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PAIN TREATMENT: TESTING THERAPY FOR EFFECTIVENESS

The aim of these tests is to reveal the consistent action of the therapy liberated from the bias of patients and therapists who think it ought to work. The major bias is the placebo response, which is surprisingly powerful.The standard test for efficiency is the randomized double-blind placebo-controlled trial. ‘Randomized’ means that patients with a particular condition have been chosen at random in order to avoid choosing some special types who might tilt the result. ‘Double-blind’ means that neither the patient nor the people running the trial know if the real therapy or a mock therapy has been given. ‘Placebo-controlled’ means that the true therapy and a mock imitation of the true therapy have been given.To give an example, suppose that a pharmaceutical company wishes to market a new analgesic and that they have completed all the preliminary trials for safety and apparent beneficial effect. They are then required by law to submit their new tablet to this rigorous type of trial. A group of patients with some definite problems, a wisdom-tooth extraction for example, are asked to volunteer for a trial. They are told they will either receive the new tablet or a blank one that looks exactly the same. Then the patient, who does not know which tablet he received, tells an observer, who is also unaware of the nature of the tablet, whether the tablet reduced his pain. Finally, after all the data have been collected, the code is broken and it is calculated whether the new drug is superior to the placebo.This type of trial sounds simple, even if it is elaborate and costly, but there are severe problems. The first problem is that the tested group never includes all the types of people who might use the therapy: a test group in New York is unlikely to contain many Inuits. The group is usually deliberately restricted, to healthy young adult men, for example. This means that the results do not necessarily apply to Inuits, women, children, old people and so on.Much more serious is the famous difficulty in keeping a secret. A tested drug may have side effects such as drowsiness so it is obvious to patients and observers who has received the active therapy. There are ways around this particular problem by deliberately giving a sedative that is not believed to be an analgesic to compare with the tested analgesic that has sedative side effects. It will be seen that the crucial element of keeping patients and staff ignorant becomes more and more difficult as the therapy becomes more elaborate. Take the problem of subjecting acupuncture to a rigorous trial. What would be the placebo arm of the trial? The problems escalate to an extreme with surgical therapy, where it would be quite unethical to subject a patient to a general anaesthetic and a mock operation in order to test the true efficiency of the surgery.There are subtle ways around these problems, which we will discuss with particular therapies. However, no one should forget that the background for these trials is based on the powerful assumption that all people are the same and that individual psycho-social factors are irrelevant. This leads to the present vogue for ‘evidence-based medicine’, driven partly by the tradition of academic medicine and partly by the financiers’ need to identify proven therapy whose cost is justified by trial.The trials are designed to identify a class of pains, medicines and patients who respond reliably and to exclude a class where personal individuality is a factor. The separation of these two classes is itself an artefact because they interact.*52\219\2*

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REFLEX SYMPATHETIC DYSTROPHY: THE CONSEQUENCES OF LINDA’S FALL

Linda, a 32-year-old public hospital cleaner slipped on a wet floor and struck her knee. Although she was able to get up with some difficulty and continue working for the rest of the day, she slowly developed more severe pain in her knee. After several months, and having experienced a number of occasions when the knee gave way beneath her, she was referred to an orthopaedic surgeon.

He performed an arthroscopy — passing a thin fibre-optic instrument into the knee — and removed some cartilage and damaged tissue from the back of the kneecap.

It was thought that this procedure would probably alleviate the condition but some months after the operation Linda’s knee was extremely painful. She had also developed a burning sensation in the skin above the knee and had noted that the pain was now present whether she was walking or at rest.

More X-rays were taken and it was decided to do a further arthroscopy. On this occasion it was noted that the back of the patella, or kneecap, showed an erosion, or damage, of the cartilage which normally exists to ensure smooth passage of the kneecap over the thigh bone.

Linda’s damaged cartilage was removed during the arthroscopy and an assurance was given that she would have no more pain. But by then the knee had swollen to several times its normal size and she was only able to walk short distances, with great difficulty.

Meanwhile, she was finding it difficult to look after herself, let alone her family and she had not worked for six months. Linda was then referred to a pain clinic for assessment and treatment. Upon examination it was noted that the affected knee was several degrees cooler than the normal knee. She was also unable to flex or bend the knee in any normal way. It was decided to perform thermography. This confirmed the presence of a reflex sympathetic dystrophy affecting her knee.

Linda was initially treated as an out-patient with an antidepressant medication and TENS therapy. But the depression was so severe that it was eventually decided to admit her to the in-patient program for further treatment and assessment. In the meantime, she was also referred to an orthopaedic surgeon who was an expert in the assessment and treatment of reflex sympathetic dystrophy. He agreed that the treatment Linda was receiving was probably the most appropriate under the circumstances.

During her stay of four weeks in the in-patient program, Linda was taught relaxation techniques and was encouraged to become more active. As part of her rehabilitation, she was to swim regularly and to walk as often as possible.

Meanwhile, her depression was controlled by appropriate medication, the antidepressant Surmontil and also Rivotril. She was seen by an occupational therapist who showed her how to maximise the use of her limb without pain or disability.

By the time she left the in-patient program, Linda was coping extremely well with her pain. She had accepted the fact that there was probably no further surgical intervention that would help her. She had accepted that surgical procedures might even worsen her condition.

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TYPES AND CAUSES OF CHRONIC PAIN

How do you know if you have chronic pain? What are the conditions that cause chronic pain and prompt someone to seek help?

Descriptions of pain vary greatly: ‘A river of ice in the arm,’ said a patient with a brachial plexus injury. ‘The pain is excruciating — just like having a tight metal cap over my entire scalp. I even dread combing my hair,’ said Jill who had suffered chronic headaches for 10 years. ‘All vertebrae feel as though they’re moving on one another as if there’s no gristle between them,’ said Max with a three year history of low back pain.

Chronic pain is a disease that is complex both in its causes and the symptoms it produces. It can originate in the muscles, the ligaments and the supporting tissues of the joints, or in the arterial or the nervous systems.

Pain can be triggered in different ways. There could be an initial trauma (an injury) which in turn leads to emotional problems and then to the awareness of pain. Some chronic pain sufferers may well worsen their problems with the treatments they seek. Often, pain is increased by the development of adhesions formed as a result of scar tissue attached to healthy tissue after one or more surgical operations.

Further problems occur when excessive dosages of multiple inappropriate medications, sometimes prescribed by more than one physician are taken. (Some see up to six different practitioners and are found to be taking as many as three different antidepressants and several tranquillisers as well as anti-convulsant medication. No wonder they feel sick!)

Pain can sometimes result from the adverse reactions these drugs have on one another and on the body’s system and can sometimes be completely eliminated by rationalising the medication.

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STRESS AND THE NEUROTRANSMITTERS

Since Selye’s research, scientists have found that stress provokes a number of even subtler chemical changes in the body which may have profound physical and mental health effects. For example, medical researchers are now certain that stress triggers chemical changes in the brain. Particularly sensitive to such emotional strains are the concentrations of potent chemicals called neurotransmitters. These act as messengers between nerve cells. They include: serotonin, epinephrine (adrenaline), norepinephrine (noradrenaline), acetylcholine and dopamine. In a Stanford University study, rats were forced to swim in 4 degree C water for three minutes. Later examination of their brain tissue showed that levels of norepinephrine had fallen 20 per cent and epinephrine between 30 and 40 per cent. Scientists have also discovered that the body produces its own painkillers, morphine-like chemicals called endorphins. Stress boosts the production of these analgesics, thus raising the pain threshold.

Because stress alters the body’s chemical balance, it seems to influence the development of many diseases,including psychiatric disorders. Depression has also been associated with low levels of two neurotransmitters — serotonin and norepinephrine.

Stress has been found to severely affect the body’s immune system. Researchers have also discovered that chronic stress inhibits the body’s production of its own cancer-fighting cells, including natural killer cells, T-lymphocytes and macrophages. A remarkable chemical triggers the body’s stress reactions — corticotropin releasing factor (RTF), which is produced in the hypothalamus, a powerful but tiny structure sometimes called the brain’s ‘brain’.

Research with animals has shown that.stressful stimuli can be less damaging when regulated. Being in control of the situation seems to make all the difference.

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SOME REMEDIES: KILL OR CURE?

Pharmacopoeias, which were comprehensive lists of drugs compiled during the Renaissance period included practically every known organic and inorganic substance. One fourteenth-century recipe for relieving dental pain, for example, recommended combining gall of a cow, heart of a magpie, mouse fat, cow dung, lice and oil of cloves (the only active ingredient recognised in our time).

Patients have chewed, imbibed, sucked, or suffered treatment with crocodile dung, teeth of swine, hooves of asses, spermatic fluid of frogs, unicorn fat, fly specks, lozenges of dried vipers, powder of precious stones, oils derived from ants, earthworms and spiders, bricks,feathers, hair, human perspiration and moss scraped from the victim of a violent death. George Washington is a good example of the treatment lavished on the wealthy in the eighteenth century. When he had a throat infection, complicated by pneumonia, it was said that he was fortunate ‘he could afford the best medical care available’. This wonderful treatment consisted of a mixture of molasses, vinegar and butter. Vomiting and diarrhoea were induced. But still he lapsed. In desperation, his physicians applied irritating poultices to blister his feet and throat while draining several pints of blood. Then, mercifully, he died.

Also pity the British monarch, Charles II. He was treated by the best physicians of the day, using the multiple treatment methods then believed appropriate for treating pain. Many are now known to have little therapeutic value and some may have actually done more harm than good. The treatment given to Charles II as he lay dying in 1685 was:

‘A pint of blood was extracted from his right arm and a half pint from his left shoulder. This was followed by an emetic, sneezing powder, bleedings, soothing potions, a plaster of pitch, and pigeon dung was smeared on his feet. Potions containing 10 different substances, chiefly herbs, as well as 40 drops of extract of human skull, were swallowed. Finally, application of the bezoar stone (gallstones from sheep or goats) was prescribed. Following extensive treatment, the king died.’

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SUNLIGHT AND HEADACHES

Sunlight can affect headaches in two completely different ways. Too much sunlight produces glare, while in certain people too little produces a condition called Seasonal Affective Disorder.

Glare

Brilliant sunlight causes glare. We respond to glare by tightly screwing up our feces in order to minimise the amount of light coming into our eyes. Over a short period of time, glare does no damage (provided you’re not looking directly into the sun), but over a longer period, screwing up the muscles around the eyes I Buses tension headaches. The longer the glare continues the more likely it is to cause headaches

Glare is essentially too much unwanted light, but it doesn’t have to be a very sunny day to cause glare; the direction of light counts, as well. It’s unwanted light coming into your eyes that determines whether glare is present; it’s quite possible to have a sunny day in a Mediterranean country, with the sun at its zenith, and have little glare. On the other hand, you can experience glare by driving straight into the sun at three o’clock on a December afternoon in Manchester!

So what is it about light that makes it glare? The answer is two fold. Obviously the more light there is the more likely it is that glare will occur. However, a lot of sunlight falling on a landscape that is primarily dark won’t cause much glare. It’s the bounce-round of light reflecting on light surfaces that causes the difficulty; i.e., light coming off snow, off sand, off water, off light-coloured surfaces such as concrete paths and buildings, reflecting off windows, off the white pages of a book or newspaper, and off white garden furniture and walls. And anything that reflects sunlight as brilliant flashes of light makes glare even worse.

However, direct, intense sunlight isn’t always necessary. A lot of glare is created when the sun is behind a thin haze of high cloud. This makes the whole sky radiate light, instead of it coming just from the sun. If you’ve ever been to an air show under these conditions, you’ll know how much more wearing it is to look at aircraft against a bright white background like this, than it is to watch the Red Arrows against the backdrop of a deep blue sky.

What can you do about glare? The answer is quite simple – minimise the amount of reflected light coming into your eyes. For instance, if eating outside minimise glare by using a dark-coloured tablecloth and using pottery cups and saucers, rather than glasses or china which reflect light so much more. Putting up a parasol helps as well! And, if you have a particularly bright area in the garden (perhaps a patio with a white, concrete floor), avoid it during the brighter times of the day.

Sunglasses are very effective. Simply donning a pair of tinted spectacles may make all the difference and it certainly allows you to read a book more comfortably. Polarised sunglasses are particularly useful; they have a material within them which only allows light to pass through if it is vibrating at a particular angle. Basically this means that they can selectively cut out glare and reflected light, instead of just light in general. Tinted glasses simply reduce the total amount of light, which is of some benefit, but not as effective as polarised lenses.

Seasonal Affective Disorder (SAD)

Seasonal Affective Disorder (or SAD, for short) is a recently discovered cause of. depression which is primarily related to a lack of sunlight. Sufferers from SAD find that they become lethargic and depressed around October. This feeling lasts until about April, when suddenly they get a burst of activity, their depression lifts and they feel normal again … until the following autumn. SAD is now a well-recognised cause of depression, which can cause muscle tension and headaches.

Only a small proportion of people seem to be susceptible to SAD, which seems to be related entirely to the amount of light coming into the eyes. So, if you work outdoors, you’re less likely to be affected, while if you work inside you could be afflicted that much more quickly.

The treatment, as you’d expect, is exposure to light; but the intensity of light is very important. Normal levels of artificial light, even in brightly lit surroundings, are simply not enough. In other words, what we feel is powerful artificial light is, by comparison with sunlight, very weak indeed.

There are special lights available to treat sufferers of SAD; these are called ‘light boxes’ and are of particularly high intensity. It isn’t necessary to look straight at the box, as long as you have it in your field of vision. You could read, or watch television at the same time, for example.

What do you do if you are suffering from SAD? To begin with, make the most of any natural light you can, especially towards autumn and winter. Ensure that you have an outdoor hobby – walking, golfing, gardening – and make a point of going out in the sunlight whenever you can. Perhaps you could have your mid-day meal on a bench in the park rather than merely sitting in the office. Secondly, think about a winter holiday somewhere much sunnier, where there are longer periods of daylight, or a lot of snow (snow will tend to multiply the effects of daylight by producing a lot of glare).

Lastly, in cases where SAD has been diagnosed, your doctor can arrange light therapy in which you are exposed to artificial light of a sufficiently high intensity to counteract the effects of lack of natural sunlight.

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HEADACHES IN WOMEN: TOXAEMIA OF PREGNANCY

During pregnancy, some women start to develop a syndrome call toxaemia of pregnancy. As yet, no one is completely sure why this occurs, but it is a very well-recognised problem. In its early form, there is puffiness of the ankles and the fingers, and weight gain, both of which are caused by water retention (oedema). Blood pressure rises slightly and there may be a little protein in the urine. Normally this settles with rest, but in its worst form (which is fortunately very rare) the patient gets a frontal headache, gross puffiness of her fingers and ankles, leaks protein into her urine, and her blood pressure continues rising. If this situation isn’t checked, in extreme circumstances she may experience flashing lights in the eyes, together with a headache over the forehead and then have a fit. This condition is called eclampsia. After an eclamptic fit, the foetus has a high chance of dying – so too has the mother.

Thankfully, full-blown eclampsia is a very rare event, largely due to good antenatal care. During routine anti-natal checks a woman’s blood pressure is measured, she’s weighed to make sure that she’s not suddenly put on too much weight (which usually means that she’s retaining water rather than that she’s eating too much) and her urine is tested to make sure that there is no protein present.

A small percentage of pregnant women do get the symptoms of early toxaemia – a little swelling of the fingers, a slight rise in blood pressure, or perhaps a little protein in her water, but the early stages are relatively benign. Pre-eclampic toxaemia (PET) like this responds well to rest. In most cases, the blood pressure falls, the excess water is lost, and the leakage of protein stops. In more severe-cases it make be necessary for the patient lo be admitted to hospital for strict bed rest, sometimes under quite heavy sedation.

Although rest usually makes the symptoms of toxaemia go away, it’s very often difficult to get a woman to rest in her own home. At least two hours lying in bed in the morning and two hours in the afternoon – may be all that is required to bring the blood pressure down. In early toxaemia, however, if the symptoms persist and the blood pressure continues to rise, then hospital admission is going to be necessary. In extreme cases it may be necessary to induce childbirth by medical means, to make sure that the baby is delivered as soon as possible; and in some cases an emergency Caesarian section is needed to save the baby’s life or simply to prevent the blood pressure going even higher.

Full-blown toxaemia is a potential medical disaster, and must be treated as an emergency. On the other hand, although many pregnant women experience a few of the early symptoms of pre-eclampsia very few progress to the much more malign full-blown toxic stage. It is only in full-blown toxaemia that the frontal headaches occur, but if you’re in the later stages of pregnancy and have developed any of the symptoms listed above, you should contact your doctor or midwife immediately

We still don’t know why toxaemia occurs. It may be related to exercise and certainly it’s helped by rest. Interestingly, its usually less common in subsequent pregnancies,

Finally, a small point needs to be made about blood pressure in pregnancy – the blood pressure rise caused by toxaemia is quite different from the blood pressure rise caused by ‘ordinary’ blood pressure. It is quite possible to have high blood pressure during pregnancy from ‘ordinary’ blood pressure without any problems: on the other hand a rise of blood pressure at this lime may indicate toxaemia.

Type of headache

The headache is severe, and across the forehead, accompanied by flashing lights in the eyes.

What else could it be?

A tension headache produces a similar type of headache. Migraines can produce flashing lights in the eye, but the headache isn’t at the front, but over one half of the head. The tests your doctor does of your urine, blood pressure and weight will indicate whether or not it’s toxaemia.

Self-help

Make sure you get good ante-natal care, and try to rest as much as possible during the later stages of pregnancy, though this can be very difficult; and if your doctor is advising you to rest more because of a rise In blood pressure, then do please take his advice – it’s important.

Some doctors feel it is caused by a lack of high-quality proteins (meat, fish, eggs, etc.) and will suggest a dietary change. Do try to eat a healthy, well-balanced diet. Light exercise can also help prevent PET, but once you’re got PET, rest is essential.

Complementary treatment

Full-blown pre-eclamptic toxaemia, or full-blown eclampsia, must be treated by a doctor – and preferably in the hospital. However, there are some complementary measures that can be undertaken on a preventative basis.

Efforts to keep your blood pressure down should be made, and that includes watching your diet and taking measures to reduce stress. Avoid coffee, tea and alcohol, and in its place try soothing camomile teas, Dandelion root coffee is a mild diuretic, which may help control oedema.

Homoeopathy and acupuncture both offer therapies to deal with high blood pressure and pre-eclampsia, but the treatment will be tailored to your individual needs.

Oedema can be relieved by massage of the legs with geranium and rosemary essential oils. Lavender may relieve headaches, as can acupressure

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CAUSES OF HEADACHES: EPILEPSY

Epilepsy can be divided into three main types:

Petit mal is characterised by a sudden loss of consciousness lasting for a very short time – perhaps a quarter of a second to a few seconds. These are often called ‘absence seizures’ and during an attack the patient may suddenly stop talking in mid-sentence and then pick up from where he left off. Occasionally the muscles go limp and the patient drops down to the floor. Attacks like this are normally not followed by headaches.

Grand mal epilepsy is what most people normally associate with the idea of somebody who has fits’. A grand mal attack may be preceded by an aura, an overwhelming feeling in which the patient becomes aware that an attack is pending; then he loses consciousness, falls to the ground, and goes into spasm for up to thirty seconds, during which time he stops breathing and goes blue. Then generalised jerking of the limbs begins.

A variant of grand mal epilepsy is Jacksonian epilepsy, in which the twitching starts in one small part of the body, gradually spreading towards the trunk and eventually involving the whole body: consciousness is eventually lost.

After a grand mal fit, the patient is very drowsy, is sometimes confused, often has a generalised headache, and usually wants to sleep off the attack, which he-will probably do quite successfully without any need for interference.

•    Temporal lobe epilepsy can be much harder to recognise, because the symptoms can be quite different. There may be visual hallucinations, which can consist of flashes of light or balls of fire, or even more complicated hallucinatory events. There may be disorders of smell and taste, automatic odd behaviour (such as suddenly undressing in public); occasionally there may be outbursts of aggression, or rage – or even attacks of laughter. Finally, temporal lobe epilepsy doesn’t necessarily progress to a fit.

There is a crossover in symptoms between temporal lobe epilepsy and migraine; sufferers from temporal lobe epilepsy can get severe headaches, preceded by an aura with visual hallucinations – just like migraine. Usually muscular shaking and loss of consciousness gives the clue to the diagnosis, but sometimes a full-blown fit doesn’t occur. Just to make things more complicated, very occasionally a migraine can end with a fit.

Usually the diagnosis of epilepsy is easy to make; either there has been a fullblown fit (grand mal) or else short episodes of loss of consciousness. If there is any doubt, an electro-encephalogram (EEG) may quickly show what is happening by monitoring the electric activity within the brain.

Most people with epilepsy had their first attack before the age of twenty. Why certain people are susceptible is unknown, though a brain injury does predispose to attacks. Sometimes attacks can start out of the blue in adult life, and then go away again within a few months. I suspect that some of these cases are the aftereffects of viral infections in the brain.

Epilepsy usually starts in childhood, but the first fit has to be distinguished carefully from a fit due to meningitis; it’s also important that fits from febrile convulsions (fever) aren’t mistaken for epilepsy, and vice versa. Febrile convulsions are always associated with a rise in temperature and never last beyond the age of seven years. (They never lead on to epilepsy.) On the other hand, epileptic attacks occur out of the blue, unrelated to temperature.

It is unusual for epilepsy to start after the age of twenty. When it does, the doctor has to be careful to make sure that there is no underlying disease causing the epilepsy, such as a tumour. Epilepsy can also arise as a result of abnormal blood vessels stimulating the brain; and from scars in the brain caused by head, injuries, operations, small strokes, and sometimes even strokes following migraine.

The doctor will want to fully investigate a first fit. A young child with a first attack of convulsions needs to be admitted to hospital for a lumbar puncture, to ensure that the fit isn’t due to meningitis. In an older person it’s much easier to be sure that a fit isn’t meningitis, so there isn’t quite the same rush to investigate. CAT scans and MRI scans will help to pinpoint any abnormality which is triggering off the attacks, and can be used when the EEG points to unusual brain-waves. CAT scans and MRI scans are also very useful in adults who have developed epilepsy, where the doctors are particularly concerned that there isn’t an underlying tumour.

*84\20\2*

MISCELLANEOUS CAUSES OF HEADACHES: RESPIRATORY FAILURE

Far and away the biggest causes of respiratory failure are bronchitis and emphysema. In both cases the tubes leading to the inside of the lung get blocked with excess mucus; the delicate lining of the bronchii which transports mucus away is damaged and so the mucus remains where it is. Finally, when the air gets down deep into the lungs it can’t enter the blood easily.

The main cause of bronchitis and emphysema is smoking. All smokers eventually get a certain amount of bronchitis, although only a small proportion get lull-blown respiratory failure.

The chief symptom of respiratory failure is progressive breathlessness. Usually this comes on slowly. At first the shortness of breath is only slight, associated with exertion, but gradually preventing the patient from undertaking normal day-to-day activities. The shortness of breath increases until eventually the person is breathless, even at rest.

There are two varieties of respiratory failure, depending upon how the control mechanism for breathing copes with the problem. The type which concerns us here is when the level of carbon dioxide in the body rises greatly. When this happens the patient becomes blue around the mouth, lips and tongue, and has a headache; there may also be restlessness, anxiety, delirium and drowsiness.

Obviously illness like this must be treated by a doctor, possibly even in hospital. Oxygen therapy may help, but for complex physiological reasons it isn’t always possible to give large quantities of extra oxygen. Inhaled steroids and drugs to open up the airways may sometimes be helpful in bronchitis; physiotherapy to help clear mucus from the lungs is often useful.

Bronchitis and emphysema can place a great strain on the heart; added to this, the tobacco that causes the bronchitis also furs up the arteries of the heart, so patients with respiratory failure frequently have a degree of heart failure. Controlling the heart failure may help the respiratory failure.

In the long run there is little we can do to help those who have respiratory failure. It is so sad to see someone in this situation, knowing that it has almost always been caused by the patient himself … through smoking.

Self help

Respiratory failure can be prevented, and that means no smoking. And the sooner you give up, the longer your lungs are likely to last. Tobacco smoke contains carbon monoxide which also poisons the red cells and stops them carrying oxygen. In the long-term, carbon monoxide also causes furring up of the arteries in the heart.

If you have respiratory failure you can also help yourself by keeping as relaxed as possible. The more anxious you are the more tense your muscles will become, and the more you tense your muscles the more oxygen you use up and the more carbon dioxide you create.

Complementary treatment

If an attack of bronchitis or emphysema comes on, get plenty of bed rest, with a hot water bottle on your chest. Steam inhalations are also helpful to loosen the phlegm. Avoid damp, cold and dust. There are a number of homoeopathic treatments for bronchitis and emphysema – including aconite, belladonna, kali bichrom or Pulsatilla. You will need a full consultation to receive the most useful treatment.

Under the care of a registered practitioner, Vitamins E, A, C and D can be supplemented, and zinc can help. Extra iron is often recommended.

Oils of eucalyptus and hyssup are expectorant. Cloves and eucalyptus can he steeped and drunk as a tea, with lemon. Teatree and oregano oils are a good choice for the vaporiser.

*120\20\2*

HEADACHES DURING SEX: COMPLEMENTARY TREATMENT

If the headache is due to a sub-arachnoid bleed you need medical alien/ion. urgently; complementary therapies are not useful until after help has been sought and attention given.

If the headache is an exacerbation of a tension headache, all the complementary therapies listed in the chapter on tension headaches will help.

In the meantime, however, there are numerous things that can be undertaken – many of which can enhance sexual intercourse. Try massaging (or having your partner massage) around the hack of the neck, temples and eyes with a blend of basil, camomile, coriander, lavender, melissa or clary sage, in a grapeseed or avocado carrier oil. eye compresses of camomile or rosemary can help, if you use them for twenty minutes or so when the headache sets in, or following intercourse.

Tea tree, geranium, niaouli or lavender on the lamp or radiator beside the bed will provide a stimulating aroma, as well as working to relax you. If you are worried about sexual performance, try a bath with ylang-ylang (a known aphrodisiac) or rose (for women, in particular).

Acupressure can be done between partners, as can reflexology – both of which are relaxing and preventative. Soft music will release tension, as will candlelight- romantic and therapeutic.

Regular courses of feverfew may help to prevent headaches during sex, in the same way it can control migraine. Acupressure and Shiatsu are helpful for long-term conditions, and osteopaths and chiropractors can also pin-point a musculoskeletal cause that orthodox medicine might just have missed. Psychotherapy can help you deal with feelings of fear or apathy surrounding sexual intercourse. Often deep-rooted feelings can be the cause of physical pain.

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