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Pain Relief-Muscle Relaxers
The anti-gravitational force created by posture-controlling muscles and general muscle tone is the most important factor for back health. Trauma, nutritional deficiencies, birth defects (like spina bifida), osteoarthritis, polymyalgia rheumatica etc appear in a relatively rare number of cases. Scientific medicine claims that the majority of backache cases originate from the discs and joints of the spine. Muscular and ligament sprains or inflammation form the second largest group of backache. If the anti-gravitational force in the living body is what determines the state of delicate spinal structures like joints, discs etc, the lack of it leading to backache and other related problems, then why haven’t we looked at this over the centuries? Why did medicine go in the direction of treating symptoms only (pain, inflammation, nerve damage, scoliosis etc)? A branch called ‘orthopaedics’ (which someone once suggested to me translated as ‘bone setting’) was created, aimed at treating bones, joints and related hard tissues, which actually have hardly any primary role to play in the genesis of back-related problems. The bones and nerves are the final sufferers or victims of the weakening of another system, namely the muscular system, part of which, in a conscious state, produces an upward thrust that maintains the erect posture. This part of the muscular system is less voluntary and more involuntary, like the diaphragm muscles. Therefore, exercising it requires special skills as these muscles are under dual control, unlike skeletal muscles which are controlled entirely by the conscious brain.
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Pain Relief-Muscle Relaxers Opium is a herbal remedy with an even longer history than willow bark. Like aspirin, it has spawned hundreds of descendants, so aspirin and opium together are responsible for at least 95 per cent of the analgesic medicines used today. Unfortunately, unlike aspirin, opium has gathered a disgraceful public image since Victorian times. For three thousand years, opium was used to produce sleep and dreams, the origin of the phrase ‘pipe dreams’. Although opium and its derivatives, morphine and heroin, have become associated in the puritanical mind with misuse by social drop-outs, opium was used for centuries as a means of relaxation. Robert Clive, who conquered and organized India for the British, adopted the local custom and used opium regularly for the rest of his life. Where the harried New York businessman may drink his evening Martini to relax, his equally powerful Chinese rival in Singapore smokes his evening opium pipe for the same purpose.
By the nineteenth century, physicians had begun to realize that opium was not just a way of knocking out patients into a nearly unconscious state. By this century, it was finally realized that low doses had a purely analgesic action while leaving the patient thinking in a clear fashion. The advance can be attributed to Dame Cicely Saunders, who invented the hospice movement for the care of terminally ill patients. She and her colleague Robert Twycross decided to combine the best of modern medicine with age-old tender loving care to bring comfort to cancer patients who became dominated by their pains in the anxious shambles of their last weeks.
Doctors up to that time had joined the generally held opinion that narcotics were dangerous and that comfort was brought at the price of addiction to rapidly escalating doses, which led to killing the patient. A cool, calm analysis of the effect of narcotics demolished this view and showed that doses carefully titrated to bring down pain to a bearable level led instead to a patient in comfort with clear thinking. The success of carefully controlled and monitored narcotics for the benefit of cancer patients in pain spread to other problems, such as the control of postoperative pain and pain in childbirth.
The variable herbal mixture of opium was analyzed into its constituent components in the nineteenth century. The most powerful fraction was found to be morphine, which was synthesized, while a weaker component, codeine, was also found to be effective against less severe pains. This discovery set off the expected search for related compounds in the hope that one could be found which was a pure analgesic, which could not be misused as an addictive social toy, and which would not stop the patient breathing when high doses were given. The 150-year search for this pure analgesic has failed, but that has not stopped the drug companies from trying. If you enjoy black humour, you may be interested in the late nineteenth-century discovery by the Bayer Company of a morphine derivative which they named ‘heroine’ as a particularly powerful narcotic that they claimed was free of an addiction potential. How wrong can you be!
Work in the past century has generated hundreds of compounds with slightly varying properties but hugely varying potency. One, called etorphine, is 10,000 times more potent than morphine. This is the drug used in darts by wildlife experts to immobilize big game. I have made it a personal rule never to remember drug doses because it was always safest to look up the dose. However, I make an exception for etorphine, for which the dose for elephants is one milligram per ton. A large elephant gently lies down if shot with a syringe containing 3.5 milligrams of etorphine. Once the veterinarians have done their job, the same dose of an antagonist is injected and within minutes the elephant stands up and wanders off with a puzzled expression.
Not surprisingly, a drug effective as a narcotic always has unwanted effects even if it is used as an analgesic. Narcotics produce constipation, and opium has been used for centuries to control diarrhoea by taking advantage of this side effect of gut paralysis. High doses of narcotics depress respiration, so weak narcotics such as codeine are included in most cough mixtures. When pain fails to respond to one of the aspirin-like drugs, it is common to move the treatment to a mixture combining an aspirin-like component with a weak narcotic. The widely advertised strong painkillers which are available over the counter contain these mixtures. Much commercial and scientific ingenuity has gone into inventing mixtures that will optimize the desired effect and reduce the unwanted ones.
Only in the past twenty years has the rationale for the use of narcotics against pain become apparent. This was revealed in a series of very surprising steps. First, Tony Yaksh in the United States searched the brain by giving small, localized injections to discover where morphine was acting to reduce pain. He found two areas, one in the midbrain, the other in the spinal cord where sensory messages were arriving from the tissues. Next, Kosterlitz in Aberdeen, as described before, ended a fifty-year search by discovering that the brain was itself producing its own narcotic-like substances. These endorphins, as they are known, were made by nerve cells which were particularly concentrated in the two target areas discovered by Yaksh. Finally, Snyder found that the brain also made special protein receptors which snapped up narcotic molecules and changed the excitability of the nerve cells on which they resided.
With this series of discoveries, it was possible to put together a most curious story. In the first place, the brain contains its own system for controlling the arrival of pain-producing messages. One part of this system exists as a barrier zone in the spinal cord where the sensory nerve fibres enter. The other part exists in the midbrain, from which region control orders descend into the spinal cord and further reduce the incoming message. When narcotics are given as a medicine, they penetrate the brain and stimulate the very system which the brain uses to control its own sensory input. There was an immediate practical consequence of the discovery of the location of the pain control systems. Because the spinal cord was one site of action, and because it is simple to make a needle penetrate to the surface of the spinal cord, it was possible to apply morphine precisely to the site where it is carrying out its useful action. This has grown into the widespread use of epidural narcotics, where a strong analgesia can be produced in an area of the body with a dose ten times smaller than that needed if the whole body is treated by tablets or injections. Because this targeted dose is small, the side effects, produced by the effect of narcotics on distant parts of the body, do not occur.
Cannabis is another herbal remedy with a terrible social reputation. It is going through a surprising revival as a therapeutic analgesic, which repeats with a gap of twenty years the story just described of the emergence of narcotics from being drugs of social menace to ones of therapeutic value with rational understanding. Cannabis has been used for millennia as folk medicine for poorly defined problems and for social entertainment. Queen Victoria used tincture of cannabis for her period pains. In this century, patients began to report beneficial effects of low doses of cannabis in very specific conditions including nausea and pain in multiple sclerosis. In the hostile social atmosphere, where the use of cannabis and narcotics were equated with abuse by inadequate people, these reports were dismissed or ignored.
In the meantime, scientists were at work with the traditional series of investigations like those into opium. Cannabis was purified by Meshulam in Jerusalem and found to contain a series of active compounds called cannabinoids. It was found that the brain itself was normally producing cannabis-like compounds. Finally, to round off the progress which imitates the investigation of narcotics, special receptors tuned to react specifically to natural and synthetic cannabinoids were found to be widespread in the brain and body tissues. While cannabinoids are at present only used in legal practice to control certain types of vomiting, it seems highly likely that they will also emerge to control some pains.
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Men's Health-Erectile Dysfunction By fundamental equality is meant not deadening uniformity, but agreement in those traits of character which ordinarily form the basis of friendship. In other words, in order for a marriage to be happy, a pair must not be merely lovers but also friends, in the deepest sense. There is a popular saying that opposites attract one another. In the first place, this is generally not true. In the second place, if it should happen to be true in a particular case, the person who feels such an attraction is foolish to heed it. While one cannot deny that a certain amount of diversity is stimulating and pleasant, yet the fact remains that most friendships, especially durable ones, are based on a community of interests, tastes and ideals. The same is true of successful marriages.
One cannot despise the taste, deplore the ideals or be bored by the interests of a wife or a husband without finding that this lack of communion is carried over into the romantic relationship also. Before marriage the overwhelming urge toward unity, which is the sublimation of the inhibited sex impulse, makes all differences sink into insignificance. But after marriage, when sexual inhibitions and the consequent illusion of unity are removed, the differences assert themselves and eventually may destroy all the love which temporarily submerged them. As Dr. Joseph Collins says, a young woman who likes poetry and music should beware of a young man to whom these have never appealed, but who, under the spell of love, says that he knows he would enjoy them with her. After they are married, he will read the sport page, as before, not poetry, and when she wants to go to a concert, he will prefer to stay home and play poker. And this divergence in taste may in time alienate them from one another—literally make them strangers to one another, though living under the same roof.
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