Information on popular complementary and alternative medical topics

As attention shifts to pain, alertness appears. There is something wrong. Alarm bells ring. Action stations! Muscles tense and the body stiffens to a ramrod. Unknown to the victim, these overt changes are part of a massive reorganisation of many parts of the body. The heart and vascular system get ready for action, the hormone system mobilizes sugar and alerts the immune system, the gut becomes stationary and sleep as an option is cancelled.
The eyes, head and neck turn to inspect where the pain seems to be located. The hands explore the area. Muscles are contracted to learn what makes the pain worse and what eases it, and to seek a comfortable position and then hold it. The end result is a body fixed in an overall pain posture. Muscles are in steady contraction and, as time goes by, some muscles grow while joints and tendons deteriorate because this frozen posture itself sets off local changes. The vascular and endocrine systems hold their emergency state if pain is prolonged, but these systems are not evolved to cope with this prolonged stress state. The quiet gut demonstrates its inactivity as constipation. Perhaps worst of all, sleep is impossible and chronic pain patients become completely exhausted. Even intermittent sleep deprivation drives the strongest of us into pretty peculiar ways of thinking, as any doctor on night duty and any parent with a new-born baby know. Patients with chronic pain reach their wits’ end as their grim experience is prolonged.
Clearly, this state of affairs needs therapeutic attack. The key word is relaxation and much ingenuity has been used. The problem is to override a natural defence mechanism that has a protective role in brief emergencies but becomes maladaptive when prolonged. Drugs that inhibit the overactive muscle are commonly prescribed but they are sedative and intellectually flattening. After a while, patients refuse them or become zombies. Physiotherapists have many ways of relaxing muscles and of re-establishing movement in frozen zones. First, they have to overcome the patients’ natural fear that movement which produces pain does not necessarily increase the injury, and that lack of movement which seems at first to prevent pain eventually acts to prolong pain. Yoga and the Alexander technique are examples of posture training. Relaxation is not easy and training methods are needed. One successful version, ‘bio-feedback’ training, provides the patient with an electronic indicator of the amount of contraction in a muscle and allows the patient to judge, second by second, their success in relaxation. The patient has to learn how to relax and how to prolong the effect into real life outside the training sessions. Sleep follows relaxation hut it may need help of its own, so no-one should resist tablets until they can sleep on their own.
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A range of physical therapies are used in the management of various types of pain. Some are of value in the treatment of cancer-related pain.
Surgery-Surgery is most frequently required for orthopaedic complications and visceral obstruction. Ablative endocrine surgery for hormone-sensitive tumours has been largely replaced by hormonal and pharmacological therapies.
Internal surgical fixation is indicated for pathological fractures of long bones and should be considered in situations where there is a high risk of fracture. Internal fixation will provide prompt pain control and will allow more rapid mobilisation and rehabilitation of the patient. Where the responsible metastases are adjacent to a joint, such as the hip joint, replacement arthroplasty may be required for pain control.
Pain secondary to gastrointestinal, biliary or urinary obstruction can be relieved by various surgical procedures.
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The better your muscle tone, the less pain you may experience. Good muscle tone has a positive effect on your pain for not only is a well-stretched muscle less likely to be injured, it will also experience less pain.

If you are experiencing chronic pain it is important that you attempt to stretch a little each day. As your muscles stretch, your muscle tone will be improved.

There are a few important pointers you should note:

1. Stretch only until you feel the pull in your muscles. These muscles have been inactive and it will take some time until you can accomplish a full stretch.

2. Start out slowly and build up your stretching day by day.

3. As you begin the stretch, take in a breath, then as you follow through with the stretch, slowly let your breath out. This will help you to remain in a relaxed state as you stretch and you will be less likely to cause any injury.

4. Become aware of each part of your body as you stretch. You will become familiar with your body and know where more attention is needed.

5. You will achieve more mobility through stretching.

6. Stretching promotes good circulation, which in turn creates healthier muscle and speeds up the healing process.

7. Your stretching will be something that you do for yourself. It will affirm that you not only believe in your ability to take control of your body, but you are willing to be responsible for a part of your recovery. It will help to raise your self-esteem.

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In his book ‘Applied Hypnosis and Hyperempiria’, American psychologist and expert in imagery techniques, Dr D. E. Gibbons, presents a catalogue of useful imagery techniques. Gibbons believes that the use of imagery can in fact enhance sensory experiences. Thus, people are better able to utilise suggestions aimed at helping them to achieve pain relief — or even a significant change in behaviour.

Amongst these is a dolphin image where migraine sufferers are asked to imagine themselves as a dolphin swimming in the sea. By slowing the heartbeat and decreasing blood pressure, circulatory congestion in the head may be alleviated and the headache symptoms gradually cease. The effect of the following suggestions may be enhanced by the headache sufferer assuming a seated position before the imagery session begins:

‘Picture yourself now as a dolphin, swimming lazily along just below the surface of the sea. Feel the water above you gently warming your back. And, feel the cooler water beneath you as you swim lazily along.

‘You think how refreshing it would be to dive down all the way to the bottom. . . . Let yourself begin to dive now, diving easily and gently all the way down to the bottom through the crystal clear water.

‘Any previous discomfort you may have felt is fading away. You feel the cool, soothing currents rushing by as you sink deeper and deeper. Your system continues to slow down in response to the increasing pressure and cold. ‘You continue to drift down and down, sinking all the way down to the bottom. You’re almost there. You experience for a few moments the enjoyment of the cool freshness as you swim along. ‘You will return to your normal sense of time and place. But, after you return, the feeling of peace and well-being will remain with you and all traces of your previous headache will have vanished.

‘Even after you have returned to your normal sense of time and place, you will continue to feel just as good as you do right now.

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Very few people have any real knowledge of hypnosis. Usually, what little they know has been gained from stage hypnosis, television or from popular books.

Joan’s headaches

‘I get these incredible headaches every day above my right eye. I’ve had them so long that it’s hard to remember exactly when they started. But they’ve increased over the past 18 months,’ related Joan, 39, a fashion buyer at a large department store.

She had been suffering for years with persistent migraine headaches for which she had not been able to get relief from her GP, psychiatrists, osteopaths, physiotherapists and chiropractors.

‘I’m at my wits’ end. I can’t sleep,’ Joan complained. ‘The slightest upset at work, or cross word at home, brings on these crushing headaches. ‘I can’t take much more. I feel I’m going to snap,’ she said, describing how acupuncture and numerous medications had failed to give her long-term relief.

With two or three sessions of hypnosis, together with an appropriate anti-depressant medication, Tryptanol, she was able to control her headaches for the first time in many years. It is now some two years since she attended the pain clinic but Joan still uses her hypnosis tapes. She is still taking the long-term dose of Tryptanol which is being used primarily to control her pain.

When first seen her marriage was suffering, she had lost interest in sex and there were numerous rows because her husband seemed incapable of understanding the reasons for her frequent headaches. Extensive psychological tests at the clinic established that Joan had a very high score for obsessionality. She was an absolute perfectionist.

One of the things Joan learned from hypnosis and relaxation therapy is that things don’t have to be absolutely perfect all the time. She has learned to flow with life’s day-to-day problems rather than having a low threshold of tolerance to annoyances.

This means she now virtually has no headaches. She has accepted the need for taking long-term medication, being reassured that anti-depressants, unlike tranquillisers, are totally safe and are non-addictive. The important thing is that she has accepted the fact that she may have pain of varying degrees indefinitely but that she can cope as long as she takes the medication and uses self-hypnosis.

Joan’s case is an excellent example of what a powerful pain treatment tool hypnosis is — far removed from the tawdry stage-show image. Hypnosis is a form of psychological therapy involving a state of selective concentration, spontaneity and detachment. Thus, it has long been applied as either a primary or additional therapy in many pain states including burns, migraine, cancer and also in obstetrics. It may also be highly effective in chronic organic pain, particularly of malignant origin and for patients able to disassociate themselves from their pain experience.

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Although the use of procaine in the treatment of chronic pain is relatively new, it has been used as a local anaesthetic since it was discovered by the research chemist, Einhorn, in 1905 as a synthetic alternative to cocaine.

It is still widely used to produce localised nerve blocks and has stood the test of time as far as toxicity and safety is concerned. Commonly known as Novocaine, it is very similar to a dental injection to block pain.

Its pain-killing action was first noted during the First World War, but was then largely forgotten. Its use, when given intravenously in the treatment of chronic pain, has been gradually established over the past ten years. This has been mainly due to the work of Dr K. Livingston of Toronto.

Is It addictive? This question is particularly important when the treatment of chronic pain is a continuing situation and the danger of addiction looms large.

Procaine is quite different from any narcotic. There is no evi¬dence that it produces any addiction or dependency despite pro-longed clinical trials involving hundreds of patients.

Initial studies presented at pain conferences in Australia are tending to confirm the safety of the treatment. Another more potent and longer lasting local anaesthetic, Xylocaine or Lidocaine is now being promoted as the first choice alternative to narcotics in acute migraine episodes in hospitals and clinics around the world. Like procaine this drug is administered directly into the vein.

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