28 MarThe politics of pain management

Doctors make a general distinction between acute pain from an injury that’s going to heal or disease that’s going to be cured, and chronic pain where you will be forced to deal with pain over a long period of time. So, for acute pain, all you need is a few pills and patience while the pain slowly fades away. Chronic pain should have a different approach but, for the following reasons, doctors prefer the pill bottle. If you look at the way the US healthcare service is organized, the basic motivation is making a profit. Because most patients carry some insurance, the strategy for doctors is to see as many patients in the day as possible so they can maximize the bill presented to the insurers for payment. In the good old days, a caring physician would take the time to get to know the patient and understand his or her needs. Now it’s straight to the business of writing out a prescription and calling for the next patient. Very few doctors ever take the time to investigate the underlying causes of the pain and find the best treatments because this takes time and time is money. Of course, the patients with the top-of-the-line insurance plans are covered. And the wealthy can afford to pay their own way to the best treatment. But the average citizen is on a conveyor belt to the fastest and easiest treatment which, by some strange coincidence, just happens to be a drug.

Why a coincidence? Because all the ads you see on television and in the newspapers and magazines, are paid for by the pharmaceutical industry. The corporations making the drugs are using hard-selling techniques to reinforce your dependence on pills as the primary form of treatment. That way, you go into your doctor’s clinic with the brand names of the relevant drugs on your lips. You are brainwashed into thinking the use of drugs should be the first response to all your problems. Why is this a problem? Because it’s turning the US into a country of addicts. Worse, as people continue to use many of the drugs, their tolerance increases and the effectiveness of the drugs declines. According to the National Centers for Health Statistics, approximately 75 million people in the US suffer some degree of chronic pain, i.e. pain giving them a poor quality of life. Agreeing, the American Pain Foundation offers a simple comparison. If you count up all the people who have cancer, strokes and heart disease every year, only a million or so die every year, but the pharmaceutical industry, hospitals and clinics devote vast amounts of time and money to offering treatments. Because there’s not the same amount of money to be made out of people suffering chronic pain, you are offered second-best service.

This is a political problem and, so far, there’s no sign the reform bills going through the House and Congress will deal with this. It all comes down to the priorities of how limited money is to be spent. On the one hand, you can be offered painkillers on a take-it-or-leave it basis. This is not so bad. Tramadol is an excellent drug and gives consistent relief from moderate to severe pain. Or you can be offered access to proper diagnosis and treatment. While we wait for a revolution, buy tramadol and find some relief from the pain of your condition.

04 MarNo phentermine for weight loss during pregnancy

According to Sarah Palin, the European healthcare service operates like the Canadian cull of seals. On a regular basis, men armed with clubs go out among the unhealthy and older members of society, and put down those who no longer contribute to the strength of the group. Death panels decide who shall live and die. That means, by her standards, one of the leading panels is UK’s NICE – the National Institute for Clinical Excellence. This group of so-called experts draws up guidelines to be used by the medical profession. Whenever there is good research evidence that a particular treatment is effective, it is incorporated into the national practice standards. But if a given treatment or drug is not shown effective, the medical profession and hospitals are instructed not to use them. So, many of the procedures that are standard in the US are not allowed in the UK, and many of the drugs routinely prescribed in the US are either not available in the UK or only available if the patient pays privately. Despite this, people in the UK live longer and enjoy better health than Americans.

Anyway, NICE has just launched a consultation process to decide what advice to give pregnant women about weight loss. If you want to offer an opinion, you can do so during the next month through http://guidance.nice.org.uk/PHG/Wave18/3. NICE offers the opinion that women do not need to increase the amount they eat during the first six months of pregnancy. The idea that pregnant women are “eating for two” is a myth. The most needed is an extra 200 calories a day during the last three months. That said, it is always better for women not to get pregnant if they have a BMI of 30 or more. This is not to suggest there is a high risk to the fetus. But the evidence shows there are fewer complications during pregnancy if women lose weight before getting pregnant. In general, trying to lose weight during pregnancy is not advisable. Stability and consistency of behavior are more important. That means women who routinely exercise before pregnancy should continue. Finally, women should not be misled by celebrities who slim dramatically after giving birth. It is better to lose weight gradually. Even so, there is no evidence that the quantity or quality of milk is affected in women who do crash diet after giving birth. NICE simply suggests women do what feels right for them. If they are tired, they should rest. Hopefully, they are eating a healthy diet anyway. As long as they get back to their pre-pregnancy weight at some point, this will be good for their long-term health.

There have been no tests performed in the UK or the US to determine whether it is safe for women to take phentermine hcl during pregnancy. So applying the precautionary principle, it better if you do not take this drug during pregnancy unless your doctor has specifically approved it. What can be said with certainty is that the active chemicals do enter the mother’s milk and can have an adverse effect on nursing babies. Thus, if you do want to lose weight after giving birth, do not buy phentermine online and take it while breast-feeding. You should either wean the baby or find another drug that suppresses your appetite without endangering your child.

28 FebWhat is better for muscle pain treatment: massage or Skelaxin?

We have to start with a slight problem of definition. The practice of massage varies significantly between different cultures. In some countries, it is not considered a part of medicine but serves a more social purpose, designed to improve mood and help people relax. In other countries, massage is fully integrated into the healthcare service as one of the many possible processes of physical therapy. In the US, massage would be considered a complementary or alternative medical treatment, i.e. it serves as a back-up to conventional medicine. Thus, when combined with other treatments, massage therapy helps to improve the mobility of joints, reduce swelling, ease muscle spasms and reduce pain. In accepting massage, the US medical profession is recognizing patients can get the best of both worlds: the healing powers of Western science and the more spiritual and relaxing powers of Eastern wellness. Massage is therefore increasingly made available to treat both physical conditions causing neck and back pain, nerve pain, etc., and also mental disorders such as anxiety, stress-related insomnia, etc.

In accepting massage in its hospitals, the US healthcare service is opening itself to the increasing body of scientific evidence showing massage as an effective treatment. Until a few years ago, the medical profession resisted holding clinical trials to test “alternative” remedies. Such studies as existed in other countries were treated with some contempt. Massage was nothing more that an indulgence in high-priced spas. Now the manipulation of the soft tissues by a skilled therapist is acknowledged to reduce physical pain, relieve stress and bring down blood pressure. The methods differ depending on the purpose of the treatment. In general, the therapist will press, manipulate and rub the relevant parts of the body. Most techniques rely on the use of the hands and fingers, but others use the forearm, elbow and, in a few cases, the feet. The pressure may be light and involve gentle stroking. Or it can involve the use of significant pressure to knead and reach down to deep layers of muscle.

If you are experiencing muscle spasms, i.e. an involuntary contraction like cramp that persists, the combination of massage therapy and the use of a muscle relaxant like skelaxin has been found particularly effective. This most commonly occurs in the back, buttocks and legs. It may be from a physical cause such as a herniated disk or sciatica with pain radiating from the nerve. The manipulation of the disk can rapidly reduce pain and improve mobility. As the more acute symptoms are relieved, the drug will ease the problems in the muscles and reduce the risk of further spasms. In the case of sciatica, more aggressive treatment may be required in the use of steroids or, if the pain does not subside, surgery. But, in all this, the therapist will be able to guide you through the process of relieving the acute symptoms and planning a rehabilitation regime to reduce the risk of the problems recurring. At this time, it is most useful if your doctor and the therapist work as a team. That gives you the best advice on the use of prescription painkillers and drugs like skelaxin, while receiving comprehensive physical therapy. It delays treatment and can lead to misunderstandings if you constantly have to move between different hospital or clinic departments.

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