ExerciseIt is generally believed but not rigorously tested that exercise, even when it causes pain, shortens periods of pain.RelaxationApparently contradictory to exercise, relaxation is intended to correct abnormal postures.Deep massageIt is intended to break tissue free from constriction.Manipulation, osteopathy and chiropracticeThe most organized of complementary therapies, manipulation, osteopathy and chiropractice are designed to force tissue in abnormal locations into a normal position. They use escalating force to achieve this end. Evidence is lacking that the abnormal location existed in the first place and that normality is restored. A large number of so-called trials have been carried out but they are so far uniformly unsatisfactory. The most common problem if one therapy is compared with another is that the differences are so obvious to the patient. For example, chiropractors organized an elaborate trial in which randomly assigned patients received either chiropractic therapy or a course of hospital physiotherapy, and the chiropractic patients did better. But the chiropractic patients were given a series of treatments in the private offices of practitioners who knew their profession was on trial. The other patients went without fanfare to receive routine physiotherapy by unchallenged practitioners who gave fewer and shorter sessions. No wonder chiropractice appeared superior.In another recent analysis of various types of physiotherapy matched against so-called placebos, the only significant result was that the longer the treatment lasted, the better was the outcome. This result applied equally to the designated therapies and their placebos. Whatever the placebo component may be, there is no doubt that these therapies, like many of those we have considered, produce some tissue damage.*59\219\2*
Archive for the ‘Pain Relief-Muscle Relaxers’ Category
A properly constructed exercise programme including stretching exercises would seem to be a useful adjunct to the field of music education.
This may well lead to the prevention of some of the overusage syndromes seen in musicians. Painful musculo-ligamentous overusage appears to be the most common form of occupational malady seen in musicians.
As the unnatural hand positions of some strings players and the unnatural head/neck positions of flautists and violinists are ‘natural’ to those instruments perhaps one saving intervention may be to teach students a proper awareness of their posture and the force with which they play their instrument.
G. Alexander in Denmark (not to be confused with the originator of the Alexander Method — the Australian F. Matthias Alexander) developed a special method for improving muscle tone, called eutony, meaning good or most advantageous tonus. This approach is now used throughout Denmark both in the primary school system and in the preparation of practical artists and musicians.
It is described by Dr. Beata Jencks in her book Your Body: Biofeedback as an optimal balance of body muscle tone with least energy expenditure within the dynamic equilibrium necessary for unhampered blood circulation, respiration, and muscle tone during movement and rest Jencks goes on to give details of numerous methods of enhancing this process.
Imagine all your weight concentrated in the abdomen, just above the pelvis Fed it at first during relaxing exhalations, but then allow the abdomen to remain expanded during diaphragmatic breathing and let the centre of gravity remain at its low level during inhalations. Raft
Imagine the buttocks supported by a broad, anchored raft or plat¬form carried by the ocean waves. Feel the broadness and resilience of the base. Fee’ trie flexibility and ease of the upper body. Awake breathing
If you are not alert enough to be adequate to an occasion or the job at hand your breathing may be too shallow.
Allow the breathing to become as awake and aware as the task or situation demands, but at intervals revert to your natural breathing rhythm allowing sighing or yawning to occur naturally. Again and again enliven vour breathing with refreshing inhalations.
*82\37\8*
Treatments available for tension headaches include the simple analgesics such as aspirin and paracetamol. These sometimes provide a degree of pain relief above that expected in other chronic pain conditions.
Probably the best forms of therapy for such headaches are the psychological methods of treatment. These include hypnosis, biofeedback and relaxation therapy.
But there are a number of headache sufferers with such a high degree of tension that the use of relaxation therapy is inappropriate. For them, it may be appropriate to use the minor tranquillisers — much maligned as they are — for short period prior to the non-drug treatments. (The minor tranquillisers, such as Valium, Serepax, Tranxene and Xanax are in fact valuable tools for doctors who are prepared to talk with their patients and also offer other therapies.)
In some cases the headaches are the only sign of chronic depressed mood and the appropriate therapy includes the use of antidepressant drugs. Initially these will be the more commonly used group of tricyclic antidepressants.
These include such drugs as Tryptanol, Surmontil, Sinequan, Prothiaden, Pertofran and Anafranil. Tolvon is another anti-depressant from another class of drugs and causes fewer side effects such as gastric irritation and cardio-vascular complications.
Those not responding to these drugs may respond better to the more potent Mono Amine Oxidase Inhibitors or MAOI’s such as Nardil or Parnate. While these must be taken with dietary precautions they do not cause the sedation, constipation or weight gain that the other groups are shown to cause.
Physical treatments including massage, acupuncture and TENS therapy may also have some value.
*59\37\8*
The ‘pain cycle’ plays a vital role. When trauma strikes,that is, physical or psychological injury, a painful response is frequently felt. This pain precipitates responses by the body to protect itself by guarding — usually noted as physical spasms. This guarding promotes subsequent dysfunction, that is, abnormal functioning, of the soft tissue and the joints.
The pain cycle is accompanied by certain internal changes which tend to compound the element of pain. The guarding process in turn produces a state of muscle tension which reduces the blood supply within the area. The condition is called ischaemia — deficient blood supply. There is an increased production of metabolites as a by-product of the muscle contractions. Metabolites are the breakdown products of the chemicals necessary for proper muscle function. Metabolism is the series of changes in a living body by which life is maintained. About 20 per cent of the energy produces mechanical movement or stabilisation, while most of the energy produces heat with the by-products of increased metabolites. Thus there tends to be an increased accumulation of these metabolites. Trauma may also include the production and concentration of internally made pain-producing substances such as peptides, amines, substance P, and prostaglandin.
*38\37\8*
Although we may be surprised by the use of such treatments of yesteryear, today’s therapeutic interventions are hardly less extraordinary. For example, the age old treatment of acupuncture, sophisticated electronics linked to mind-body relaxation in the form of biofeedback, ultrasound and Transcutaneous Electrical Nerve Stimulation (TENS) are frequently used today in the quest to control pain.
Modern pain theories
The modern theory of pain sensation began in the first half of the nineteenth century. During the mid-nineteenth century, five specific sensory nerves were described. It was said they carried information about the five senses with specific nerves identified as carrying sensation. Several theories of pain were developed in the nineteenth century.
The Specificity Theory, also called the Sensory Theory, held that pain was a specific sensation; pain had its own sensory apparatus independent of touch and other senses. Since its introduction there has been mounting evidence against this theory.
The Pattern Theory held that stimulation of receptor nerves causes a certain pattern of reactions which reflect the quality, intensity, and length of time in which the stimulus acts. These complicated patterns are then fed into the brain and spinal cord where specialised collections of nerve cells decipher them and then initiate an appropriate response.
The Intensive Theory was formulated in the late nineteenth century; it declared that every sensory stimulus, such as touch and pressure, caused pain if severe enough.
Later in the nineteenth century, the American Psychological Association suggested pain was a combination of the original sensation and ‘the psychic reaction, or displeasure, caused by that sensation. ,
Even throughout the first six decades of the twentieth century, research was simply aimed at supporting either theory. The Gate Theory which was only announced in 1965 suggested there is a ‘gate’ within the rear horn-like portion of the spinal cord which either closes to prevent pain signals from reaching the brain or opens to allow the pain to be experienced.
*15\37\8*
Excessive exposure to the sun causes headaches in two ways. It gives us headaches by inducing glare and it heats us up, dehydrating us and causing headaches as a result.
The human body is very good at controlling its own internal conditions, keeping the concentration of body fluids more or less the same and maintaining a constant temperature. The way we control our temperature is simple. It takes a lot of heat to change water into water vapour, so at the times when we’re hot we sweat, which takes a lot of heat away from the body.
This can occur in one of two situations – when we’re working very hard, producing a lot of excess heat as a by-product of muscular movement and also, and most importantly, when we can’t become cool because we can’t properly evaporate our sweat. This happens when it’s very humid. Sweat can’t evaporate easily into air that already carries a large amount of water, so it lies unevaporated on the skin, and we become all to quickly aware that we feel hot and sweaty.
Too little fluid in the body — dehydration – can cause headaches in its own right. In addition, sweat contains salt, and a large amount of sweating depletes our salt reserves. This in turn leads to an imbalance of body and blood chemistry, which can make us feel unwell.
Under hot, dry conditions you can lose a lot of fluid, and salt, without knowing. In conditions where the air is dry you won’t be able to see that you are sweating.
Although natural weather conditions may not seem dry enough to allow dehydration to occur through insensible sweating (sweating we are not aware of), people in artificially dry environments can lose a lot of water without realising it. Any industrial environment where the air is artificially dried can do this; and because of the laws of physics, simply heating up the air in the room has the effect of relatively drying it out. Warm air can absorb more water than cool air. Therefore hot and/or dry environments may cause dehydration-type headaches; for example operating theatres, hospital wards, foundries, and certain industrial processes taking place in rooms with controlled low humidity.
How do you know if you’re dehydrated? Simple. How much urine are you producing? And is it light or dark? If you are dehydrated your body will try to conserve fluid, so the kidneys will excrete very little urine. As a result, the waste products in your urine will be more concentrated, making it a darker yellow colour. On the other hand, (assuming you haven’t got diabetes or kidney failure) you’re unlikely to be dehydrated if you are going to the toilet several times a day and producing normal amounts of light-coloured urine.
The cure for dehydration is obviously to drink more fluid (preferably nonalcoholic), but do be careful. Drinking copious quantities of water at one sitting isn’t good for you and can even be dangerous. Nor is it necessarily just water that you need; sometimes a little extra salt will be necessary to replace some of that lost in the sweat. Wear light clothes, but not synthetics, for sweat can’t get out through this material. You’re better off wearing, say, cotton or other natural fibres which can breathe. A wide-brimmed sun-hat helps, by keeping the direct heat of the sun off your head and shoulders.
You might think that if you’re dehydrated you’d be very thirsty – and you might be – but only up to a point. Its quite possible to feel unwell from salt depletion and dehydration without necessarily being very thirsty.
To prevent dehydration, avoid caffeine and alcohol, which are diuretics. Should you become dehydrated, sachets of rehydrating salts are available from the chemist. Take them with a measured amount of water. In an emergency, you can make a version of this dilute liquid mixture yourself, with one pint of drinking water, one-quarter teaspoon of salt and one tablespoon of sugar. Sip slowly and frequently.
So, too much sun can give you headaches, working through a combination of mechanisms. Excessive sunlight can produce glare, which causes you to screw up your eyes, giving you a tension headache. Excess heat from the sun can dehydrate you and deplete you of salt, both of which can also give you headaches. Often headaches from too much sun are not caused by just one or other of these problems, but by both together. In addition, too much sun is tiring.
If you’ve had too much sun, go into a cool, less bright environment; perhaps take a cool shower. Drink adequate fluids, use sunglasses, and, if necessary, take a couple of tablets of paracetamol or (where appropriate) aspirin. You may find a short nap helps also. This is probably all that is needed to tide you over what is usually a temporary hiccup in the system.
*141\20\2*
Women are born with about two million eggs in their ovaries, in an arrested state of development. During the reproductive years, one by one, about four hundred of these eggs are stimulated to develop, mature, and finally be released into the womb, The remainder degenerate and are absorbed. The cells around each egg are important because they produce the oestrogen and progesterone of the female cycle.
Quite simply, all that happens at the menopause is that the ovaries run out of eggs. There are simply no more left to develop, and as a result, two things happen. Firstly, there are no cells able to produce oestrogens, so the level of oestrogen falls; secondly, the brain detects this and tries to stimulate the ovaries by making the pituitary produce ever larger quantities of FSH.
This lack of oestrogen is the principal cause of menopausal symptoms. For reasons that we don’t yet understand, as the oestrogen level falls, the circulatory system becomes unstable and as a result flushing and sweating occur. Other symptoms of the menopause include; woolly-headedness, vaginal dryness, poor memory, back pain, flooding (very heavy periods), depression, a general sense of feeling unwell, and headaches. Sometimes migraine can start or worsen at this time. However, simply providing supplemental oestrogen can bring the woman back to her previously normal state.
Some women get many more menopausal symptoms than others. There are those women who float through the menopause with grace and ease, while others have a wretched time of it, with hot sweats that keep them awake half the night, flushes that make them beetroot-coloured and mental befuddlement that makes them think they’re going mad. It’s unclear why some people have such a difficult time of it, and although in the past many doctors felt that there was a large psychological involvement, it now appears in most cases that any psychological effects of the menopause occur as a result of changes in the hormonal level.
Due to the effects of oestrogen, migraines are more common in women. It used to be thought that the incidence of migraines declined at the menopause, with the decline in oestrogen levels, but it now appears that this is not necessarily so. Some women have fewer migraines after the menopause; but others have more, and a small proportion of women find their migraines start at the menopause. In those whose migraines have worsened, hormone replacement therapy (IIRT) can bring matters back to normal again.
If you’re having headaches and you are also going through the menopause, then your headaches may respond to hormone replacement therapy (HRT). Some doctors believe that HRT should be given to every menopausal woman, to prevent bone-related problems like osteoporosis (thinning of the bones that is increased by oestrogen deficiency in menopause). Others feel that the menopause is a natural phenomenon and shouldn’t be tampered with unless a patient is having severe symptoms. Most doctors probably fall somewhere between these two extremes.
Diagnosis of the menopause is not always easy. Menopausal symptoms may occur at a time when the periods are still relatively regular, and having normal or nearly normal periods doesn’t mean you aren’t entering the menopause. In addition, some women have already had their womb removed (hysterectomy), even though their ovaries may still be in place, so they don’t have periods any longer. Apart from menstrual irregularities, most of the remaining menopausal symptoms can also be caused by non-hormonal circumstances. In other words, it’s not always easy to be sure, from your symptoms alone, of the point at which you’re entering the menopause. Sometimes it’s necessary to do a blood test to be sure if the symptoms are likely to be related to the menopause or not.
There is a further problem in those who’ve had a hysterectomy. Even if your ovaries are left behind, those who have had a hysterectomy have a fifty percent chance of having their ovaries fail within the next five years – in other words, of entering the menopause. Without a womb you may not realise you’re menopausal. A thirty-six year old woman who had a hysterectomy four years earlier might actually be going through the menopause.
It’s easy for a doctor to work out whether or not you’re menopausal. A simple blood test can measure the level of FSH (follicle stimulating hormone) produced by the pituitary. In menopausal women this level is always high because the pituitary is desperately trying to stimulate the production of oestrogen from the follicles in the ovaries.
If some or all of the symptoms mentioned in this chapter seem to fit you, it may be a good idea to go and see your doctor. Certainly, if you are having these symptoms and also getting headaches then hormonal replacement therapy (HRT) may well remove your headaches, as well as the rest of your menopausal symptoms.
*98\20\2*
Orthodox treatment
Some epileptic attacks can be traced to a brain tumour, an abnormal set of blood vessels, or a scar on the brain and occasionally these can be removed surgically, with good results.
Where there is no identifiable physical abnormality triggering the fits, the treatment of epilepsy is by using one of ihe many anti-epileptic drugs available, such as phenyloin, carbamazepine, phenobarbitone, sodium valproate, vigabatrin, primidone, clonazepam or ethosuximide, These are often used in combination.
Self-help
Epileptic attacks are usually random, but in some people can be triggered by external events. Flashing lights are one; going without food is another; becoming stressed a third. It’s interesting again how closely the diggers for epilepsy mirror the triggers for migraine. Once you know your triggers, then try to avoid them. However, this isn’t always possible, and sometimes conditions at work – especially lighting – can increase the possibility of epileptic attacks occurring.
Flicker can be a potent trigger lor fits, and one potential cause is the television/computer VDU. Have you ever been in a darkened room where the only source of light has been a television? If the room is lit only by the television, this means that the whole room is flickering. Watching television like this may precipitate an attack in those who are susceptible. Therefore, always have a light on in the room where you are watching television, as this prevents the flicker between bright and dark.
Working with a VDU, especially one in which there is high contrast, can also cause fits, particularly at those times when the screen is changing quickly. One note, though: flicker is reduced when contrast is reduced. Simply turning down the contrast and turning up the brightness may make all the difference between a screen that triggers off epileptic attacks and one that doesn’t.
The final self-help technique is to accept with good grace that you have epileptic attacks and that you may have problems for some considerable time. Don’t try and give up your epileptic medication without consulting your doctor. In fact, try to take your medication as regularly as possible, because the more constant the supply of anti-epileptic drugs in your bloodstream, the less likely it is that you will have any attacks.
Complementary treatment
Currently under investigation is the role of Vitamin E in controlling seizures. It has been reported that epileptic children have abnormally low levels of Vitamin E; until this research is confirmed, it certainly won’t hurt to ensure that you have an adequate intake. Vitamin E occurs naturally in foods like wheatgerm, apples, spinach and eggs.
Supplemental taurine, an amino acid, seems to he beneficial in the treatment of epilepsy. Studies are being carried out to see whether this acid can in fact be more useful than standard anti-convulsants.
Bach flower remedies can be rubbed gently into the temples and other pulse points of someone suffering seizure : these flowers have a soothing effect, and prevent shock and anxiety from setting in. Constitutional use of the remedies may also prevent an attack, if emotions are a trigger.
Constitutional treatment by a homoeopath might be successful. Specific remedies may include ignatia, belladonna, or aconite.
Vitamin B6, magnesium, calcium and zinc supplementation have proved helpful in some cases but Vitamin B6 can be toxic in excess: consult a registered practitioner for advice first. Reflexology may prevent attacks in epilepsy-prone patients, with specific massage and affirmation. Dance/music therapies can control stress, which often precipitates an attack. Any relaxation techniques will be useful in dealing with stress.
Finally, although a registered aromatherapist can suggest a specific oil, or blend of oils, suitable for treating the precursors to, and the effects of, an epileptic attack, this treatment must always be supervised. There are a number of essential oils that can provoke a fit in epileptics, and these are: fennel, hyssop, wormwood, sage and rosemary. Lavender, however, is said to be anticonvulsive and can he safely taken, a few drops at a time, in the bath.
Herbalists might suggest camomile tea, or roman camomile essence, to encourage relaxation; see the suggestions for tension headaches, on page 601, for further ideas about how to encourage relaxation, and prevent tension developing, which may be a triggerfor attacks.
Cranial osteopathy claims to help epileptics by reducing the tension in the muscles of the skull, and encouraging the patient to relax
*85\20\2*
Headaches can occur at work for a wide variety of reasons, and for our purposes it’s simpler to classify headaches by what triggers them off. In all cases of work-related headaches, treatment follows the same principles – identify the trigger factor, and then deal with it. This sounds simple, but isn’t always easy in practice.
Work-related headaches fall into four main categories, according to the type of trigger causing them. These are:
Musculo-skeletal and ergonomic problems (the relationship between the worker and his or her environment)
Light, noise and vibration
Chemicals, including allergies
If you’re getting a lot of headaches at work then it’s worth thinking carefully about whether any or all of these items apply to you. Sometimes the answer is easy: a headache coming on whenever you go into the factory’s paint shop, or one that always occurs when you’ve been using the computer, is easy to sort out.
However, there are traps. Obviously, a headache which seems to come on at work is likely to be directly related to work conditions. But headaches may occur when stress is removed, so a headache which occurs at the weekend can be due to relaxation from tension from work. Don’t forget, too, that in allergies the body can be supremely sensitive, and traces of work chemicals that are taken home on clothing or overalls may continue to cause symptoms at times away from work.
Allergies can create diagnostic traps, too; for a start, in allergies the cause-and-effect relationship can be altered by constant low doses of exposure to the offending substance. You might imagine that if you’re very allergic to a substance then your reaction is likely to be brisk, and directly related to your exposure to it. This is absolutely correct, but only if you have been away from the substance for some lime. In this case, exposure to the substance you’re allergic to will produce a sudden and often intense reaction. However, if you are constantly exposed to a substance to which you are allergic there is a more random pattern of reaction, combined with a general malaise. Therefore, if you’re allergic to the chemicals exuding from the new carpet in the office, you may feel generally under the weather while at work, with headaches coming on more or less at random, unrelated to the time of day, or the day of the week. Often it’s only when you go on holiday, away from the offending chemicals, that your headaches and other symptoms go away, returning when you go back to work. But isn’t it easy to blame the headaches on going back to the stress of the office? This is where physical and psychological causes for headaches overlap.
Discovering the root cause of headaches at work can sometimes be easy; on other occasions you may need a great deal of patience. You need to change things one by one: for example, altering only the position of your computer, or making a point of not going near the chemical, store, or avoiding the new reception area.
Altering a lot of things at once may get rid of your headaches, but finding out which of the ten items you’ve altered is the culprit may be difficult. If you’ve altered the position of your computer at the same time as staying away from the reception and avoiding the paint shop – and your headaches clear as a result -then which of them is the actual cause?
*121\20\2*
Headaches in children are somewhat different to headaches in adults. To begin with, children often have an ache in the abdomen, rather than the head, during fevers – so a child going down with a mild flu-like illness will complain of a tummy-ache. In an adult this would be a headache. This phenomenon is quite marked, and the younger the child the more likely they are to complain of abdominal rather than head pain in generalised infections.
This is particularly true in the case of non-specific illnesses such as viral infections, urinary tract infections, and so on. It makes diagnosis more difficult, of course, because many abdominal illnesses can also cause abdominal pain, and these have to be excluded from the diagnosis.
A useful point is that a tummy-ache that is really a ‘headache in disguise’ is always felt around the middle of the abdomen. When asked where it hurts, the child will always point to his navel. Some abdominal illnesses can also cause central abdominal pain, so it doesn’t exclude other things; however, what you can confirm is that if abdominal pain is somewhere other than the navel, then it’s unlikely to be caused by a temperature/infection alone. To make matters even more complex, not all children perceive general pain in the tummy – some have headaches, just as adults do. A useful rule of thumb is that the younger the child, the more a headache is likely to mean something other than just a mild infection.
A specific variety of this perception of abdominal pain is abdominal migraine. This behaves almost exactly like migraine, except that the pain is centred in the abdomen rather than the head. It has the same time span as an ordinary migraine, and seems to be a childhood equivalent.
The second reason why children get different types of headaches from adults is because children suffer from a different range of illnesses to adults. This means: more fevers, more tumours, fewer neck injuries, hardly any strokes and no menstrual or pre-menstrual problems before puberty. Eye problems and, behavioural problems also cause specific difficulties in childhood. The pattern of children’s headaches reflects these differences.
*108\20\2*