The complex language of pain
The symptom of acute pain is a high priority message from some part of
our body to our brain. It is designed to provoke evasive action or produce
a behaviour which will help the part that has a problem. Throughout the
tissues of most of the body are special nerve receptors for pain which
respond to tissue injury or inflammation. These relay information to the
brain via the nerves and spinal cord. The part of the brain that is
largely involved in receiving pain messages is the thalamus which then
relays messages to relevant part of the cortex (or outer brain). There are
also signals going to and from the brain via the spinal cord that modify
our awareness of pain signals. Factors such as anxiety can increase
sensitivity to pain, while relaxation may reduce awareness of pain.
If the spinal cord is damaged, the messages cannot get through and we
feel no pain (this is also how spinal and epidural anaesthesia works). In
diseases where nerves are affected, nerve pain or neuropathy may occur.
This may follow a virus like herpes. Damage to the pain pathways in the
brain itself may cause abnormal perceptions of pain.
Different parts of the body send different types of signals.
Understanding these helps your doctor work out where the problem is. The
skin has many receptors which give exact information about the location
and type of stimulus - pressure, burning, cutting, irritation etc. Bones
and muscles also give clear directions to the injured part. The organs
have different types of nerve signals and pain may be ’referred’ to a
different area of the body. For example, the gall bladder can refer pain
to the shoulder tip, the heart can cause pain in the jaw or arm and the
large bowel can cause pain around the navel. Gut pain tends to come in
waves, heart pain is often described as ‘crushing’ while nerve pain is
usually sharp, stabbing or burning.
Chronic pain starts as acute pain. When pain persists over time, it
changes the nervous system which appears to become oversensitive.
Sufferers of chronic pain may have increased reaction to painful stimuli
and feel normal sensations as painful. We now know that up to 10% of
injuries and operations can lead to persistent pain even after the
physical trauma is healed. Persistent or chronic pain may affect between
10-50% of people and its likelihood increases with age. Major causes are
arthritis, headaches, back pain and cancer. Chronic pain can lead to
reduced activity which in turn causes muscle weakness, tightening of
muscles and ligaments and poor posture, all of which lead to more pain.
Sleep can also be affected as can weight and mood. Management of chronic
pain must address all of these areas.
The language of pain can be complex. Medical advances in diagnostic
testing and treatments mean we are a lot closer to decoding it and both
treating the cause and managing the symptom.
Aim to keep your fish intake up
Fish is one of nature’s healthiest foods. Eating a wide range has many
benefits.
All fish are rich in protein and minerals. Those with soft edible bones,
such as sardines and canned fish, are also a good source of calcium.
Fish contain polyunsaturated fats known as omega-3 or n-3 fatty acids.
Research has shown that these reduce the effects of inflammation, lower
blood pressure, and protect against heart disease by reducing the amount
of cholesterol in the blood. Amounts of these valuable fats are highest in
dark fleshed, oily fish. These include salmon, tuna, sardines, herring and
mullet. They have a stronger flavour than fish with a whiter flesh.
Many people take fish oil supplements. However two or three meals each
week of a variety of fresh, canned, or shellfish should provide sufficient
amounts of omega-3 fats.
Fish is low in kilojoules provided it is cooked with minimal added fat.
Low fat cooking methods such as pan-frying, grilling, baking, or steaming,
are preferable to deep-frying.
When choosing fresh whole fish, it should have a pleasant aroma, shiny
eyes and gills that are red to pink in colour. Fish fillets should be firm
and dry.
Dry looking patches on frozen fish indicates freezer burn, which leaves
the fish dry and tasteless.
Fish is cooked when the flesh becomes opaque and flakes easily when
separated with a fork. Overcooked fish will be tough and dry.
The combination of ingredients in this recipe sounds a little strange,
but the delicate sweetness of the maple syrup works well with salmon.
Maple Syrup Salmon (serves 4)
4 salmon fillets
2 tb pure maple syrup
Place fish in a plate and pour the syrup over. Cover dish and marinade
in the refrigerator for at least one hour, turning the fish a couple of
times. Cook fish on a barbeque or in an unoiled non stick frying pan over
gentle heat until cooked. Brush fish with the marinating juices while
cooking. Serve with boiled, baked or steamed potatoes and a green
vegetable or a leafy salad.
COPD can take your breath away
COPD (Chronic Obstructive Pulmonary Disease) includes the conditions
known as emphysema and chronic bronchitis. Emphysema is a loss of
flexibility of the air passages in the lungs and destruction of the tiny
air sacs (alveoli) where the blood picks up oxygen during each breath.
Damage is usually from smoking or long term exposure to industrial
pollutants. Once the damage occurs it is irreversible. Chronic bronchitis
refers to a build up of mucous and secretions in the bronchial passages of
the lungs, which may become infected.
COPD increases the effort of breathing, and decreases the ability of the
lungs to provide enough oxygen to the blood. The feeling of shortness of
breath eventually becomes constant. There is an increased risk of
pneumonia, collapsed lung and heart disease. People who already have COPD
are very sensitive to toxins such as cigarette smoke, which can trigger
cough, wheeze, phlegm (mucous) and increased shortness of breath.
While there is no cure, there are things that may help. It is most
important to stop smoking and avoid exposure to cigarette smoke and other
air pollutants. There are a number of medications available to help expand
narrowed airways, reduce inflammation and fight infection. Regular
influenza and pneumococcal vaccines are recommended. Exercise capacity can
be increased with respiratory rehabilitation programs to improve fitness,
while stress management techniques are also beneficial.
In Australia, COPD is the 5th biggest killer and responsible for many
hospital admissions and much suffering. The main cause is smoking making
it largely preventable.
Bipolar disorder is a chronic mental illness
Over centuries, names like ‘circular insanity’ and ‘manic-depressive
insanity’ have been used to describe a condition now known as bipolar
disorder. The name indicates the swings that occur from mania, with it’s
increased pace of thought and speech, to severe melancholy with depressed
mood and energy. Sometimes these occur in alternating cycles and sometimes
both at once, causing a confusing range of symptoms.
When someone is manic in the medical sense, they will talk and think
very rapidly. It is often difficult to follow them as ideas do not always
flow logically. They have trouble concentrating, although they feel that
they can take on almost anything and may have grand ideas about
themselves. People with mania feel extremely happy and confident. There is
a tendency to overspend money and some engage in inappropriate social or
sexual behaviour. Episodes may last 2-7 days and usually require
psychiatric treatment. They tend to be followed by a depressive phase.
Bipolar depression tends to start at an early age – from late teens.
Sufferers may lack motivation and not take care of themselves. Speech may
become slow and sound flat. Sleep troubles are common with insomnia, early
waking and sometimes excessive daytime sleeping. There may be suicidal
thoughts and even psychosis (disordered thinking and loss of connection to
reality). It is not always easy to diagnose bipolar disorder, as depression
may occur without manic episodes in the early stages.
A family history of the disorder and a pattern of recurring episodes of
depression may be suggestive. It is important to make a diagnosis as the
treatment can be different to that of other types of depression. Mood
stabilising drugs tend to be used and long term medication may be
required. This is a chronic illness affecting sufferers and their
families. Fortunately, many people with the disease can now live
fulfilling lives with medical and community support.
Common Children’s Problem becomes Clearer
There’s good news for parents whose children have had what they call a
febrile fit – a seizure in a pre-school child who has a fever. Lots of
children have fits with fevers and they can be scary because they often
occur before anyone realises the child has a temperature. Recent research
though has confirmed current medical practice about which children need to
be watched closely and who needs careful follow up.
You see, while parents are usually reassured febrile fits are harmless,
some experts have felt that might not be true and there might, for
example, be a risk of death. Because Denmark has excellent health
records, researchers there looked at nearly two million children born in a
28 year period, following what happened to those who’d had a febrile
seizure, excluding kids whose seizure was due to something else.
There were about 200 deaths among 55,000 children who’d had a seizure
associated with a fever, with the risk highest in the first and second
years after the first fit.
The good news was that what paediatricians call a simple febrile fit,
which means one which lasts less than 15 minutes, where all limbs jerk and
which doesn’t happen again within 24 hours, in an otherwise well child,
there’s no greater risk of death than any other child. It was children
who’d had a fit under the age of 12 months, associated with only a mild
fever, with more complicated fits, who had a tiny increased risk for each
individual. Many of those children in fact had pre-existing developmental
abnormalities or epilepsy.
So it’s not such a worry and these results now help to identify those
children who need more attention.
Seek early treatment for ‘frozen shoulder’
‘Frozen shoulder’ is one of the nastier potential complications of arm
and shoulder injuries. The medical term for this is ‘adhesive capsulitis’.
In this condition, the lining of the shoulder joint (capsule) becomes
inflamed and sticky, eventually developing scar tissue (adhesions) which
restrict joint movement. What starts as a painful shoulder becomes
progressively stiffer, sometimes to the point of immobility. Muscles may
become wasted, adding to mobility problems. While it may occur with any
arm injury, sometimes there is no obvious cause. It is more likely in
people over 40, those with diabetes and menopausal women. One in five
cases will spread to the other shoulder. While most cases recover, it can
be a long, slow process.
Early treatment is important to maintain mobility. Anti-inflammatory
medications and physiotherapy are usually required. Injections of steroid
into the joint or a nerve block to relieve pain may also assist recovery.
If such measures are not working, surgery may be needed. Using an
arthroscope (a telescopic tube that allows one to see inside the joint), a
surgeon can break up adhesions to free up the joint. Sometimes fluid is
injected into the joint to separate adhesions. Following any surgery,
regular physiotherapy is needed to keep the shoulder mobile.
It is important, especially in the case of arm injuries, to keep the
shoulder moving to avoid frozen shoulder. See your doctor promptly if you
experience pain or increasing stiffness in one or both shoulders.
Thinking of becoming a parent? Or a grandparent?
It is now recommended that adults likely to be in contact with small
babies consider being vaccinated against whooping cough.
In their first few months of life, before having the routine childhood
vaccinations, babies are at risk of this infectious disease, which can
have serious consequences.
Adult whooping cough is quite common. Although not as serious as the
childhood version it can easily be spread to a new baby or grandchild.
Vaccination will protect adults from catching the infection and make life
safer for a new baby in the family.
