SLEEP AND PAIN: NON-MEDICATION CURES FOR INSOMNIA

Exercise Vigorous physical exercise in the afternoon or early evening (not too close to bedtime) has been shown to increase the portion of time spent in the deepest stages of sleep. You may not sleep more but you may well sleep better after exercise.

Schedule Set the same time for sleep each night and stick to it rigidly. It may help to prepare yourself for bed with a bed-time ritual, such as a bath, a glass of milk, etc., at the same time each night.

You should also set a wakeup time and stick to this, no matter how little you slept that previous night. It is very tempting to sleep in when you’ve been awake half the night, but this only increases the chances you won’t sleep the next night.

Naps These usually increase the problem of insomnia. They should generally be avoided by those with insomnia until their sleep has become regulated. On the other hand, a twenty minute period of napping, relaxation, meditation or yoga can help reduce the tensions, pain and discomfort of the day for many, and can enable them to resume tasks with renewed energy.

Stimulants No coffee or tea after the evening meal. You should also avoid chocolate or caffeine containing soft drinks until you have assessed their role in keeping you awake. Proprietary soft drinks such as CocaCola and TAB contain amounts of caffeine sufficient to interfere with sleep in those with insomnia.

Don’t fight it Many people drive themselves into an absolute frenzy — rolling and tossing all night in a largely futile attempt to force themselves into sleep. It may help to make a rule for yourself that if you are not asleep within 15 minutes, leave the room and do something restful.

Reading, knitting, doing jigsaw puzzles or listening to quiet music are all useful but, should always be done outside the bedroom. Loud music, exciting television programmes or suspenseful books should be avoided because they increase the level of mental arousal and consequent adrenaline production. They may also be hard to leave.

When you feel the slightest amount of drowsiness return to your bed. If you are not asleep within 15 minutes get up and leave the bedroom again.

Bedroom* are for sleeping And loving. Nothing else. Using the room for paying bills, doing homework or arguing can prevent the room from being a comfortable refuge in which you automatically relax.

Avoid habituating drugs Wherever possible avoid those drugs which are potentially addictive. This is more difficult for those with chronic pain who are offered barbiturates containing medications such as Nembudeine by doctors who still believe that they are safe. Nembudeine is one of the few drugs containing barbiturates available in Australia.

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SOME POINTS OF SPECIFIC PAIN CONTROL TECHNIQUES

• You can be asked under the hypnotic state to imagine going backward in time ‘to a time long ago, before any pain or discomfort, when you were full of energy and had a sense of complete well-being — and, when you return to the normal waking state, you will feel again that same sense of well-being. ‘ Hypnotic distortion of time can be used either to lengthen periods of discomfort or to apparently shorten periods of intense pain: ‘As a result of your new capacity to relax, time will now seem to fly whenever you experience periods of intense pain. On the other hand, time will move very slowly indeed with every second stretching out so that you can enjoy those periods when discomfort is at a minimum and so use them as positively as possible.’

• Other techniques involve asking you to transform your pain into a visual image that can be manipulated in the imagination. ‘Now see your pain. What shape is it? A triangle? A circle? Perhaps a pyramid or a cube? See its colour? Is it red? Yellow? Purple? Perhaps another colour? Now change the shape and colour. The new shape and colour are definitely not compatible with your pain.

Or the red balloon image: ‘Imagine you’re out in an open green field somewhere. It’s a beautiful day. The sky is a brilliant blue. Wisps of fleecy clouds drift lazily by. Near you, tethered by a rope attached to a peg on the ground, is a large red, helium-filled balloon. There’s a large wicker basket hanging beneath it. Now, imagine that you’re loading into the basket all of your pain and discomfort. You now free the balloon from its peg, allowing it to float into the air. See how vivid the rising red balloon looks against the blue sky.

The balloon is disappearing with all of your pain and discomfort.’

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NEUROSURGERY: UNNECESSARY PROCEDURES

The implantation of spinal stimulators and even deep brain stimulators are examples of the merging of technology and that most sophisticated of neurochemical devices — the human brain and nervous system.

However, all too often patients are subjected to unnecessary and sometimes harmful procedures because pain is still thought of in a very simplistic way. In some cases the operation is done technically with brilliance but still fails to resolve the suffering. It must always be remembered that surgery once performed is difficult to reverse.

Neurosurgeons may be involved in the treatment of such difficult pain conditions as phantom limb pain, trigeminal neuralgia and central pain following strokes.

The major involvement of neurosurgeons together with anaesthetists at pain clinics is to perform nerve blocks — or to cut nerve pathways when there is no other choice. In many cases, patients obtain temporary pain relief. With the onset or recurrence of pain six months later, the problem is again posed as what to do to help such patients.

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MEDICATION IN USE OF PAIN TREATMENT: ANTI-EPILEPTIC MEDICATIONS

Anti-epileptic drugs have been consistently used over the past twenty years, particularly for the treatment of facial pain.

The most severe cause of facial pain is trigeminal neuralgia. The more commonly used anti-epileptic medications such as Dilantin and Tegretol have been found to be useful in treating this painful condition and also the pain associated with shingles.

Rivotril, which was included in the minor tranquilliser group, is more commonly used as an anti-epileptic drug.

These medications have been used successfully in many of the painful states associated with nerve damage, such as RSI and the central pain that sometimes follows ‘strokes’ (cerebrovascular accidents). Central pain is thought to be due to the damage to the normal pain control centres in the brain and the brainstem.

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