Ways to Help Pain Without Medication and Surgery

More medication? How about some yoga instead?

I promised a series about pain, and a series you will have! In my last post, I talked about lifestyle changes that can help with managing pain. Chronic pain requires a long-term plan, and life-style change should be part of that plan. Although, I don’t know about you, but when I am in pain, I usually need some relief NOW. Some of that can come from medication, but what happens when medication isn’t enough? Lots of times the answer is more meds, but as someone who has given people narcotics and seen the dependence it creates without really improving quality of life, I have asked myself if it is really worth adding more. Not to mention the fact that I am always worried about whether I am contributing to the supply of narcotics on the street. Don’t get me wrong – thousands of people are able to get through the day because of their percocet, tramadol and oxycontin. It’s just – at what cost? That is where non-medication based therapies come in. The ones I talk about here are the ones that I see most commonly used successfully. Obviously the list of therapies is endless – I would love to hear your suggestions too!

Nerve Stimulation Based Therapies - There are several ways to help both new and chronic pains with electrical stimulation. the most famous way to do this is with a TENS device. TENS stands for transcutaneous electrical nerve stimulator. These devices send electrical signals to your nerves and help to control pain signals from them. How they do so is still up for discussion. A simple amazon search yields several options for TENS devices that are very affordable. They are regularly dispensed by pain management doctors and lots of people find lots of relief from them. Electrical stimulators that are more high-tech can often be found at physical therapist and chiropractic offices as well.

Physical Therapy - Many of our joints rely as much on the muscles surrounding them for stability as on the tendons and ligaments keeping them together. When the muscles that support joints become weak, we start to use other, smaller and weaker muscles, creating irritation, scar tissue, and spasm in the process. Physical therapists use a combination of graded exercise training, massage, electrical stimulation, and heat to help people decrease pain and risk of injury. Since NOT moving can worsen the pain, learning how to exercise safely from a physical therapist is essential. It helps people ease back into exercising while minimizing the risk of injury.

Manipulative Therapy – Osteopathic manipulative therapy, Chiropractic adjustment, myo-fascial release, massage and other manipulative therapies can be helpful. Chiropracters have the most training in manipulative therapy. Scientific studies have not shown manipulation to be better than conventional treatment. As for most integrative therapies, the trials are small, but evidence is accumulating. In my experience, these therapies work best when combined with physical therapy.

Acupuncture/Acupressure - There is more and more evidence accumulating to suggest that acupuncture and acupressure are effective therapies for many conditions, but especially for pain and injury. Acupuncture is predicated upon the East Asian theory of health and illness that attributes disease to a blockage in the flow of Qi (pronounced like “chee”). What has always been interesting to me is that Chinese meridians are exactly along the lines of what call fascial planes – the planes into which the various body compartments are separated by tissue called fascia. I remember being at a presentation about how acupuncture might work. Some say that it stimulates our connective tissue cells called fibroblasts to do what they do when we stretch our muscles. All of this is still being worked out in labs and peer reviewed journals. In the mean-while, getting needled to help your pain may not be such a bad idea!

Trigger-point Injections – Trigger points are tender areas on the body where pain can be localized, often co-existing with muscle spasm. While there are physicians who use small needles to introduce steroids into trigger points, there are also several acupuncturists and physical therapists who use dry needling to release trigger points medication free. Here’s a cool video!

What do you do when medication fails to treat your pain? Would love to hear what works for you!

- DS

Managing Pain through Lifestyle Changes

This post has been a long time coming. As someone whose life-long dream it is to help people come off of medications, this is an important topic. There are thousands of articles, journals, books and tutorials in medicine on managing chronic pain. In fact, pain management is a whole specialty in and of itself.

Pain medications can cause tolerance, withdrawal and even CAUSE one to feel more pain, a phenomenon know as opioid-induced hyperalgesia. Patients are often forced to take higher and higher doses of pain medications as they develop tolerance for them.

Part of the problem is that pain is subjective – there is no established test that can objectively quantify and compare each person’s pain level. And it is as debilitating as it is elusive. There are many people who would rather die than be in pain, and indeed, it can make people suicidal, depressed, anxious and generally unable to function. Further complicating matters is the fact that once pain becomes chronic, neurologic connections form between the parts of our bodies that feel pain and our brains. That means that, yes, part of people’s pain is in their heads.

To me, pain is like a spider-web – interconnected, complex, and where it truly started is unclear. For the same reasons that pain has multiple causes, it needs multiple treatments and they need to act in concert with eachother. The best way is to take an inter-disciplinary approach- meaning multiple providers and treatment methods working together to put a plan of action in place. We will dedicate a series on different non-pharmacological ways to manage pain. In a previous post, we mentioned healing foods for muscle and skeletal injuries/pains. This entry focuses on lifestyle changes.

Lifestyle Adjustments

Avoid alcohol and tobacco when managing chronic pain. Alcohol can dull the senses and it can help relax people, but not only are there other ways to achieve both of those things, but the combination of alcohol and chronic pain medication can be dangerous. Always ask your doctor if it is ok to have your daily glass of wine if you start a chronic pain medication. Dependency on alcohol is not helpful in the management of chronic pain. Tobacco can cause muscle to spasm, and increases inflammation, which is linked to pain. It is also important to avoid pro-inflammatory foods-such as refined carbs, sugar and excess meat. Try to incorporate fresh fruit and vegetables, which are anti-inflammatory.

Exercise and stretches, such as yoga, are also important for decreasing pain and speeds up body’s natural healing process. Check with your instructors on different modifications you might need to accommodate your injury. Not only does exercise help to reduce pain, it also helps to get you back on your daily routine by recovering movements you have lost.

Meditation/Relaxation: The mind and body are connected, and with chronic pain, this is even more so. No chronic pain intervention is complete without a behavioral intervention that deals with pain from a psychological perspective. An important part of treating chronic pain is actually learning to decrease the sensation of pain. Relaxation techniques helps to minimize the pain sensation and focus on controlling the pain. They also help to decrease tension on muscles making for smoother and stronger movement. The idea of relaxing to help get rid of pain might feel counter-intuitive, but the research is compelling. {include a compelling study about relaxation technique efficacy here}. Bio-feedback and mindfulness based stress reduction, are probably the most studied relaxation techniques. Others methods include hypnosis and guided imagery.

-DS and NZ

 

Freezer-Friendly Tomato-Onion Indian Curry Base

As a resident, I am forever trying to find the fastest way to eat fresh and healthy food. When I am working long, exhausting winter days, salad just doesn’t cut it for me. I need comfort food! For the past few months, I have been stuck on the idea that it might be convenient to  make large amounts of a curry base in bulk. This way, I can divvy it up in small portions, and then freeze them to be thawed and used to for flavoring in cooking, or as a base for a bean or vegetable dish. Some considerations when deciding whether a dish is freezer-friendly:

  • Soups tend to freeze well
  • In what form have I eaten this vegetable frozen and enjoyed it before?
  • As water freezes, it expands, destroying the cell walls of plants which are hard. That is why thawed fresh vegetables are more limp than fresh ones, even though they have been not been cooked. For the same reason, pre-cooked vegetables tend to taste better than raw ones because you have already broken down the cell-walls in the cooking process.
  • The flavor of herbs and spices intensifies in an already cooked dish once it is frozen because of the increased cell-wall breakdown. Keep this in mind when thawing an already spicy dish!
Tomato-based curry

Tomato and onion curry base

My first successful attempt was a tomato-onion curry base. Tomatoes are the ultimate stew-friendly veggie and they absorb flavor well. Their tangy juice is wonderful for flavoring almost anything. The flavor becomes more concentrated as you cook them down, but they are delicious from the beginning so they are pretty idiot-proof.

Ingredients:

  • 6 small vine ripened tomatoes or 3 large beef-steak tomatoes, roughly chopped
  • 2 onions chopped into 1/4 inch pieces
  • Jalapenos, chopped into thin rounds
  • 2-3 cloves of garlic chopped finely
  • Olive oil or grape-seed oil
  • Spices: 1/4 tsp turmeric, 2 tsp salt, chilli powder

Directions:

  1. Heat olive oil in a fry-pan
  2. Add a piece of garlic to the heated oil to see if it starts to sputter/bubble. If it does, the oil is ready!
  3. Add the garlic to the pan
  4. Once it is slightly done, add the onion. Sautee until almost translucent. Try not to continually stir the onions but rather wait until they cook a little, then move the top onions to the bottom. Keep repeating this process until all the onions are mostly translucent.
  5. Once onions are cooked, add 1 tsp salt and turmeric. Adding turmeric too early makes it harder to tell if the onions are cooked. Adding salt too early releases the moisture from the onions into the rest of the dish too early. This makes them boil more than fry, which makes them more sweet and less pungent.
  6. Now, add the tomatoes. Cook them to your desired thickness and flavor. Add the other teaspoon of salt to help release the moisture from the tomatoes into the dish

And voila! You have a finished curry base. My favorite way to incorporate this dish is to add about 1/4 cup with 2 cans of refried beans and some water. This makes them a hundred times better than when they started.

Different ways to use the curry base:

  • Sautee black mustard seeds, ginger-garlic paste, cumin and dried red chillis in olive oil and add it to the base with almost any bean or lentil, you get tomato daal.
  • Add it to a cooked grain to make a tomato based rice or pilaaf.
  • Add it to cooked cracked wheat along with black mustard seeds, cumin, ginger-garlic paste and curry leaves sauteed in oil, you get upma.

-DS

Flavorful Baked Corn on the Cob

As we enter into long and hot summer days, corn on the cob are popping up all over the local markets. An ear of corn is perfect for everything from BBQ with friends to a light summer meal. I like to bake mine for added flavor and aroma.

Different varieties of corn have varying phytonutrients. Yellow corn are rich in antioxidant carotenoids, with high concentrations of lutein and zeaxanthin – important for protecting eyes against light induced oxidative damage which can lead to macular degeneration.

To start, make sure the corn are organic, as a majority of conventional corns are genetically modified. To avoid GMO corns, look for ones that are certified USDA organic. You can also check Non-GMO Project for a list of certified non-GMO products. Then, pick the cobs that are tightly wound to their husks with fresh looking corn silk sticking out on top. If the husk or the corn silk looks dried out, chances are its been in the sun for too long.

The below recipe calls for butter, I recommend using grass-fed butter or ghee. Vegan alternatives include coconut oil or olive oil. In some countries where corn on the cob is a street-food, butter is skipped entirely and is replaced with sprinkles of lemon or lime.

Ingredients:

  • 2 ears of corn on the cob
  • 3 tablespoon of melted butter (or a vegan alternative)
  • 1/4 teaspoon salt
  • 1/8 teaspoon pepper
  • ¼ tsp of dill weed
  • ¼ tsp of parsley
  • ¼ tsp of paprika
  • ¼ cup of parmesan cheese (optional)

Directions:

  1. Preheat oven to 450°F.
  2. Husk corn, remove silk then wash the corn.
  3. Place each ear on  a12-inch square of aluminum foil, spread the melted butter on all sides of ears and season it with remaining ingredients. Seal the foil.corn
  4. Place sealed ears of corn directly on oven rack. Bake about 30 minutes.

    wrapped ready for the oven

    wrapped ready for the oven

  5. Remove the baked corn from the oven and serve hot.

-NZ

Four Healthy Products to Satisfy Your Chocolate Craving

So I tried to go vegan last year, and I was pretty successful for a few months. Then came the holiday season, which fell during one of my stints on the night-shift in the hospital. Helloooo sugar-cravings. My biggest pit-falls? Cheese and chocolate. One thing that people don’t know about ICU and ER nurses, especially the night-shift ones, is that there is ALWAYS a stash of candy. Med school and residency has taught me to learn from every failed exam, every bad evaluation, every wrong decision. I have decided that last year was a learning experience, and the only way to combat the endless candy resources during Christmas, Easter, Thanksgiving, and New Years is to bring in my own chocolate craving artillery. Here are my favorite secret, oh-so-decadent, weapons. Besides, it is the sugar in chocolate that is bad for you. Chocolate itself is just chock-full (pun intended :-p) of anti-oxidants and essential minerals like magnesium.

Hail Merry Chocolate Tart: With an almond shell and tart made of chocolate and coconut butter, this is one of the most decadent treats you will ever have, whether or not you are vegan. It is especially good for special occasions. I have also made similar recipes to this and it is quite reproducible, although the crust is hard to make as good as the original. It’s great to take to parties! The best part about this treat is that it is so decadent it is hard to eat the whole thing.

Fearless Brand Exploding Coconuts Chocolate with 70% Cocoa: This is one dark chocolate that melts in your mouth. Half of one of these bars has 6 grams of fiber and only 9 grams of sugar. Because of how dark the chocolate is, it is super satisfying, and lasts me 3 days usually. As a plus, the chocolate is fair-trade, gluten-free, soy-free, vegan and every other kind of ethical you can imagine. Just check out their FAQ. 

6 grams of fiber and only 9 grams of sugar in half a bar!

 

Justin’s Hazelnut Butter: My husband loves Nutella, so naturally it is around my house. Someone at my residency brought some and stuck it in our lounge too. Even if I don’t use it, I end up with dog-gone craving for sweets. Then I found Justin’s. I kid you not this stuff tastes like chocolate icing and 2 tablespoons of it only has 7 grams of sugar. To die for.

Tastes like chocolate icing!

 

Cacao nibs: When you buy these suckers, remember initially that they are bitter – it is like eating 100% chocolate. My friend Ingrid clued me into this one – dip a spoon full of honey into cacao nibs, and it will be full of chocolatey goodness! You can also put them in a smoothie. My favorite company to buy these is David Wolfe’s company sunfood.

cacao nibs – crunchy bursts of chocolatey-ness

Finally, a constructive way to deal with cravings is to try to dissecting them. Chocolate is a complex food with lots of flavors and textures. Is it the richness you are craving? Is it sweet? Is it that cocoa smell? The bitterness? Sweetness can be combated with salt sometimes (try an olive or a sun-dried tomato based food), but you can also try eating something sweet that is healthful can be helpful. If it’s the richness, a smoothie with frozen banana and your choice of healthy milk might be the ticket. Maybe try something flavored with a healthy oil. If it is bitterness or aroma, you can try dark chocolate or coffee that has cocoa undertones. Of course, I have to say, eat your greens. Greens have lots of magnesium in them. In the holistic nutrition world, it is thought that cravings may be related to micronutrient deficiencies. In this case, a chocolate craving could be a craving for magnesium, which is found in high amounts in leafy green veggies. In Ayurveda, chocolate would be a dry, bitter and astringent food. Tea, coffee and many leafy greens fall into this category and would make a good replacement for chocolate.

- DS

Nettle Tea for Allergy Relief

In my past entry, I mentioned foods that can help against allergy symptoms, but I didn’t mention the benefit of nettle tea for allergies.

nettle

The stinging nettle plant might be a thing to avoid during your hike, but they are a welcome sight for allergy sufferers when brewed as a tea. As a natural antihistamine, nettle helps against hay fever and allergy attacks by blocking the histamines in your body that are responsible for your allergy symptoms. Best, is that nettle tea has a pleasant sweetness that makes it enjoyable served cold and hot.

Brewing Directions: (serves one)

  • Place one heaped teaspoon of dried Nettle leaves and add boiling water.
  • Steep for 5 minutes, and enjoy.

NOTE: Many teas are heavily sprayed with pesticides which can worsen your allergies, so be sure to buy organic nettle leaf teas.

-NZ

Healing Foods for Joint Sprains

When you have an injury, the hardest thing to do is sit tight and let your body recover. Unfortunately, modern medicine doesn’t have much to speed up bone formation and remodeling. While physical therapy and exercise is the key to recovery and minimizing pain, there are certain foods that can help decrease inflammatory pain and improve recovery:

  1. Beta-carotene: important for collagen formation. Beta carotene is an important component in the process of ligament re-growth.
  2. Zinc: topical wound healing formulations often include zinc oxide. An important mineral, zinc is key for growth and wound healing . Foods rich in zinc include sesame seeds and raw pumpkin seeds
  3. Pineapples: this delicious fruit contains bromalain, the enzyme key for wound healing and to reduce swelling. Pineapples are also high in Vitamin C which is anti-inflammatory and supports collagen formation.
  4. Omega-3 fatty acids: researchers found that when a person consumes a high ratio of omega 6-to-omega 3, there is over-activation of COX-2, the inflammatory enzyme responsible for joint pain.

While studies on food that can affect pain and sprains are still very limiting, those who are chronic pain sufferers can often attest to consuming foods that affect pain and inflammation level. If you have had these experiences, we would love to hear about them!

-NZ

References:

Bromalain http://www.nlm.nih.gov/medlineplus/druginfo/natural/895.html

Zinc http://ods.od.nih.gov/factsheets/Zinc-HealthProfessional/