Pain Killers

There is help out there for managing pain – whether from a car smash-up, sports injury, workplace accident or disease – if you’re willing to look further than your family doctor for alternatives to drugs.
Chronic pain is a silent epidemic affecting some 10 million Canadians. Although there are many types of chronic pain and many pain levels, the universe of pain shares some common issues. Most family doctors know little about chronic pain and offer little in a 10-minute visit. Although some GPs take a special interest in pain treatment, many prefer not to deal with often-difficult patients. Whether justified or not, pain patients frequently say they are angry and frustrated with the cursory treatment they receive.
There’s also a lot of needless suffering. Some people won’t take medication for fear they’ll become a vegetable or an addict. The big guns in today’s pain arsenal are the narcotics derived from morphine or codeine. However, physicians often refuse to prescribe them in sufficient quantities because of addiction concerns. In addition, most people won’t get complete relief with narcotics. These drugs just “take the edge off” leaving the patient feeling drowsy and disoriented. Experts agree it’s better to learn alternative pain management techniques.
In the conference room at Burnby’s Thorson Health Centre there is a lively group of physicians, chiropractors, physiotherapists, psychologists, counselors and technicians who are brainstorming complex issues. “We encourage personal growth and help clients accept responsibility for their physical and emotional well-being,” says Thorson. At the clinic that’s done with support and education, plus treatments such as nerve blocks, trigger point therapy, group work, biofeedback, stress management, psychotherapy, hypnotherapy, physiotherapy, massage, chiropractic, nutrition, exercise and acupuncture.
Neuropathic pain, or pain resulting from a damaged nerve, is another type of chronic pain. Dr. Chan Gunn, head of the Institute for the Study and Treatment of Chronic Pain (iSTOP) uses IMS or intramuscular stimulation to ease nerve pain. Therapy involves inserting long, thin needles of up to several inches in length, into the constricted part of the muscle, also known as the “knot” or trigger point. When introduced accurately, the muscle will contract and grab the needle and then relax. Gunn claims to resolve acute neuropathic problems in one or two visits, though some cases take longer.
At the Comox Valley Nursing Centre, nurses assist patients in the management of their chronic pain. Clients can attend a chronic pain education program, join relaxation, exercise or therapeutic swim classes or participate in a chronic pain support group. Most important says Diane Lewis, a nurse in the program, is that they get plenty of time and support.
Farabloc, is another pain relieving device. It is the invention of Frieder Kempe whose father suffered phantom leg pain after being wounded in 1944 and losing his leg. Kempe realized that his father’s scar had no healthy skin covering, hence no protection from electro-magnetic fields. By 1978, he’d developed a thin fabric cloth with interwoven metal fibres that significantly reduced his father’s pain. The product, called Farabloc, is produced at Kempe’s Coquitlam factory. Manufactured in many shapes and sizes and sold across the globe, it has proven to reduce phantom limb pain and delay the onset of muscle soreness experienced by athletes. German researchers are currently studying its effectiveness with painful fibro-myalgia.
Chronic pain disables more people than cancer or heart disease. For many, their best hope is contained with multi-disciplinary clinics with offer a variety of treatment options.
SOURCE: BC BUSINESS (Burnaby, Canada) June 2003, pp. 38+ Original article by Vicki O’Brien

Headache: Hope through Research

An estimated 45 million Americans experience chronic headaches. For at least half of these people, the problem is severe and sometimes disabling. It can also be costly: headache sufferers make over 8 million visits a year to doctors’ offices. Migraine victims alone lose over 157 million workdays because of headache pain.
Understanding why headaches occur and improving therapies are among research goals of the National Institute of Neurological Disorders and Stroke (NINDS). As the leading supporter of brain research in the Federal Government, the NINDS also supports and conducts studies to improve the diagnosis of headaches and find ways to prevent them.
When Should You See a Physician?
Not all headaches require medical attention. However, some types of headache are signals of more serious disorders and call for prompt medical attention, for example: a sudden severe headache; headache associated with convulsions; headache accompanied by confusion or loss of consciousness; headache following a head injury; headache associated with eye or ear pain; persistent headache in someone who was previously headache free; recurring headache in children; headache associated with fever; and headache that interferes with normal life.
Diagnosing a Headache
Experts agree that a detailed question and answer session with a patient can often produce enough information for a diagnosis. Most physicians will also obtain a full medical history from the patient, inquiring about past head trauma, surgery and medication use. A blood test may be ordered to screen for thyroid disease, anemia, or infections which might cause headache. X-rays or CT Scans or MRIs may be ordered to rule out the possibility of a brain tumor or blood clot. Sometimes eye exams are recommended, and an experimental technique called Thermography – using an infrared camera to measure blood flow through the skin – can show strikingly different heat patterns from headache sufferers vs. those that rarely get headaches.
A physician will analyze the results of all of these tests and arrive at the following headache diagnoses: (1) Vascular, (2) Muscle contraction (tension), (3) Traction, or (4) Inflammatory headache.
Vascular headaches include the well-known Migraine type. It is thought to involve abnormal function of the brain’s blood vessels or vascular system. Migraine headache involves severe pain on one or both sides of the head, an upset stomach, and, at times disturbed vision. Sometimes migraine headaches begin with an “aura.” The individual sees zigzag lines or flashing lights before the headache actually begins.
While researchers are unclear about the precise cause of migraine headaches, there seems to be agreement that a key element is blood flow changes in the brain. People who get migraines appear to have blood vessels that overreact to various triggers.
There are two ways to approach the treatment of migraine with drugs: prevent the attack, or relieve symptoms after the headache occurs. For infrequent migraines, drugs can be taken at the first sign of a headache in order to stop it or at least relieve the pain. For occasional or mild migraine, sometimes aspirin or acetaminophen taken at the start of the headache can help. Small amounts of caffeine may be useful also if taken in the early stages of migraine.
For those who get moderate to severe headaches, and for all cluster patients – those that get a severe, but shorter-type of migraine that comes in groups or clusters – there are stronger drugs such as Ergotamine Tartrate. This is a vasoconstrictor which helps counteract the painful dilation stage of the headache. For optimal benefit, the drug is taken at the start of the headache.
For headaches that occur three or more times a month, preventive treatment is usually recommended. Drugs used to prevent classic and common migraine include methysergide maleate, which counteracts blood vessel contriction; propranolol hydrochloride, which stops blood vessel dilation; and amitryptline, an antidepressant.
Several drugs for the prevention of migraine have been developed in recent years, including serotonin agonists which mimic the action of this key brain chemical. Prompt administration of these drugs is important.
There are other vascular headaches besides Migraine. Some can be caused by infection, exposure to chemicals, solvents and certain drugs.
Muscle Contraction Headaches are also known as “tension” headaches. They are often triggered by stress. They are named contraction headaches as the headache is caused by the contraction of neck, face, and scalp muscles as a result of stressful events. It is believed ninety percent of all headaches are classified as tension/muscle-contraction headaches.
Non-drug therapy for these headaches includes biofeedback, relaxation training, and sometimes counseling. A technique called cognitive restructuring teaches people to change their attitudes and responses to stress. In progressive relaxation therapy, patients are taught to first tense and then relax individual muscle groups. Sometimes, those suffering from infrequent headaches may benefit from something as simple as a hot shower or moist heat applied to the back of the neck.
People with chronic muscle contraction headaches may also be helped by taking antidepressants or MAO inhibitors. Mixed muscle contraction and migraine headaches are sometimes treated with barbiturate compounds, which slow down nerve function in the brain and spinal cord.
The two other types of headache: Traction and Inflammatory can be caused by very serious disorders. Traction headaches occur if the pain-sensitive parts of the head are pulled, stretched or displaced, such as with a brain tumor. Inflammatory headaches could be caused by meningitis, or diseases of the sinuses, spine, neck, ears or teeth. These headaches are treated by curing the underlying problem.
Children can also experience headaches as a result of infections, stress or trauma. These headaches can also include migraine. Parents should alert the family pediatrician if a child develops headaches along with other symptoms such as change in mood and sleep patterns.
Finally, today’s headache research offers hope for many chronic headache sufferers. The work of NINDS- supported scientists around the world promise to improve our understanding of this complex disorder and provide better ways to treat it.
(Summarized from Headache: Hope Through Research, October, 1996; Pages 1-36; Health and Human Services Department (HHS); National Institute of Neurological Disorders and Strokes; SuDoc Number: HE 20.3502:H 34/4/996

The New Vitamin Push

About 20 years ago, knowledge about vitamins was just beginning to expand. The role that low levels of folate, or folic acid, play in neural tube defects, for instance was not known, nor was its role as a major risk factor for heart disease.
Yet, many doctors have been telling their patients for years to take vitamins. Nearly 1 out of every 3 Americans take multivitamins and many of them are afraid to tell their doctors for fear he or she would disapprove.
Now, the Journal of the American Medical Association is endorsing the use of multivitamins based on researchers’ understanding of how vitamins benefit health.
Health experts are worried that most American adults do not consume healthy amounts of vitamins in their diet, although they may be getting enough to ward off vitamin deficiency disorders. Almost 80% of Americans do not eat at least five helpings of fruits and vegetables a day, the recommended minimum amount believed to provide sufficient essential nutrients.
“All of us grew up believing that if we ate a reasonable diet, that would take care of our vitamin needs,” said Dr. Robert H. Fletcher of Harvard University. “But the new evidence, much of it in the last couple of years, is that vitamins also prevent the usual diseases we deal with every day – heart disease, cancer, osteoporosis, and birth defects.
The results of 150 studies of nine vitamins: B6, B12, D, A, E, and C, point to their important role in maintaining optimal health.
SOURCE: CHICAGO TRIBUNE June 19, 2002, n.p. & Knight-Ridder Newspapers. Distributed by Knight-Ridder / Tribune Information Services

What is SAD and how does Light Therapy Help

Seasonal Affective Disorder, or SAD, is a form of depression that follows a seasonal pattern. It appears to result from changes in the length of day, although more than lost sunlight may be involved. The disorder tends to last longer and be more severe at higher latitudes where is greater difference between the long days of winter and the short winter ones.
However, the influence of light doesn’t completely explain SAD. Thus far, no studies have demonstrated a causal link between a reduction in daylight hours and the development of the disorder. And various experiments have shown that some of the body’s cycles persist in the absence of light cues. Nevertheless, light therapy is uniquely, although not universally, effective in treating “winter depression.” Light therapy is usually the first therapy recommended for a person suffering this type of depression, provided they are not suicidal.
The “light box” contains florescent lights mounted on a metal reflector. There are several light box models. Some are designed to sit on a tabletop or desk, and others clamp onto a stand. They differ in size and portability. Some are small enough to be packed in a travel bag. They can also be adjusted for height and intensity.
Other light therapy devices include a battery operated light visor worn on the head, and the dawn simulator, a bedside light on a timer that gradually illuminates the bedroom in the morning to create an artificial early dawn.
The cost of light boxes is usually covered by insurance. (Summarized from Harvard Women’s Health Watch, Feb. 2005, Vol. 12, No. 6, pp

Theory and Treatment of Winter Depression

Seasonal Affective Disorder (SAD) was named in the 1980’s to describe the depression that some people feel as the days shorten in fall and winter. Seasonal depression is thought to be more common and longer lasting at high latitudes, so it appears to be the result of changes in the length of day.
But more than lost sunlight may be involved. Many physiological rhythms – sleep and waking, body temperature, energy – are also adjusted daily by synchronization with the sun. Cells in the retina of the eye transmit evidence of changes in light to a pacemaker in the part of the brain called the suprahchiasmatic nucleus, which controls some of these body rhythms. According to a popular theory, this internal clock does not adjust properly to later dawns and early sunsets in people with seasonal affective disorder.
An effective treatment for seasonal affective disorder has been to expose an individual to fluorescent lights mounted on a metal reflector. This light box can sit on a stand or tabletop. An individual will sit nearby the light box for anywhere from a half-hour to two hours per day. In another version, lights can be attached to a visor worn on the forehead.
Experts recommend an intensity of 10,000 lux, which is similar to early morning light. Morning light is usually preferred, as it supposed to reset the body’s internal clock.
Other potentially effective ways to treat seasonal affective disorder are antidepressant medications, such as Prozac, Zoloft or Celexa and even the herbal St. John’s Wort.
SOURCE: HARVARD MENTAL HEALTH LETTER Nov. 2004, Vol. 21, No. 5, pp. 4-5

Are Alternative Therapies Effective Against Depression

If you are thinking about alternative therapies to fight depression, you need to be discriminating. Following is a summary of study results from five different alternative therapies in the treatment of depression.
Acupuncture – The needles placed at certain point in the body are believed to enhance the flow of energy and relieve emotional problems. A 1995 study found that three quarters of depressed women having acupuncture said they felt “significantly” better after eight weeks.

Herbal Remedies – If taken correctly, herbal compounds taken as teas, tinctures, or pills have been said to alleviate many conditions including depression. Few herbs have been studied as antidepressants, but Saint John’s Wort seemed to work against moderate depression with few side effects in a German study.

Exercise – It lessens anxiety and other negative emotions for hours, or if done regularly, for days and weeks. According to a 1970’s study of men who reported moderate depression, those who took up exercise were 12 times less likely than non-exercisers to remain depressed two years later.

Meditation – The “relaxation response” of meditation is said to decrease pain and reduce anxiety and depression. Based on dozens of studies, doctors have been urged to accept meditation as an effective treatment for chronic pain, anxiety, and panic attacks.

Nutrition – Some alternative practitioners recommend a fast to purge “toxins” from the body; types of food are then gradually re-introduced to track how patients respond. There is no reliable scientific literature on the psychological value of abstaining from food.
SOURCE: HEALTH - JAN / FEB 1997 PP 72-78

Can Vitamin D Prevent Infection?

A number of researchers are finding that vitamin D may play a large role in fighting infection. In July, 2005, the FASEB Journal reported that vitamin D boosts white blood cell production of cathelicidin, one of the antimicrobial compounds that fights germs.
Recent studies link vitamin D intake to increased cathelicidin production. One study that investigated the relationship between vitamin D and susceptibility to tuberculosis also supports the idea that Vitamin D deficiency may make individuals susceptible to infections.
Legions of germs come into contact with our bodies every day. Most would-be invaders, however, don’t succeed. They are destroyed by cellular recruits called up to participate in local immune militias. Scientists hadn’t been sure what serves as the call to arms for these immune cells and what triggers the production of their antibiotic arsenal.
However, over the past five years, a number of studies began to show the importance of cathelicidin, which, according to Richard L. Gallo of the University of California, San Diego, “targets the bad guys.”
Researchers discovered that Vitamin D, in its active form of 1,25-D, transforms into a compound called a pre-hormone. When researchers administered 1,25-D to a variety of cells, the gene for making cathelicidin “went boom” according to John H White, of McGill University in Montreal.
There are numerous independent and promising studies underway testing vitamin D’s effect on infections such as tuberculosis and influenza. It is possible that a shortfall in Vitamin D might seriously compromise a body’s defense system.
SOURCE: SCIENCE NEWS Nov. 11, 2006, Vol. 170, No. 20, pp312+