it is metabolized directly during digestion and doesn’t make it to the brain. Also, chocolate is not as good a source as cabbage—do with that information what you will!
However!
Chocolate contains theobromine and small amounts of caffeine, both stimulants and both generally likely to improve mood; it also contains flavonoids which in turn stimulate production of nitric oxide, which is a relaxant. All in all, things that are convivial to having a good time.
On the other hand…
That relaxation comes specifically with a reduction in blood pressure—something typically considered good for the health for most people most of the time… but that means lowering blood pressure in all parts of your body, which could be the opposite of what you want in intimate moments.
Chocolate also contains zinc, which is essential for hormonal health for most people—the body uses it to produce testosterone and estrogen, respectively. Zinc supplements are popularly sold to those wishing to have more energy in general and good hormonal health in particular, and rightly so. However…
This approach requires long-term supplementation—you can’t just pop a zinc tablet / bar of chocolate / almond before bed and expect immediate results. And if your daily zinc supplementation takes the form of a 3.5oz (100g) bar of chocolate, then you may find it has more effects on your health, and not all of them good!
The Verdict: dark chocolate, in moderation, may promote “the mood”, but could be a double-edged sword when it comes to “the ability”.
“Chocolate Is Good During Menstruation”
The popular wisdom goes that chocolate is rich in iron (of which more is needed during menstruation), and indeed, if you eat 7oz (150g) of dark chocolate made with 85% cocoa, you’ll get a daily a dose of iron (…and nearly 1,000 calories).
More bang-for-buck dietary sources of iron include chickpeas and broccoli, but for some mysterious reason, these are not as commonly reported as popular cravings.
The real explanation for chocolate cravings is more likely that eating chocolate—a food high in sugar and fat along with a chemical bombardment of more specialized “hey, it’s OK, you can relax now” molecules (flavanols/flavonoids, polyphenols, phenylamines, even phenylethylamine, etc) gives a simultaneous dopamine kick (the body’s main “reward” chemical) with a whole-body physiological relaxation… so, little wonder we might crave it in times of stress and discomfort!
The Verdict: it helps, not because it serves a special nutritional purpose, but rather, because the experience of eating chocolate makes us feel good.
Fun fact: Tiramisu (this writer’s favorite dessert) is literally Italian for “pick-me-up”
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Feel-Good Productivity – by Dr. Ali Abdaal
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“Rise and grind” is not a sustainable way to live. Yet for most of us, there are things we do have to do every day that we don’t necessarily do for fun. So, how to be productive with those things, and not feel like we are constantly compromising and sacrificing our time on this earth for some intrinsically trivial but extrinsically required activity that’ll be forgotten tomorrow?
And most of us do also have dreams and ambitions (and if you don’t, then what were they before life snatched them away from you?), things to work towards. So there is “carrot” for us as well as “stick”. But how to break the cycle and get more carrot and less stick, while being more productive than before?
Dr. Abdaal frames this principally in terms of neurology first, psychology next.
That when we are bored, we simply do not have the neurochemicals required to work well anyway, so addressing that first needs to be a priority. He lays out many ways of doing this, gives lots of practical tips, and brings attention to the ways it’s easy to go wrong (and how to fix those too).
The writing style isdeceptively relaxed and casual, leading the reader smoothly into understanding of each topic before moving on.
Bottom line: if you want to get more done while feeling better about it (not a tired wreck), then this is the book for you!
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How can I stop using food to cope with negative emotions?
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Have you ever noticed changes in your eating habits when you are sad, bored or anxious?
Many people report eating either more, or less, as a way of helping them to cope when they experience difficult emotions.
Although this is a very normal response, it can take the pleasure out of eating, and can become distressing and bring about other feelings of shame and self-criticism.
Adding to the complexity of it all, we live in a world where diet culture is unavoidable, and our relationship to eating, food and body image can become complicated and confusing.
Drazen Zigic/Shutterstock Emotional eating is common
“Emotional eating” refers to the eating behaviours (typically eating more) that occur in response to difficult emotions.
Research shows around 20% of people regularly engage in emotional eating, with a higher prevalence among adolescents and women. In a study of more than 1,500 adolescents, 34% engaged in emotional eating while sad and 40% did so while anxious.
Foods consumed are often fast-foods and other energy-dense, nutrient-poor convenience foods.
Stress, strong emotions and depression
For some people, emotional eating was simply a habit formed earlier in life that has persisted over time.
But other factors might also contribute to the likelihood of emotional eating. The physiological effects of stress and strong emotions, for example, can influence hormones such as cortisol, insulin and glucose, which can also increase appetite.
Increased impulsivity (behaving before thinking things through), vulnerability to depression, a tendency to ruminate and difficulties regulating emotions also increase the likelihood of emotional eating.
Depression increases the likelihood of emotional eating. TommyStockProject/Shutterstock So what do you do?
First, know that fluctuations in eating are normal. However, if you find that the way you eat in response to difficult emotions is not working for you, there are a few things you can do.
Starting with small things that are achievable but can have a huge impact, such as prioritising getting enough sleep and eating regularly.
Then, you can start to think about how you handle your emotions and hunger cues.
Expand your emotional awareness
Often we label emotions as good or bad, and this can result in fear, avoidance, and unhelpful coping strategies such as emotional eating.
But it’s also important to differentiate the exact emotion. This might be feeling isolated, powerless or victimised, rather than something as broad as sad.
By noticing what the emotion is, we can bring curiosity to what it means, how we feel in our minds and bodies, and how we think and behave in response.
Tap into your feelings of hunger and fullness
Developing an intuitive way of eating is another helpful strategy to promote healthy eating behaviours.
Intuitive eating means recognising, understanding and responding to internal signals of hunger and fullness. This might mean tuning in to and acknowledging physical hunger cues, responding by eating food that is nourishing and enjoyable, and identifying sensations of fullness.
Intuitive eating encourages flexibility and thinking about the pleasure we get from food and eating. This style of eating also allows us to enjoy eating out with friends, and sample local delicacies when travelling.
It can also reduce the psychological distress from feeling out of control with your eating habits and the associated negative body image.
Try to be flexible in thinking about the pleasure of food and eating with friends. La Famiglia/Shutterstock When is it time to seek help?
For some people, the thoughts and behaviours relating to food, eating and body image can negatively impact their life.
Having the support of friends and family, accessing online resources and, in some instances, seeing a trained professional, can be very helpful.
There are many therapeutic interventions that work to improve aspects associated with emotional eating. These will depend on your situation, needs, stage of life and other factors, such as whether you are neurodivergent.
The best approach is to engage with someone who can bring compassion and understanding to your personal situation, and work with you collaboratively. This work might include:
- unpacking some of the patterns that could be underlying these emotions, thoughts and behaviours
- helping you to discover your emotions
- supporting you to process other experiences, such as trauma exposure
- developing a more flexible and intuitive way of eating.
One of the dangers that can occur in response to emotional eating is the temptation to diet, which can lead to disordered eating, and eating disorder behaviours. Indicators of a potential eating disorder can include:
- recent rapid weight loss
- preoccupation with weight and shape (which is usually in contrast to other people’s perceptions)
- eating large amounts of food within a short space of time (two hours or less) and feeling a sense of loss of control
- eating in secret
- compensating for food eaten (with vomiting, exercise or laxatives).
Evidence-based approaches can support people experiencing eating disorders. To find a health professional who is informed and specialises in this area, search the Butterfly Foundation’s expert database.
If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14, or the Butterfly Foundation on 1800 ED HOPE (1800 33 4673).
Inge Gnatt, PhD Candidate, Lecturer in Psychology, 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 Avoid Self-Hatred & Learn To Love Oneself More
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Alain de Botton gives a compassionate, but realistic, explanation in this video:
The enemy within
Or rather, the collaborator within. Because there’s usually first an enemy without—those who are critical of us, who consider that we are bad people in some fashion, and may indeed get quite colorful in their expressions of this.
Sometimes, their words will bounce straight off us; sometimes, their words will stick. So what’s the difference, and can we do anything about it?
The difference is: when their words stick, it’s usually because on some level we believe their words may be true. That doesn’t mean they necessarily are true!
They could be (and it would be a special kind of hubris to assume no detractor could ever find a valid criticism of us), but very often the reason we have that belief, or at least that fear/insecurity, is simply because it was taught to us at an early age, often by harsh words/actions of those around us; perhaps our parents, perhaps our schoolteachers, perhaps our classmates, and so forth.
The problem—and solution—is that we learn emotions much the same way that we learn language; only in part by reasoned thought, and rather for the most part, by immersion and repetition.
It can take a lot of conscious self-talk to undo the harm of decades of unconscious self-talk based on what was probably a few years of external criticisms when we were small and very impressionable… But, having missed the opportunity to start fixing this sooner, the next best time to do it is now.
We cannot, of course, simply do what a kind friend might do and expect any better results; if a kind friend tells us something nice that we do not believe is true, then however much they mean it, we’re not going to internalize it. So instead, we must simply chip away at those unhelpful longstanding counterproductive beliefs, and simply build up the habit of viewing ourselves in a kinder light.
For more on all this, enjoy:
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Want to learn more?
You might also like to read:
- Escape From The Clutches Of Shame
- To Err Is Human; To Forgive, Healthy
- How To Get Your Brain On A More Positive Track (Without Toxic Positivity)
Take care!
Don’t Forget…
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