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FEELINGS IN PEOPLE WITH SPINAL CORD INJURY: DEPENDENCE AND CONTROL
Sometimes anxiety stems from the loss of control and the extreme dependence on others imposed by the disability, regardless of how the injury occurred. Spinal cord injury caused by a vascular problem or spinal tumor (rather than an accident) may not cause posttraumatic stress, but it nevertheless results in a major loss of independent function. Basic biological functions and the simplest tasks of daily living may suddenly require the assistance of another person.
When you are no longer able-bodied, you must depend on others to take you to the bathroom, get you dressed, or help you dial the phone. You are suddenly confronted with a host of uncertainties. Will the nurse answer your call-bell in time, or will you wet the bed? Will you get help to make a call home before your wife leaves for work, or will you have to wait until visiting hours to talk to her? What if the staff doesn’t like you? What if your injury is repulsive to others? Will you still get the help you need? These uncertainties produce anxiety and feelings of helplessness in the rehabilitation hospital and often afterward, when problems become even more complex. Will my office or school be wheelchair accessible? How will I reach the files? Can I use the bathroom independently at my favorite restaurant?
Just as when you were a small child, you have to depend on the care and assistance of others for many of your basic needs. At first you may expect the hospital to take care of all your needs, but you’ll inevitably be disappointed. You’ll learn that there aren’t enough nurses, or that other patients’ needs are more urgent, or that priority is given to biological over social needs, even though the latter may be just as important to your sense of well-being.
You may feel frustrated and angry about not getting help. You may also be quite anxious and afraid – that you will never get help, that others will forget about or abandon you, or that something terrible will happen to you because you are helpless and alone (you will fall, stop breathing, or lose your sanity!). This type of anxiety, if left unchecked, can lead to disabling attacks of panic, requiring medication or other treatment. But more often, this anxiety is experienced as a humiliating regression to an infantile state of fear, frustration, and irritability, a loss of control over oneself and one’s environment, which is at best unsettling and at worst an assault on one’s dignity.
Learning to manage anxiety is an important task for every person, regardless of circumstances. Most people need some predictability and some sense of control over their bodies, their behavior, and their environment in order to feel secure and confident. We all learn ways to manage anxiety about new situations: by learning about what to expect (knowledge), developing skills to meet the new demands (mastery), gradually imposing some regularity or predictability (control), and allowing for periods of rest or “down time” when we temporarily set aside the new demands (pacing). These strategies are also helpful in coping with the anxiety generated by disability and dependence.
*38/156/5*

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THE TREATMENT OF MIGRAINE-ABORTIVE TREATMENT
For mild, infrequent migraine, simple analgesics, like aspirin and acetaminophen, may occasionally effectively and safely abort the pain, but analgesics should not be taken daily for headaches. Sometimes, a sedative or a sleeping pill can help the victim sleep through the several hours of discomfort.
Unfortunately, analgesics, even the narcotic type given by injection, are not always effective in relieving migraine, and many people cannot afford the luxury of sleeping. Recently we suggested sleeping for a housewife who has occasional migraine. She quickly responded, “How can you expect me to take the afternoon off when I have three screaming kids? They’ll destroy my house!”
Although these drugs are of value in some circumstances, most patients with migraine need special medications that exert some control of blood vessels. Various forms of the so-called vasoactive medications (medications that affect blood vessels) can be used in either the abortive approach (to stop an attack) or the preventive approach (to prevent the onset of an attack).
Ergotamine is the most commonly employed specific agent to abort a migraine. Ergotamine is often combined with caffeine, sedatives, and antinauseants. Ergotamine can be administered in ordinary tablet form, inserted in the rectum as a suppository, used as a tablet that dissolves under the tongue, given as an inhalant to be breathed into the lungs, or injected. To be most effective, the ergotamine preparations must be taken at the very first sign of migraine. In the case of classical migraine, this means during the preheadache phase. This requires that the drug be constantly available. The unpleasant preheadache phase of classical migraine, which announces that a headache will follow, is, naturally, not prevented by ergotamine since the drug’s major effect is to combat the painful dilation of the blood vessels and not the constriction associated with the preheadache phase. This is a serious shortcoming of the abortive medications because it is the preheadache phase and its potential permanent neurological symptoms that pose the greatest medical risk.
There is some evidence to suggest that vasoconstricting medications, when given during the preheadache phase, may actually impose an additional risk toward stroke. We advise our patients with classic migraine either not to take vasoconstrictive drugs at all or to delay their use until the preheadache phase has terminated. While this reduces the potential effectiveness of the drug by delaying its entrance into the bloodstream, we believe that the reduction in therapeutic effectiveness is worth the enhanced safety that this delay affords.
The major failings of this widely used and frequently successful abortive approach include the need to have the medication available at all times, the inability to prevent the preheadache symptoms, and the potential unwanted reactions associated with ergotamine’s use.
Usually a medication capable of producing beneficial effects can also be responsible for side reactions, some equally as troublesome as the primary complaint. Were you to read the list of adverse and potentially dangerous side effects of simple aspirin, you might shudder to think that such a drug could be used without a prescription or medical supervision. A basic principle governing the use of any medication is that the possible benefits must be carefully weighed against the possible risks.
Fortunately, most of the side reactions associated with the medications used for migraine are relatively mild and usually disappear when the drug is withdrawn. Nevertheless, ergotamine should not be taken by people with blood vessel disorders, such as coronary artery disease and high blood pressure, or with significantly impaired liver or kidney function, or during pregnancy. The reason for abstaining during pregnancy is that ergotamine may directly affect the uterus and its blood vessels.
The most common adverse reactions associated with ergotamine are nausea and vomiting, often symptoms of the migraine itself. Other adverse effects include leg cramps, numbness and tingling of the fingers and toes, chest pain, abnormal heart rate, and itching and swelling of extremities. These drugs can be given safely only once or twice a week, and they are not recommended when migraine occurs more frequently. When these drugs are taken regularly, dangerous narrowing of blood vessels may occur. Rebound widening of blood vessels often develops when the medication’s effect wears off. Taking more medication will improve the rebound headache, but a dangerous cycle of dependency can lead to serious consequences.
The unwanted effects of ergotamine, including severe constriction of arteries, may be intensified with fever or significant infection. Patients taking ergotamine should either reduce their dosage or avoid the use of this drug during such episodes.
The following are some of the preparations containing ergot derivatives used in the abortive approach to treatment: Cafergot (tablet or suppository form), Ergomar and Ergostat (under the tongueЂ”sublingual form), Ergotamine Medihaler (inhalant), Migral (tablet form), and Wigraine (tablet or suppository form).
In Canada, ergotamine is found in many of the same preparations as in the United States. In addition, a Canadian preparation available in capsule form, called Gravergol, contains ergotamine, an antinauseant (dimenhydrinate) and caffeine. Dimenhydrinate (Gravol in Canada, Dramamine in the United States) is also available alone as an antinauseant.
Midrin is a combination tablet (vasoactive, analgesic, and sedative substance) also used for abortive relief of migraine. The active antimigraine agent in this product is isometheptene mucate and is not marketed by itself, but only in combination. Although isometheptene may cause some of the same side reactions as ergotamine and has many of the same precautionary restrictions, it is our experience that it is usually well tolerated by most people for
mild-to-moderate migraine. Its effectiveness is sometimes enhanced by the simultaneous administration of two aspirin.
Pain Relief/Muscle Relaxantcontrol of nausea. They may exert control over pain in a way quite independent of its other effects. We have found that chlorpromazine (Thorazine), which has both tranquilizing and antinauseant effects, can be very helpful in some patients.
The abortive drugs are used to treat an individual attack. Combinations of analgesics, sedatives, antinauseants, and specific antimigraine drugs are sometimes necessary.
*32/88/2*

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FREQUENCY AND PATTERN OF MIGRAINE ATTACKS
Pain Relief/Muscle Relaxant Attacks may develop as often as three or four times a week, once a month, or only once in several years. Some individuals experience a remission, with the attacks absent for ten to twenty years, only for the headaches to reappear again, decades later, in the same or a different pattern. The frequency of attacks may change with time, occasionally becoming more frequent during periods of increased stress and frustration.
Just as the frequency of attacks can change, the intensity of the attacks and their pattern can also change. For example, an adult who seeks medical attention for migraine often recalls that headaches of a less bothersome nature or of a completely different pattern were experienced in childhood, misbelieving that the migraine attacks are a recent problem, when in all probability, they are all part of the same headache condition.
*20/88/2*

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SURGERY FOR BACK PAIN TREATMENT

If the basic treatment plan is not effective or gives only partial relief, surgery may be a useful consideration for acute back pain. The good news is that most people, even those with ruptured lumbar disc, improve without surgery. Researchers have shown that 80 to 90 percent of people with acute back pain can improve with medical treatment and can return to work without surgery.
A ruptured disc is the most common condition requiring surgery for back pain. If the pain is intolerable and does not respond to treatment, or if muscle weakness or problems with the bladder or bowels occur, then surgery should be considered. Your doctor can arrange to get an opinion from an orthopedic surgeon or a neurosurgeon who can tell you your chances for success and relief of pain with surgery. Ask about the chances that your pain might not be relieved, and about the risks of the surgery.
Gather as many facts as possible, to be able to make the best decision for yourself. Ask for more than one consulting doctor’s opinion, until you are confident that you have enough information. You should not feel rushed or allow yourself to be pressured about having back surgery.
The following different types of surgery are used to correct ruptured (herniated) lumbar disc:
Ђў Laminectomy and discectomy remove a portion of the bone around the herniated disc and then remove the disc material.
Ђў Microsurgical discectomy, which requires a smaller incision and microscope techniques, attempts to deal with a smaller area, risking less injury to surrounding tissues in the back.
Ђў Percutaneous discectomy begins with a small incision that allows placement of an instrument into the disc space for removal of the disc.
Ђў Chemonucleolysis is the injection of an enzyme (chymopapain) into a disc by a surgeon. The enzyme is supposed to dissolve the abnormal disc material. The potential side effects, such as reactions to the medication, and questions about its effectiveness in the treatment of a ruptured disc have made it less popular recently.
Each procedure may have an advantage for certain patients and may have less chance of response in others. Your surgeon is in the best position to choose the appropriate type of surgery. The factors that must be taken into account include your specific problem, the cost, and which procedure will best accomplish the goal.
When surgery is considered, you should discuss the planned type of surgery with your surgeon until you fully understand it and agree with the choice. You should feel comfortable that you have made the best arrangements for a favorable result.
*28/135/5*

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HEADACHES AND MIGRAINE: CEREBRAL BLOOD FLOW
Recent exciting discoveries have revolutionized our ideas of the relationship between thought and blood flow. Previously it was considered that thinking did not use any significant amount of energy and the blood flow to the brain was constant. It is now known, however, that when a group of brain cells is activated it uses up oxygen, produces carbon dioxide, and causes a local increase in blood flow to that area by enlarging the blood vessels.
Using radioactive tracers it is now possible to follow these changes and remarkable pictures have been obtained. For instance, the resting pattern of blood flow shows a marked increase in the frontal areas; talking to the subject causes a decrease of flow to these areas whilst part of the temporal lobe of the brain shows a marked increase of activity – dynamic proof of the long-held hypothesis that this area is one of the speech centers. Similar things happen when other intellectual activities are undertaken so that these techniques confirm localization of various functions in specific areas of the brain. This close relationship between blood vessels and brain cells leads to interesting possibilities. For instance, if the control of blood vessels were to be deranged, subtle changes in brain function could be expected; this has been confirmed in certain forms of mental disease.
Pain has been shown to increase metabolism in the brain and to dilate vessels generally. The increase in vessel diameter makes small local controlling changes more difficult and this could explain why thinking becomes more difficult during severe pain. The paradox is that pain, like stress, produces increased sympathetic activity, yet it increases blood flow to the brain. The resulting vasoconstriction would be expected to decrease it. The answer is probably that the sympathetic controls the larger, so-called resistance vessels, while pain in this context activates local capillaries.
The system which controls blood flow to the brain is highly complex as it is affected by nervous factors, circulating chemicals (amines), and outside factors such as pain, as well as by mental processes. An interesting experiment highlighted the importance of the latter: subjects had to solve problems of mental arithmetic while their brain blood flow was being measured. There was a slight increase to appropriate areas but this became greatly magnified when they were offered money for the successful solution to the problems. This shows that motivation and concentration have a direct effect on the blood flow to the brain and the experiment clearly confirms yet another psychosomatic link.
*24/152/5*

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Other names: Benemid

THE TREATMENT OF MIGRAINE-TREATING YOUR OWN MIGRAINE WITHOUT MEDICATIONS
Chronic headaches, such as migraine, in which there is no injured tissue to account for the symptoms, can be treated but not cured. Pain of a migraine and muscle contraction headache, as well as the other chronic headache disorders, is most likely a reaction of normal tissue to various physiological or psychological events. It cannot be treated as can a wart, an infection, or a tumor. There is no surgery, antibiotic, or other specific therapy that can “heal” or remove the injured tissue. The tissue is not primarily abnormal. What must be attempted is to control the symptoms, and this can be effectively achieved in most individuals.
Treating Your Own Migraine Without MedicationsЂ”Most severe migraine attacks require medication for relief, but there are some simple nondrug therapies that may help to prevent the headache or retard the frequency and severity of your attacks. The following suggestions may be helpful in preventing migraine attacks, but do not assume you have migraine unless a physician has established the diagnosis.
1. Discontinue or avoid any circumstances, events, foods, over-the-counter medications, or beverages that you feel could have precipitated your attacks.
2. If your headaches seem to be related to the use of birth control pills or other prescription medications, discuss the matter with a physician before discontinuing them.
3. Learn to relax and to reduce stress; make sure that each day you have at least one-half hour to yourself for thorough relaxation.
4. Engage regularly in enjoyable hobbies and relaxing activities.
5. Unless exercise is known to provoke your attacks, regular physical exercise is advisable, providing your health is good.
6. Avoid sleeping late. In fact, get up as early as possible each day and avoid daytime napping.
7. Biofeedback and behavior modifications appear to be worthwhile in some cases of migraine. In fact, after adequate screening by a physician, biofeedback may be the treatment of choice for children and young people with migraine. Biofeedback and behavior modification can be learned from qualified professionals and we encourge this treatment in many patients because it imposes no health risk, and therefore deserves special respect. Other similar efforts, such as yoga and transcendental meditation, may also be useful.
Pain Relief/Muscle Relaxant9. If you are troubled by migraines on weekends, holidays, or during vacations, reappraise your indulgences, like sleeping late, too much coffee, cocktail parties, and spicy or preserved foods, and go to bed and get up on weekends the same time you normally do on weekdays.
10. Many patients state that they have fewer headaches after they have quit smoking. It is possible that the products of combustion play a role in dilating arteries. This may result from the body’s attempt to get more blood to the brain when challenged by the oxygen reduction or other elements in the polluted air.
*29/88/2*

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MIGRAINE HEADACHES: EVENTS AND CIRCUMSTANCES THAT TRIGGER AN ATTACK-FOODS, BEVERAGES, AND DRUGS
Some foods, beverages, and drugs can precipitate migraine in certain individuals. A quarter of our patients think that their headaches are influenced by what they eat or drink. The foods and beverages most often charged as offensive are fatty foods, cheese, alcohol, chocolate, citrus fruits (particularly oranges), monosodium glutamate (MSG), and nitrite-containing foods. Monosodium glutamate is found in many packaged foods, spices, seasonings, and canned foods. Nitrites are found in hot dogs and other smoked, preserved, or cured meats.
A migraine headache may also be precipitated by certain drugs, particularly those that lower blood pressure. Examples of this are reserpine and hydralazine, two agents found in many
Pain Relief/Muscle Relaxant
Anti-Allergic/Asthma While some foods, beverages, and medications can provoke a migraine, missing meals can also trigger an attack. If your headaches occur during long periods without food or as a result of diets or fasts( five to six hours or more), you may be one of the people susceptible to an attack from this cause. Going without food from an early dinner hour the night before until breakfast the following day, about twelve to fourteen hours or more, may likewise provoke an attack. This does not necessarily mean that you have hypoglycemia, or low blood sugar.
An early-morning headache can sometimes be prevented by eating a low-carbohydrate snack just before bedtime. While eating a small snack between meals may be helpful in preventing attacks in some people, once the headache begins, eating may not have much effect. It is important to reemphasize that simply because headaches are triggered by missing meals or prevented by eating snacks prior to retiring, this does not imply, much less prove, that hypoglycemia is present. Most normal human beings can go weeks without food and, because of the body’s ability to make sugar from its own protein and fat, maintain relatively normal blood sugar levels. During shorter fasts, say overnight, the body draws on its storage supply of sugar in the liver in order to maintain a normal blood level. It is believed that the physiology required to maintain normal blood sugar levels between meals, not hypoglycemia, may be the triggering factor. Perhaps by eating regularly, one eliminates the need for the appropriate physiological changes, thereby removing the trigger for the migraine attack.
*23/88/2*

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REHABILITATION AFTER CORONARY ARTERY BYPASS SURGERY: EXERCISE
Exercise is a major part of all rehabilitation programs after coronary bypass surgery. You will have already been doing special exercises for your chest, shoulder girdle and neck while in hospital. You will have been advised to continue these at home.
If the hospital has an outpatient exercise program, you will be invited to attend it. If unable to attend, you may be referred to another program, or the physiotherapist or rehabilitation coordinator will give you a set of exercises to do at home to improve the general suppleness of your body and muscles, and to help you recover normal respiration and movement.
You will also be given a walking program to do at home. You will probably be advised to walk for at least half an hour per day, preferably every day, and preferably in company to make it more pleasant. You may wear normal clothes or special walking clothes.
Start slowly; do what is comfortable for you. If you feel you can only manage 10 minutes that is fine. You should walk enough to make you almost breathless. That is, you may not be aware of your breathing or just aware of it. The speed and distance you walk will increase as you recover from your operation. You should be able to walk and talk comfortably at the same time.
You may push yourself a little further until you are aware of slightly heavy breathing throughout the walk.
In this case, you should do stretching and warm-up exercises before your walk and a period of slower walking, stretching and relaxation at the end.
As part of your exercise program, you will be encouraged to resume housework and activities about your home and garden or in your workshop. You will also be encouraged to resume your social, sporting and other activities which involve effort.
*20/160/5*

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MIGRAINE HEADACHES: EVENTS AND CIRCUMSTANCES THAT TRIGGER AN ATTACK-EXERTION AND OTHER TRIGGERING EVENTS
Some people experience attacks only during or after physical exertion. Jogging, jumping rope, and playing tennis are often cited. It is possible that the headaches related to exertion may be caused by either the chemical or blood vessel changes that occur during physical exertion or perhaps by the depletion of certain biological substances following the exercise. Perhaps related are the severe headaches that occur in some people, particularly men, at the time of sexual orgasm.
Other Triggering EventsЂ”A variety of other factors can trigger migraine. Among these are light-related influences, like glaring artificial light or sunlight, flickering light from a television set, or moving pictures. Some people are sensitive to motion, especially the often jarring quality of automobile or train travel. In some people the combination of flickering lights and motion is particularly irritating. Many of our patients have told us that sunlight flickering through trees or off water is a particularly provoking stimulus. Airplane travel can also cause throbbing
headaches in many individuals. This may be related to changes in cabin pressure.
“Hypertension” is a term that means high blood pressure. There is some evidence that people with migraine may be more likely to develop hypertension than nonmigraine people. If hypertension becomes severe, migraine attacks can be triggered. And many of the medications used to treat hypertension, particularly drugs containing reserpine, hydralazine, and some of the diuretics, can provoke headachesЂ”migraine or other varieties.
During the winter, faulty furnaces that emit into the house products of combustion can cause headaches in some ways similar to migraine. This should be at least suspected in individuals free from headaches except in cold months.
Individuals who either visit or live in highly elevated locations, such as mountain areas, can experience migraine-like headaches as a consequence of the rarefied atmosphere and the reduction of oxygen, which causes a biological compensation in your blood and blood vessels.
In a similar way, smoking may provoke migraine-like headaches in patients with the vascular headache predisposition. Research has indicated many biological changes in the blood and blood vessels of smokers. Many patients will report an improvement in their headaches when smoking cigarettes is curtailed. Some patients state that just being in a smoke-filled room will trigger an attack.
Before leaving the subject of elements that trigger migraine, we suggest that if your migraines unexpectedly worsen, you might consider the following as possible explanations:
Recent use of birth control pills or other hormones.
Elevation of blood pressure.
An emotional state of anxiety, depression, or stress.
Pain Relief/Muscle Relaxant A recent change in eating habits, including missing meals.
Unfortunately, the true explanation of why your headaches have worsened usually remains a mystery.
*26/88/2*

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CORONARY ARTERY BYPASS SURGERY: MAINTAINING HEALTHY HABITS
Lifestyle
You already know that coronary heart disease is partly due to lifestyle. Thus, your future lifestyle determines your future well-being, quality of life and length of life. In the future, therefore, you need to control your eating pattern and cholesterol level; maintain a reasonable weight; take your medication on a regular basis; remain a non-smoker; ensure that your blood pressure is checked regularly and stays at a normal level; and remain physically active. You will also need to have learned how to handle stress in ways that benefit rather than harm you.
Stress and smoking
The manner in which you handle stress is up to you. So is whether you remain a non-smoker. If you have trouble with stress, or if you resume smoking, bring this to the attention of your doctor or another health professional. If you start smoking again and find it difficult to stop, you might find it useful to design for yourself another chart to record the events or feelings which seemed to trigger the desire to smoke. You could then learn to avoid certain situations or follow certain steps which will help you not to give in to temptation next time you feel the urge.
A psychologist or other health professional can assist you to develop some behavioural techniques to help you stick to your new healthy lifestyle. This is often best done on an individual basis, because what works for one person may not work for another. The same applies to those who are trying to find ways to cope with stress.
Support
You will need support from your family and friends. You will find that there are many of your contemporaries who have similar problems to you.
You may consider joining a group for long-term support or you may consider forming such a group yourself. You will not only benefit yourself, but also others in your neighborhood. If you live alone, it is especially desirable that you join a group. You should actively seek one out or ask your rehabilitation program coordinator to recommend one.
Those who have family support, good friends or confidants, or who can spend some time in a group where they can air their problems, live better and longer than those who handle everything on their own in isolation.
Make ‘Your Life After Coronary Bypass Surgery’ long and enjoyable.
*24/160/5*

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Other names: Epitol, Carbatrol

MEDICATIONS FOR CHRONIC BACK PAIN
Some of the medications used in acute back pain may also be helpful in chronic back pain. Among those that are most helpful are the groups of non-cortisone or non-steroid anti-inflammatory drugs. These may be effective in helping to control any pain or inflammation that is present.
Another group of medications, used for years for other problems, can help the pain and stiffness of chronic back pain. For example, antidepressants may have an anti-inflammatory effect and may help control the pain of chronic back pain. The response is sometimes excellent with relief from pain and stiffness, increased activity, and an improved nighttime sleep pattern. The response is usually seen over a period of several weeks. These medications may be most helpful when combined with one of the non-cortisone anti-inflammatory drugs. However, do not combine mediations unless recommended by your doctor.
The side effects of these “antidepressants” are usually minimal when dosage is low, but they can include mouth dryness, constipation, dizziness, palpitations (rapid or forceful heartbeat), or a calming (sedating) effect. At higher doses or in older people, difficulty in urination or blurred vision can result. If you have glaucoma or prostate problems, you should take these medications with special caution and only after you discuss your condition with your doctor. In some people, these medications produce weakness or fatigue. Fluid retention or cardiac problems can be aggravated, or tremors may occur, but usually at higher doses. In addition, allergic reactions can occur, as with any drug.
The use of narcotics for chronic back pain should be avoided as much as possible because of the possibility of dependence. They give little long-term relief but may be prescribed on occasion. Some of the non-narcotic pain medications may be helpful. Your doctor can help you, after evaluating your own situation.
*31/135/5*

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ACUTE BACK PAIN: ABOUT COMBINATION TREATMENT AND PAIN RETURN
Combination Treatment May Be the Best
With a combination of proper limitation of activities, gradual increase in exercise, moist heat or ice, and medication, most people with acute back pain find the needed relief within two weeks, and almost all recover after six weeks.
Will the Pain Return?
Whether the acute back pain will return in the future depends on the cause and other factors. Unfortunately, the cause of acute back pain in most cases is not known. “Mechanical” back problems or trigger points are often blamed. These attacks return in 50 to 75 percent of cases.
The reasons for the repeat attacks are not known. Sometimes, they seem to be brought on by lifting or other activity; more often, they have no apparent reason. There often seems to be no cause for the next attack.
The most typical pattern is for the attacks to occur one or a few times per year and last a few days to a few weeks. During the attack, the patient may be bedridden because of pain, unless the basic treatment plan is followed. The attacks may come| closer together and may last longer at each occurrence.
*23/135/5*

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HEADACHES: THE AUTONOMIC NERVOUS SYSTEM
The muscle coats of blood vessels are supplied by nerves which, unlike those relaying pain sensations, have functions similar to those of nerves going to other muscle fibres; stimulation causes the muscle to contract and so narrow the blood vessels.
These particular nerves come from part of the nervous system which, because it deals with functions not usually under control of the conscious mind, is called the autonomic nervous system. This system is in two parts, the sympathetic and parasympathetic, each of which has different actions.
The sympathetic increases tension (tone) of the blood vessel walls, making them more resistant to increases in blood pressure; it also has effects on the heart, speeding its action, as well as on the circulation to other organs. It is the sympathetic system which takes over in situations of danger in the well-known ‘fight or flight’ situation. Activation of this system causes release of adrenalin from the adrenal gland, which then continues to have effects making the organism ready for action.
Stimulating the sympathetic system alters the blood vessel caliber with decrease of blood flow to the skin; this can also be altered by various techniques such as putting the hands in hot water, relaxation, or taking nitroglycerine (a drug used in treatment of angina since it dilates blood vessels and lowers blood pressure, thereby lessening the strain on the heart).
Other factors which control blood vessel diameter are local changes in the concentration of carbon dioxide and acidity, increases of which will cause the blood vessels to dilate. This is important for exercising muscles because, by producing lactic acid as a waste product, they increase the blood supply to the muscles.
*23/152/5*

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TREATMENT FOR SELF-HELP IN BACK PAIN: MEDICATIONS
Along with moist heat, exercises, and proper control of activity and rest, medications may help control acute back pain. In this situation, the medications do not cure the problem, but they give some relief while the other measures are taking effect! Try not to expect total pain relief, but do expect to be fairly comfortable. The pain reduction will allow more activity and will enable you to do more effective exercises. Medications should] be taken only until the pain is controlled enough to get along without them.
In many cases, the pain can be controlled by medications available over the counter. These medications for pain include ibuprofen (Advil), aspirin, and acetaminophen. Follow the directions on the package label.
If you do not get enough pain relief from these medications, your doctor may prescribe one of a group of drugs called the non-cortisone (or non-steroid) anti-inflammatory drugs. These can help reduce the inflammation in the muscles and other soft tissues of the back. They also have a pain-relieving (analgesic) effect.
Over 20 of these anti-inflammatory medications are available. You should be able to find one that gives you satisfactory relief without side effects. Many of these products require a prescription from your doctor.
It is not possible to predict which of the medications will be the most effective. It is best to try a small supply for about two weeks and judge the effect. This sampling can allow you to find the “correct” one for you. If there is no improvement or if side effects occur, then another should be tried. You can continue the one that gives the most pain relief.
Although most people do not have side effects, you should constantly watch for any upset stomach, nausea, heartburn, abdominal pain, change in the bowel habits, or other abdominal discomfort. If any of these occurs, report it to your physician. In this way, you can find the medication that gives the best relief with the least side effects.
If you take anti-inflammatory medications over a long period of time, be safe and check with your doctor at intervals for evaluation and blood tests.
Analgesics, a type of medication, may be needed simply to treat the pain associated with your back. There are times, especially before treatment is started, when ibuprofen (Advil) or acetaminophen in low doses can greatly improve comfort. Occasionally, stronger prescription pain medications are needed for short periods of time. These may include propoxyphene (Darvon) or codeine (often combined with acetaminophen or aspirin). Propoxyphene, codeine, oxycodone, pentazocine, and hydrocodone should be used only when very necessary, to avoid becoming dependent on these drugs.
Other medications for pain that are available only by prescription include ketorolac (Toradol), which is actually an anti-inflammatory drug. Its advantage is that it may give pain relief without the use of a narcotic. It is used for up to five days at a time and can be given by injection as well as in tablet form. Your doctor can advise you according to your own situation.
Muscle relaxants may be used for muscle spasms in the lower back in acute back pain. A muscle relaxant may be helpful a night to improve sleep. These medications may cause drowsiness and require a prescription from your doctor. If no muscle spasm is present, these products may not give any further relief from back pain.
*21/135/5*

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TREATMENTS FOR ACUTE BACK PAIN: WHAT ABOUT REST?
Rest, including bed rest, is probably one of the oldest treatments for acute back pain. Even a few years ago, many persons with acute back pain were sent to bed for weeks at a time. This seemed reasonable at first, but when researchers looked more dozily, they found that in most patients with acute back pain, bed rest helped very little. In many cases, it seemed to make things worse!
Staying in bed adds to muscle weakness. A normal person who goes to bed for one to two weeks is likely to become weak from loss of muscle tone and loss of conditioning. Instead of building stronger muscles to help protect the back, bed rest makes the muscles become weaker. A vicious cycle may be started, and the result may be more limitation, weakness, and pain.
Studies of people with acute back pain have found that the longer an employee remains out of work and at bed-rest, the less the chance that he or she will return to work. If a person misses three months or more of work, the chances of ever returning to work go down alarmingly. In other words, the faster you are able to return to work, the better – and the less chance that you will suffer a long-term disability. Remember, most of the total health costs of back pain are incurred by the small percentage of people who become disabled.
*22/135/5*

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Other names: Aleve, Anaprox

AVAILABLE TREATMENTS FOR BACK PAIN: TENS, INJECTIONS AND BACK BRACES
TENS
TENS (transcutaneous electrical nerve stimulation) is the use of electrical impulse to control pain. Electrodes are applied to the painful area and the electrical source can be controlled by the patient. This treatment is cumbersome because of the need to wear the device, and it can be expensive.
Researchers have found that some patients gain relief with the use of TENS for back pain, but most studies have found less than major effectiveness. TENS can still be held available for patients who do not find relief with other treatments. Remember, TENS is simply pain control; it does not affect the underlying cause of the pain. If you try TENS, still keep up the basic treatment program to control back pain and help to prevent its return. TENS is used more often in the treatment of chronic back pain than acute back pain.
Injections
When trigger points are a cause of back pain, it may be possible to use a local injection for relief. The trigger point is injected with local anesthetic, which may give quick and effective relief. Unfortunately, the relief will not be permanent, but it may allow you to use other measures more easily.
For example, if the pain is relieved temporarily, you may be able to apply moist heat and do exercises more easily. These injections are safe and are easily done in your doctor’s office.
Other injections are available for pain relief. Injections around the spine, called epidural injections, can be used, especially for constant severe pain that has not responded to other treatments. The injection is usually a combination of a local anesthetic and a cortisone derivative.
These injections do not cure a ruptured disc or a similar cause of back pain, but they may give pain relief. The effect is not permanent, but commonly lasts weeks or even a few months. If the duration of relief is excellent, the injection may be repeated, but be aware that these injections may be expensive, depending on your situation. You must decide for yourself whether your own pain relief is worth the trouble and expense.
Back Braces
Back braces and corsets can be tried for acute back pain, but, to be effective, they may be heavy and can be very uncomfortable. Most patients find them so uncomfortable that they leave them off. If a brace or corset helps your acute pain, use it only as needed. Remove it when you exercise and as soon as you experience some improvement. Continued use of a back brace will not improve the strength of the back muscles, which is a major goal of the treatment and prevention of back pain.
*27/135/5*

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Other names: Emulgel, Voltaren Xr, Voltarol

MIGRAINE HEADACHES: EVENTS AND CIRCUMSTANCES THAT TRIGGER AN ATTACK-HORMONES, HORMONAL CHANGES, AND PREGNANCY
Many women appear to experience migraine more intensely at times of hormonal
changeЂ”menstruation, ovulation, menopause, or at the beginning or just following pregnancy. It is known that female hormones, either those occurring naturally (endogenous) or those ingested (exogenous), have emotional as well as biological influences upon the body, and about half of the women patients who have migraine believe that their attacks occur most frequently just
before, during, or soon after their menstrual period.
Most women with migraine who take birth control pills or other female hormone preparations experience more frequent and more painful attacks of longer duration. When these agents are withdrawn, there is often a dramatic improvement in the patient’s condition. Occasionally women will experience an ameliorating effect from these drugs.
It is our opinion that women with migraine, particularly the classical form, should not use birth control pills or other female hormone preparations unless there is an extraordinary medical reason to do so. Stroke and other serious illnesses occur more frequently when these substances are taken. Accumulating evidence suggests that the inconvenience encountered by not taking the pill may be worthwhile. When advised to discontinue birth control pills, some of our patients state that this action will succeed only in creating one “headache” in place of another!
Pain Relief/Muscle Relaxant
Women’s Health
Healthy Bones There is an urgent need for additional scientific evidence regarding these issues. Learning a way to determine in advance which people are most apt to develop serious complications is particularly important, and until the evidence for or against the use of these hormones is conclusive, restraint is essential.
Pregnancy has a varying effect on migraine headache. There is a good chance that preexisting migraine will markedly improve after the first three months of pregnancy but return soon after delivery. However, some women with preexisting migraine experience a worsening throughout pregnancy, and still others say that at delivery, or the days immediately following delivery, their migraines first began.
*22/88/2*

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PHYSICAL METHODS TO TREAT MIGRAINE WITHOUT DRUGS: ACUPUNCTURE
In recent years the ancient Chinese technique of acupuncture has become increasingly used. Great claims have been made for the technique, particularly in the field of pain relief e.g. in patients undergoing major surgery with acupuncture anesthesia.
The old Chinese teachings stated that the body consists of a balance of positive and negative forces, the ѓ in and the yang, which flow through the body through various channels, along which there are special points where flow can be influenced. Particular points were thought to relate to specific organs. The acupuncturist feels many acupuncture ‘pulses’ and, through abnormalities in these, arrives at a diagnosis. Insertion of sharp needles into the appropriate combination of points are claimed to produce cessation of pain, as well as healing, in a particular organ.
There is no doubt that this technique can work as far as pain relief is concerned, but the evidence that it influences healing of disease is doubtful. The theoretical basis has no scientific substantiation-no-one has demonstrated the system of channels and points which are meant to cover the body, although there are areas of the skin with a decrease in electrical resistance (corresponding to acupuncture points).
We are then left with the question as to how pain is relieved. Legend has it that acupuncture was evolved following the observation by a soldier that the pain of his wound was relieved when he had been pierced elsewhere in his body by an arrow. In the heat of battle, adrenalin, noradrenalin, and Cortisol are released into the blood stream; in addition, there is increased release of chemicals in the brain called peptides, particularly those involved in the appreciation of pain. This could explain how the body feels less pain when geared for a fight. The arrow wound could act, not only by its effect of further increasing the release of the pain-reducing substances, but also by another mechanism, by affecting the gating mechanism for pain. This theory explains how transmission of other sensations can block pain impulses, preventing them from ascending to consciousness. In effect, the pain gate can be shut by other sensations.
Acupuncture may work through similar mechanisms although the exact mode of action is unknown. Treatment by acupuncture sometimes needs to be fairly painful to be effective and, in some centers, a modified form of acupuncture is used passing a small electric current down the needles.
The usefulness of acupuncture in migraine has not yet been fully assessed. Theoretically the technique is useful for chronic pain but it is not so easy to see why it should be effective in a condition as episodic as migraine, although it has proved useful in the treatment of some cases of chronic migrainous neuralgia.
*48/152/5*

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AVAILABLE TREATMENTS FOR BACK PAIN: MASSAGE AND MANIPULATION

Massage
Massage of the muscles, tendons, and other “soft tissues of the back can be very helpful. Gentle rubbing and a “rubdown” at home can relieve painful and stiff muscles. If this cannot be done as needed at home, you may want to see a massage therapist.
Find a licensed professional massage therapist who has training and experience. Good massage can give relief that lasts hours to days. Massage can greatly help your treatment program by allowing your exercises to be easier and more effective.
Manipulation
Spinal manipulation for back pain has been practiced for several thousand years. Hippocrates, the father of medicine, used spinal manipulation for treatment of his patients. Over the centuries, treatment in which manual manipulation is used has led to the development of chiropractic and osteopathy.
Spinal manipulation (sometimes referred to as spinal adjustments, by chiropractors) attempts to relieve pain by increasing the mobility between spinal vertebrae that have become abnormally restricted or “locked” and/or slightly malpositioned (subluxation).
After taking an appropriate medical history and performing a physical examination, the doctor of chiropractic, osteopathy, or medicine additionally palpates the spine to detect areas of restricted movement between vertebrae. Then, by applying specific manipulative procedures by hand, the doctor attempts to restore the lost mobility to the joint, thus allowing the vertebrae to settle into the most normal and natural position for them. The manipulations can range from a gentle stretching or pressure maneuver to multiple repeated motions at the same area or to specific high-velocity thrusts to affect the joints properly.
Patients may sense anything from a stretch or pressure sensation to a slight popping sensation as the vertebral motion and position are corrected. As with most physical medicine procedures, the doctor may prescribe that you have a series of manipulations performed until maximum relief is obtained.
These are some of the ways in which spinal manipulation works to decrease back pain:
1. Improves the mobility between two or more vertebrae, thereby reducing the temporary inflammation that occurs as a result of the locked spinal joint.
2. Often, reduces nerve irritation as a result of the improved mobility.
3. Allows surrounding soft tissues-including, but not limited to, the smaller spinal muscles attaching one vertebrae to another-to relax, thus reducing spasm and the pain that accompanies spasm.
4. According to some studies, manipulation causes the body to temporarily release endorphin, a pain-relieving chemical manufactured in the body.
There may be some temporary increase in back pain after the manipulation procedure, but that usually passes and the patient finds relief from the pain. Many patients note immediate relief after the treatment, without any exacerbation of their pain. If the pain continues to worsen after subsequent manipulations, the doctor will usually re-evaluate the condition before proceeding.
Manipulation is typically not done when the treating doctor determines that there is fracture, infection, cancer, severe arthritis, or other possible conditions that would contraindicate its use. As with other treatments discussed, there is no definite proof that regular spinal manipulation prevents future attacks or cures the acute back pain problem. But, for some patients, a periodic evaluation by doctors skilled in manipulation for the detection of any potential problems is part of their total health care plan, along with their regular physical examinations and dental checkups. Additionally, some patients once treated with manipulation never have problems again with the treated area of their spine.
Patients who get significant relief from spinal manipulation find that it helps them to continue with their basic treatment plan of heat and exercises, and allows them to resume a more normal life-style. Spinal manipulation by their doctor of chiropractic, osteopathy, or medicine may be part of a total team approach to the treatment of some of the more chronic, permanent spinal conditions. The skilled doctor of manipulation would then work in concert with a neurologist, orthopedic surgeon, or rheumatologist to bring about the best total results for that patient.
*24/135/5*

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Other names: Urispas

BEAT HEART DISEASE WITHOUT SURGERY: EXAMINING THE EFFECTS-SUMMARY OF BENEFITS
Cardio & Blood
Pain Relief/Muscle Relaxant Two or three recently discovered benefits centre around the removal of iron and copper, two of the most destructive, free radical producers in the body. Apropos of this facility, research has shown it to have a striking effect on hyperactivity in children caused by exposure to lead. It enhances the heart muscle’s phosphorous utilization, therefore improving heart function. And it effectively removes cadmium from tobacco smoke which is known to compete with zinc, a vital requirement for enzyme activity.
EDTA could become a valued remedy for controlling the effects on the circulation and other body systems of unprecedented toxic loads characterized by our twentieth century life on a polluted planet.
*52/104/2*