Dr James Le Fanu: 30 August
Pain is one of God’s great gifts, eliciting so rapid a protective response it has no time to pass through our conscious minds before, pulling the hand away from the stove, we thrust it under an anaesthetising jet of cold water. And when the threat is less immediate, the pain bres continue to issue their unambiguous orders until the cause is sorted out. Without the gift of toothache there would be no incentive to visit the dentist.
And yet pain is also the gift that nobody wants. When the nerve bres are damaged, their bene cial protective role is transformed into its antithesis, a life-sapping and burdensome discomfort.
There are two main types of this chronic pain. In the rst the explanation is obvious enough – the pain bres are damaged or compressed by, for example, a prolapsed intervertebral disc in the spine. More difficult to deal with are the ‘chronic pain syndromes’ in sensitive parts of the body such as the face or genital organs.
Still, the prospect of controlling these syndromes is vastly better than just 20 years ago. The drugs are better and one in particular, gabapentin, usefully alleviates so-called ‘atypical’ facial pain or the peripheral sensory neuropathies of legs and feet.
Next, after initial scepticism, doctors have belatedly acknowledged the bene ts of acupuncture. ‘While waiting to be seen in the casualty department at Northwick Park Hospital, the consultant treated a man with shingles-induced neuralgia of such severity he had been unable to sleep for a week,’ a reader informs me. ‘We gathered round and watched him inserting the needles in the patient’s hand and leg. In 10 minutes his pain had gone. It was amazing.’
Now virtually every hospital has its own pain clinic where anaesthetists with carefully placed injections can block the action of individual nerves. Still, it would be quite wrong to suppose the problem of chronic pain will ever be truly solved – and it is always useful to learn how others have managed in such situations.
An American author, Arthur Klein, himself a martyr to low back pain, had the ingenious idea of asking 1,000 chronic pain su erers what ‘works for them’ – and they rated the various options most interestingly. Thus exercise gets an ‘excellent’ rating (‘few live active lives without exercise playing a key role in their recovery’) as does biofeedback, cold and heat therapy, yoga and t’ai chi.
By contrast, the more conventional medical treatments such as electrical stimulation and analgesics are perceived as ‘poor to fair’.
This week’s medical query comes courtesy of a lady from Norfolk who about five years ago developed a chronically sore tongue. Her family doctor investigated all the obvious possibilities, such as vitamin B12 deficiency, to no avail. Then suddenly after a year, it vanished.
To her dismay it recently recurred. ‘There are no ulcers; eating temporarily relieves rather than aggravates it and mouthwashes provide only temporary relief,’ she writes.
The most likely explanation for a sore tongue where there is nothing abnormal about its appearance, is sensitivity to food or chemicals. The two main culprits are the preservative benzoate found in processed foods with the E numbers E210-19, and the chemical sodium lauryl sulphate (SLA) found in toothpaste.
Email drjames@lady.co.uk
And yet pain is also the gift that nobody wants. When the nerve bres are damaged, their bene cial protective role is transformed into its antithesis, a life-sapping and burdensome discomfort.
There are two main types of this chronic pain. In the rst the explanation is obvious enough – the pain bres are damaged or compressed by, for example, a prolapsed intervertebral disc in the spine. More difficult to deal with are the ‘chronic pain syndromes’ in sensitive parts of the body such as the face or genital organs.
Still, the prospect of controlling these syndromes is vastly better than just 20 years ago. The drugs are better and one in particular, gabapentin, usefully alleviates so-called ‘atypical’ facial pain or the peripheral sensory neuropathies of legs and feet.
Next, after initial scepticism, doctors have belatedly acknowledged the bene ts of acupuncture. ‘While waiting to be seen in the casualty department at Northwick Park Hospital, the consultant treated a man with shingles-induced neuralgia of such severity he had been unable to sleep for a week,’ a reader informs me. ‘We gathered round and watched him inserting the needles in the patient’s hand and leg. In 10 minutes his pain had gone. It was amazing.’
Now virtually every hospital has its own pain clinic where anaesthetists with carefully placed injections can block the action of individual nerves. Still, it would be quite wrong to suppose the problem of chronic pain will ever be truly solved – and it is always useful to learn how others have managed in such situations.
An American author, Arthur Klein, himself a martyr to low back pain, had the ingenious idea of asking 1,000 chronic pain su erers what ‘works for them’ – and they rated the various options most interestingly. Thus exercise gets an ‘excellent’ rating (‘few live active lives without exercise playing a key role in their recovery’) as does biofeedback, cold and heat therapy, yoga and t’ai chi.
By contrast, the more conventional medical treatments such as electrical stimulation and analgesics are perceived as ‘poor to fair’.
This week’s medical query comes courtesy of a lady from Norfolk who about five years ago developed a chronically sore tongue. Her family doctor investigated all the obvious possibilities, such as vitamin B12 deficiency, to no avail. Then suddenly after a year, it vanished.
To her dismay it recently recurred. ‘There are no ulcers; eating temporarily relieves rather than aggravates it and mouthwashes provide only temporary relief,’ she writes.
The most likely explanation for a sore tongue where there is nothing abnormal about its appearance, is sensitivity to food or chemicals. The two main culprits are the preservative benzoate found in processed foods with the E numbers E210-19, and the chemical sodium lauryl sulphate (SLA) found in toothpaste.
Email drjames@lady.co.uk