aches and pains

Pop a pill to kill pain

Your Health DR GITA MATHAI

Pain is something that everyone has felt at some time in his or her life. That unpleasant sensation is usually caused by an injury, which leads to release of chemicals that the local nerves pick up. They are then carried by the nervous system to the brain. Pain is protective. It signals danger, and alerts the body to try and avoid the stimulus that leads to it. Acute pain is usually due to an injury, infection or trauma. It lasts only as long as the condition is present. It responds to medication and treatment. Chronic pain on the other hand persists for weeks, months, even years. It may follow an attack of acute pain, (fracture, surgery), persist because of an untreated condition (sinusitis, ear or tooth infections) or incurable disease (arthritis, cancer). Some people may also suffer pain for a long time despite there being no history of injury or any sign of damage. Even doctors and clinical tests may be unable to find out its cause. Headache, backache, leg pain, sharp electric nerve pains and other chronic pains are commoner in older adults and women. Four to five per cent of the adult global population suffers from pain. It is the commonest reason for medical consultations across all specialties, as the patient picks and chooses consultants, depending on their perception of the diagnosis (back ache — orthopedics, headache — neurologist). Patients in constant pain lose manhours at work, are unable to concentrate, feel depressed and lethargic and suffer from insomnia. Their efficiency and productivity are affected. They feel that their lives are out of control. Pain is of several types, superficial, deep, visceral, spasmodic or neuropathic. It is treated with a group of drugs called analgesics. Many are available OTC (over the counter) and do not require a doctor’s prescription. Some are even advertised. Patients often self medicate with inappropriate analgesics in inadequate or excessive dosage but you have to remember that the same medication does not work for all pain. It is best to consult a doctor who can make an educated choice of medication. More than 60 per cent of the patients who approached doctors for pain relief improved, and had fewer side effects compared to the less than 40 per cent of those who treated themselves. Treatment for pain starts with the lowest dose of the mildest agent and the analgesics should gradually be increased step by step. Once the maximum dose is reached, another group can be added or the medication changed. The safest drugs are paracetemol, salicylates and NSAIDs (non-steroidal anti-inflammatory agents). For best results, the prescribed dose and the time between each dose should be followed meticulously. Do not supplement prescribed painkillers with OTC drugs or herbal preparations as all of them may actually contain the same ingredients. Then the total dosage may unknowingly exceed the safety limits and produce dangerous side effects. All these drugs can cause gastric irritation and prolong bleeding time. Long term use can result in aggravation of ulcers, liver and kidney toxicity. Hearing loss can occur subtly and be gradually progressive. The next group of drugs is the COX inhibitors. Various derivatives are available but across the board, they have been associated with deleterious effects on the heart. Opioid derivatives like tramadol, codeine and morphine are effective but can be addictive. The traditional analgesics may not work satisfactorily for “nerve pain”. To be effective and reduce the stimulus to the nerves, they may have to be combined with medications traditionally considered antidepressants or anticonvulsants. All painkillers (even aspirin and paracetemol) can be habituating, with higher doses gradually required to produce the same effect. They can be addictive as well. Before starting medication try a few simple remedies. Chronic pain (particularly arthritis and back pain) responds to topical applications of ointments containing capsaicin, ibuprofen, diclofenac or menthol. These need to be gently applied over the affected site every four hours, followed by an ice pack. Yoga, acupressure, Tai chi and meditation are traditional but effective methods to reduce pain perception. Physiotherapy helps with mobility and pain relief. Bio-feedback techniques can be used to alter pain perception and trick the body into feeling that the pain has disappeared. Exercising regularly — walking, jogging, running, cycling or swimming — teaches the body discipline and enables it to work through pain and fatigue. It has also been proven that exercise can prevent many of the diseases responsible for chronic pain. Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in

heart aches

Take care of your heart Your Health DR GITA MATHAI Heart attacks are responsible for 25 per cent of deaths in India. By 2020, 50 per cent of people with heart disease all over the world will be Indians. Unlike in the developed countries where older people are affected, in India the young — many in their early thirties — are cut down by heart attacks. Women were traditionally considered protected by their hormones till menopause but today, the number of “attacks” in premenopausal women is steadily rising. Women tend to have atypical pain with heart attacks. Any symptom is unfortunately taken less seriously than in men. They are also less likely to reach an appropriate hospital in time. This makes them more prone to die during the first attack. Even when women reach for treatment, their ECG and angiogram may not show typical blocks. Their blood vessels are also smaller in size. Earlier, the results of cardiac intervention in women did not do as much good as in men. Now, this problem has been rectified. The instruments and stents are smaller in size and the outcome has improved. Certain visible body changes are associated with an increased risk of developing heart disease. In almost 50 per cent there are small yellowish white lumps called xanthelesmata around the eye or the elbow. The earlobe may have a vertical crease on one or both sides. Obesity is a definite risk factor. The body stature is different in Indians so even relatively thin individuals have a “tummy”, indicating a high waist hip ratio. To determine the waist to hip ratio, use a measuring tape to measure the circumference of your hips at the widest part of your buttocks and your waist at the smaller circumference, usually just above the belly button. Then divide your waist measurement by your hip measurement. Abdominal obesity exists when the waist-hip ratio is above 0.95 for males and above 0.80 for females. The ideal BMI (body mass index) is not 25 (the value internationally) in Indians but 23. The BMI is calculated by measuring the height in metre squared and dividing it by weight in kg. Ideal body weight is, therefore, height in meter squared multiplied by 23. Many Indians carry the “thrifty gene”, a small change in chromosome 3q 27. This helped store fat during seasons of plenty and use it during times of famine. We do not have to face famine situations now —thanks to better availability of food, government distribution and storage facilities — but the gene still works to conserve calories. This predisposes the affected individual to obesity, insulin resistance, diabetes and heart disease. Abnormal lipids with elevated cholesterol, triglycerides and altered ratios in lipoproteins cause deposition of fat plaques in the blood vessels. These may obstruct the blood vessels in the heart, brain or even in the limbs. The blood supply is compromised and heart attacks and strokes are the result. This tendency can also be inherited. The interplay between inherited tendencies and manifestation of disease is a complex one. The expression of the unhealthy genes mentioned above can be modified by the environment (food availability and family habits) and lifestyle. Children have to be taught from a young age to eat 4-6 helpings of fruit and vegetables instead of snacking on high calorie foods like potato chips, cream biscuits, iced cakes and aerated sweetened beverages. Oil consumption should be reduced to half a litre per person a month. Palm oil, coconut oil, butter, ghee and other saturated oils should constitute only seven per cent of the total intake. Refined flour and cereal should be substituted with whole grain products (atta instead of maida, red rice instead of white). Eating should be a focused activity. It should not be combined with distracting activity such as reading or viewing television. This is because the satiety signals from the brain are interfered with. More food will be eaten than required. Eating out is also fraught with danger. The food served may be more than required and unnecessarily oily. Since we are taught from a young age not to waste food, we tend to eat everything ordered even when we are not hungry. Smoking (active and passive) is a definite risk factor, which increases all others. Exercise makes the heart work harder, utilising its maximum capacity. The rhythmic contractions force blood vessels open and improve blood supply. New connections are forged in compromised vessels. Walking briskly for 40 to 60 minutes a day will achieve these benefits and modify many of the detrimental effects of inherited bad genes. “No time” for regular aerobic exercise will result in a lot of time for heart disease. Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in Share on emailShare on printShare on facebookShare on twitterMore Sharing Services