Health and medical news blog

The progestational agents, medroxyprogesterone acetate and megestrol acetate, are claimed to be of benefit in relieving the pain related to metastatic disease in patients with breast, prostate, endometrial and renal cancer. Progestogen therapy may have an antitumour action in some patients with these diseases, but the co-analgesic action is claimed to occur in a significantly larger proportion of the patients. The mechanism by which progestogens might exert this effect is unknown.     The usual dose is 200-500 mg/d of medroxyprogesterone acetate or 160 mg/d of megestrol acetate. Side effects include nausea and vomiting, fluid retention leading to weight gain, oedema, cardiac failure and hypertension, and vaginal bleeding.     Neuroleptic-The neuroleptic drugs such as chlorpromazine and haloperidol have no analgesic action but are of benefit in treating patients with pain by reducing anxiety and improving night-time sedation. However, unless specifically indicated for the treatment of delirium or nausea, the same benefits can be obtained with a benzodiazepine which will not have anticholinergic and extrapyramidal side effects.*60\55\2*

When the affected muscles are held contracted in one position without rest for lengthy periods. The loading is the weight the muscles have to support. This usually occurs in the parts of the body that are normally kept still while the hands or arms are moving to produce the music or when typing or working on the production line.

The posture adopted by some pianists predisposes them to overusage symptoms in the shoulder girdles and upper limbs. The use of an upright playing position with the keyboard at a height that allows the forearms to be at an approximate right angle to the upper arms would reduce the static loads on the muscles of the upper back and shoulder girdles — those muscles along the upper dorsal vertebrae, around the shoulder blades and at the junction between the neck and upper shoulders.

There is therefore a greater possibility for the products of metabolism of muscle to be cleared from muscles which must otherwise be adversely affected by the anaerobic processes that follow such overuse. A simple programme ensuring that long periods of practice are punctuated by movement and relaxation away from the keyboard should therefore be a high priority in the teaching of piano and other instruments where the muscles of the shoulder girdles are under constant tension.

Such programmes have been introduced by many concerned employers as an intrinsic part of the increased interest in occupational health and safety. Frequent periods of rest, or isometric exercise or even aerobics programmes are now common in a range of industries.

For those who play musical instruments in the upright position a proper awareness of the position of the body and limbs, as well as the head and neck should be taught. They should be aware of how they grasp their instruments and how excess tension in the muscles will lead to a deterioration in the quality of the music that they produce.

It must always be remembered that the ubiquitous lumbago or chronic back pain afflicts the majority of humans at some time in their life and that early intervention through improved body awareness and exercise is never introduced too early.

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Headache is One of the most common painful afflictions seen by general practitioners and yet it is often not taken seriously by doctors.

According to Canadian neurologist Prof. John Edmeads, speaking at the 4th International Headache Congress nine out of ten women and about seven in 10 men get headaches. In cases where the pain is so severe that it disrupts normal life, headache is no trivial thing.

Symptoms which could indicate serious disease include sudden onset, clouded consciousness, associated fever, scalp tenderness and the presence of other neurological symptoms.

In most chronic headache sufferers pathology tests will be of limited value. However the eyes should be checked with an ophthalmoscope to assess the condition of the back of the eyes for the presence of blood vessel abnormalities, or evidence that the pressure inside the head may be raised. The blood pressure must be measured and the patient’s field of vision should be checked.

CT scans can be used to exclude tumours or other causes of raised brain pressure.

About 95% of all headaches are said to be benign. In 1988 the International Headache Society classified headaches into 13 groups.

• Tension type headaches

• Migraine

• Cluster headache and chronic paroxysmal hemicrania

• Miscellaneous headache not associated with structural lesion

Headache associated with

• Head trauma

• Vascular disorders

• Non-vascular intracranial disorder

• Substances or their withdrawal

• Non-cephalic infection

• Metabolic disorder

• Headache or facial pain associated with disorders of the cranium, eyes, ears, nose, sinuses, teeth, mouth or other cranial or facial structures

• Cranial neuralgias, nerve-trunk pain and de-afferentiation pain

• Unclassifiable headaches

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Stress plays a big part in the onset of pain. A Columbia University research project showed that people with little control over their jobs, such as cooks, garment machinists and assembly line workers, have more heart disease than people who can dictate the pace and style of their work. Worst off in the stress stakes are telephone operators, waiters, cashiers and others whose work makes substantial psychological demands but offers little opportunity for independent decision making.

In recent times, doctors have increasingly come to recognise ‘Type A’ behaviour — which drastically increases an individual’s vulnerability to heart attack and other stress-related illnesses. Typically, such an individual tries to accomplish too many things in too little time. Such people have a low threshold to irritation. Even trivial things quickly upset them. However, for some individuals, quiet meditation twice a day can permanently lower blood pressure and achieve a necessary state of inner peace which may be reflected in changed behaviour.

Stress is commonly treated by medication such as tranquillisers, muscle relaxants, sleeping pills, stimulants, antidepressants and mood enhancers.

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Among the peasants and lower classes, pain treatments often consisted of piercing the painful areas of the body with a ‘vigorous’ twig of a tree and then burying the twig deep in the earth. It was assumed that the vigorous twig would absorb the patient’s pain and that burying the twig would prevent anyone from being exposed to the pain!

Birth of the placebo

The non-active substitute for medication — the placebo, meaning ‘I please’ — is not to be scoffed at. It works because the patient believes it works. The more sophisticated ‘sugar-coated pill’ of hard-pressed country doctors, with few resources, makes an important contribution to psychological factors in pain alleviation. It is now known that simply believing that a pill or potion is a powerful painkiller is enough to stimulate the brain to produce its own natural opiates.

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