Ananda Mahony is a naturopath with a special interest in helping people struggling with chronic pain. Working with individuals that have a wide variety of chronic pain conditions, from rheumatoid arthritis to endometriosis to digestive pain, or any condition where pain is a predominant feature, she has developed programs to for group and individuals to help resolve chronic pain and get back into life. Ananda has completed a Masters in Pain Management

www.anandamahony.com.au

 

Nirala Jacobi:

Welcome to another episode of The SIBO Doctor Podcast. I'm your host, Dr. Nirala Jacobi. And today the topic of this podcast is chronic pain and pain in general, which is prevalent in many health conditions including IBS, SIBO and other digestive disorders as well, of course, as the common joint disorders and autoimmune conditions that many of your listeners may have.

Today, we'll unpack some of the mechanisms that drive chronic pain with a special focus on how dietary factors, microbiome imbalances and the nervous system play a role in the development of pain. My guest today is Ananda Mahony, a naturopath with a special interest in helping people struggling with arthritis to endometriosis, to digestive pain, or any condition where pain is a predominant feature. She has developed programs for groups and individuals to help resolve chronic pain and get back into life. Ananda has completed a master's degree in pain management. Welcome to the program, Amanda.

Ananda Mahony:

Thanks for having me, Nirala. I'm excited to be here and talk about pain and diet and whatever else we come up with.

Nirala Jacobi:

Great. Yeah. I saw you in Paris and I thought I got to have her on the program because you touched on so many factors of pain that I think really apply to a lot of people, whether they have chronic pain issues or even digestive pain. So let's get started with the conversation by just tell us how you really got into this topic.

Ananda Mahony:

Yeah. That's a good question. And sometimes I look back and wonder how I got into this topic as well, but essentially I was working in a clinic with the musculoskeletal therapist and they were referring patients to me. And what I realized is that there was a lot I didn't know about chronic pain. And some of the strategies that I'd been trying in other chronic conditions and used successfully with patients, and the things that I'd been taught in college through naturopathy just weren't working.

I was dampening down inflammation, I was changing diets, I was working with stress responses, but they weren't working for chronic and persistent pain in some patients. I got a little bit curious about the topic and ended up doing a master's in the science of pain management. So I delve into it a little bit more deeply than I thought I would, but I just found it so fascinating learning about something that back about it was about eight to 10 years ago I started that, there wasn't a lot of information about, but I think that the area is there's more information out there for consumers and patients now, but back then it was quite limited. And so that's really good to see.

Nirala Jacobi:

Yeah. I remember, we also as naturopathic practitioners, we have our favorite herbs and things like that, but really the whole pathways of pain are actually really fascinating. I wondered if you could just give us a basic primer on pain perception and how the body deals with pain and what's going on there.

Ananda Mahony:

Yeah, sure can. I think the first thing that I would say is that it's complex and pain is also multifactorial. We can't just focus solely on tissues or damage or biomechanics. And I think it's critical to view pain through the lens of the biopsychosocial framework. And so that means considering psychological inputs if you like, or psychological drivers and social factors as well as those biological or biomechanical factors. And that is the first point, and fortunately that is the predominant viewpoint in the pain research and it matches very well with that naturopathic concept of mind, body, spirit.

So we are looking at the whole person and that's I think the only really thorough lens to look at chronic and persistent pain through. But before I go into chronic pain, I probably give a little bit of a primer very short about acute pain because when considering pain, it's really important to know that acute pain is very different from chronic pain. And most of us, I'd say everyone has had an acute pain experience. And so we think we understand pain. And usually there's a clear cause. It's pain following an injury or even the threat of an injury.

And acute pain is a protective response, or if you like a survival response, it alerts the body of potential danger and we respond in a protective way. So the example would be picking up something hot and we drop that because that protective response is to let go of the hot kettle or cup of tea or whatever it might be to prevent further injury and damage. Pain of this type, acute pain is usually of limited duration and it subsides long before healing has occurred.

Another example here would be a twisted ankle where... Or you roll your ankle and immediately it's painful. And that pain is a warning to not put pressure or try to walk on that ankle because it may create further damage in that moment, but usually the pain subsides a long time before complete healing of the ankle has occurred. And that is a real characteristic of acute pain responses that the tissue still might be a little bit fragile or a little bit delicate. There's not pain associated with walking on it anymore. And so it just takes a couple of days and that pain starts to resolve, but the tissues take a little bit longer.

Speaking of that though, thinking of that example, I think another key point that I want to make is that pain isn't created in the body at the side of the injury. We think pain is there because our ankle is sore, but pain might be experienced in the body however it's created in the brain. I can go into that in a little bit more detail if I've got the space and time to do that. I guess an explanation of how pain is created in the brain is probably important here.

So first thinking about the nerves and we've got nerves and they're specialized nerves called nociceptors and they're all over the body. And they're sensors for noxious or unpleasant stimuli. So when they detect a change or a threat and that threat could be damage, hit our hand with a hammer, could be inflammation, it could be some other change in the local environment like a change in pH or a pulled muscle or something like that.

These nerves nociceptors send danger signals from the body. At this point, they're not pain, they're just danger signals and the messages travel up the spine to the brain where the information is evaluated in the context of the situation, and then the brain decides how to respond. So is this an emergency or is it just a paper cut and a false alarm? What needs to happen to keep me safe and protected?

So if there's any reason to think that protection is needed, the brain creates pain and it's very context driven. And the brain is our central driving system for that context driven response. And the brain influences pain intensity and duration and pain type.

Nirala Jacobi:

So yeah, sorry.

Ananda Mahony:

No, I just realized I've talked for a long time already.

Nirala Jacobi:

No, that's okay. It's all super fascinating. We all can understand the kind of acute pain I think. But when we go into chronic pain, it gets really a lot more complicated. But one of the reasons I wanted to talk to you is because when we are dealing with pain, whether that's osteoarthritis or some of the more chronic pain pictures, as naturopaths, for a long time we've always looked at diet and we looked at other components of a person's lifestyle that general physicians wouldn't necessarily consider with pain management because in conventional medicine, it's all about just pain management through the use of medications.

We have different types of tools that we utilize that are more looking at pathways of why something is painful, whether that's inflammation or other aspects of the immune system. So can we veer into the type... Or maybe not the type of pain, but what you found through your research of what directly impacts pain when we're talking about diet, for example?

Ananda Mahony:

Yes, absolutely. I think that probably I'll just do a little bit of an explanation of chronic pain and then I'll really strongly link that with diet because when I was looking at the research, this is what came through very strongly. There's some implications for dietary strategies that can really make a difference in chronic pain states. But to talk about that, I want to go back and talk about some of the mechanisms that drive chronic pain. I'll just be brief, I promise. So chronic pain, as I said-

Nirala Jacobi:

No problem.

Ananda Mahony:

Chronic pain, as I said, is really different from acute pain. The point of pain, acute pain is to generate that protective response like an alarm, but like all alarms, they keep going off long after they're useful. They become a problem. And in chronic pain, the alarm becomes disconnected from the initial problem. So there are changes in the nervous system and the nervous system becomes programmed to a hypersensitive overprotective setting, which means that the body produces increasingly painful responses and pain is amplified.

So it's disconnected from whatever issues there were in the tissues, and it's disconnected even from some of the context in which pain is usually created. So people can start to experience more pain with less signals from the body or more pain with the same amount of signals or even pain with no signals at all.

Nirala Jacobi:

Can you give us an example of that? Maybe you had a patient or so that perhaps had something like this.

Ananda Mahony:

Yes, I'll give an example of pain being created with no signals at all. It is an acute pain story, and that is the example of a workman in the 1950s, and he was on a work site, and he had work boots on. He jumped down onto a nail and a big nail went all the way through his boot and he was in agony. He was of course rushed to emergency and he was in so much pain and distress that they had to sedate him before even trying to take the boot off. And when they finally removed the boot, what they found is the nail had gone between two toes. So there was absolutely no damage at all.

That is an example of context where there's absolutely no nociceptive input from the body, and yet someone is in persistent pain. So when we've got a chronic pain setting and when there's hypersensitivity in the nervous system, the immune system gets involved in this and causes something called neuroinflammation. And there's a whole lot that starts to drive amplification of pain responses to the point where pain is being created to protect the body even when there's no need for protection or even when the pain is detrimental.

And in essence in this case, the brain learns that pain is the go-to response and it becomes a vicious cycle of threat perception, and the threat doesn't have to come from the body, it can come from thoughts, emotions, everyday movement situations. And that threat perception leads to amplified pain responses.

Nirala Jacobi:

So this kind of like a learned, but it's subconscious obviously. A person is not aware of this, but it is a learned behavior. So what you're saying is that there's all new kind of approaches to pain management that don't necessarily involve medications that address the pain?

Ananda Mahony:

Yes. Well, they don't just involve medications that are working on dampening down local tissue concerns or what people think are driving the pain. So if people think it's damage, it's not focusing on the damage because often pain is unconnected from damage in the tissues anymore, or there might be inflammation, but it might be low grade inflammation. It's just that the threat messages from that inflammation are being amplified and the pain is being experienced in a more severe way or more prolonged way than it would in an acute pain setting. It is hard to say because pain and tissue damage are not closely aligned. We think that they are, but they're not.

Nirala Jacobi:

Well, I often have this experience with patients where, for example, they have what they believe is gastritis, they have a lot of stomach pain, and on an endoscopy it's perfectly fine. There's no damage whatsoever. It could be a lot of different sources of pain, but I do think there is this component where the pain may have been initially there, but it continues to be activated in some other way that's not necessarily connected to tissue damage. So I find that really a whole fascinating concept. But can we veer now to the dietary influences? Because I mean, we're not saying that pain is all in somebody's brain, right? I mean, it is in some way, but those of you listening that are in pain, this conversation is really just a platform to discuss different types of approaches to pain rather than always thinking pain needs to be mitigated through medication because that's, I think, a big deal.

A lot of people are taking painkillers and pain medication, whether that's NSAIDs or other types of medication that aren't necessarily all that helpful in the management of pain. So I wanted to have this veer into what you found with your literature review or research review of how pain was influenced positively or negatively with different diets.

Ananda Mahony:

Yeah, absolutely. I can talk probably first about some of the research into dietary influences that might be sustaining or maintaining pain. So there's some processes that occur that implicate in the transition from acute to chronic pain, and they're the potential targets for nutritional inflammation. And that's that neuroinflammation and central nervous system sensitization. It was part of the research that I looked for. And essentially the premise of this is that there's potential for pathological adaptation of the nervous system occurring in the context of a persistent increased inflammatory load from diet.

So the diet is driving inflammation, which is then impacting that central nervous system hypersensitivity and the foods that are implicated in that are high fat and high sugar. And I'd say also while not explicitly stated ultra processed foods because they're often high fat and high sugar. And what we know about high fat and high sugar is it's positively associated with pain intensity and a reduced pain threshold. And that is thought to be through the dietary induction of that nervous system hypersensitivity I talked about. There's various mechanisms and I can talk through those if you'd like me to talk through how that happens.

Nirala Jacobi:

Sure. I think just summarizing or briefly mentioning some of these pathways is really useful for people to really get a good picture as to why it's helpful to reduce these foods if they have any kind of pain really.

Ananda Mahony:

Yes. And this is for any kind of pain. I looked in the literature review specifically at musculoskeletal pain, but this research didn't take that such a narrow focus. It was for all kinds of pain or all kinds of chronic pain. Some of the mechanisms of vagal nerve activation. So the vagus nerve informs the brain about all sorts of factors such as dietary intake and nutritional status and peripheral inflammation.

And if there's a lot of input to the brain saying that there's a lot of inflammation here, it can lead to immune activation in the brain and central nervous system. And of course diets high in saturated fat and sugar can also induce changes in the gut microbiota. And that can directly and indirectly lead to inflammatory responses again in the brain or spinal cord, which can contribute to the onset and progression of pain is induction of oxidative stress, which activates whole-like receptors.

I just think about them as sentinels for danger, and they've got a really long memory and they activate the brain and natural central nervous system again. So all of these factors lead to that sensitization and amplification or have the potential to amplify pain. There's some preclinical studies that support the idea that if we can use nutritional interventions that lower sugar and shift the ratio of fatty acids, so shift away from high fat diets or even high saturated fat diets over to mono and polyunsaturated fats, then we can potentially inhibit nervous and immune activation and lead to a diminished central nervous system sensitization and thus reduce pain amplification.

It's unlikely that just cutting out fat and sugar will clear up all your pain, but it may actually just reduce the severity of pain. And I think that that's a pretty good starting place. And specifically also because high fat, high sugar and ultra processed foods are linked with a whole plethora of chronic disease states anyway. So there's further benefit.

Nirala Jacobi:

Metabolic disease, et cetera. But I want to mention here about the fats and it's mainly saturated fats and they're found in animal flesh, really animal products including dairy, but also coconut oil. There was a study that looked at increased absorption of lipopolysaccharide, which of course is the inflammatory substance that I so often mentioned on this podcast that's in the cell wall of gram-negative bacteria. So when they are overgrown and you eat a lot of saturated fat, it's been shown that the absorption of this inflammatory substance is greatly increased with this type of fat.

So that's just one mechanism of how saturated fats can really drive some of that inflammation. And this is always where a lot of the paleo people start to pipe up of how their pain has been greatly reduced potentially by going paleo, especially when they've had an autoimmune condition. We're just talking about pathways. We know this happens, and it may be different for you who's listening because you have different types of situations happening that are maybe not just saturated fats or animal products.

But in general, what you're saying is that your research has shown that those are the two main factors sort of generally on the diet, but then there were also other studies that looked at food allergies and pain. Can you talk about that a little more?

Ananda Mahony:

Yes. This was a recent research in the literature from 2022, and I hadn't seen research like this before, so I was really interested. And this looked at immunoglobulin and IgG4. I guess the concept of food intolerances perhaps driving or exacerbating chronic pain. And immunoglobulin IgG4 are food specific antibodies that results from exposure of the gut immune system to certain nutrients or food components. It's produced by the immune system just to advise about that particular food that's being eaten. So high levels have been associated with inflammation locally in the gut and increased gut related issues.

But in this study though, the researchers were looking at the broader systemic effects of high IgG4 levels and if there was an association with chronic pain. And so the study itself had 54 individuals from various different primary pain types. So it was neuropathy, diffuse pain, which is akin to fibromyalgia, back pain and headache. All the subjects had suffered chronic pain for more than one year. The researchers tested their immunoglobulin levels to a wide range of foods. And what they found is that 87% of the subjects in the trial had high immunoglobulin levels, high IgG4 to more than five different foods.

And across the board... And sorry, I should just go back a bit. All of those profiles of the IgG levels for the individuals were quite different. So it was a very individual food responses, food results if you like, or IgG 4 results. But across the board, on average, the highest IgG levels overall with eggs, dairy products, grains and dried fruit. And then they did an intervention, so they did a one-month exclusion diet. What they found after one month is that the visual analog scale, which is a perception of pain, so the pain scores had decreased by more than 50%, and there was also improvement in mood and quality of life scales.

So I found this quite interesting. It was particularly relevant or they had the highest response I should say, in those with low back pain and neuropathy. But what this really highlighted for me is the need for a context specific and individualized approach for dietary therapy. And that's what it came out across all of the research is that there's no one diet that fits everyone.

Nirala Jacobi:

Right. But those five top foods, I think we do see them a lot, show up as sensitivities. The eggs for sure. I get a lot of people that have egg sensitivities. I used to do a lot more IgG for food allergy testing, but for some reason I haven't found really very reliable labs. I had one and that then sold. And so sadly, I don't do it as often as maybe I should, but it's a good thing to remember for people that's that it is very individualized.

I often think that people that have multiple, multiple foods show up on those panels that it's more of a situation potentially of leaky gut or intestinal permeability that has so many more implications than just food sensitivities where foods were basically exposed to the immune system in not a processed way. And so the body basically made antibodies to that food, and that's abnormal. So if you have a lot of food sensitivities, it's very possible that the underlying driver of that might be more intestinal permeability. So I just wanted to throw that in there.

Ananda Mahony:

I totally agree. And I don't think that this is certainly something that I'll be jumping at and doing a lot in clinical settings. I think it has utility in some cases. After this research, I had a patient come in and she had migraines, chronic lower back pain and a few other things that suggested food sensitivities. And in that patient I was more strongly indicated. So we went down that process. But I think probably as I said before, it just comes back to it being an individualized approach is what really counts. And certainly I agree with you about the intestinal permeability that you start to see that... And that's even what the researcher said in this paper is that it's highly likely that intestinal permeability was one of the drivers of that driving inflammation systemically and then leading to chronic pain.

Nirala Jacobi:

Great information. Let's move into more of microbial influences on pain perception or drivers of pain. I think the biggest or the most researched model there might be the model of autoimmunity, right? We have a couple of diseases that are much associated with bacteria that originate in the digestive tract. Can you talk about that a bit more?

Ananda Mahony:

Yeah, absolutely. And I think probably the area that I work in most is with rheumatoid arthritis, and that's got quite some strong associations between rheumatoid arthritis and the gut microbiota. Or not just the gut microbiota, the oral microbiota as well. And the idea with rheumatoid arthritis is it begins at mucosal sites where there's damage to the barriers.

So be that the intestinal barrier or the oral mucosa. So for example, it might be food driving intestinal permeability. It might've been some kind of pathogen. It could be smoking or it could be the microbial composition itself that leads to gut inflammation and expansion of inflammatory and immune responses. So kind of spill over. I call it inflammation and immune responses from there.

It's quite interesting in that space, they've actually linked the development of rheumatoid arthritis or what they suspect the development of rheumatoid arthritis and some of the inflammatory and pain responses to some specific bacteria. One of those is the gingival bacteria in the mouth. And what they've seen is evidence of bacterial translocation to joint sites of those bacteria. So not just lipopolysaccharides, but bacterial translocation. And then also from the gut, prevotella copri was the other one. Look, there may be others, but those are the two they're focusing on at the moment in the research.

They suspect even that some of the drugs that use to treat rheumatoid arthritis work, at least in part by manipulation of the gut microbiome. So it might be that they're dampening down those responses in some way or the drivers or the impact of those bacteria more broadly.

Nirala Jacobi:

I think it's a whole new frontier that's coming. That's one of the reasons I wanted to have this conversation because yeah, I think that there is a lot more coming down the pike when we talk about microbial influences on all sorts of conditions. So besides the rheumatoid arthritis that you mentioned, we also know about ankylosing spondylitis. We know also about endometriosis be associated with different IBS kind of bacteria. So it's just the beginning I feel.

I think as naturopathic practitioners we're really well positioned to understand this connection and be ready with some good advice for people. Well, further to this, I would also say the microbiome in general that can also produce certain metabolites that can dampen an inflammatory response or improve neuronal damage has already been shown with things like endo proprionic acid, which is a microbially produced antioxidant that is really, really imperative to prevent things like leaky gut.

So this is the exciting, I think, frontier is to continue to improve microbial health and microbiome health to not just impact pain but also improve overall health.

Ananda Mahony:

Yes, absolutely. I think that this is a space that even looking at the research with osteoarthritis, there's emerging evidence that bacterial composition impacts osteoarthritis. And they're talking now also about... So that's the gut brain joint axis. Now, they're also talking about the gut-brain disc axis for low back pain-

Nirala Jacobi:

Wow.

Ananda Mahony:

... in considering the vertebra of the spine. So I think this is certainly space to watch and an exciting space to watch in terms of potential benefit if we work within that kind of therapeutic area.

Nirala Jacobi:

And that moves me into, or moves us into this next segment of really what are some of the options for people that are dealing with chronic pain and just some basic suggestions. We've already mentioned some of the foods to consider to avoid, which is the saturated fats and sugar, and processed carbohydrates or processed foods in general. We'll move into what you can offer and what you're offering to your patients, but are there some general suggestions that you have for people?

Ananda Mahony:

We'll talk just about diet a little bit more for a start. And this is general advice, not necessarily specific to conditions, but one of the things across the research, and there was multiple different diets studied in multiple types of chronic musculoskeletal pain. I've also looked at migraines and endometriosis. There's no consensus across any of those spaces, but one of the common themes was that whole food diets, they all are the ones that tend to show benefit, and they do that largely by lowering inflammation and oxidative stress. And in some part, even through weight reduction, because weight itself can be a low grade. Obesity can be a low grade chronic inflammatory state.

So lowering inflammation and lowering oxidative stress, and they share common attributes such as improved diet quality, increased nutrient density. So they support the gut microbiome, all a part of the complexity that extends beyond a single diet. So there's lots of opportunities to find a diet that suits a person in particular based on their preferences, but also supports lower inflammation, lower oxidative stress, and whole foods. And if we just expand on that idea of complexity, I think that that is the space that we have to look at for chronic pain, looking at the whole person, not just the issues in the tissues and focusing on what's happening in their body, rather considering what's happening on a biopsychosocial level or the whole mind, body, spirit, if you like, because there's so many factors within our beliefs, our emotions, and how we view the world and perceive the world that can be considered threatening and drive persistent pain or amplify persistent pain.

Nirala Jacobi:

So would you say... Sorry.

Ananda Mahony:

No, you go.

Nirala Jacobi:

I'm just trying to understand. So are you saying that for example, people that generally have more anxiety or are more fear-based would have more pain? Or what are you saying about the biopsychosocial factors?

Ananda Mahony:

What I'm saying is pain that is context driven. And I talked about threat perception before. So threat can come from say a signal from the body, but it also can be perceived as perceiving the world as a threatening place or feeling anxious about the world or what's happening to you. So yes, those anxiety, particularly anxiety about what's happening in your body or anxiety about a situation, a place or a person, it can be anything really, can actually be in context considered a threat and amplify pain responses. So yes, it is part of a pain response potentially.

So some of the features that are in stronger characteristics you like if you like or more strongly associated with pain perception are anxiety, a previous history of depression and a tendency to catastrophize. So what they've shown in the research is if there's anxiety, depression or the tendency to catastrophize... Sorry about that. And then they've shown that pre-surgery, those people who have those qualities or tendencies tend to be more likely to develop chronic pain post surgery.

So if you like they're risk factors for chronic pain development. So yes, what's happening from a psychological perspective can drive pain and pain perception, and certainly it can amplify pain both acute and chronic pain. And if we think about social environment... Again, if we think about that from a survival perspective or a threat perspective, we are social animals, we like to engage. So isolation might be one of those things that's considered threatening.

Or if there's a little bit of a social anxiety engaging when perhaps we wouldn't want to might be considered threatening or a hostile workplace or the threat of losing your job because you are in pain and you can't do what you used to. So all of those factors can amplify and make pain more chronic and persistent. And that's what I mean by looking at the whole person. It's not just about considering what's happening in their body or [inaudible 00:38:48]

Nirala Jacobi:

At the location of pain, right?

Ananda Mahony:

Yeah.

Nirala Jacobi:

Okay. So further to that then, how do you address this? And I want to wrap up with this thought about what you offer to your patients or how you address some of these contributing factors to their pain syndromes?

Ananda Mahony:

Yes, of course. In some cases it's out of my skillset, and so I identify. Sometimes I just think it's about doing a full map of all of the factors that might be contributing to the pain and identifying what I can work with and then identifying other areas that the patient might need support outside of my scope for. So it might be referring them on to a pain psychologist or a counselor or someone who works with trauma or a body worker. Part of it is actually-

Nirala Jacobi:

We're like direct traffic in a way. Often I have also a big referral base of people. And I think that makes us good practitioner people that understand their limits and refer on to the appropriate expert in that field. So that's really great advice. But you also have programs and things that people can... Just tell us more about your practice and where people can find you.

Ananda Mahony:

Yes. So I consult one-on-one with some patients, and I use a really a functional matrix if you like to map what's happening for that person and really identify all the inputs to their pain, all the sources of potential threat. And then that allows us to put in place individual strategies to unlearn their pain, if you like, and move through it. So that might be some of what I do. And then some referral or some use of selected things, apps like Curable or The Gupta Program, the strategies for, I guess unmapping or unlearning some of the pathways that have got them into the pain space.

So I'll just say there that getting into a chronic pain space may have been an unconscious process, but you can consciously work your way out. And that's where we use some of those strategies like Curable app, or mindfulness and meditation, or The Gupta Program.

Nirala Jacobi:

Great. Great advice. Obviously, you also dive into their diet and you do give potentially targeted substances or supplements that are also pain relieving, I'm assuming, right?

Ananda Mahony:

Absolutely. And that really just depends what type of pain they have, whether they're coming for endometriosis and related pain or whether they're coming for fibromyalgia or migraines. It really depends. We work sometimes in the chronic pain space with the brain and central nervous system, but of course we work with any other drivers that are contributing to that pain. So it really depends on what they're presenting with.

And on that note, I do group pain management consults for people in pain too. So group pain education and strategies, again to unlearned pain as well as individual guidance. And I do that for endometriosis and joint pain. So I've got two groups running in that space.

Nirala Jacobi:

That's great.

Ananda Mahony:

And where can people find you?

At my website, which is my name, AnandaMahony.com.au.

Nirala Jacobi:

Okay, fantastic. I love that, unlearning pain. I think that's such a great visual somehow that you are not just a victim. You can be a participant in solving that for yourself, or at least reducing pain if you are in chronic pain. A lot of people are in terrible pain and are really sort of held hostage by just basically pain pills. So any other approaches are just fantastic to be able to offer to patients. Do you have any other last minute sort of pearls or nuggets you want to throw in?

Ananda Mahony:

Oh, yes. Next year I'm starting a foundational pain management course for practitioners. So practitioners, naturopaths and nutritionists who want to learn more about how to manage pain, I'll be doing that from February. In terms of nuggets or other gems, I would just say that there's great complexity in pain and that can be seen as something that's difficult, but it can also be gems in complexity. It means it's not a linear pathway. There's not just one way to go. The example I use is osteoarthritis. It's like, "Oh, I've got osteoarthritis." Now it's pain medication or eventually something like surgery and knee replacement. It's a very linear pathway, but with complexity, there's many pathways in, and that gives us real opportunity to work with people because we are complex. Pain is complex.

The solutions don't necessarily have to be complex, but they can work with that complexity. And I love that notion that it's not just a straight one way road that we've got multiple ways in to work with a person.

Nirala Jacobi:

That's wonderful and a great place to stop. All of your contact details will be available in the show notes. So thank you so much for your time and for your wonderful explanation of pain.

Ananda Mahony:

Thanks, Nirala. It's been great talking to you.