Surgery won’t fix my chronic back pain, so what will?
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’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.
Don’t Forget…
Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!
Learn to Age Gracefully
Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:
-
Honeydew vs Cantaloupe – Which is Healthier?
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.
Our Verdict
When comparing honeydew to cantaloupe, we picked the cantaloupe.
Why?
In terms of macros, there’s not a lot between them—they’re both mostly water. Nominally, honeydew has more carbs while cantaloupe has more fiber and protein, but the differences are very small. So, a very slight win for cantaloupe.
Looking at vitamins: honeydew has slightly more of vitamins B5 and B6 (so, the vitamins that are in pretty much everything), while cantaloupe has a more of vitamins A, B1, B2, B3, C, and E (especially notably 67x more vitamin A, whence its color). A more convincing win for cantaloupe.
The minerals category is even more polarized: honeydew has more selenium (and for what it’s worth, more sodium too, though that’s not usually a plus for most of us in the industrialized world), while cantaloupe has more calcium, copper, iron, magnesium, manganese, phosphorus, potassium, and zinc. An overwhelming win for cantaloupe.
No surprises: adding up the slight win for cantaloupe, the convincing win for cantaloupe, and the overwhelming win for cantaloupe, makes cantaloupe the overall best pick here.
Enjoy!
Want to learn more?
You might like to read:
From Apples to Bees, and High-Fructose Cs: Which Sugars Are Healthier, And Which Are Just The Same?
Take care!
Share This Post
-
Remember – by Dr. Lisa Genova
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.
Memory is often viewed as one thing—either you have a good memory, or you don’t. At best, a lot of people have a vague idea of selective memory. But, the reality is much more complex—and much more interesting.
Dr. Genova lays out clearly and simply the various different kinds of memory, how they work, and how they fail. Some of these kinds of memory operate on completely different principles than others, and/or in different parts of the brain. And, it’s not just “a memory for faces” or a “memory for names”, nor even “short term vs long term”. There’s working memory, explicit and implicit memory, semantic memory, episodic memory, muscle memory, and more.
However, this is not just an interesting book—it’s also a useful one. Dr. Genova also looks at how we can guard against failing memory in later years, and how we can expand and grow the kinds of memory that are most important to us.
The style of the book is very conversational, and not at all textbook-like. It’s certainly very accessible, and pleasant to read too.
Bottom line: memory is a weird and wonderful thing, and this book shines a clear light on many aspects of it—including how to improve the various different kinds of memory.
Click here to check out Remember (we recommend to do it now before you forget!
Share This Post
-
Getting Your Messy Life In Order
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.
Getting Your Messy Life In Order
We’ve touched on this before by recommending the book, but today we’re going to give an overview of the absolute most core essentials of the “Getting Things Done” method. If you’re unfamiliar, this will be enough to get you going. If you’re already familiar, this may be a handy reminder!
First, you’ll need:
- A big table
- A block of small memo paper squares—post-it note sized, but no need to be sticky.
- A block of A4 printer paper
- A big trash bag
Gathering everything
Gather up not just all your to-dos, but: all sources of to-dos, too, and anything else that otherwise needs “sorting”.
Put them all in one physical place—a dining room table may have enough room. You’ll need a lot of room because you’re going to empty our drawers of papers, unopened (or opened and set aside) mail. Little notes you made for yourself, things stuck on the fridge or memo boards. Think across all areas of your life, and anything you’re “supposed” to do, write it down on a piece of paper. No matter what area of your life, no matter how big or small.
Whether it’s “learn Chinese” or “take the trash out”, write it down, one item per piece of paper (hence the block of little memo squares).
Sorting everything
Everything you’ve gathered needs one of three things to happen:
- You need to take some action (put it in a “to do” pile)
- You may need it later sometime (put it in a “to file” pile)
- You don’t need it (put it in the big trash bag for disposal)
What happens next will soothe you
- Dispose of the things you put for disposal
- File the things for filing in a single alphabetical filing system. If you don’t have one, you’ll need to get one, so write that down and add it to the “to do” pile.
- You will now process your “to dos”
Processing the “to dos”
The pile you have left is now your “inbox”. It’s probably huge; later it’ll be smaller, maybe just a letter-tray on your desk.
Many of your “to dos” are actually not single action items, they’re projects. If something requires more than one step, it’s a project.
Take each item one-by-one. Do this in any order; you’re going to do this as quickly as possible! Now, ask yourself: is this a single-action item that I could do next, without having to do something else first?
- If yes: put it in a pile marked “next action”
- If no: put it in a pile marked “projects”.
Take a sheet of A4 paper and fold it in half. Write “Next Action” on it, and put your pile of next actions inside it.
Take a sheet of A4 paper per project and write the name of the project on it, for example “Learn Chinese”, or “Do taxes”. Put any actions relating to that project inside it.
Likely you don’t know yet what the first action will be, or else it’d be in your “Next Action” pile, so add an item to each project that says “Brainstorm project”.
Processing the “Next Action” pile
Again you want to do this as quickly as possible, in any order.
For each item, ask yourself “Do I care about this?” If the answer is no, ditch that item, and throw it out. That’s ok. Things change and maybe we no longer want or need to do something. No point in hanging onto it.
For each remaining item, ask yourself “can this be done in under 2 minutes?”.
- If yes, do it, now. Throw away the piece of paper for it when you’re done.
- If no, ask yourself:”could I usefully delegate this to someone else?” If the answer is yes, do so.
If you can’t delegate it, ask yourself: “When will be a good time to do this?” and schedule time for it. A specific, written-down, clock time on a specific calendar date. Input that into whatever you use for scheduling things. If you don’t already use something, just use the calendar app on whatever device you use most.
The mnemonic for the above process is “Do/Defer/Delegate/Ditch”
Processing projects:
If you don’t know where to start with a project, then figuring out where to start is your “Next Action” for that project. Brainstorm it, write down everything you’ll need to do, and anything that needs doing first.
The end result of this is:
- You will always, at any given time, have a complete (and accessible) view of everything you are “supposed” to do.
- You will always, at any given time, know what action you need to take next for a given project.
- You will always, when you designate “work time”, be able to get straight into a very efficient process of getting through your to-dos.
Keeping on top of things
- Whenever stuff “to do something with/about” comes to you, put it in your physical “inbox” place—as mentioned, a letter-tray on a desk should suffice.
- At the start of each working day, quickly process things as described above. This should be a small daily task.
- Once a week, do a weekly review to make sure you didn’t lose sight of something.
- Monthly, quarterly, and annual reviews can be a good practice too.
How to do those reviews? Topic for another day, perhaps.
Or:
Check out the website / Check out GTD apps / Check out the book
Share This Post
-
Running: Getting Started – by Jeff Galloway
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.
Superficially, running is surely one of the easiest sports to get into, for most people. You put one foot in front of the other, repeat, and pick up the pace.
However, many people do not succeed. They head out of the door (perhaps on January the first), push themselves a little, experience runner’s high, think “this is great”, and the next day wake up with some minor aches and no motivation. This book is here to help you bypass that stage.
Jeff Galloway has quite a series of books, but the others seem derivative of this one. So, what makes this one special?
It’s quite comprehensive; it covers (as the title promises) getting started, setting yourself up for success, finding what level your ability is at safely rather than guessing and overdoing it, and building up from there.
He also talks about what kit you’ll want; this isn’t just about shoes, but even “what to wear when the weather’s not good” and so forth; he additionally shares advice about diet, exercise on non-running days, body maintenance (stretching and strengthening), troubleshooting aches and pains, and running well into one’s later years.
Bottom line: if you’d like to take up running but it seems intimidating (perhaps for reasons you can’t quite pin down), this book will take care of all those things, and indeed get you “up and running”.
Click here to check out Running: Getting Started, and get started!
Don’t Forget…
Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!
Learn to Age Gracefully
Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:
-
Mediterranean Diet Book Suggestions
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.
It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝What is Mediterranean diet which book to read?❞
We did a special edition about the Mediterranean Diet! So that’s a great starting point.
As to books, there are so many, and we review books about it from time to time, so keep an eye out for our daily “One-Minute Book Review” section. We do highly recommend “How Not To Die”, which is a science-heavy approach to diet-based longevity, and essentially describes the Mediterranean Diet, with some tweaks.
Don’t Forget…
Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!
Learn to Age Gracefully
Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:
-
How To Engage Your Whole Brain
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.
The Stroke Of Insight That Nobody Wants
This is Dr. Jill Bolte Taylor. She’s a neuroanatomist, who, at the age of 37 (when she was a post-doctoral fellow at Harvard Medical School), had what she refers to as her “stroke of insight”.
That is to say, she had a massive stroke, and after a major brain surgery to remove a clot the size of a golf ball, she spent the next 8 years re-learning to do everything.
Whereas previously she’d been busy mapping the brain to determine how cells communicate with each other, now she was busy mapping whether socks or shoes should go on first. Needless to say, she got an insight into neuroplasticity that few people would hope for.
What does she want us to know?
Dr. Taylor (now once again a successful scientist, lecturer, and author) advocates for “whole brain living”, which involves not taking parts of our brain for granted.
About those parts…
Dr. Taylor wants us to pay attention to all the parts regardless of size, ranging from the two hemispheres, all the way down to the billions of brain cells, and yet even further, to the “trillions of molecular geniuses”—because each brain cell is itself reliant on countless molecules of the many neurochemicals that make up our brain.
For a quick refresher on some of the key players in that latter category, see our Neurotransmitter Cheatsheet 😎
When it comes to the hemispheres, there has historically been a popular belief that these re divided into:
- The right brain: emotional, imaginative, creative, fluid feeling
- The left brain: intellectual, analytical, calculating, crystal thinking
…which is not true, anatomically speaking, because there are cells on both sides doing their part of both of these broad categories of brain processes.
However, Dr. Taylor found, while one hemisphere of her brain was much more damaged than the other, that nevertheless she could recover some functions more quickly than others, which, once she was able to resume her career, inspired her model of four distinct ways of cogitating that can be switched-between and played with or against each other:
Meet The Four Characters Inside Your Brain
Why this matters
As she was re-learning everything, the way forward was not quick or easy, and she also didn’t know where she was going, because for obvious reasons, she couldn’t remember, much less plan.
Looking backwards after her eventual full recovery, she noted a lot of things that she needed during that recovery, some of which she got and some of which she didn’t.
Most notably for her, she needed the right kind of support that would allow all four of the above “characters” as she puts it, to thrive and grow. And, when we say “grow” here we mean that literally, because of growing new brain cells to replace the lost ones (as well as the simple ongoing process of slowly replacing brain cells).
For more on growing new brain cells, by the way, see:
How To Grow New Brain Cells (At Any Age)
In order to achieve this in all of the required brain areas (i.e., and all of the required brain functions), she also wants us to know… drumroll please…
When to STFU
Specifically, the ability to silence parts of our brain that while useful in general, aren’t necessarily being useful right now. Since it’s very difficult to actively achieve a negative when it comes to brain-stuff (don’t think of an elephant), this means scheduling time for other parts of our brain to be louder. And that includes:
- scheduling time to feel (emotionally)
- scheduling time to feel (gut feelings)
- scheduling time to feel (kinesthetically)
…amongst others.
Note: those three are presented in that order, from least basic to most basic. And why? Because, clever beings that we are, we typically start from a position that’s not remotely basic, such as “overthinking”, for example. So, there’s a wind-down through thinking just the right amount, thinking through simpler concepts, feeling, noticing one’s feelings, noticing noticing one’s feelings, all the way down to what, kinesthetically, are we actually physically feeling.
❝It is interesting to note that although our limbic system fucntions throughout our lifetime, it does not mature. As a result, when our emotional “buttons” are pushed, we retain the ability to react to incoming stimulation as though we were a two-year-old, even when we are adults.❞
~ Dr. Jill Taylor
Of course, sometimes the above is not useful, which is why the ability to switch between brain modes is a very important and useful skill to develop.
And how do we do that? By practising. Which is something that it’s necessary to take up consciously, and pursue consistently. When children are at school, there are (hopefully, ideally) curricula set out to ensure they engage and train all parts of their brain. As adults, this does not tend to get the same amount of focus.
“Children’s brains are still developing”—indeed, and so are adult brains:
The Brain As A Work-In-Progress
Dr. Taylor had the uncommon experience of having to, in many ways, neurologically speaking, redo childhood. And having had a second run at it, she developed an appreciation of the process that most of us didn’t necessarily get when doing childhood just the once.
In other words: take the time to feel stuff; take the time to quiet down your chatty mind, take the time engage your senses, and take it seriously! Really notice, as though for the first time, what the texture of your carpet is like. Really notice, as though for the first time, what it feels like to swallow some water. Really notice, as though for the first time, what it feels like to experience joy—or sadness, or comfort, or anger, or peace. Exercise your imagination. Make some art (it doesn’t have to win awards; it just has to light up your brain!). Make music (again, it’s about wiring your brain in your body, not about outdoing Mozart in composition and/or performance). Make changes! Make your brain work in the ways it’s not in the habit of doing.
If you need a little help switching off parts of your brain that are being too active, so that you can better exercise other parts of your brain that might otherwise have been neglected, you might want to try:
Enjoy!
Don’t Forget…
Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!
Learn to Age Gracefully
Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:
