Medical Weblog » Pain Relief-Muscle Relaxers

THE PLACEBO RESPONSE FOR PAIN TREATMENT: POSTOPERATIVE PAIN

admin — Thu, 07 Jul 2011 11:42:34 +0000

In the 1950s, Henry Beecher, the Harvard pioneer of pain studies already mentioned, and his colleague Lasagna studied a placebo versus morphine for the treatment of postoperative pain. Each patient received two medications, morphine and a placebo, but the order of the two was varied. Half the patients received the placebo first and half received the morphine first. They found that those who received the morphine first responded very well to the second injection, which was a placebo. By contrast, those who received the placebo first responded rather poorly to the second injection, which was morphine. Evidently, the patients’ expectation had been built up by their experience of the first trial.

Fifty years later, this crucial and surprising effect is still studied in Turin by Fabrizio Benedetti’s team. They were treating 33 patients who had been operated on for the removal of part of one lung, a famously painful type of surgery. The patients were treated for their pain for twelve to eighteen hours after their operation with intravenous buprenorphine, a powerful narcotic. Their pain was carefully monitored during this time, as was their lung function. One of the side effects of narcotics is to depress respiration, although the patients were quite unaware of this effect.

As shown long ago by Beecher and Lasagna, the pain responses to narcotics is surprisingly variable. Some patients achieve excellent pain relief with one small dose while others require repeated doses to get the same reduction of pain. The same applies to the side effects. After the Turin patients had experienced satisfactory narcotic-induced pain relief for twelve to eighteen hours, each was given placebo injections of saline. The results show clearly that those patients who responded to small doses of the narcotics also responded well to small doses of the placebo. Even more surprisingly, those patients who, unknown to them, responded with respiratory depression to the narcotics, also showed respiratory depression with the placebo. Evidently, the placebo mimics the details of the experienced pain relief and the covert side effects. It is apparent that the placebo may be indistinguishable from the drug after the patient had experienced the drug’s effect.

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SERVICING THE SPINE: SLEEP

admin — Thu, 24 Mar 2011 14:12:20 +0000

As mentioned earlier, sleep is very important for muscles as it is in a deep and comfortable sleep that the muscles and ligaments get an opportunity to rest and replenish the lost energy. In wakefulness or disturbed sleep, the muscles are in a tonic state (tensed) while in deep sleep they are completely relaxed. The spine can comfortably take a few hours (four to six) of supporting itself in a vertical position at a time. The neck muscles in the waking state continuously support the heavy head throughout the day. A short nap or siesta after lunch is highly recommended to give the neck a rest.

One should avoid eating late in the evening as the process of digestion (movement of the intestines, release of gas, heavy food) can disturb sleep. Disturbing films or newscasts that focus on violence on television often cause excitement in the mind and affect the quality of sleep. One should read something pleasant or listen to soothing music before going to bed. Sleep is also disturbed by dehydration at night. It is best to drink some water before going to sleep and use the toilet to empty the bladder, as rising to do so is another disturbing factor at night.

Sarangi, an ancient Indian musical instrument, produces in my opinion the right vibrational sound to soothe the mind. It makes a sound that is almost identical to a soothing human voice. In India a ‘Lori’ or bedtime lullaby has a most powerful hypnotic effect on a child before it is put to sleep. It resonates in the mind and relaxes the muscles to a state where sleep is imminent.

Ustad Sultan Khan, one of the greatest exponents of the Sarangi and a phenomenal singer of devotional songs (Sufi songs dedicated to the Almighty), has created a few Loris or lullaby songs which he has sung, as well as played on his instrument, for my therapeutic use. I recommend this music be played at bedtime as it produces the vibrations in the mind that induce sleep. This soothing music relaxes muscles, slows down the heart rate and prepares the body for sleep. It breaks the barrier of language as it consists of human voice and sounds of nature, which are universal.

It is no wonder that Lord Yehudi Menuhin, having heard this music, said ‘Sarangi is the music of the soul’. People have been known to become emotional and often weep with joy during live performances with this instrument.

Finally, always remember, a healthy spine supports a healthy mind.

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SERVICING THE SPINE: SLEEPAs mentioned earlier, sleep is very important for muscles as it is in a deep and comfortable sleep that the muscles and ligaments get an opportunity to rest and replenish the lost energy. In wakefulness or disturbed sleep, the muscles are in a tonic state (tensed) while in deep sleep they are completely relaxed. The spine can comfortably take a few hours (four to six) of supporting itself in a vertical position at a time. The neck muscles in the waking state continuously support the heavy head throughout the day. A short nap or siesta after lunch is highly recommended to give the neck a rest.One should avoid eating late in the evening as the process of digestion (movement of the intestines, release of gas, heavy food) can disturb sleep. Disturbing films or newscasts that focus on violence on television often cause excitement in the mind and affect the quality of sleep. One should read something pleasant or listen to soothing music before going to bed. Sleep is also disturbed by dehydration at night. It is best to drink some water before going to sleep and use the toilet to empty the bladder, as rising to do so is another disturbing factor at night.Sarangi, an ancient Indian musical instrument, produces in my opinion the right vibrational sound to soothe the mind. It makes a sound that is almost identical to a soothing human voice. In India a ‘Lori’ or bedtime lullaby has a most powerful hypnotic effect on a child before it is put to sleep. It resonates in the mind and relaxes the muscles to a state where sleep is imminent.Ustad Sultan Khan, one of the greatest exponents of the Sarangi and a phenomenal singer of devotional songs (Sufi songs dedicated to the Almighty), has created a few Loris or lullaby songs which he has sung, as well as played on his instrument, for my therapeutic use. I recommend this music be played at bedtime as it produces the vibrations in the mind that induce sleep. This soothing music relaxes muscles, slows down the heart rate and prepares the body for sleep. It breaks the barrier of language as it consists of human voice and sounds of nature, which are universal.It is no wonder that Lord Yehudi Menuhin, having heard this music, said ‘Sarangi is the music of the soul’. People have been known to become emotional and often weep with joy during live performances with this instrument.Finally, always remember, a healthy spine supports a healthy mind.*122\330\8*

THE MONTHLY MENSTRUAL CYCLE: OLD-FASHIONED REMEDIES

admin — Wed, 29 Apr 2009 08:25:21 +0000

When a system as complicated as this seems to be going wrong, it’s very difficult to pinpoint exactly which part is at fault. This is why there are no easy remedies for period pain and why

different doctors in different clinics suggest different treatments. There was a time, about twenty or thirty years ago, when the standard remedy for the cramps was a strong dose of aspirin. If that failed, and it usually did, the only other possibility was to refer the patient for the operation called a ‘D and C, standing for dilatation and currettage. This involved giving you a general anaesthetic and then stretching the neck of your womb and scraping out the inner lining. In most cases this seemed to reduce the pain for a few months, but for most women the effect didn’t last very long and soon they were suffering as much as ever. Doctors now don’t suggest this operation so readily.

After D and Cs there was quite a vogue for what were called psychosomatic illnesses. Rather a lot of doctors thought that period pain was all in the mind and that if you cultivated a healthy attitude towards it, it would go away. For a handful of women who were genuinely snarled up, this approach was a help. For the rest it was absolutely demoralizing; being told it’s all in the mind doesn’t cure the pain, it simply makes you feel guilty or abnormal. This is precisely why a point was made of establishing right at the beginning of this book that period pain has physical causes. The trouble is that we don’t know exactly what they are.

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THE ACHING MISERIES (CONGESTIVE DYSMENORRHOEA)-MOOD SWINGS: IRRITABILITY, NERVOUS ENERGY, DEPRESSION-NERVOUS TENSION

admin — Tue, 28 Apr 2009 11:55:22 +0000

Many women are constantly on the go before a period; some can’t even sit down; some can’t stop talking. This type of mood swing seems to upset husbands and relations particularly, because the change is so abrupt. Many complain that they hardly recognize this new hyperactive woman. She wears them out. They don’t know how to respond.

It seems to me that there are two possible ways of dealing with this mood and they are the two extremes. You can either use your energy in the most violent work or exercise possible, or you can put your body into reverse by deliberate and lengthy relaxation. But it must be total relaxation, lying down, lasting at least half an hour, or it won’t have much effect. In a busy life I know how difficult that is to arrange. Fingertip massage can help you to relax too and so can dreamy background music. But even as I write I can remember women telling me that just attempting relaxation like this made them more tense and frantic than ever. So you’ll need to try both methods and see which is best for you.

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