Archive for April 29th, 2009

THE PSYCHOLOGICAL APPROACH TO FUNCTIONAL PAIN: UNDERSTANDING THE CAUSE

Wednesday, April 29th, 2009

One of the difficulties in the management of functional pain is that we find it very hard to accept the idea that the pain is in fact due to our nerves. We feel the pain; it hurts; it is a real pain. We are convinced in our mind that such real pain is not psychological in origin. We tell this to the doctor, but somehow he does not seem to understand. If he would only do some additional test we feel sure that it would show some organic cause for our trouble. We undoubtedly want to find an organic cause. Such is our scale of values that no one is very proud of himself when he has to explain to his friends that his pain is merely due to nerves. But there is more to it than this. The pain is so bad that we ourselves feel sure that it must be due to some physical condition of our body. This is particularly the case in psychosomatic abdominal pain. Our anxiety has affected the smooth working of our bowels. They contract in spasms, and often quite violently, and the part of the bowels in front of the contraction does not relax properly in the way that it should. The pain nerves in the bowels are stimulated and we experience real colic.

It is clear that the first step in the self-management of such a condition is the acceptance of the idea that the pain is in fact the result of our anxiety. By acceptance of the idea I do not just mean verbal agreement with our doctor. It is very easy to do this, and at the same time to keep our own reservations on the matter. No. We must accept the truth openly and without reservation.

There is a further point that needs explanation. We are often inclined to think that our pain should be directly related to the cause of our anxiety. For instance, if our anxiety is caused by a sexual conflict, as it often is, then we might expect it to show itself in pain in the sexual parts rather than in pain in the stomach. But this is not so. There are usually two factors: one is the conflict or conflicts which produce our anxiety; and the other is usually some incidental matter, such as past trouble in some organ, so that our attention is focused there in a way that has the effect of localizing our psychological pain in this part of the body.

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TUMMY TROUBLES: CROHN’S DISEASE

Wednesday, April 29th, 2009

Q. What is this?

A. It is a disorder of the bowel, commonly of the small intestine but often including the colon. It is named after a New York physician, Dr. Burrill Crohn, of the late 1800s, who first described it, calling it regional ileitis. It is common in western countries and is much like ulcerative colitis, producing similar symptoms and also greatly increasing the patient’s risk of bowel cancer, especially if it starts before the age of 21 years.

Q. What are the symptoms?

A. Recurring bouts of pain in the lower abdomen, often worse after meals, loss of weight, diarrhoea, recurring fevers, probably the passage of blood.

Q. How is it diagnosed and treated?

A. The methods for diagnosis include x-rays, the use of the endoscope for the upper small bowel or the colonoscope for the large bowel and taking a biopsy for laboratory confirmation. The bowel is often rigid and thickened and the canal narrowed. Treatment is unsatisfactory and although various drugs such as the corticosteroids, sulfasalazine, azothioprine and others have been used, they are not curative. Surgical treatment may be resorted to if symptoms become intolerable.

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SCIATICA: EASING THE PAIN

Wednesday, April 29th, 2009

While medical treatments can cure many forms of back problems, including those that give rise to sciatica, it still remains a fact that many sufferers will continue to experience pain at times because of their underlying condition. Essentially, a patient is most likely to have to cope with pain under the following circumstances:

When the problem first manifests itself, pain being almost invariably the first symptom. Naturally, depending upon the severity of the problem, the sufferer will then either seek medical help immediately or perhaps wait a while in the hope that the symptoms ease or disappear of their own account.

Even when medical treatment or other remedial therapy has been initiated, it may take a while for this to take full effect and pain may still be experienced now and then.

Then, of course, many people have what might be called ‘mild sciatica’ in that occasionally they have pain or perhaps only discomfort, which although bothersome, they feel is not severe enough to seek medical help. It needs to be stated once again that anyone experiencing symptoms severe enough to cause concern should seek medical advice. However, there’s little doubt that good though this advice is, not everyone will take it, many people preferring to try to control or reduce their pain rather than seeking to deal with the problem that may be causing it.

While the many forms of treatment available for back problems are described elsewhere in this book, in this chapter we will concentrate solely on those measures intended to eliminate or reduce pain. But first of all. . .

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