Too frequent use of painkillers can cause rather than cure headaches | BMJ – will Scotland agree?

  “NICE advises the NHS to be alert to the possibility of drug induced headaches in patients whose headache developed or worsened while they were taking triptans, opioids, ergots, and combination analgesic treatments for 10 days a month or paracetamol, aspirin, and non-steroidal anti-inflammatories such as ibuprofen either alone or in combination for15 or more days a month. Drug induced headaches are five times as common in women as in men.”

With regards to the Scottish Government’s stance that NICE guidelines need to be re-evaluated by SIGN in Scotland (when justifying not accepting NICE guidelines for non-specific lower back pain*) – is the Government going to disregard the latest NICE headache-related guidelines until they can be re-assessed in a few years time? Or is this decision selective?

* “NHS QIS have established a Scottish Chronic Pain Steering Group to take forward recommendations in the Getting to GRIPS Report. Part of this work will be to develop a SIGN guideline on aspects of chronic pain management. NICE Clinical Guidelines have no formal status in Scotland” Shona Robison 11/March/2011 (http://bit.ly/CAMNHS-NICEGuideRobKerr)

Too frequent use of painkillers can cause rather than cure headaches | BMJ

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Pain reduction doesn’t (always) reduce disability

HealthSkills Blog

ResearchBlogging.org

The relationship between pain and disability is a particularly vexing one in primary care. It would be great if it was possible to get rid of pain and be assured that any lingering effects on function would be similarly abolished, but it just doesn’t seem to be quite that simple.

Many different approaches to managing this situation have been suggested. One is to argue that people should be referred for a quick pain reduction injection – for those who have pain that is thought to respond to this approach. Another is to just “reassure” and review often. And still another is to provide a cognitive behavioural approach usually reserved for those referred to a secondary or tertiary treatment centre.

For several reasons I find the first and second options above not particularly satisfying. 

For the avoidance of doubt, I want to make sure readers are aware that I am not…

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Gratitude when you’re in pain? You’ve got to be kidding!

HealthSkills Blog

ResearchBlogging.orgOr – introducing the “parent of all virtues” (Wood, Joseph & Linley, 2007).

For some time now I’ve been exploring the contribution of positive psychology on wellbeing in people with chronic pain.  Positive psychology is the ” scientific study of the strengths and virtues that enable individuals and communities to thrive”. (Seligman, ND). It strikes me that in chronic pain management, we’ve responded to the issues raised by people who don’t “live well” with their pain, leaving the group of people who do cope well largely ignored. We have much to learn, I believe, from those who have faced their situation and either been stoic – or in a surprising number, grown from their experiences.  Some excellent resources in the field of positive psychology in general can be found at The Positive Psychology Center and Authentic Happiness, and for Kiwi’s, the New Zealand Association of Positive Psychology.

Gratitude…

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EU directory on herbal medicines – it is not all bad news

You may already know about the EU’s attempt to remove the rights from European citizens to choose how to deal with their health matters by denying access to herbal remedies amongst others. All details can be found on ‘GoPetition’ (http://media.causes.com/ribbon/1002638) where you will also have the option of signing the petition against the EU directive (The Traditional Herbal Medicinal Products Directive)
 
There is also a ‘Cause’ on Facebook with over 88,000 members connected to the petition, with facilities to invite more people to sign and spread the information (it’s amazing how few people know about this!).  It is on  http://www.causes.com/causes/529778-medicinal-herbs-will-disappear-in-eu-and-we-are-the-only-ones-who-can-stop-this?m=d71e5307 (if you’re on Facebook, you can invite everybody in your network to join and sign)
 
Apart from the petitions (there are a few, I’m told), it is very important to support the Alliance for Natural Health (ANH).  They are the ‘official’ organisation fighting EU this directive in court.  They are not just campaigning against the herbal ‘ban’ but also the whole  ‘codex alimentarius’. 
 
Currently they need £90,000 for the next round of court challenges and they only have £73,682 so far. (donations can be made on the home page). So, please spread the word so that more people will be aware of this attempt to limit our freedom to choose.
 
The good news

HOWEVER, things are not as gloomy as they seem (good strategy from those with an vested interest on the ban as gloom brings about hopelessness so people stop trying).
 
Apart from the ANC  court challenges, there is a possibility that the Lisbon Treaty offers a way round to prevent the ban. A Lisbon Treaty-led broadening of the rights of individuals and corporations to act against European Union law could permit generic, article 13 health claim challenges, even though they, “are not addressed to individuals”, according to an EU food law specialist.  (http://www.nutraingredients.com/Regulation/Lisbon-Treaty-could-permit-EU-health-claim-challenges)

I post all the information on my Facebook page and Twitter so, if you or anyone interested join my network, you will be able to get any updates on this issue and drug-free health in general. (I’m on http://www.facebook.com/PauloQuadros  and http://twitter.com/#!/pauloquadros )
 
Although the EU legislation should affect Britain, there are signs that the UK government is uneasy about the directive and is taking measures to circumvent what is effectively a ban on herbal remedies and the destruction of ancient healing systems such as Ayurveda and Chinese medicine.
 
In 2010, the Complementary and Natural Healthcare Council (CNHC) was asked by The Secretary of State for Health to register practitioners supplying herbal medicines to members of the public in England and Wales. More to come later.
(The CNHC is a Government-sponsored, voluntary registration body for complementary healthcare practitioners, and its key function is to provide access to a list of practitioners that have been assessed as meeting national standards of competence and practice).
 
You may have recently learned the news that Britain has passed measures to defy the EU Directive.

The Health Secretary Andrew Lansley said that consumers will be able to get continued access to the medicines under plans to register all practitioners in the UK who supply them (hence the CNHC registration of herbalists in 2010).
 
Andrew Lansley said that “This approach will give practitioners and consumers continuing access to herbal medicines. . . . It will do this by allowing us to use a derogation in the European legislation to set up a UK scheme to permit and regulate the supply, via practitioners, of unlicensed manufactured herbal medicines to meet individual patient needs.” But I’m sure that he will face a barrage of accusations from people related to ‘Big Pharma’ and will need public support in order to allow herbal remedies to be sold in the UK.  The written ministerial document can be found on http://www.nimh.org.uk/wp-content/titkosuploads/2011/02/Written-ministerial-statement-on-SR1.pdf
 
Not that he is all good for CAM as he is banning herbal manufacturers of organic products to say so on the label.  The MHRA (Medical Health Regulatory Authority) say that manufacturers cannot call the product "organic",  cannot show the Soil Association logo on the outside of the packaging and are have even banning companies like the ‘Organic Herbal Medicines’ from using company names in the branding. (apparently the MHRA says that "the use of the word organic is promotional" and can only be used in small print or footnotes on labels for licensed herbal medicines. But that’s something else.
 
On the other hand, The BMJ reports that Switzerland have just announced that they will fund complementary therapies (including phytotherapy) for 6 years to assess benefits (on their equivalent of the NHS). Although Switzerland is not in the EU this should have repercussions on the EU directive as they have many treaties with European countries which may affect herbal remedies trade. You can find the BMJ article on http://www.bmj.com/content/342/bmj.d819.short?etoc
 
Apparently, The European Union relaxed its norms of 15-year usage criteria under the Herbal Medicinal Product Directive that posed technical barriers to Indian exporters of herbal products (according to a communication by the Asia-Pacific Traditional Medicine and Herbal Technology Network).

A European Union delegation and Indian health authorities, Dr Konstantin Keller, chairman of the committee on Herbal Medicinal Products of the European Medicines Agency (EMEA) made it clear that producers of Ayurvedic herbal medicines could apply for registration of their products in Europe, even if they had not been in use for 15 years in the European Union.  As I said, this was in 2007 but I’m pretty sure that they will be making representations against the EU ‘herbs legislation’.
 
I haven’t heard any official Scottish voices against the EU directive yet – this is where I live. I would really like to know what the Scottish government’s position is on this issue and think that Scots who are interested in preserving their freedom of choice should prompt the government to detail their views in this respect.  Elections are just around the corner and it is a good time to do this. My gut feeling is that the Scottish Government is also against the ‘ban’ and curtailment of freedom.
 
The main thing is for all to realise that the directive does not have to happen and not to let hopelessness set in.  There is much to fight for yet.  To quote Margaret Mead: “Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed it’s the only thing that ever has.”

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MPs want homoeopathy funding stopped – some comments

This refers to an article published by the New Scientist on 23rd/Feb/2010 by Andy Coghlan
( http://www.newscientist.com/article/dn18559-stop-funding-homeopathy-say-british-mps.html )

Brief points:

1- "Homeopathic remedies work no better than placebos, and so should no longer be paid for by the UK National Health Service, a committee of British members of parliament has concluded":

I can think of at least one double blind placebo controlled research which showed that homoeopathy is effective for rhinitis (led by Dr David Reilly and published in the Lancet quite a long time ago. I remember the Lancet dedicating the editorial to this piece of research – if you know details please let me know)

2- "The committee also says that prescribing of placebos, which have an effect because a patient believes they will, involves a "degree of patient deception" and so is "not consistent with informed patient choice"."

Many vets treat animals with homoeopathy (pets and farm animals). I can’t work out how they can be subject to the placebo effect

3- It is quite a well-known fact that GPs routinely prescribe placebos (which are not homoeopathic remedies). So, in this respect, there has always been a "degree of patient deception". As far as "informed patient choice", it is very limited in practical terms, especially if we consider that a great proportion of medicines prescriptions are not based on evidence.

4- "The committee failed to identify any plausible explanation for how such remedies might work":

Because we cannot have an explanation, it does not mean it does not exist. This is the equivalent as saying that one thing cannot be in two places at the same time or that matter cannot also be a wave or even less believable, matter can change how it behaves when/if it gets observed. But that happens in the quantum ‘world’

Some time ago, Dr Jacques Benveniste, a highly regarded scientist at INSERN (the French equivalent of the British Research Council) demonstrated that water has memory and that this memory is electromagnetic. I saw his demonstration using a biting heart of a chicken. He got the heart to beat faster when he dropped a homoeopathic preparation on it (can’t remember what it was) and later he submitted the homoeopathic remedy to a strong magnetic field. After that, the homoeopathic remedy did not affect the heart – it was just water. The water memory had been deleted by the electromagnetic field just like a cassette tape would. That experiment was repeated a few times.

Physicists have since demonstrated that water molecules change according to environment and thought.

5- "The Prince’s Foundation for Integrated Health, which backs complementary therapies, including homeopathy, acknowledges that homeopathy is "scientifically implausible", but defends the use of such remedies nonetheless."

I’m surprised at the FIH’s comment that homoeopathy is "scientifically implausible". It may be implausible to current limited scientific knowledge WITHIN medicine. And so is Quantum.

To quote part of Dr Vera Madzarevic reply to the article:

"My personal and humble opinion is, as a scientist, that I cannot answer all the questions of how allopathic drugs work, I can propose mechanisms of action, but hardly demonstrate them in some cases, but they work………….and they are approved and used….. Sometimes the best answer to a complicated medical problem is simple. I understand that we are not the holders of the absolute truth, and we have to leave doors open to other opinions"

 

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Food and pain – Choosing the right food to reduce pain and inflammation

FruitDid you know that some of the things we eat or drink can make pain and inflammation better or worse?  This is because they have a direct effect on the pH (acid-alkaline balance) of our blood.  This means that some foods make our bodies more acid or alkaline.  Our bodies have mechanisms to keep some functions just at the right level (this is called homoeostasis) and when those go wrong we can become quite sick. For instance, there is an optimum level for blood sugar and, when there is too much sugar, the body releases insulin to bring the sugar down to normal levels. The same happens with salt, fluids, and many other substances – our bodies will strive to bring things back to normal levels whenever there is too much or too little of anything.

    In general, our blood (and the fluid between cells)  need to be slightly alkaline (pH of 7.4) in order to be able to keep healthy and fight diseases. The more acidic it is, the more prone to inflammation it will be. Different types of food make the body more alkaline or acid.However it has nothing to do with how the food tastes – for example lemons, vinegar and oranges are actually alkaline.  Imagine that it is the ‘ashes’ left after the body ‘burns’ the food we eat that are acid or alkaline.

If there is too much acidity and we don’t eat food rich in certain minerals that can buffer the acid (calcium, magnesium, potassium, etc), our bodies need to use those minerals stored in the liver, the gall bladder, muscle tissue and bone to balance its pH. This is a natural and normal process but, if this continues for a long time, our store of buffers start running low leading to a weakening of the ‘storage organs’. For instance, our bones can become weaker (as calcium is leached from them) and muscles can become ‘stiffer’ and sore (common in fibromyalgia). Some types of food have been shown to produce arachidonic acid promoting the release of prostaglandins and other inflammation markers. Any conditions involving inflammation can be helped by an alkaline diet.

Alkaline forming foods should make about 70% of our diet for health maintenance and more to restore health – somewhere around 80% – this varies from person to person according to their metabolism.

In general, the best alkalising diet would consist of

  • most fruits (especially apples, apricots, avocados, bananas, berries, blackberries, melons, cherries, grapes, grapefruits, lemons, oranges and peaches),
  • vegetables (especially onions, Swiss chard (raw), chives, kale, spinach, mustard greens, turnip greens, watercress, spring onions, lettuce, beetroot greens, leeks, collards, cabbage, peas, chicory greens, cress, Chinese cabbage, endive, dandelion greens, carrots, green beans, pumpkin, red sweet peppers, asparagus, sweet potato, peas, Brussels sprouts, squash and cauliflower),
  • fish (especially oily fish such as mackerel, salmon and herring),
  • olive oil (especially extra virgin, unfiltered olive oil), flaxseed oil
  • quinoa,
  • spices, herbs and seasoning (especially chillies, parsley (raw), basil (fresh), sage, marjoram, thyme, oregano, ginger, turmeric, onion and curry powder) and
  • some types of seeds and nuts (walnuts, flax and pumpkin seeds). Some sources recommend the avoidance of all other seeds an nuts as most if not all of them contain n-6 fatty acids, which are pro-inflammatory.

I say ‘in general’ because, for instance, some people are sensitive to plants of the nightshade family (such as potatoes, tomatoes and aubergines) as they contain a chemical called solanine, which can trigger inflammation in those people. Some sources advise that citrus fruits should not be consumed at the same time as any other food. Drinking enough water (especially if it is alkaline) and fluid is also important.

Acid forming foods to be avoided include

  • sugar (probably worse of all – especially refined),
  • red meat,
  • saturated fats and food containing trans (hydrolysed) fats
  • too much coffee and alcohol.

Many people are intolerant of certain foods such as wheat and cow’s milk. Buttermilk, whey, yoghurt and goat’s milk are often acceptable. When food intolerance is present, those foods will also have an acidic effect.

If you want to be sure which is the best anti-inflammatory food for you personally, a good nutritionist or naturopath should be able to help.

There is also some evidence that  other factors  contribute towards blood pH balance such as breathing but this is beyond the scope of this article.

For further information:

1. Interview David Seaman, author of Clinical Nutrition for Pain, Inflammation, and Tissue Healing

2. Look Up IF Ratings (How to use IF ratings is HERE)

3. The Inflammation-Free Diet Plan by Monica Reinagel published by McGraw-Hill

4. www.inflammationfactor.com

5. “Anti-Inflammatory” Diet May Improve Postprandial Glucose, Cardiovascular Health (Medscape)

6. Dietary suggestions for chronic pain

Healing and feeling better

Healing and feeling better are two different things.

Many people focus on getting rid of symptoms (emotional or physical pain for instance), assuming that if they feel better, there are no problems. Mainstream, conventional medicine also tends to focus on this.

But, if you imagine that our bodies are like a car, when we feel ill, when we have some discomfort, it is equivalent to lamp bulbs lighting up in our dashboard. Wanting to just get rid of the symptom is like unscrewing the lit bulbs in our dashboard in the false assumption that if we do so, problems will be resolved.

Although the process of unscrewing the bulbs is the same, unscrewing different bulbs have more or less serious consequences.

In a car, if we unscrew the bulb telling us that we’re running out of petrol, the worst that can happen is that we might run out of petrol eventually.

If we unscrew the bulb that is telling us that the engine is running out of oil, we might eventually have to buy a new engine.

If we unscrew the bulb telling us that the breaks are failing, this could eventually lead to death.

The process of unscrewing a bulb is the same but the consequences are different.

We need the dashboard lights on until we can find out what is going wrong under the bonnet and, if we don’t know what the lit dashboard light means, we need to find out, even if we have to trace the path of the wires to find out from which part of the car they come from.

Our body’s dashboard has many more lights than a car’s and we only know very little about what they mean. Unscrewing any of those bulbs can lead to consequences many years later.

Medication can be important and necessary. Symptomatic relief can be useful in order to give us a ‘breathing space’ so that we can start the process of repairing whatever is responsible for our discomfort and restoring balance in our organism.

Your body continuously tries to maintain or restore balance and health and all it needs is to be given a chance. In order to do this it simply needs the appropriate environment and raw materials that only you can give it. Our bodies and minds just need good nourishment.

Only you can stop or reverse the process of illness, only you can avoid what is harmful to your body or mind. You are more powerful than any medicine and any intervention.

When you use your mind, your have powers only limited by your imagination.

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