About this show:
Is it possible for a person who stubs their toe to feel more pain than someone who breaks their foot!?
YES.
Wow.
This week on the LOW TOX LIFE podcast, we take a deep dive into PAIN with our guest Ananda Mahony, who is a highly experienced practitioner who holds a Bachelor of Science in Naturopathy, a Graduate Diploma in nutrition and a Master of Medicine (majoring in Pain) and cover:
- What pain IS.
- What brings it on and makes it as mild or severe an experience as it is for someone.
- How our nervous system impacts our pain experience
- Gender research and the differences in the pain experience
- How dietary inflammation compounds the pain experience
- How pain management/treatment is changing
- The building of your own personal pain ‘map’ as a key to moving forward
- How a scan result can impact the pain experience – this one will blow your mind!
- Connection and purpose as pain relief? What the science says
Big show. Helpful show. Hope you love it + pass it on to those who need it
Enjoy the show,
Alexx Stuart
Founder of Low Tox Life and the Low Tox movement
Join me on Insta @lowtoxlife
Ananda Mahony is a highly experienced Naturopath based in Brisbane, with over 20 years of expertise in holistic health care. Her passion for natural healing and evidence-based practice has shaped her approach to supporting individuals with skin issues, chronic pain, and complex health conditions.
Ananda holds a Bachelor of Health Science in Naturopathy, a Graduate Diploma in Nutrition, and a Master of Science in Medicine (Pain Management)
Connect with Ananda’s work
https://www.instagram.com/ananda_mahony_naturopath/
https://linktr.ee/anandamahony
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About Ananda Mahony
Ananda Mahony is a highly experienced Naturopath based in Brisbane, with over 20 years of expertise in holistic health care. Her passion for natural healing and evidence-based practice has shaped her approach to supporting individuals with skin issues, chronic pain, and complex health conditions.
Ananda holds a Bachelor of Health Science in Naturopathy, a Graduate Diploma in Nutrition, and a Master of Science in Medicine (Pain Management). She has completed further training with dermatologist Michael Tirant to support her focus on skin health. Her extensive training allows her to integrate traditional naturopathic principles with modern medical insights, providing comprehensive and personalised care for her clients.
Her clinical expertise includes:
• Chronic Pain Management: Ananda helps individuals manage persistent pain through a combination of education, nutrition, lifestyle modifications, and self-care strategies.
• Complex Health Issues: She specialises in addressing multifaceted health concerns by conducting thorough assessments and diagnostic testing to identify and map underlying causes and develop targeted treatment plans.
• Skin Health: With a particular interest in skin conditions such as acne, eczema, rosacea, and psoriasis, she focuses on holistic approaches to help clients achieve clear, healthy skin.
Beyond her clinical work, Ananda is passionate about education and mentorship. She teaches and mentors aspiring naturopaths and nutritionists, equipping them with the skills to become effective practitioners. She also believes in empowering her clients through knowledge, ensuring they have the tools to take control of their health.
More about this month’s sponsors:
Thank you to this month’s sponsors for partnering with our show and helping you make your swaps with their special offer:
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Title show track, by LIOR.
Love the podcast music? You will hear excerpts from Lior’s track “Caught Up” – go check it out on iTunes or Spotify if you want to hear the whole song or album, Scattered Reflections. Co-written with Cameron Deyell, it’s a great song and I love the reflective energy of it – perfect for the show, right? Enjoy. Lior is always touring, so do check out his website. It is wonderful to hear him sing live, trust me.
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If you would love reading like me or you just simply want to go through the full transcript, you can check below.
[Alexx Stuart] (0:00 – 9:46)Let me ask you something about pain. Do you think it’s possible for someone who stubs their toe to feel more pain than someone who breaks their foot? Today we find out the answer to that question.
It’ll blow your mind. We are deep diving into the story of pain. Hello and welcome to the Low Tox Life podcast.
I’m Alexx Stuart, your host, and today’s show 421. I’m thrilled to have you here with me. Thank you so much for the recent uptick in reviews.
We have 4.8 stars, over 700 reviews I think now on iTunes. I would love to get that to a thousand. There’s so many huge players out there these days, fancy studios, and you know I love to interview in a way that brings you the facts, that brings you the empowerment, that brings you brilliant experts, often people who fly under the radar, just very steadily doing incredible work in their clinics and practices, and a little review goes a long way.
So whether you’re on Spotify, iTunes, YouTube, wherever you’re listening to this, I would so appreciate those reviews to keep on coming. Thank you so, so much. It’s awesome to have you here.
Now today we’re talking about pain and I wanted to find a practitioner in the space who was very experienced and who had specifically subject studied, so done a big piece of work on pain themselves, and Ananda Mahoney is our naturopath of over 20 years experience, nutritionist as well, and has a master’s in pain, exactly who I was looking for. She is brilliant at explaining not only all the things that go into setting the stage for our pain alert to go off, but also things that might be a bit kinky in our different inputs that mean we struggle to get out of pain. Our signaling’s off, we move into chronic states, inflammation, gut, a whole bunch of other pieces in the puzzle, trauma.
Oh my gosh, pain is a huge topic. And I think what really drove it home was the example of the shark attack victim and the construction worker. I’m going to let her tell the story.
It absolutely blew my mind, but also was a massive light bulb as to how we can’t just say, as Ananda says, there’s an issue in the tissue, let’s fix it. We actually have to look at the many factors that play into a pain presentation and a pain duration for that individual, right? So she’s going to take us through it.
I am going to hook into that in a little minute. It is a brand new month, of course, which means we not only have our major sponsor, Ozclimate, giving you 10% off their dehumidifiers, Winix air purifiers, and now air circulators and cooling and heating ranges with the code LOTOXLIFE, which by the way, works even if they’re doing a sale price, just mental note that you should jump on their newsletter because then as an Australian that is, because it is an Aussie offer, then you get the alerts that something’s on sale and you can jump in and get a mega deal as well. I’m not going to harp on about dehumidifiers again, but I will tell you, we are about to do a 10 part educational sort of series, if you like, really practical tips on dehumidification, probably from about the third week of March. So stay tuned for that on Instagram.
Come find me, LOTOXLIFE is how you know it’s me and not LOTOX something else. LOTOXLIFE, registered trademark. So that is the website, the podcast, the socials, that’s where we are.
And then of course, because it’s a new month, we always have a special guest partner and this month is BioFirst. I love these guys, a brilliant family business, an incredible founder, Dr. Jude with a PhD in self-care. I mean, does that not alone tell us how important the stress plays into our skin stressors?
Jude is incredible and she’s an amazing formulator working with research up to the minute and a lot of traditional herbal research as well in making their formulations. And I was so, so thrilled about this one because I know a lot of my friends in the postpartum kind of stage when you’ve just had your kids and you’re like, what the heck happened to my skin? Blemishes all of a sudden you think, I thought this was puberty and women get to find out.
We just get to experience that again and again after birth, if we’ve had kids and then often again, also my friends now in their forties and fifties experiencing breakouts again through this peri and menopause transition. So the blemish, it’s blemish ban, that’s the name of the range. It’s two pocket rocket products.
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I found it in my teenager’s bathroom. So I’m kind of coming up with my own tagline for this range for people in their forties using this for blemishes. So good your teen is going to steal it.
That’s, that’s kind of where I’m at that. Of course, we should check for zinc levels and all the other things that play into hormonal stress and how it reflects on our skin. But let me tell you right now, these products are incredible.
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All right, let’s now talk about pain. I really can’t wait to hear how this community, what you take from this episode, share it with me on Insta. I’m like genuinely, I thought it was so powerful.
We did talk actually about diet as well before I hook in and fats came up and in the research, saturated fats come up, but just be sure to tune into context there. Cause a lot of people like, Oh no, we’ve been demonizing saturated fats and they are unhealthy. There is a link to inflammation with them that we can’t ignore.
And so it’s just more, it’s not that it’s unhealthy. It’s just that if you’re experiencing any kind of pain, chronic pain, and you’ve tried a lot of things, you might want to look at a dietary adjustment. And that would probably look like a, as Ananda talks about in the research, a more Mediterranean style approach with the olive oil, for example, as a great fat option.
And a lot of people think you can’t cook with olive oil. You can extra virgin olive oil. Actually, there’s a lot of research that’s been done on it.
And I spoke with the founder of Cobram estate olive oil many years ago on the podcast. So I’ll pop that show in the links on the show notes and the polyphenols remained intact on quality, extra virgin olive oil after using in a high heat frying pan situation. So that’s a bit of a myth folks, as long as it’s not something sort of cheap that just says olive oil, and you don’t really know if something’s been blended in it somewhere before it’s been shipped to your country, but good quality, extra virgin olive oil is not to be afraid of.
So I just wanted to give that little caveat with fats. It’s not that they’re unhealthy. We don’t need to all like skip all saturated fats.
And Ananda talks about that as well, but I just wanted to emphasize it because we have this swinging pendulum kind of approach often with topics like this, where something’s all in or all out. And when we talk saturated fats today, it is all context. That’s what’s important.
So enjoy the show and hit me up on socials to let me know what you thought. Hello, Ananda. How are you?
[Ananda Mahony] (9:46 – 9:50)Great. Thanks for having me today, Alex. I’m really looking forward to this chat. [Alexx Stuart] (9:50 – 10:41)
I am too. I was putting it out to the universe that I wanted to do a show deep diving into pain and there you literally just arrived out of a conversation with someone on my team and looking at your work, I can absolutely see why and I’m thrilled to explore not only your work, but this topic because pain is so psycho neuro, isn’t it? It’s got that component to the actual physical things that happen that our body communicates to us.
There’s something wrong. And then like everything else joins the party and it can get really confusing. So can you give us a bit of an introduction by way of speaking about how as a this topic has unfolded for you?
[Ananda Mahony] (10:42 – 11:52)Oh, yes. Interestingly, I don’t have chronic pain and I will say that straight up, but in clinic settings, I was seeing a lot of patients with chronic pain. I was working in with a musculoskeletal therapist.
And so patients were being referred to who had significant pain and persistent pain of various different types. And I just wasn’t understanding it. It’s not something that we look at in depth in our undergraduate training.
And well, I should say we look at the biology of acute pain. We don’t necessarily explore the concepts in chronic pain. And seeing people with persistent, recurring or chronic pain, that’s an entirely different story.
And so the strategies that I were trying wasn’t working very well. And at that stage, look, I was I was curious, I wanted to know more. So instead of doing a few courses, I jumped in and did a whole masters in.
[Alexx Stuart] (11:53 – 11:55)Because you’re that kind of gal. [Ananda Mahony] (11:56 – 13:07)
Yes, I did a masters in the science of pain management. And I’ve got to say the first few trimesters blew my hair back a little bit. I was a bit like, well, hold on for the ride.
But then it really, I started to realize that the approaches to chronic pain that were being discussed in the research really overlaid well with the wholism of naturopathy. Because we cannot look at pain with a reductionist approach. And of course, naturopathy is, I’m sure it can be reductionist, but we try not to make it reductionist.
And so there’s complexity in both of those. And I found that those philosophical underpinnings of the frameworks dovetailed quite well. And so that gave me some really good ways of working with people in chronic pain that were beyond just what I was doing.
I wasn’t working in silos. It was like, how do we create a team of people to help support this person in chronic pain? Because it’s more than just the issues in the tissues.
More than what’s just happening in the physical body. You have to go beyond that.
[Alexx Stuart] (13:07 – 13:11)Okay. And so let’s go beyond that. What is the more? [Ananda Mahony] (13:12 – 15:21)
Okay. Well, I think that probably to explain the more, it’s good to just understand what happens in an acute pain situation. Because the biology of pain is never very straightforward.
And pain is modulated by many factors across our body. So physical, and I call those issues in the tissues, but also our mind, and even how we interact with the world around us. But essentially, pain is a survival response.
And it’s actually a perceptual inference, whereby the experience is considered an output that reflects a best guess estimate of an advantageous or survival response. And we tend to err on the side of protection. What do I mean by that?
This is a way of making sure that we don’t leave our hand on the hot kettle, or walk on a foot that we’ve sprained. And that protective response will often come in quite strongly, so that we don’t further injure or harm ourselves, or so that we do aim to get ourselves out of a tricky situation that has the potential to cause harm. But to provide a starting place, all types of pain result from an interaction between a collection of systems in the body.
And this is probably the fundamentals, which is the central nervous system, which is the brain and spinal cord, the peripheral nervous system, which is all of those threat receptors all over our body, and they’re called nociceptors. So they respond to signals around temperature, around heat, around damage, things like that. It involves our immune system, and particularly where the immune system and the nervous system intersect.
And there’s special cells in the spinal cord and brain called glial cells. I won’t go into any more detail about those, but really that intersection of where the immune system and the nervous system come together, and then our cognition. So our thought processes are a really significant part of that pain experience.
[Alexx Stuart] (15:22 – 15:45)Wow. So can I stop you there? Because what you were saying before about how it’s basically our body’s best guess estimate of a survival response.
So because our emotional factors and our nervous system come into play, and they’re connected to our immune system, can they get it wrong?
[Ananda Mahony] (15:46 – 18:09)Oh, yes. Oh, yes. Yeah, absolutely.
So, and what I would say about this is that pain is the pain we experience is rarely proportional to the tissue damage. I’m just going to give you an example, two big examples. And these are you may have seen on the news every few years, there’s a surfer who’s been out and been bitten by a shark.
And this, I live in Brisbane, so in Stradbroke Island, a couple of years ago, there was a surfer and he’d had half his leg bitten off by the shark. And he was lying there on the stretcher because the ambos had just got him out onto the beach and he’d been rescued. And he was smiling with his thumbs up.
So when we consider pain response, it’s so contextual. In that case, what was beyond or higher than pain was the survival response. And he survived.
And that was first and foremost. And he could see that, yes, his leg had been bitten off. But in that moment, the threat of that was less than the fact that he’d survived a shark attack.
And he was probably going to survive the surgery and the recovery and things like that. So that’s one example of how contextual pain can be. Another is a classic example that’s been in the literature.
It was in 1950 sometime in Nature, a big journal article. Actually, don’t quote me on that. It was the 1950s.
I can’t exactly remember the journal. But it was this story of a guy on a construction site. And he’d put a massive nail through his shoe.
And you could see this photo of this old-fashioned style boot with a massive nail through it. And he was in agony. He was screaming in pain when they got him to the hospital, so much so that they had to knock him out in order to get the boot off.
And when they cut the boot off, what they found is the nail had gone right between two toes and there was absolutely no tissue damage. So there are two kind of extreme end examples of how context-driven pain perception is.
[Alexx Stuart] (18:12 – 18:14)It’s pretty mind-blowing, isn’t it? [Ananda Mahony] (18:14 – 18:48)
Yeah. When we have those nerves in the periphery called nociceptors, they are there for noxious or unpleasant stimuli. And when they’re detected, say you hit your thumb with a hammer, these nerves don’t send pain signals.
They send potential danger signals or threat signals from the periphery up the spinal cord into the brain. And these signals mean there is potential for tissue damage and that perhaps you should do something about it. And you can see even from there that we could get it wrong.
[Alexx Stuart] (18:48 – 19:16)Mm. So it’s almost like a triage that you then let your subconscious brain take over and assess. And depending on your neuro-emotional state, you may assess, oh my gosh, my life is over.
And then you’ve got the hammer example where the nail example where it didn’t even go through the toe or oh my gosh, how amazing I’m still here. Shark attack example. And every shade in between.
[Ananda Mahony] (19:16 – 20:34)Absolutely. So the brain is actually the central driving system for pain output. So pain is a response.
It’s not an incoming signal. It’s an outgoing response from the brain. And it influences pain intensity, duration and type of pain we experience.
That’s the brain. So you feel pain in your body. And so it’s natural to think that it’s simply a physical experience.
But it’s so much more than what you feel just in your body. It’s also what’s going on, as you said, that neuro-emotional experience, I think was the word you used, but emotionally, your thought processes and how your brain interprets the threat messages that are coming in from the periphery. Acute pain is that harm alarm.
And we have all sorts of sympathetic nervous system responses to that, but they all die down pretty quickly. And even pain will resolve long before healing has a complete healing has occurred. Yeah, cut on your finger, you know, it stops being painful before the wound is healed.
Twist your ankle, you can walk on it without pain, even though there’s still some instability in the ankle. Harm alarm is no longer necessary. So the pain subsides.
[Alexx Stuart] (20:34 – 20:47)And is that because almost the nervous system and immune system know like you’re onto it, you’re looking after it and we can back off now because we’re happy with the way this is being dealt with? Is it almost like that sort of situation? [Ananda Mahony] (20:47 – 20:54)
I think if I could just put it in slightly different words, I’m going to say, and it’s a reflection of how threatened you feel. [Alexx Stuart] (20:55 – 21:29)
That’s what I wanted to get to. That’s interesting because that would then suggest that based on our general senses of perception of threat in life, perhaps past traumas or, you know, poor vagal tone, we could go on with all the presentations of what might make someone rise to panic faster than the next person. But that then plays a role in the perpetuity of something moving into chronic pain as well, maybe. [Ananda Mahony] (21:29 – 22:14)
Absolutely. So past experiences, general health, beliefs, beliefs around pain is significant. Sleep where everything always hurts more when we’re tired.
How fit we are, our psychological well-being all play a role in how much pain an individual might experience. So I will just make this point. We could say that individual context means pain, a very individual experience.
We can’t compare pain. So if someone’s got fibromyalgia and another person A and person B, we can’t say that their pain experience is going to be the same because they’ve got the same condition. Or if someone has low back pain or any kind of pain, it is a very individual experience as to how much pain perception and how much pain they’re experiencing.
[Alexx Stuart] (22:15 – 22:19)Which is why we always need to remember to meet people where they’re at. [Ananda Mahony] (22:19 – 22:20)
Yes. [Alexx Stuart] (22:21 – 22:37)
So important. And it’s almost like our medical system doesn’t really have a great way of doing that because we need to systemize to be able to be as efficient as we need to be to see as many people as we need to see. [Ananda Mahony] (22:38 – 22:38)
Absolutely. [Alexx Stuart] (22:39 – 22:39)
Yeah. [Ananda Mahony] (22:39 – 22:43)
And that’s a luxury that I have is that I have more time to spend with people. [Alexx Stuart] (22:43 – 23:20)
Yeah. Which then brings the subject of privilege, but not everyone either A knows about holistic health care. I remember I got to be antibiotic resistant to strep bugs before I found out about naturopathy and haven’t had tonsillitis since, well once.
And I think about like people who wouldn’t be able to spend, you know, 250 on an initial consult to spend an hour with someone. And, you know, really it just, again, speaks to our whole system being off in terms of actually supporting everybody.
[Ananda Mahony] (23:21 – 24:37)Yeah. And there are some good, I won’t say they’re good, but there are some emerging spaces where there are strategies through pharmacies to help people with both pain medication appropriateness. I don’t want to say appropriateness.
I don’t mean there’s no judgment around that. Just are the pain medications appropriate to the individual and what they’re experiencing? Are they necessary?
Are they sufficient? And then also around some limited pain education. I don’t know how much traction that that’s got.
There are public health in outpatient services for chronic pain, but they’re usually so busy that there’s up to 18 months waiting time. So I agree that some of the strategies that we’ll talk about are about have a healthy dollop of privilege in. I will try and incorporate some strategies that people in chronic pain can do without a lot of money or a necessity to go and see someone.
And there are some good free resources.
[Alexx Stuart] (24:38 – 25:06)Yeah. Thank gosh for the internet, right? I often think like what we have available to us now through free podcasts and really targeted subjects where people can dig deep with some of the best minds in the business on any subject.
I mean, that is definitely revolutionizing access as well. Okay. So something I thought of as you were talking about different people experiencing pain differently.
[Ananda Mahony] (25:06 – 25:31)There is sex differences, but there’s also gender differences. So if we just talk about sex and biology, they’re looking into that space and showing that in fact, some of the mechanisms that say drive pain persistence or lead to pain persistence in the immune system are different from male mice versus female mice. [Alexx Stuart] (25:31 – 25:36)
So it’s a watch this space, but we’re finally getting some better research. [Ananda Mahony] (25:37 – 26:59)
There’s a very good book. I can’t remember the author. She’s Australian though.
She was a journalist with endometriosis and she wrote a book called Pain and Prejudice is all about the lack of funding and the lack of research around women and females in this space, both from a sex perspective and a gender perspective. And there’s some great papers at this. I was looking at one the other day around gender and it’s like stoic men and emotional women in the pain space and how even the fact that a woman presenting will often be their pain experience will be lessened or belittled, but okay, I want to use that word.
Minimized is the word minimized because of emotions or they’re less likely to get as much effective pain relief. So it is such a complex space to unpack. And it’s only in the last 10 years that we’re seeing research, significant research into the biological basis between the sexes, but also more research into the gender space.
[Alexx Stuart] (26:59 – 27:11)I was going to say, so it’s almost like culturally, we have accepted a higher pain tolerance because our pain has been minimized for so long. [Ananda Mahony] (27:11 – 28:34)
Perhaps, but I also am mindful that pain is such an individual experience and we can have biological difference, gender difference, conditioning, but it also comes back to things like what happened in their childhood. Did they have adverse childhood experiences? Were there vulnerabilities?
And that is such an individual. And sure, we might see more of a trauma history in some women that has meant that women are more vulnerable to pain later in life, but pain is such an individual experience. And when we look at, sometimes I do mind maps, I’ll call them pain tangles, where patients draw up all of the factors and we draw up on the board, all of the factors that we think might be contributing to their experience of pain.
And it ends up looking like a big tangle because everything’s connected and everyone’s pain tangle or map is different. So I do struggle to talk about, well not struggle, I find it complex to talk about differences like that.
[Alexx Stuart] (28:34 – 28:37)Yeah. It’s extremely common. I’m hearing that.
Absolutely.
[Ananda Mahony] (28:37 – 28:45)Because it’s just not clear cut and we don’t really know enough yet. We see trends, but we don’t really know enough yet. [Alexx Stuart] (28:46 – 28:52)
Thank gosh for separating women and men out in the medical research at last, the last couple of decades. [Ananda Mahony] (28:53 – 29:19)
And there is no doubt that women experience more pain than men. Yeah. So I think this might be slightly out of date.
One in six men and one in five women, something like that. Don’t quote me on that. I can look it up and give the facts to you later.
That’s to you later, but it is, there’s no doubt in the pain experience a bias towards women.
[Alexx Stuart] (29:19 – 30:24)Yeah. I was looking at some research on perimenopause and pain recently and how that was costing women between the ages of, I think it was 45 and 60 or something as a bracket like that, $17 billion in Australia, in scans and testing and medication and doctor’s visits because of the increased amount of pain people experiencing estrogen drop phase, just fascinating. And, and so the cost of pain, the tax, it’s like a pain tax because what’s biologically happening will of course inadvertently like matter of fact cause more issues for people.
So it’s, yeah, it’s a fascinating, fascinating topic. And I really want to unpack also though the acute pain and the chronic pain and what is happening that makes pain become a chronic presentation.
[Ananda Mahony] (30:25 – 30:26)Yeah. Okay. [Alexx Stuart] (30:26 – 30:30)
So that’s a three day seminar. Yeah. [Ananda Mahony] (30:31 – 32:01)
I’ll go back to that and go, yeah. I think about, we talked about that harm alarm and the point of pain being to provoke a response, to pull your arm out of, you know, out of the fire or your hand away from the hot kettle. And so it was really annoying.
And so in persistent pain, the alarm isn’t useful and it becomes quite disconnected from the initial problem. It isn’t telling us if there’s smoke or even a fire, the fire is out under control, but the alarm is still sounding. And technically, if we want to give a medical definition to this, it’s pain becomes chronic after three months, and that can be either persistent pain or recurring pain.
If it’s been experienced for over three months, then it falls into the chronic category. And there is certainly more going on than just the issues in the tissues. We know that with acute pain as well, but with chronic pain, there starts to be changes in the nervous system and the nervous system becomes programmed to be hypersensitive and set on an overprotective setting, which produces increasingly painful responses and pain amplification.
[Alexx Stuart] (32:02 – 32:07)Wow. So this is like a negative feedback loop almost. [Ananda Mahony] (32:08 – 33:33)
Yeah. It’s that concept of neuroplasticity. This changes and adapts, but in this sense, it changes and adapts in a space where we don’t necessarily want it to.
And it means we stay in that overprotective state and even the map for responding to pain or threat messages expands in the brain. So we become excellent at producing pain and the brain learns, if you like, that this is the go-to response or go-to output for threat. And so it stays in that state.
And we talked about the immune system, it becomes involved in those sustained pain responses and it can become or can contribute to that sensitization of the nervous system, which means that incoming threat signals are given more attention and importance. It’s like pay attention, incoming threat, really important. The spinal cord and the brain.
So when the immune system is involved, everything becomes more ramped up, more turned up and edgy and the whole system is on higher alert. And then this becomes a vicious cycle and it’s a bit of a learnt cycle. Now we don’t necessarily consciously learn it, but it does become us, as I said, the go-to response.
And then we start to see it being disconnected from the original source of the pain. Bingo.
[Alexx Stuart] (33:33 – 33:40)This is where I was hoping we would end up because that’s like probably huge for so many people. [Ananda Mahony] (33:40 – 34:39)
Yeah. So as sensitivity increases, our brain starts to link pain with normal sensations, normal activities like bending over or even situations. So if you’ve had a bad day at work or you’ve had a fight with your partner, you might get pain amplification.
And so things that we used to be able to tolerate can even become triggers for pain and things that we become more sensitive with that nervous system sensitization. So we might be sensitive in a lot of ways, not just more pain, but foods that we used to be able to eat we’re now sensitive to or light or noise or people just become more irritating. And then external factors like our work environment and social engagement kind of just all dump in like unhelpful baggage and further entrench this persistent pain, making it that vicious cycle.
[Alexx Stuart] (34:39 – 35:12)Wow. And so you can see then how gut health becomes involved in this vicious cycle, which I was talking to Dr. Gundry about the gut brain paradox a couple of weeks ago and how yeah, exactly what you’re just saying. Then the implication of pain relief coming in and that further damaging the gut, which damages immune, which damages the nervous system response.
So the loop is very complex.
[Ananda Mahony] (35:13 – 35:53)Yes. And so there’s lots of loops, sustaining loops in chronic pain. And that’s why when we have a look at how many sustaining loops there could be, it really comes back to, well, what is this individual, what is triggering their threat responses?
And then once they’re in chronic pain, what are the factors start to contribute as well? And when we have I say normal everyday situations, but things that we used to be able to tolerate now becoming threats, that’s when we really see persistent pain amplify and become a cause of significant morbidity.
[Alexx Stuart] (35:54 – 35:55)Yeah. [Ananda Mahony] (35:55 – 37:08)
And there’s lots of factors that are at the intersection of chronic pain. So we’ve got those sensory inputs, that’s the issues in the tissue. So that could be injury or inflammation or musculoskeletal issues or gut issues.
So that’s still a sensory input, that gut link, even though it influences the brain. There could be psychological vulnerability or comorbidities such as depression and anxiety. We might have environmental inputs such as our of social connection, our stress levels, attachment styles, whether we feel secure and like we belong.
Other comorbidities such as obesity or addiction or other pain conditions. So what we have is we start to see multiple overlapping pain conditions such as temporomandibular joint dysfunction with migraines, with fibromyalgia or irritable bowel syndrome, with endometriosis, with fibromyalgia or joint hypermobility. So we start to see pain conditions amplifying pain responses.
[Alexx Stuart] (37:09 – 37:15)It’s very normal in this picture to see multiple things diagnosed. [Ananda Mahony] (37:16 – 38:13)
And also with chronic pain, one of the things that’s quite interesting, I find, is that we start to see pain spread and move. So a person in chronic sustained pain and has been there for a certain length of, not any particular length of time, but they’ve been in this situation for a while, will start to say is I have multiple pain sites and sometimes they move and shift. And often there’s a degree of somatization around that, which is what’s this new pain?
Does it mean that things are getting worse? Does it mean that there’s more tissue destruction, that there’s more trauma to something’s more inflammation? And often the case is no, it’s just part of that chronic pain situation where we will see moving, shifting pain and pain amplification with stress or pain amplification with a poor night’s sleep or mood changes.
[Alexx Stuart] (38:14 – 38:37)Mm. A hundred percent. I broke my foot nearly two years ago.
And if I’ve had a poor night’s sleep, that’ll be the day that I can just feel a teeny tiny little, Oh, that’s right. I broke my foot a couple of years ago. Um, but I would never be feeling it at any other time other than a shocking night’s sleep.
So that really rings true for me.
[Ananda Mahony] (38:37 – 38:39)Yeah, absolutely. Mm. [Alexx Stuart] (38:39 – 39:39)
And so issues with the tissues. I love that phrase because it’s, um, it’s going to help us with this next question I have, which is around, um, when you actually do have a diagnosis, maybe it’s an arthritic condition, maybe it’s, um, like nerve pain, neuropathy, maybe it’s a, um, irritated nerve that you need to get injected every six months or, um, recurring might, whatever it might be as a diagnosis, that’s a, that’s a real thing.
Like a real inflammation is happening and a real, um, uh, pathology might be happening or a real wasting away of tissues might be happening in, in, um, or rheumatoid arthritis in these situations where there’s a way to make sense of the chronic pain. What do these people have to, um, support that journey?
[Ananda Mahony] (39:41 – 39:44)I just need to step back and say, all pain is real. [Alexx Stuart] (39:44 – 40:31)
Oh, yes. Sorry. My language was off there.
What I meant more was, um, uh, like you’ve had a scan or you’ve had a, you know, a, a CT scan or a hip scan. And it’s like, Oh, this is what that is. Um, whereas, um, like a situation where there’s a recurring pinch and no one can really figure out why that’s happening or why you’re experiencing ongoing pain, even though we can’t find anything in the scans.
That’s kind of more what I meant between the two different groups, not pain isn’t real. Sorry. I meant more, um, uh, what a doctor might be able to logically put something down to versus not.
[Ananda Mahony] (40:32 – 40:36)Absolutely. And I’m still going to give you probably an annoying answer because no, no, that’s okay. [Alexx Stuart] (40:36 – 40:40)
It’s a hazy topic. This is exactly why we’re digging around. [Ananda Mahony] (40:41 – 41:12)
So there’s some interesting information around scans and then in people who are in the, you know, the second half of their life, if you take a scan of their spine and say, you know, a huge percentage of those people will have changes that are identifiable in their discs, um, bony spurs or the generation or shifts or change that could be attributed to say low back pain or other musculoskeletal complaints, but a large percentage of those people will experience no pain. [Alexx Stuart] (41:13 – 41:14)
Wow. Okay. [Ananda Mahony] (41:15 – 41:27)
And in fact, there is some research to show the more scans and imaging you have, the more likely you are to have greater intervention, which can lead to ongoing pain. [Alexx Stuart] (41:28 – 41:42)
Ah, it’s like getting the confirmation that there is indeed something wrong makes your brain go, aha, I knew it. And so we like double down. [Ananda Mahony] (41:43 – 42:27)
It can be like, I talk about that particularly with musculoskeletal pain, but the degree of imaging can be linked to, uh, greater intervention is probably the strongest link here. And there’s a little bit, we also see that with endometriosis, you know, women who’ve had laparoscopies and the degree of endometriosis that they have, infiltrating endometriosis or more superficial endometriosis, lesions, endometrial lesions can be associated with varying degrees of pain. And so I do think that even if we have identifiable pathology, it doesn’t dictate the pain experience. [Alexx Stuart] (42:28 – 42:36)
Wow. Because of all the things we were talking about before, um, you know, the shark and the nail in the toe example. [Ananda Mahony] (42:37 – 42:37)
Yes. [Alexx Stuart] (42:38 – 42:38)
Wow. [Ananda Mahony] (42:39 – 43:50)
And the, but there will be people listening to, to this, who will say, but that’s not me. I have pathology. I know why I’m in pain and I’m like, yes, it is highly, you know, yes, absolutely.
And all of those other factors that we talked about are still going to contribute to the pain experience and how amplified that pain experience is and how much it impacts your quality of life. Yeah. So there are things that of course, in any situation with chronic pain that we can do, but once a pain becomes chronic and there’s those changes occur in the nervous system that is likely to amplify pain responses.
So we can work with the issues in the tissues, but we also absolutely have to start after. I think it’s highly advisable, highly advisable to start to work with what’s happening in the central nervous system and start to move people towards active pain management strategies, rather than just focusing on the source of the pain.
[Alexx Stuart] (43:50 – 43:55)So can you talk to us about what active pain management strategies look like? [Ananda Mahony] (43:56 – 46:01)
Yes. And I kind of have six key areas that I think that people can take away and start to work with without even the first one. Yes.
But without even seeing someone, but the first one is pain education. Now there is a lot of good resources and I can give you links to those resources after this that listeners can go on and have a look at if they’re interested. But I think a shared understanding, if you’re working with someone, a shared understanding of what’s happening and personally meaningful information can make life more predictable and less stressful.
So you understand why you have a sudden random pain and that it might just be part of the pain amplification experience rather than evidence of further tissue damage. And of course, there are people with certain types of pain, like cancer-related pain, where we just say there might be a whole lot of different circumstances in that case. But for someone with chronic long-term, rather stable pain, that’s not necessarily getting worse, but not getting better.
If we can understand why that’s happening beyond just the issues in the tissues, that there is some central nervous system and brain involvement, and then there might be things that we can do to work with that, that can just make things easier to cope. Sense-making is really important in chronic pain and understanding how pain works in the body can be part of that sense-making experience because it increases coping skills and self-management strategies. And it can also help people stop chasing a cause.
In some types of pain, it’s a little bit like a hammer that broke a window. The window is broken, that’s what we need to focus on. But if we’re chasing the cause all the time, it’s like chasing after the hammer.
That is not the issue anymore.
[Alexx Stuart] (46:01 – 46:02)And the window is still broken. [Ananda Mahony] (46:03 – 47:51)
Yeah, the window is still broken. So that’s the first thing. And as I said, I’ll send through some resources around that.
The second thing is to really work with managing stress and addressing trauma if it’s present, because thoughts and emotions change our physical state. And they do that by the immune system, by the nervous system and the endocrine system. So our cortisol responses and the like.
And mindfulness and other techniques of emotional calming, be they meditation, prayer, being in nature, patting your dog, can translate to a reduction in nervous system sensitization. It can also help reduce inflammation and potentially reduce pain intensity. So these mindfulness-based therapies, and I use that term, there’s a category of them, so it’s not just one strategy, also influence the regulatory areas in the brain that modulate threat-based responses.
So if we’re in high alert, then all of those incoming threat messages are treated as being important warnings. But if we can manage and calm down those parts of the brain that modulate that activity, well, we can start to put into context some of that threat response. So mindfulness-based therapies also help with reduced stress, depression and anxiety, and increase in self-efficacy.
There’s so much benefit that’s seen with these kind of strategies. The big but here is that it takes time and persistence.
[Alexx Stuart] (47:52 – 48:10)I was going to say you might get the, like you were talking about before the response, but no, my pain is real and it’s a pathology and I can see it on the screen. And that’s why I’m in pain. I don’t need any of this relaxation stuff.
I just need someone to fix it. Would you get that quite a bit in pain land?
[Ananda Mahony] (48:10 – 48:38)Yeah. And so in that case, I would say, but what if using some of these strategies help reduce pain intensity? It’s not necessarily going to make the disease state go away, but it might help with reduced pain intensity and greater quality of life.
So I kind of reframe it away from the disease state, which needs attention, but all of the attention.
[Alexx Stuart] (48:39 – 48:39)Yeah. [Ananda Mahony] (48:39 – 48:49)
And so most studies will say that 12 weeks of ongoing practice and, you know, usually four to five days a week is enough is where we start to see meaningful change. So persistence is key there. [Alexx Stuart] (48:50 – 49:45)
And probably I would imagine helping people find what works for them because often I’ll never forget when my first coaching clients, this super, super successful CEO guy, and, you know, he really needed to relax. He really did. He found it very hard and we talked about meditation.
He goes, fine, I’ll try it. Comes back for the next coaching session. He’s like, I hate meditation.
It’s awful. I’m not doing it. And I was like, Oh, you know, what did you experience?
I just, I couldn’t, I just couldn’t sit there. I couldn’t sit there and listen. I’m like, couldn’t sit there and listen to what?
Oh, her voice. It drove me insane. And I’m like, you do realize there are like a bazillion apps now and different people.
You could even do a guided meditation with on YouTube, or even just a quiet bird sounds and focus on your breathing for three minutes, anything. It’s got to be something you want to show up for, not something you think you need to do.
[Ananda Mahony] (49:45 – 50:43)I think that’s so important. And I even talk about that with trauma, as opposed to stress management, where someone experienced trauma, their body is often in a heightened state of alertness or stress. So that hyper vigilance of the nervous system, big challenge in treating trauma is how do we help people live in bodies that feel fundamentally unsafe.
And so I think trauma informed therapies really can be very helpful. But again, it’s so individual, what works for some doesn’t work with us. So is it counseling or psychology?
Is it somatic therapy, yoga, trauma informed yoga, tapping or EMDR? You know, there’s so many different ways that we can work with that trauma space. But I do think it’s really important that the practitioner is trauma informed and knows what they’re doing in the trauma space.
[Alexx Stuart] (50:43 – 51:19)Yeah, 100%. I’ll pop a couple of resources that I’ve really enjoyed myself over the years too. And as someone who’s gone through the mold toxicity thing, trauma is huge because of the financial implication, the home being unsafe, really messes with your psyche.
And I genuinely believe it is necessary. If anything, just as a support tool, when you’re going through hard things, pain being a hard thing, especially chronic pain, because it messes with you.
[Ananda Mahony] (51:20 – 51:45)Yeah. And in the trauma space, I mean, I think about my patients journeys and what works for them. But even in my own space with trauma, you know, I did years of talk therapy.
And then when that didn’t, you know, that stopped being effective, it was like EMDR, which was amazing. And then the next layer was somatic therapy. And so it’s almost sometimes you’re just peeling back the layers of the onion.
[Alexx Stuart] (51:45 – 52:02)Yeah, for sure. And do you find that the people who engage in these support tools to work on the nervous system actively might even require less medication if they’re on pain medication? [Ananda Mahony] (52:03 – 52:19)
Yeah. Yeah. That’s part of the whole point of this is if there’s less pain perception, then there’s less medication reliance or need.
So because there’s just less pain, I think point that I made there.
[Alexx Stuart] (52:19 – 52:24)Yeah. Yeah. No, the alarm’s going off less, which makes you think you need to reach for the tablets less. [Ananda Mahony] (52:24 – 52:25)
Yeah. [Alexx Stuart] (52:25 – 52:27)
Yeah. Okay. [Ananda Mahony] (52:28 – 52:30)
Cover off some other points. Sorry. [Alexx Stuart] (52:30 – 52:34)
Yes, please. No, no, no. Go for it.
I’m ready for the next one was what I was going to say. So go for it.
[Ananda Mahony] (52:35 – 52:36)I must talk about diet. [Alexx Stuart] (52:37 – 52:38)
Of course. Yeah. [Ananda Mahony] (52:38 – 54:40)
And I did a literature review about this about two years ago, and I’m due to do another one because the research in this space is changing. But two years ago, it was that there’s a broad, there’s a breadth of research in the types of diets working with chronic pain. So it’s either diets or dietary patterns in different pain states, but there’s no depth.
So there’s no one diet or dietary pattern that is better than another diet or dietary pattern. But even amongst that, if you look at all the research, there’s themes. And so if we pick the themes out, then we start to get something that could be more meaningful for people with chronic pain to put into place.
And the first theme is foods that are contributing to chronic pain or associated with pain amplification. And there’s three of them, and I’m just going to list them. They’re sugar, saturated fat and ultra processed foods.
And we just can’t get away from that because people are going to ask me, what about keto? Well, even the keto diets that have been done in the chronic pain space don’t have more mono and polyunsaturated fats in them than they do saturated fats. Saturated fat is associated with greater inflammation and other health issues.
So we kind of don’t say low fat diets, we just say shift your fat ratios over to the healthier fats, not no fat, no saturated fats, just that ratio shift. The second thing is sugar. And there is actually some numbers around this in the chronic and particularly in chronic musculoskeletal pain.
The research shows that it’s less than a teaspoon per thousand calories. And really, we go, okay, if I’m going to cut out sugar, I’ll just move to artificial sweeteners. I just don’t think that’s a good viable solution.
[Alexx Stuart] (54:40 – 55:00)And can I ask on that front, because there’s this whole extra category of sweeteners, like your monk fruits and stevias and allulose and maltolol and all of those guys, are any of those appropriate substitutes if someone really is finding it hard to cut back? Or would you lump those as? [Ananda Mahony] (55:00 – 55:21)
No, I wouldn’t necessarily. Look, I think some of the sugar alcohols like mannitol can be problematic for the gut microbiome. But some of the monk fruit and stevia in moderation are fine.
I personally don’t like them. I just prefer all my supplements unflavored these days are things.
[Alexx Stuart] (55:22 – 55:22)Yeah. [Ananda Mahony] (55:23 – 55:38)
But, you know, it’s not no sugar, it’s just less sugar than is gen for general consumption. And if we talk about sugar and saturated fat, the perfect vehicle for those two foods is ultra processed foods. [Alexx Stuart] (55:38 – 55:43)
It is indeed. Yeah. If we focus on that, we knock two over the head. [Ananda Mahony] (55:44 – 56:42)
Yes. Just reducing ultra processed foods. Then there’s themes around what to add in.
And again, sometimes I feel like in the land of keto, where keto, carnivore and paleo diets are at the fore, people don’t love hearing what I have to say about this. But it is plant foods, and I’ve been vegan or vegetarian diets, but the diets that reduce inflammation significantly and support the gut microbiome tend to be plant foods. And the research shows generally the theme sorry, in the research is that higher plant based diets, not no meat, not no grains, you can do that if you want to, but I’m not saying cut them out, but crowding out with plant foods is what we start to see reductions in pain.
[Alexx Stuart] (56:44 – 57:55)Yeah. And so do we then have a problem given the state of gut dysbiosis in the general population these days, perpetuated by the rise of ultra processed foods and factory farming and a huge amount of synthetic farming out inputs. Do we have the situation where though there needs to be some gut healing done to be able to increase those plant foods?
Because if you talk to people, a lot of people can’t eat beans and legumes or cruciferous veggies, just like literally makes them clear the room within half an hour, or, you know, a lot of digestive distress in eating plant foods or trying to increase it, which would then put people off and make them run into the arms of more of those carnivore keto paleo diets. Cause it just feels safer. Can you speak to that?
Because a lot of people are like, well, but that doesn’t work for me. So what does that mean? I’m just going to be in pain now because I can’t do the high plant food diet.
What’s what’s the bridge, I guess, is what I’m asking there.
[Ananda Mahony] (57:55 – 58:54)Yes. And some of what I say is going to be based on clinical experience, some of it’s opinion, but the opinion based on the research that I’ve seen is that yes, in some cases we are going to have to do that gut work first. And in doing that gut work, we’re not just going to be able to change their diets.
We’re also going to have wider effects and doing improving gut health anyway. So there’s not a bad place to start, but we can start with some gentle strategies like increasing resistant starches in small quantities. It doesn’t have to be massive.
You know, some of the, you know, if you look at the FODMAP diet and the reintroduction of FODMAPs is like eat massive amounts of the, an increasing amount. And I’m just going to do a call out to Brad Leach in this space, Dr. Brad Leach, who’s done a lot of, and Dr. Jason Horlick, both of them.
[Alexx Stuart] (58:54 – 58:57)Yes. I love Jason. I’ve had him on the show a couple of times. [Ananda Mahony] (58:58 – 59:54)
Really good work in this space. And some of the things that they’re doing is working with food introduction. And so, again, I will take what I know from the pain space and do look at some of the work that they’re doing and then use that to support my patients in my clinical setting.
And so it might be starting really small and slow with some cooked and cooled rice or some cooked and cooled potatoes in small quantities. Or if you’re trying to introduce legumes, it’s like start with half a teaspoon. Don’t start with a chili con carne that has lots of red kidney beans in it.
And start with really small and see it as a process over time to support that shift in food diversity.
[Alexx Stuart] (59:55 – 1:00:57)Yeah. There’s so much to explore when it comes to that. But if we think about food diversity as a goal, then it’s about working towards it rather than one type of diet being bad and one being good.
Can I ask you a question about the saturated fat research? Because a lot of people have moved to more natural, what would be considered to be more natural fats, butters, tallows, even coconut oil, all the memes. I’ve got a hundred problems and coconut oil solves 99 of them.
I mean, we’ve all lived through that coconut phase where I remember about 15 years ago, I just could not look at another coconut thing after I thought coconut was my savior. And then I made everything with coconut and then I was like, oh, this is just really not a good idea. I feel really heavy and gross.
And that was my personal experience. I’m not making a statement about coconuts, poor things. But what is it about saturated fats that are implicated in pain specifically?
Do we know?
[Ananda Mahony] (1:00:59 – 1:01:11)It’s likely that they drive inflammatory processes. Look, it’s not necessarily that saturated fats are inflammatory in their own right, but it’s what environment are they in? [Alexx Stuart] (1:01:11 – 1:01:24)
That’s what I was going to say, because often it’s the lifestyle piece. It’s the burgers. It’s that kind of situation that we find these high saturated fat eaters. [Ananda Mahony] (1:01:24 – 1:02:28)
Yes. And I am asked this by my students all the time. It’s like, what is your issue with coconut oil?
Because like you, I have an issue with coconut oil and looking at the research, the research is mixed about whether it’s beneficial or not. So that’s when I’m in doubt, I go back to what available research do we have? And then I use a kind of evidence informed approach, which is taking into account the personal circumstances, the person, my own clinical experience.
But the thing I say to my students is when we look at populations that had a significant coconut oil consumption in their diet, they also had, say, to pick an example, Pacific Islands, they also had a really low processed food, low to no processed foods, fairly high fibre and seafood. So they ate what was around them, including coconut and coconut oil until colonial diet shifted that and ruined their health.
[Alexx Stuart] (1:02:28 – 1:02:28)Yes. [Ananda Mahony] (1:02:28 – 1:03:06)
But when you cherry pick that concept of coconut oil did them no harm. Well, why don’t we cherry pick it and drop it into a Western style diet? That is an entirely different set of circumstances.
And when you put saturated fat with other dietary components that are going to drive inflammation, such as a high hydrogenated omega-6 intake, low omega-3s and other polyunsaturated fats that have more neutral effect or beneficial effect, then you’ve got adding fuel to a fire of inflammation.
[Alexx Stuart] (1:03:06 – 1:03:20)And the starch and saturated fats combo, which we all know from the sugar and fats my studies like disaster. And so what you’re basically painting is the picture of the burger and fries at the pub. [Ananda Mahony] (1:03:21 – 1:04:44)
Sure. And there is some research there because we go, oh, well, I only have a burger and fries once a week. It’s like, good, but in there’s some research from the Food and Mood, I think it’s Institute or Food and Mood Centre, which and this was Australian research, it was actually in depression.
And it showed that it is overall dietary patterns, not specific, necessarily specific foods. But if you eat like fantastically well, really healthily during the week, and then go for broke, eat whatever you want, the burger, the fries, alcohol, the sweets, everything on the weekend, that still has similar impacts to not eating well across the week. So there really is that from a dietary pattern perspective, it has to be a real emphasis on whole foods and healthier choices.
And then we think, yeah, more emphasis than we think. And patients ask me, they say, well, what, what, give me a number. And it’s like, if you’re eating 21 meals a week, you know, make sure that nine, 18 or 19 of them are really healthy.
Healthy, whole food, whole food meals.
[Alexx Stuart] (1:04:44 – 1:04:55)And I really took from your one teaspoon per thousand calories on a 2000 calorie average diet, have one small sweet thing a day. That’s it. [Ananda Mahony] (1:04:55 – 1:05:02)
Yeah, absolutely. And enjoy it. Don’t feel guilty about it because that’s a whole lot of wrath of its own problems. [Alexx Stuart] (1:05:02 – 1:05:16)
Yeah. It’s why I invite friends whenever I bake a batch of biscuits. I’m not being left alone with those things in my house.
Thank you very much. Cause I know one small thing a day does not work for me. And I think it’s also about knowing yourself.
[Ananda Mahony] (1:05:17 – 1:05:37)Yes. And I really do think we have to be careful about restrictive diets and being the problem. So my message is, you know, yes, I’m talking about being healthy overall, but you know, when you’re having to cut out more and more food groups or so conscious about what you’re eating, that that becomes a stress in its own right.
Then that is equally problematic.
[Alexx Stuart] (1:05:38 – 1:05:41)Yeah. Because then the nervous systems in like danger, danger. [Ananda Mahony] (1:05:41 – 1:05:43)
This is awful. I’m stressed. [Alexx Stuart] (1:05:43 – 1:05:47)
Yeah. Gosh. Okay.
What’s next on the pain list?
[Ananda Mahony] (1:05:49 – 1:06:06)Yeah. Movement, of course, motion. There’s so many little things like movement is medicine, all of those things.
What movement does is improves physical function can improve mood and reduce pain. And it just winds down the nervous system.
[Alexx Stuart] (1:06:06 – 1:06:38)I’ve noticed it myself in starting strength training last year. And something I’ve really noticed is in terms of the, I can, I’ve got this in a voice when you lift heavy, heavy things, or you do something that’s challenging. And then you come out the other end of that hour session or half hour session and you’ve done it.
I think that is a priceless little success picture that your nervous system then says, I’m strong. I’ve got this.
[Ananda Mahony] (1:06:38 – 1:06:40)Yeah. Self-talk. [Alexx Stuart] (1:06:41 – 1:06:44)
Yeah. I’ve really noticed the increase. It’s quite amazing. [Ananda Mahony] (1:06:44 – 1:07:15)
Great. So a movement has to be appropriate to the person and the type of pain. So we talk a lot about paced movement and not boom or bust cycles.
So if necessarily working with someone, but if again, that’s out of your capacity, there’s a whole lot of paced movement strategies that are freely downloadable from pain societies statewide or from the federal government that are really useful.
[Alexx Stuart] (1:07:16 – 1:07:32)Yeah. Brilliant. And so many wonderful osteopaths, physios, people online helping step you through by age group, by condition, by, I mean, you can find a 10 minute workout with anyone who can safely guide you through wherever you’re at. [Ananda Mahony] (1:07:33 – 1:08:57)
Yeah, absolutely. And then probably not finally, but one of the six key categories that I talk about is social connection or connection to your tribe. So people in chronic pain who report, who have low social connection report higher pain and greater reliance on medication.
And so the things we know about connection, those with greater social connection experience pain differently. And it’s not how many social connections they had or have, but it’s generally how close they are to other people and that sense of belonging. So it can be one other person, as long as it’s that sense of connection and belonging.
And essentially that connection can help protect us from pain. So conversely, being isolated or lacking social connection has physical implications. We can actually now measure the level of inflammation in those people who are lonely and show that it’s higher than those who are socially connected and have a sense of belonging.
You know, we think, oh, social connection. Yeah. Yeah.
But so important because we as human beings, we connect in tribes and it’s so who is your, who are your people? Who is your tribe?
[Alexx Stuart] (1:08:58 – 1:09:09)Yeah. And do you feel like a sense of purpose and servitude is helpful there as well? I feel like that’s so big and so underrated.
Like what are you showing up for?
[Ananda Mahony] (1:09:09 – 1:10:29)Yep. Absolutely. There is some, that kind of falls into that spiritual, I use that word loosely, but that sense of belonging, sense of purpose, sense of meaning in life is important.
And I’ve had, I just remember one patient in particular, who this was really significant for, she was in pain and she had peripheral neuropathy, which meant that she couldn’t walk a lot. And so there was a lot of being housebound and she just said that it wasn’t the isolation so much, but it was a loss of purpose because she was retired and she just didn’t know what to do or what to focus on and being at home and hanging out with her husband while that was nice and wasn’t an issue, didn’t fulfill that sense of purpose. So in the end, she looked at things that she could do from a volunteering perspective that would fulfill that sense of purpose, but that meant that she didn’t have to be on her feet all the time.
And there was some really nice programs around working with newborns and holding newborns who are premature to give them that contact with people when their parents can’t be there. I can’t remember exactly what the program’s called.
[Alexx Stuart] (1:10:29 – 1:10:35)I don’t know either, but it sounds beautiful. I mean, who wouldn’t love to hold a newborn? [Ananda Mahony] (1:10:37 – 1:10:41)
She went and did that and we started to shift things for her. [Alexx Stuart] (1:10:41 – 1:10:42)
Wow. [Ananda Mahony] (1:10:42 – 1:11:20)
So that literally shifted her symptom picture? Quality of life. Sometimes we don’t talk about pain, we do, but pain isn’t always the most useful measure of progress or success.
It’s not everyone says less pain is the outcome I want. Some people want to be able to walk further, have more engagement, have more quality of life, use less medication. So it’s a little bit like saying weight loss is all about a number on a scale.
[Alexx Stuart] (1:11:20 – 1:11:22)It’s about so much more. [Ananda Mahony] (1:11:22 – 1:11:33)
It’s about so much more. And so really exploring, yes, pain reduction and what else does that person want to experience working with you? [Alexx Stuart] (1:11:35 – 1:12:36)
Wow. Okay. Last question is on holistic, like naturopathic support for pain.
What does the tell us? Because there are a lot of people who are like, I don’t want to be taking painkillers. I don’t want, like, they really feel like they want to break cycles of reaching for the whatever, Neurofen, Voltaren, codeine, whatever it is, opioids even.
And we know that’s a crisis and we know that’s a loop with a lot of factors. I think your mind mapping, like how many things are playing into this for this individual is brilliant because it really helps people realise it’s not just I’m stupid and I have a dependency. It’s like, wow, I’m still going despite all of that.
That’s, you know, that can really help people in this new little doorway of hope. Are there supplements, things that we can support people within this road that are really effective in natural health space?
[Ananda Mahony] (1:12:39 – 1:13:40)Yes. I’m going to be cynical for a second. If you listen to the marketers of supplement companies, it’d have you believe that if you address the inflammation, the pain will go away.
Just take this turmeric, this quercetin, this fish oil, this blah, blah, and it’ll reduce your pain. And sometimes it does and sometimes it doesn’t. But pain isn’t just all about inflammation.
So, you know, addressing inflammation where it’s present is important. And those supplements might have a role, curcumin or turmeric, quercetin, fish oils and specific pro-resolving mediators. Boswellia, there’s a bunch of them that fall into that category.
There are some newer supplements that work with descending pain modulation, which is the brain’s capacity to dampen down the incoming threat messages. That’s different from an anti-inflammatory.
[Alexx Stuart] (1:13:41 – 1:13:45)So does that mean it’s working across into the nervous system almost? [Ananda Mahony] (1:13:46 – 1:14:14)
Yeah, totally. The brain is an extension of the spine. So it’s all part of that, that whole system.
So, yes, and it can work on reducing the importance of those threat messages and therefore reducing the threat context, if you like. So PEA, and you’re going to ask me what that stands for, and I’m not going to be able to.
[Alexx Stuart] (1:14:14 – 1:14:34)I have even known what that stood for once, but I don’t know now. Because I know it’s used in Long COVID quite successfully. And so I did actually know about it through interviewing the lovely Carla Wren on that subject.
But I’ve forgotten the name significance as well. Let’s just say PEA.
[Ananda Mahony] (1:14:34 – 1:14:49)Because I would crash it. I’ve just crashed it. And lots of people call it PEA.
And so I just like the calling it PEA because at least I know I’m talking about for me when I say that.
[Alexx Stuart] (1:14:49 – 1:14:50)Yeah, agreed. [Ananda Mahony] (1:14:51 – 1:15:41)
So that can be, and it works on the cannabinoid pathway. So we’ve got also people working with things like CBD. I don’t work a lot in that space.
I just don’t know enough about that. And it’s not within the naturopathic sphere. It’s more in a medical sphere now anyway.
But PEA does work on that cannabinoid pathway. And it’s an agonist, which means it helps make that pathway work more effectively. And that’s a pain modulatory pathway.
So it helps, as I said, with those incoming response. And it takes a little while to work though, particularly for neuropathic pain. And that’s where it was first researched.
And so up to 12 weeks of working with PEA, you might get some significant pain modulation or pain reduction working with PEA.
[Alexx Stuart] (1:15:41 – 1:15:57)And what kind of dosages do people take to have clinical effects? Because you can buy something on iHerb, but that’s really the safest, lowest recommendation because there’s no clinical recommendation being made. Is it often higher? [Ananda Mahony] (1:15:57 – 1:16:16)
Yeah, with ultramicronized PEA, it’s the research is 1200 milligrams. So in a divided dose, either 403 times a day or 600 twice a day. And it has to be in a divided dose for, it doesn’t have to be, but for best effect, because it has a half-life and so it’ll work like, you know. [Alexx Stuart] (1:16:16 – 1:16:22)
You need a steady stream of it working through the system. [Ananda Mahony] (1:16:22 – 1:17:24)
Yes. So up for up to 12 weeks and then reassess the dose. Sometimes depending on the type of pain, you might reassess the dose sooner and either increase it or decrease it.
But I find that quite useful in some situations and I will use PEA as a band-aid to either support someone who’s going through the process with their doctor to come off pain medication or to help manage pain so that we can put into place other strategies. It’s not a cure all in its own right. Nothing is.
So none of the supplements will, you know, I don’t think will ever be the magic bullet. It can be used in concert with some of these other strategies to reduce pain levels and improve quality of life.
[Alexx Stuart] (1:17:24 – 1:18:10)Yeah. From everything I’m hearing, it is a multifaceted and we need to look after our neuro-emotional state to ensure we can minimize the chance of all the negative feedback loops starting to build as well. That’s been a huge message through everything you’ve said.
And I just, I think it’s so great to have this topic on the show. There are so many other questions I had. Ananda, I feel like I need to ask you for a part two later on in the year, because I think hormones are a very fascinating part of the pain experience as people, men and women, all genders travel through life.
[Ananda Mahony] (1:18:11 – 1:18:13)Yes, we didn’t get into that hormone. [Alexx Stuart] (1:18:13 – 1:18:15)
We didn’t. And we can. Yes. [Ananda Mahony] (1:18:16 – 1:18:18)
At some stage, yeah. [Alexx Stuart] (1:18:18 – 1:18:30)
Yeah, definitely. I’d love to have you back. So thank you for this foray into the huge topic of pain and making it as concise as we were able to in this time.
And I look forward to having you back on the show.
[Ananda Mahony] (1:18:31 – 1:18:33)Thanks, Alex. It’s been such a pleasure talking to you today. [Alexx Stuart] (1:18:34 – 1:21:31)
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