Health News. Lots of resources and medical information

Angus was an example of the way in which patience on the part of both patient and therapist can pay dividends in the battle to help ‘patients’ to become people again.

Angus, a 40-year-old Scot, was injured at work when his left leg was crushed between a reversing forklift truck and a delivery truck which was about to unload plumbing supplies.

He had initially been taken to a public hospital where the injury was assessed and was initially found to be a minor fracture. But his pain persisted despite what seemed to be adequate treatment with plaster of Paris, physiotherapy and pain medication.

During the next twelve months his pain became so severe that he was unable to return to his old job as a plumber. He found himself unable to climb ladders or to kneel. For him to get into any confined space was almost impossible. Angus described the pain below his left knee as being ‘constant, like a hot needle is sticking into my leg and feeling as though it’s surrounded by millions of pins and needles’.

When Angus discovered the pain clinic, he was found to be so depressed that it was decided to put him on high doses of the anti-depressant Surmontil, and to admit him to the inpatient programme.

Initially, Angus was not able to accept the fact that psychological measures could help ease his pain. He had already decided that his major problem was primarily physical — a trapped nerve at the site of the fracture.

In order to exclude this possibility, Angus was referred to a plastic surgeon who performed a small exploratory operation. It showed no sign of any such problem area.

While Angus was finally convinced of the absence of any treatable condition his depression deepened. He was experiencing such severe pain that it was decided to give him a course of intravenous procaine injections.

Angus continued the procaine injections together with effective doses of pain modifying anti-depressants and Rivotril over the next twelve months.

Then almost by chance Angus attended the pain clinic for a review and for repeat prescriptions of his medication. He had been using a single channel TENS unit for the past four years with only limited”benefits. He had to wear it switched on constantly in order to drive himself to the clinic or to attempt any physical activity. By chance, a new type of TENS type electronic stimulator was being trialled in the pain clinic. This machine — the Likon — had been spectacularly effective in the short period of time it was on trial. Although much less portable than the standard TENS units,the Likon was said by users to provide deeper pain relieving sensations than the other available stimulators.

Angus was given only 10 minutes treatment on the first day and experienced 4 hours of total pain relief for the first time in years. After two further trial sessions of up to 20 minutes he was so impressed he bought a Likon — even though it cost nearly $700.

Within weeks of purchasing the Likon Angus had sought and found a job in which he could use the experience of 20 years as a plumber without the need to go onto building sites. His new job is behind a desk and he can cope with driving to and from work despite the persistent recurrence of his pain.

However, as long as he uses his ‘new miracle machine’ twice a day he is able to function at reasonable levels. His medication levels have remained stable for over two years now and his intake of painkillers is down to almost nothing.

‘Life’s not exactly a rose garden. But my family stresses and tensions have been relieved to a great extent. I’ve come to grips with the fact that I’m likely to have pain for the rest of my life.’

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The following, taken from ‘Mirrors Of The Mind’1 will help guide you through a relaxation imagery process with particular reference to cancer.

1. Go to a quiet room with soft lighting. Shut the door, sit in a comfortable chair, or lie in a comfortable position, and let your eyes close.

2. Become aware of your breathing.

3. Take in a few deep breaths. As you let out each breath, mentally say the word ‘relax’ and allow your tension to drain from your muscles and your mind.

4. Concentrate on your face and feel any tension in the muscles of your face and around your eyes. Make a mental picture of this tension. For example, a clenched fist or a rope tied in a knot. Then, mentally picture it relaxing and becoming comfortable like a limp rubber band.

5. Experience the muscles of your face and eyes becoming relaxed. As they relax, allow a wave of relaxation to spread through your body.

6. Tense the muscles of your face and around your eyes, squeeze tightly and then relax them and feel the relaxation spreading through your body.

7. Move slowly, down your body — jaw, neck, shoulders, back, upper and lower arms, hands, chest abdomen, thighs, calves, ankles, feet — until every part of your body is more relaxed. For each part of the body, mentally picture the tension. Then, picture the tension melting away, allowing you to feel beautiful relaxation.

8. Now, picture yourself in pleasant, natural surroundings — in a position which feels the most tranquil and natural for you. Use your imagination to fill in the details of colour, sound and texture. Make it as real as possible.

9. Continue to picture yourself in a very relaxed state in this natural place for two to three minutes.

10. Then mentally picture the cancer in either realistic or symbolic terms. You can think of the cancer as consisting of very weak, confused cells. Just think that our bodies destroy cancerous cells thousands of times during a normal lifetime. Realise that your recovery requires your body’s own defences must return to a normal, healthy state.

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Factors helpful in predicting the outcome of hypnotic pain control include:

1. The nature and origin of the pain and whether it is organically or mainly psychologically caused.

2. Whether you believe in hypnosis or not — and if you expect it will bring you pain relief.

3. The presence of ‘secondary gain’ — that is the presence of social or financial rewards for the maintenance of your pain problem.

4. Your motivation to improve.

5. The development of a positive and trusting relationship between you and your therapist.

6. Your willingness to practice self-hypnosis. The ability to produce a deep state of hypnotic trance is not always important and good results occasionally occur in the presence of light hypnotic or slight sleep-like states.

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These psychological therapies are available from trained practitioners, usually medical practitioners or clinical psychologists.

Relaxation Relaxation training is also carried out by a number of physiotherapists and occupational therapists who have been properly trained. Exercises form the basis of a form of therapy known as biogenics — a treatment favoured in certain parts of the United States.

Relaxation training may vary from the formal relaxation training described initially by Jacobson in Europe and popularised by Schultz.

Biofeedback Biofeedback training is relaxation combined with the use of electronic devices. It can give the patient an instant feedback of a degree of tension or relaxation, as measured by electrical conduction of the skin, muscle tension or skin temperature.

These are fed back to the patient in the form of an audible signal, a series of light-emitting diodes similar to the LEDs in an electronic 35 mm camera or as a display with a needle that swings according to the level of stress.

Biofeedback training is particularly useful for patients who feel unable to let themselves go sufficiently with relaxation or hypnosis.

Uses There are few disadvantages to relaxation therapy and biofeedback techniques. Both require time to learn the technique and to perform it. As with other meditation-type techniques, a certain degree of discipline is necessary for the patient to become proficient.

There are few direct arguments against using these therapies apart from obvious depression or severe mental illness.

The treatment is usually done by a registered clinical psychologist. The fees are appropriate for the time the psychologist spends with the patient. These fees range from about $80 to $100 an hour. Some private health funds rebate these fees at about $15 to $20 per session.

As long as referral is made by a doctor, health insurance companies usually cover the cost of such treatment where appropriate.

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