СИНДРОМ ХРОНИЧЕСКОЙ БОЛИ-CHRONIC PAIN SYNDROME

A current trend is to discuss holistic medicine as if it were something new, invented by alternative practitioners of the Seventies and later. Some people even seem to think that holistic medicine is a new approach, in comparison with orthodox medicine, which is deemed dry, mechanical and unrelated to real life.

In fact, nothing could be further from the truth. Orthodox medical doctors have known for a long time that your genetic make-up, your working environment, your marriage, your hobbies, the chemicals with which you’re in contact, your thoughts and your concerns, in fact, your whole lifestyle, are all intimately bound up with whether you feel well or ill. Holistic, in terms of medicine, means caring for the whole person – mind, body and spirit. It is not the form of medicine that is holistic, but the attitudes and views of the practitioner – orthodox, alternative or otherwise.

This point is very important, especially for headache sufferers. Good orthodox medicine is holistic, too. It’s all about treating the whole person, not just little bits of him. You don’t have a headache in isolation. You are a person with a headache, and in order to understand and treat that headache we need to look at the whole of you, not just the bit from the neck up. Orthodox and complementary treatments all have their place in assessing and treating that headache.

There is a second reason why it is so important to consider all aspects of you and your condition – many people don’t have headaches from just one single cause. Usually there are a lot of different reasons, and their effects all multiply together. Perhaps, you’ve identified the cause of your own headache as cervical spondylosis. But, if you look more closely, you’ll find you get other headaches as well – those caused by tension, for example (a common fellow traveller with cervical spondylosis). Maybe you get the odd migraine, too, and of course there’s the pain from that whiplash accident you had ten years ago, to say nothing of the fumes that you get from the old jalopy you drive, and the mid-life crisis you’re currently going through …

It’s vital to emphasise the degree to which all the various causes of headache are interlinked and inter-related. Some are so tightly bound together that its almost impossible to disentangle them; for example, arthritis in the neck is almost inevitably accompanied by reflex muscle spasm, which gives tension headaches.

This is where true holistic medicine comes in, and by this I mean medicine which looks at every single aspect of the individual. In dealing with headaches it’s important to recognise that both orthodox and complementary medicines may have a part to play; that environmental, working and living conditions are important; that psychological, social and spiritual factors are involved.

With a bit of luck, you’ve now worked out what is the main cause for your own headaches. Or, to put it more accurately, you have probably found a number of things that interact, and you’re not yet certain which of them is the real culprit.

The answer, of course, is that you needn’t try to find one culprit; all the various triggers may have an effect on you. You don’t need to worry about whether you’ve mainly got a tension headache or whether there’s a bit of migraine there as well. Instead, accept all these as possible diagnoses and go to work on each of them, one at a time.

Headaches have a nasty habit of not just adding together, but multiplying each other. It’s surprising how often a small problem – such as a worn-out joint in the neck – can have such amazing knock-on effects. Maybe the amount of stress that you’re under wouldn’t normally give you a headache, except that having a worn-out joint multiplies the effects of the tension on your neck muscles, so that even a small amount of stress manifests itself as pain, which in turn will give more spasm, which gives more pain … It’s important to look at each and every one of the possible causes of your headache and try to deal with each of them, however minor each may appear to be.

In some cases, there will be one major cause for your headaches, plus a few minor ones, in which case removing the major cause may clear up the problem entirely. On the other hand, where there is no clear-cut single cause, the best treatment consists of trying to remove or minimise as many of the contributing factors as possible. You will probably find there comes a point where you have reduced the level of insult to your head and neck below the threshold for causing pain, and suddenly your headaches go away – or at least become manageable, which is half the battle.

*142\20\2*

Treatment of menopausal symptoms is by replacing the oestrogen. Almost as soon as this is done, any true menopausal symptoms will disappear.

Oestrogens are powerful drugs and, used on their own, they can cause cancer of the womb to develop. But don’t be alarmed, there’s a simple way to get around this. Adding progesterone during the second half of your cycle removes this extra chance that you will get cancer of the womb. If you still have a womb in place, then you will need oestrogen and progesterone; if your womb has been taken away then you only need oestrogen.

What are the benefits and problems associated with hormone replacement? Firstly, the menopausal symptoms go – all the physical and mental symptoms improve and there is often a feeling of well-being where previously there was a vague sense of malaise. Secondly, as the normal drop in oestrogen at the time of the menopause causes the bones to lose calcium, artificially prolonging the time the bones are exposed to oestrogen keeps them stronger for longer, and in later life reduces the chances of developing osteoporosis or of getting a fracture.

Hormone replacement therapy also massively reduces the chance that you will get ovarian cancer and it may also reduce the chance of heart attack.

The drawbacks of HRT are that the periods return again and there is a possibility of an increased chance of breast cancer. Overall, the statistics are in favour of the HRT user. The chances of dying following a fractured hip, from ovarian cancer, or from heart disease are all reduced by a greater factor than the chance of getting breast cancer from having HRT. About five times as many lives will be saved through using HRT by comparison with those lost by HRT.

However, HRT has not been in use long enough for us to be certain that there are no long-term side effects. Although HRT is probably safe for the first five years, and may well be safe for much longer, the statistics are not yet entirely conclusive.

If you would prefer not to be on HRT, but would like treatment for some of the symptoms, the drug clonidine may help with hot flushes; and oestrogen cream applied locally to the vagina may assist with vaginal dryness.

*99\20\2*

It’s sometimes very difficult to know just where to draw the line between what is normal and what is abnormal, especially where mental processes occur. For example, tension and stress occur in all of our lives at some point – but although mentally we are wearied by them, the fact that we are tense or stressed doesn’t necessarily mean that our mental processes are abnormal. In fact, some stress is necessary constitutionally to our bodies. Nevertheless, excess tension and stress can make us ill, and if we don’t recognise and deal with it, we can become exhausted mentally or physically.

Anxiety is similar – undue anxiety can be an altered way of thinking, in which we get anxious and stressed without any external triggers. At this point anxiety becomes a psychological problem.

In practice, it isn’t easy to define the point at which these processes become part of illness behaviour. Tension headaches can occur in those who, psychologically peaking, are completely normal; in others, they can be part of an anxiety state. Therefore tension, stress, tension headaches, stress management, and relaxation techniques apply both to healthy and to psychologically unwell people. Don’t assume that because you’re stressed you necessarily have a psychological illness -you probably don’t. Nor should you think that because you get tension headaches you’re psychologically unwell; again you may well not be. However, if you are aware that your mental processes aren’t quite what you would like them to be, and that your anxieties or your inner turmoil are such that they, rather than tension itself, are the underlying problem, then read on.

There is a definite group of people who have headaches due primarily to Mychological illnesses. It is a gross misconception to say that these headaches are ‘all in the mind’. It’s all real pain; it’s just produced differently.

Some people have headaches that are entirely caused by muscle spasm from Biental tension, but there is often a mixed cause; any underlying neck injury will magnify, and be magnified by, the excess muscle tension caused through stress.

There is a second psychological cause for headaches, which is much more difficult to understand. This occurs when there is no apparent external source for the pain, and no muscle tension, either. It would be easy to think that pain like this really was all in the mind, but to the sufferer the pain is extremely real, as real as any other type of headache. We’ll come to this subject in more detail later.

*86\20\2*

Too much, or too little light can cause headaches. Factors such a the contrast of computer screens and the glare of sunlight are covered elsewhere on this book.

Fluorescent Lighting.

Although fluorescent tubes appear to be giving off a steady shadowless light, in reality they flicker one hundred times per second. Because the retina smooths out these little bursts of light, normally we’re not consciously aware of the flickering. However, this flickering still has a very special and very odd effect. When you switch your gaze from one point to another, the eyes move in a smooth line; however, if the fluorescent light is in its ‘off phase at the time you are about to look at another point in the room, your eyes can’t see it, and will overshoot it slightly. When the light comes on a hundredth of a second later, your brain realises that it’s overshot the mark and starts moving your gaze back again until it gets to the right position.

Therefore, under fluorescent lights your gaze is constantly overshooting and needs constantly to be corrected. Making these extra corrections is tiring on the eyes, and is one of the reasons why so many people find working under fluorescent lights irritating and tension-making.

There is a very quick way to stop this happening – double the frequency of the current in the lights. Then the fluorescent tubes flicker at two hundred cycles per second, which is too fast to allow the eye overshoot to occur. Working under fluorescent lights like this is much more restful, but lamps like this are more expensive than the ordinary sort.

*122\20\2*

Headache from fever occurs much more frequently in children, for two reasons. Firstly, an infection in a child usually causes a much higher fever than the same infection would in an adult: a mild viral infection producing a temperature of only 99.5° F (37.4° C) in an adult might produce a fever of 103° F (39.4° C) in a child.

Secondly, the higher the temperature, the more powerful the headache, and children get many more high fevers than adults. As we’ve just seen, part of this is because some illnesses produce high temperatures in children, and not in adults. But there is a second and more important factor at work: children are simply much more vulnerable than adults to being infected by the germs that are present in the community at the time. The reason is quite simple. A person is vulnerable to any illness he hasn’t met before, but once he’s had the infection, he develops immunity to it, so he can’t get it again. This is why (with very few exceptions) it’s only possible to have an illness like mumps once. After the initial infection the body recognises the mumps virus, and on every subsequent occasion that this virus tries to gain entry, the immune system locates and neutralises it.

Lastly, and very importantly, don’t forget meningitis is a cause of fever and headache. Meningitis is more common in children, so get into the habit of checking for a stiff neck every time your child gets a temperature. That way, if it is meningitis, you’ll be giving your child the best possible chance of getting over it. Meningitis in the very young doesn’t always give a stiff neck: a bulging fontanelle (the soft bit at the top of a baby’s head), vomiting, irritability and/or drowsiness, are among the things to look for. And remember that in meningitis immediate medical treatment may save your child’s life.

But meningitis is rare. Don’t get over-anxious about the possibility of your child having it. Just check that neck, routinely, each time he or she gets a temperature.

*109\20\2*