Medical Articles, Medicine Information.

Pain patients can only rejoice at the recent concept of pain clinics. They have largely overcome the major problem of pain being treated by the well-intentioned but tunnel-visioned approach by each medical specialist.

For example, Ted:

‘I had this awful pain across the bottom of my eye and down my nose. There’s a sizzling noise on top of my head and in the morning my left hand has pins and needles all over,’ said Ted, 66, who had been a foundry worker for 30 years.

Two years earlier, Ted had been referred to the pain clinic. He had been struck on the face by a bolt that had spun out from a galvanising machine like a high-speed missile. The bolt hit him in the face fracturing his cheek bone and causing severe lacerations. There was damage to the nerve just below the eye, leading to a neuralgia — or severe pain in the face due to damage of one of the main nerves to the face.

Consequent surgery had failed to remove the pain and in fact led to Ted suffering from severe depression which had been initially treated by his general practitioner.

‘Since the accident, I am very tense. I’m always fighting at home. I’m hard to put up with. The operation I had only helped in one way. Before the operation, my right nostril was always dry and blocked. But after the plastic surgeon operated on my face, my nose got better. But I still had the pain.’

Ted’s initial laceration had been sewn up and a plastic surgeon had confirmed there was nerve damage. But Ted’s pain was unremitting and he was totally incapable of coping with it. When Ted came to the pain clinic, he was very depressed because he had not worked for two years.

After examining him, it was decided to try a combination of medications because there was no suitable physical treatment. Also, he was too depressed to respond to psychological treatment. Ted was started on an anti-depressant, Surmontil, to control his pain and depression. He was also put on the anticonvulsant medication, Rivotril, to modify his experience of pain.

To his delight, Ted became pain-free on this combination. His depression stopped and he improved enough to get a job as a part-time cleaner in a school. This worked well until the school council decided that he had become too old and he was retired.

The pain team was also delighted with Ted’s progress at the clinic. The alternative suggested by insurance company doctors handling the Workers’ Compensation case, was that he should have had an alcohol block — carried out by injecting alcohol into the affected nerves causing the pain area to permanently block or damage the affected nerves.

Alternatively, he faced the more drastic step of severing the facial nerve causing the pain. This would have led to a permanent degree of numbness over the side of his face. The medical team argued strongly against this to the insurance company stating their belief that Ted’s personality change was also entirely secondary to his pain condition and, with proper medication and care, this personality change would be reversed.

By the time he finished at the pain clinic, he was a happy man. His marriage was back to normal and he had settled his claim for a very small amount of money. He was content to be rid of the pain and walk away from a nightmare episode in his life.

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‘Or, perhaps you may imagine that you’re drinking something nice which gives you a beautiful warmth. Perhaps there’s something like a warmly glowing ball rolling around within you. Allow it to gently warm you inside so that you feel all soft and relaxed. Bring one hand to your mouth and lick two fingers. Now stroke the moist fingers over your forehead. Just stroke your forehead and feel the coolness of the moisture. If you want to moisten your forehead again, feel free to do so. And then, while you breathe in, feel the refreshing coolness of your forehead. Imagine again that giant rag doll, or rag animal from your childhood, lying with its head in the cool shade. Now just lie there and completely relax for a while thinking of the rag doll and its body warmed so wonderfully, comfortably, relaxed in the sun.

Again, feel the gentle cradling of the waves of your breathing rhythm. And, while breathing in, feel the cool shade and the coolness on your forehead.

While breathing out, feel how your body is so comfortably relaxed.

‘In time, you become more and more aware of being refreshed as you breathe in. And, when you decide it’s time to end the state you’re now in, yawn and breathe in deeply and refreshingly while you stretch and flex your arms and legs. And then open your eyes. Look around and breathe in once more. If you were lying down, sit up by supporting yourself with your arms while you breathe out.’ (This keeps the body relaxed and prevents dizziness after the deep relaxation.)

Further information

This sampling of many of the approaches that may be used in the management of chronic pain is likely to whet the appetite of readers. It is suggested, therefore, that those interested in pursuing them further should contact the local state branch of the Australian Society of Hypnosis Limited or any hypnosis society affiliated with the International Society of Hypnosis which is based at the Austin Hos¬pital, in Heidelberg , Victoria. These are organisations consisting of only medical practitioners, dentists and psychologists. All have attended or are attending, recognised courses in hypnosis.

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Hypnotherapy is often ineffective with pain of a psychological nature, particularly when pain is a depressive equivalent. Masked depression is one of the conditions where hypnosis should be avoided unless the hypnotist is able to properly deal with depression with medication and psychotherapy. This should be suspected if the patient gives a history of sleep disorder, fatigue, lack of interest in sexuality or in general, or inability to work — or a tendency to stay in bed, particularly if the patient functioned effectively previously. Such people can respond dramatically to antidepressant therapy. Hypnosis can be used after the depression is controlled.

Safety

Hypnosis is a remarkably safe procedure providing certain precautions are taken. Because self-hypnosis is entirely self-governed, there is no way it can be harmful. By choosing only to attend a properly qualified practitioner, a doctor or psychologist or one of the properly qualified dental practitioners, you can be assured that you will be reasonably assessed and properly treated. Nothing can be suggested which is not under your control.

*128\37\8*

‘Look, I’ve got no problems with the procaine and intravenous Valium injections. I’m starting to feel terrific again.

‘While I still have bouts of pain at night, they’re not as diabolical. I feel the treatment’s a success.’

Jane, 29, a television script writer had had a long history of severe abdominal pain following surgery for endometriosis. This condition can cause severe abdominal pain and the adhesion of pelvic organs due to bleeding into the pelvis as a result of cysts bursting.

Jane had been told that she had adhesions and that this was the cause of her severe pain. She had been attending one of the major public hospitals for more than six months and had been seen by different specialists including gastroenterologists as well as psychiatrists.

Before coming to the pain clinic, Jane had been given full medical investigations including CT scans and laparoscopics.

She had also had some acupuncture, transcutaneous nerve stimulation and a spinal nerve block. She had taken very strong compound analgesic tablets such as Panadeine Forte without any relief.

Jane claimed she was only getting up to 20 to 40 minutes of pain relief from either Pethidine or Morphine injections. She was taking these frequently.

She was also taking very high doses of anti-depressants at one stage. One reason for her depression was that, when she came to the pain clinic, she had not been working for six months.The pain specialist suggested that her pain be controlled with medication other than narcotics. This did not really appeal to her and she disappeared after two visits.

She was later referred to an outside colleague of the specialist not associated with the pain clinic for assessment, and she was finally admitted to the in-patient pain program but once again quit after only a week saying that she did not need the program’s intense psychological aspects. So it was decided that she should try procaine treatment.

A test dose of procaine was given and she had a very marked psychological reaction from the treatment, experiencing perceptual distortions.

‘The walls seem to move in on me. I get anxious and edgy about everything and nothing in particular,’ she said.

It was noted that even after the test dose of each injection her pain was much better. The progress continued after each further injection. But she was so shaken by the sensory experience that it was decided to give her the procaine combined with intravenous Valium.

Even then, she was still very anxious and disturbed by the way she felt during the procaine therapy. This is one of the lesser-known side-effects of the procaine therapy.

Handling the psychological/tension problems caused by the procaine injection itself calls on all the experience that a pain clinic has gained. But Jane was still prepared to try this treatment of procaine and intravenous Valium because it worked. In fact, since the day she started the procaine therapy she had virtually had no other pain-killing medication.

Jane started doing part-time work and then eventually went back to full-time work. She had a procaine injection about once every month for a further 3 months.

The only other treatment she now has for the abdominal pain is the occasional injection to relieve spasms of the internal organs due to adhesions. But she has had no narcotic analgesia now for over twelve months.

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Hypoglycaemia is the medical term for ‘low blood sugar’, and it is usually a result of too much insulin being produced (or too much injected, in the case of diabetics). Everyone suffers from this condition to some extent – especially when they eat meals containing a lot of sugar and starch. Drinking alcohol with the meal makes matters worse. Extra insulin is produced to cope with this onslaught of high-glucose food, and in an excess of zeal it reduces the blood sugar to a very low level, producing symptoms of tiredness, confusion and hunger about two to five hours after the meal. If the blood sugar drops to a very low level, then adrenaline is produced, to help the body cope with what is a major crisis. The effect of the adrenaline is to make the subject irritable and aggressive. He or she will also sweat more, tremble and look pale – and there may be a change in the heart rhythm. Since this type of hypoglycaemia is a response to too much sugar, it is known as reactive hypoglycaemia.

In the past, doctors often advised people with reactive hypoglycaemia to drink a cup of sweet tea, or suck sweets or glucose tablets, whenever they felt the symptoms coming on. This may relieve the symptoms temporarily, but in the long term it just perpetuates the problem. The influx of sugar will simply stimulate the body to produce more insulin, and so make matters worse.

People who are overweight and eat a lot of starchy or sugary food may suffer from reactive hypoglycaemia on a daily basis. Their body cells become more responsive to insulin, because they have to cope with such a high glucose load, so they easily become hypoglycaemic, especially if they miss out on one of their usual sugary snacks. Simply changing their diet will help such people, although they may find it quite difficult to wean themselves off the high-sugar diet that their body has become accustomed to. They should eat more meat, fish, eggs, cheese and vegetables, and cut out sugar and honey entirely. White flour and bread should be replaced by wholemeal, since this is digested more slowly and does not release a lot of glucose at once. Even so, the amount of bread, pastry and potatoes should be restricted, and no cakes, biscuits, sweets, puddings or jam must be eaten. If there is an improvement, then some sweet foods can be reintroduced to the diet later, once the body has regained its natural equilibrium.

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Happiness is like warmth. Even the coldest heart must melt if this warmth is allowed to penetrate for long enough. If whatever you do can somehow help your neighbour, the resulting happiness you receive will permeate your entire being. Whether you are a farmer, salesperson, housewife, office worker, doctor, lawyer, butcher, candlestick maker, or whatever, your fellow human being needs your skill and by rendering a service to him it should bring happiness to you. Do not go about your work sullenly, thereby spoiling the blessing of it. If you are a teacher or a doctor and perhaps you feel that what you do does not receive proper recognition, at least take comfort and happiness from the fact that you are in a position to help those who need and want to be helped. Those who work only for the sake of making money, or are forced to because of circumstances, gain very little, if any, satisfaction from their work. If there is no pleasure to be found in what you are doing or in your achievements, then you are cheating yourself, to be sure. If your eight- or nine-hour working day is pervaded by ill-will and discontent, and you sleep for another eight hours, it is fairly certain that you will not have many happy, cheerful and thankful feelings during whatever time remains. Such a life is one of slavery and drudgery. Your work would be so much easier and enjoyable and it would make fewer demands on you if only it could be permeated with happiness. In the evening you would be much less tired, your dinner would taste better and your morale would be higher. The hours of leisure spent with your family and friends would be filled with pleasure and peace of mind. Even though others contaminate the atmosphere with hate and discontent, your happiness would be strong enough to triumph over such discord.

*1251/28/1*

Whenever I travelled abroad to faraway places and had to watch how thoughtless and ignorant some people were in treating their surroundings, I felt pride in knowing that tidiness prevailed in my native land. Such actions upset and often repulsed me, and I would never have thought it possible for things to change so much in my own country. I vividly remember an incident in Central America where I saw a stream full of rubbish and dead animals. The same contaminated water flowed downstream and was used to irrigate gardens, for people to bathe and wash their clothes in; it was even used in their kitchens. Maybe the natives were tougher there, but they nevertheless suffered from infections on an epidemic scale, as I saw for myself. The blatant lack of hygiene among people living in such conditions, has led to rampant infestation with worms, so that in certain areas all the inhabitants can be infected with intestinal worms and amoebas. The authorities care little or not at all about taking the necessary precautions, even though such unhygienic conditions are responsible for damage to health, and can even contribute to a slow death.

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It is certainly a sign of progress that babies are today given vegetable juices to supplement their usual gruels and milk food. I am sure that this is one reason why vitamin deficiencies are much rarer now than years ago. Infant mortality has also decreased considerably, and it is quite possible that better nutrition has contributed to the improvement.

But what happens when the loving mother has prepared the juice with such care but the carrots, for example, contain poison? How ouzzled she must be when her baby does not put on any weight or, worse, loses weight, despite her constant attention. The baby’s stool becomes thinner and thinner, but the doctor is unable to diagnose the cause, having eliminated the possibility of its being coeliac disease.

*1113/28/1*

What else is there to know about potatoes other than that they are tasty? That is about the extent of most people’s knowledge about the peculiar solanaceous plant we call potato and botanists call Solatium tuberosum. Because potatoes belong to the same family as the deadly nightshade, our forefathers had some rather unfortunate experiences with them when they were first brought to Europe. No one knew this strange plant native to Peru’s highlands.

If ever you get the chance to visit the mountainous areas of that country you will be surprised to see how many varieties of potato actually grow there, many not even known to us. In the Altiplano, from Cuzco as far as Puno on Lake Titicaca especially, the Indians cultivate some beautiful vegetables.

It was as late as the sixteenth century when Spanish sailors and Sir Francis Drake first brought potatoes to Europe, with the intention of cultivating them as a food on the European continent. They gave them to their friends but did not explain anything about the new plant. Why not? Well, it often happens, does it not, that someone knows something but does not tell it to another person simply because he thinks that he will be aware of it already. That is exactly what happened with the potato. No one who planted the tubers seemed to realise that the unknown plant was a member of the deadly nightshade family and had poisonous properties. Neither could anyone imagine that it was the tubers themselves that served for food and not the round green berries growing on the plant. In fact, no one took any notice of the actual potatoes. Of course, the result of eating the berries brought only trouble, because anyone who tried the new vegetable from overseas soon suffered from diarrhoea and vomiting.

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The great progress in civil aviation has made foreign travel easy and has brought us into close contact with people from other parts of the world, who visit us and are pleased when they can get their own food and fruit in our shops. Conversely, many of us venture out and travel to faraway places, where we become familiar with other customs and habits. The result is that we now have many food items in our shops that were rare or even unknown until relatively recently.

I keep receiving letters and reports that confirm the fact that digestive problems often arise when fruit and vegetables are eaten at the same meal. Let me quote the following account as an example.

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