Thursday, 1 June 2017

June 2017: painkillers: risks and alternatives





Painkillers may seem a blessing, but we should never use them indiscriminately, and it's well worth checking whether there are other ways to face your pain.
There are basically three kinds of painkillers: paracetamol, opioids, and NSAIDs. They all have their downsides. Here are the reasons why we should try to avoid them as much as we can. 

Paracetamol or acetaminophen is an effective painkiller, but taxes the liver. It is extremely dangerous if combined with alcohol. For children, there is very poor evidence of fever relief. Giving kids calpol or similar, is not a good idea anyway - see [1].

Opioid painkillers, like codeine, are addictive, and hard to get off. Only one week of continual use can leave you enslaved.

Anti-inflammatories or NSAIDs (Non-Steroidal Anti-inflammatory Drugs) like aspirin and ibuprofen, damage the gut. Taking too many for too long, can lead to internal bleeding. If you have an ulcer, or any signs of digestive discomfort, the consequences could be serious [2]. 
Only recently, in March 2017, a Danish study led to calls for restrictions on the sale of ibuprofen, after they found it heightened the risk of cardiac arrest by 31%, with other NSAIDs presenting an even higher risk [3].
And did you know that aspirin and other fever-reducing medications actually suppress the production of antibodies, so that the infection lasts for up to 50% longer than it should? They inhibit the release of pyrogen, a substance that causes fever. And fever actually helps the body fight infections [4]. 

So we have to be very careful with painkillers. For 6 reasons, see [5].
For more detail about PARACETAMOL see [6].
More detail about OPIOIDS, and CODEINE more specifically, see [7]. 
For more detail about NSAIDs, see [8].

ALTERNATIVES
There is a marvellous general site about pain, well worth looking at for a start: [9].
You'll find plenty of non-drug therapies such as heat or cold, acupuncture, (breathing) exercise, yoga, massage etc: see [10]. For a herbal pain approach, see [11].
And did you know that 20 minutes of aerobic exercise is enough to stimulate the body to produce more endorphins - natural painkillers? And that our spit contains a painkiller more powerful than morphine: opiorphin? We have it only in minute quantities, so that we’re not off our heads all the time. Eating, though, releases more of the chemical and this may be a factor in comfort eating.



See also the New Scientist article 'Treating Chronic Pain' - click on the right hand side of this page. 




LAST but not LEAST: when it hurts, there is a reason. If all we can think of is to dull the hurt, we’ll never find the cause and it will persist and get worse. To deal with the cause, preferably in an early stage, we have to feel the pain. We have to respond to the feedback our bodies give us: when does it get better, when does it get worse? Does my food, my posture, stress or things I do, affect it? 

~~~

“People who view pain as the enemy instinctively respond with vengeance or bitterness–Why me? I don’t deserve this! It’s not fair! – which has the vicious-circle effect of making their pain even worse. “Think of the pain as a speech your body is delivering about a subject of vital importance to you,” I tell my patients. “From the very first twinge, pause and listen to the pain and, yes, try to be grateful. The body is using the language of pain because that’s the most effective way to get your attention.” I call this approach “befriending” pain: to take what is ordinarily seen as an enemy, and to disarm it, and then welcome it." (Pain: The Gift Nobody Wants’, Dr. Paul Brand)


-------------------------------------------------------------------------------------------------------------------------------------------



EAT
veg: broad beans, beet, cabbage, carrots, lettuce, new potatoes, artichokes, asparagus, broccoli, mangetout, peas, cauliflower, radish, spinach, spring onions, spring greens, watercress, kohlrabi, turnips, rhubarb, redcurrants, strawberries, gooseberries.
meat: lamb, wood pigeon [9].
fish: grey mullet, black bream, gurnard, pollock, whiting, mackerel, lobster, whelks, clams, cockles, coley, crabs, crayfish, flounder, grouper, gurnards, herring, megrim, scallops.

SOW:
beetroot, calabrese, lettuce, french beans, kale, carrots, cauliflower (mini only), salad onions, (sugar) peas, radish, kohlrabi, mooli, turnip, chicory, Florence fennel, courgettes and pumpkins.
Sow swede and sweetcorn in early June. If the soil is above 25°C, sow crisphead, cos or little Gem only.
Plant out: courgettes, cabbage, sprouting broccoli, sprouts, celery, celeriac, ridge cucumbers, runner/french beans, pumpkins, tomatoes, sweet corn.


RECIPES



BRAISED LETTUCE and PEAS for 1 or 2. 
2 tblsp butter, shallot thinly sliced, half a head of (cos) lettuce, ab. 150ml stock, 100g (frozen) peas
Chop lettuce into small pieces. Sauté shallot for a minute, add lettuce, sauté for another minute. Add stock, bring to a simmer.  Add peas, cook covered for a short while. Season if necessary. Garnish with for instance heavy cream, mint, grated carrots or lemon juice.

MARINATED LAMB'S HEART
A lovely cheap and easy dish, as long as you do some preparation   beforehand. Every lamb has a heart, so if you ask your butcher he may well come up with one, if only from the freezer.
450g lamb or beef hearts. For the marinade: 2 tblsp balsamic vinegar, 1 tsp salt, 1/2 tsp ground black pepper and 1tsp thyme.
Trim the heart(s) and cut in 1.5 - 2cm cubes. Marinate for at for least 8 hrs. Grill, spreading out into a single layer, and let brown for a minute or two. Toss and brown on the other sides for another minute; remove. Delicious!

CRAB CAKES
2 slices firm bread, 225g crabmeat, 1.5 tblsp oil, 1 tsp lemon juice and some wedges, 1/2 tsp Worcestershire or soy sauce, 1 large egg, beaten, 2 tblsp butter.
Tear bread into small pieces into a bowl with crab. Add oil, Worcestershire/soy, egg, a pinch of salt. Mix gently but thoroughly, then form into 4 patties. Heat butter until the foam subsides, then cook the cakes, turning once, until golden brown.

MACKEREL with BROCCOLI and SPICY ANCHOVY SAUCE
Mackerel and broccoli for 2; 3 anchovy fillets, 2 garlic cloves, 1 chilli (or powder), olive oil, (rosemary).
Chop three anchovy fillets, two cloves of garlic and one red chilli. Mash to a near-paste. Melt the paste in a small frying pan with 2 tblsp of butter. Meanwhile, grill or sauté the mackerel in oil. Top with rosemary if you have it. Don’t add salt, because the sauce will supply that. Steam the broccoli, drain, then stir it into the anchovy sauce. Serve next to the mackerel.
Best with plain cooked potatoes, methinks.



For more recipes see June issues from former years - click on June 2017 on the right hand side. 


The old days were not always better .....

Next issue: the immune system. To see this now, go to https://thoughtforfoodaw.wordpress.com/2017/05/10/july-2017-the-immune-system/.
 ---------------------------------------------------------------------------------------------------------------------------------------------

[4] 
[7]
OPIOIDS in general:
One of which is CODEINE : 
Though just because it’s herbal, that doesn’t mean it’s safe: see https://www.theguardian.com/society/2016/jul/11/heart-failure-patients-warned-off-over-the-counter-medications.









Treating Chronic Pain

New Scientist 23/11/2016. Jessica Hamzelou:

Hurt blocker: to treat chronic pain, look to the brain not body.

EMMA PAYNE’S day starts at 6 am, when the pain from her joints wakes her. She takes prescription painkillers and stays in bed until late morning, when they finally kick in, giving her a few hours of respite before the pain returns. “By 3 pm, all my joints hurt, whatever I’ve done,” she says. The rest of the day passes in a cycle of ever-stronger painkillers, rounded off with sleeping pills. Payne has lived this way for the past two years, not only struggling with the pain but grieving for the active life she had before.
An estimated 10 million people in the UK and a fifth of the world’s population has chronic pain, lasting 12 weeks or more. For many of them, treatments provide little relief. Even the strongest drugs often don’t eliminate discomfort, and come with serious side effects. Not to mention they are addictive, make pain worse long-term and are all too easy to accidentally overdose on.
Now, though, researchers are starting to tackle the problem by rethinking the root causes of chronic pain. Rather than seeing it as a lingering version of the acute form, they have begun to recognise it as a complex disorder of the nervous system that changes the brain’s structure, chemistry and activity. Such thinking could help dispel the myth that there is nothing wrong with those with chronic pain, and could lead to a new wave of treatments.
Part of the problem has been that most research into pain hasn’t been asking the right questions. The majority of what we know so far is based on research into acute pain, says Marco Loggia at Harvard University.
When we experience an injury, the nervous system sends a pain signal to the spinal cord and the brain. The spinal cord provides the rapid reaction that makes you recoil from the source of the injury – a hot surface, for example. Your brain tells you you’re in pain, and enlists a complex set of structures, including emotion and memory networks, to help you remember that pain for future reference.
In chronic pain, says Loggia, this system goes awry. The pain signal doesn’t switch off, and the brain networks involved in pain start to change their activity, telling you you’re at risk of injury when you’re not. “Acute pain is mostly helpful, but chronic pain is not,” says Loggia. While acute pain is like an alarm state, as it becomes chronic, the patterns of brain activity begin to change, he says.
Neuroimaging is starting to reveal physical differences between the brains of people with and without chronic pain. This suggests doctors should be looking at people’s brains when there is no obvious physical explanation for their pain. “If doctors examine a patient and see nothing, they don’t understand why the person is feeling pain,” says Marwan Baliki at Northwestern University in Chicago. “But they are looking at the wrong region – they are looking at the back or stomach, for example, when they should be looking at the brain.”

“In the US, 259 million opioid prescriptions were dished out in 2012 – more than one for every adult” (source: asam.org/docs/default-source/advocacy/opioid-addiction-disease-facts-figures.pdf)
“12 per cent of adults in the UK take prescription painkillers”

In a recent study, Baliki and his colleagues scanned the brains of people with back pain, and re-scanned them several times over the following three years. They found that two brain structures in particular – the hippocampus, which is the brain’s memory hub, and the amygdala, which processes emotion – were 10 to 15 per cent smaller in people who went on to develop chronic pain. “The brain was the strongest predictor of whether a person’s pain became chronic or not,” says Baliki.
What’s more, those who went on to develop chronic pain lost grey matter unusually quickly in the years that followed. “Patients with persistent chronic pain experience about 8 to 10 per cent greater grey matter loss than those without pain,” says Baliki. Each year lived in chronic pain causes as much brain shrinkage as 10 to 20 years of healthy ageing, he adds.
His team are studying mice to investigate why some people might have smaller hippocampi and amygdalae to begin with, and how this might affect their chance of developing chronic pain.
As for the cause of grey matter loss, there’s evidence that the immune system might be involved. Researchers started entertaining the idea in the 1970s, after they noted that people in chronic pain display “sickness behaviour”, becoming lethargic, anxious and sometimes depressed. This is a well known side effect of the immune system’s inflammatory response, which is thought to have evolved to encourage us to rest when ill or injured.
In the brain, the inflammatory response is linked to glia – brain cells that outnumber neurons and fulfil a structural and maintenance role in the brain. Some forms of glia stimulate inflammation, while others filter harmful substances, repair injuries or clear debris. Using a chemical that binds to active cells, Loggia’s team were able to track their activity in people who had had chronic back pain for two years or more and people without chronic pain.

Pain in the brain
Sure enough, they found striking differences between the groups, with those experiencing pain having significantly higher glial activity than the pain-free participants. The difference was most pronounced in sensory areas corresponding to the site of their back pain and in the thalamus, a region that acts as a gateway from the senses, including the sensation of pain. “You could just look at an individual’s scan and tell by eye whether they had chronic pain or not,” says Loggia.
They have since used the approach to look at the brains of people with fibromyalgia, a mysterious syndrome that causes pain all over the body. Volunteers with fibromyalgia also had more active glial cells in their brains, although this time in the cerebellar cortex and the medulla – regions that are linked to movement and automatic functions like breathing and digestion. Why they might also have a hand in pain is not yet clear.

“Four out of every five new heroin users in the US started out on prescription opioids”
Nevertheless, the findings suggest that different types of chronic pain could be described as different brain immune disorders, each with a particular pattern of glial cell activity, says Loggia, who presented the work at the World Congress on Pain in Yokohama, Japan, in September.
Whatever triggers the immune system in the first place, its involvement makes sense because we know it can affect pain directly. Research in animals has shown that the chemicals produced by glial cells can act to sensitise the nerve pathways that deliver pain signals, lowering their trigger threshold. “They essentially turn up the pain volume,” says Peter Grace at the University of Texas MD Anderson Cancer Center.
They might also be responsible for the brain shrinkage seen in chronic pain. In healthy brains, glia help shape the connections between brain cells to optimise the communication between them. Over-active glial cells might prune too many connections.

Many of those with chronic pain feel that people don’t believe them
If confirmed, these findings could have huge implications for people living in chronic pain, many of whom feel they are not believed by their doctors, employers or even friends and family, and are accused of being lazy or making things up. “A lot of people see fibromyalgia patients as a bunch of malingerers – that there’s nothing wrong with them,” says Loggia. “If we can show that there is inflammation in the brain, we can provide more evidence that the disorder is real.”
The research could also point to new treatments for chronic pain. Drugs that dampen down the activity of glial cells might be one option, and several candidates are in clinical trials. The hope is that such treatments could be given to people before their brains become sensitised and their pain becomes chronic. “If we could shut down glial cells, we could shut down the pain sensation,” says Grace.
Even if these kinds of treatments work, they are unlikely to be enough on their own. Chronic pain is a complex beast. As the disorder develops, it implicates more brain regions, such as those involved in emotion and memory, changing their activity, too.
Recent research has shown that emotion-linked pain has a separate pattern of activity that is distinct from pain processed from a site of injury. While both networks are active in response to an injury, the emotion-linked pain signature is what neuroscientists commonly see in the brains of people with chronic pain whose physical symptoms of injury have healed. This suggests that the signals from psychological pain networks may take over when the problem becomes chronic.
This raises the possibility that psychological interventions might be effective. A 2010 review of 30 studies concluded that, for people with chronic lower back pain, cognitive behavioural therapy and other coping techniques are more effective than standard treatments.
People can even be trained to more directly influence their own brain activity and, potentially, turn down the pain signal. In neurofeedback, electrodes placed on participants’ scalps are linked to a real-time display of their brain’s electrical activity. With training, people can learn to alter their brain activity to dial down their pain. Preliminary studies suggest that neurofeedback might be useful for people with fibromyalgia, as well as those with chronic pain resulting from spinal cord injuries and cancer.
Mindfulness meditation is a lower-tech way to achieve something similar. The goal is to achieve a state of “detached observation”, which can help people cope with pain. Studies so far suggest that it improves various types of chronic pain, including fibromyalgia and lower back pain. What’s more, a study of 17 people who practised mindfulness-based stress reduction found that, over time, meditators experienced increases in grey matter in regions of their brains involved in learning, memory and emotion – all of which influence pain perception. It’s also cheap, and can be done anywhere with a little training.

Learning to cope with pain through exercise may be more effective than drugs
Exercise is helpful, too, although if the pain starts with an injury, it can prove both physically and mentally challenging. If a person learns that a movement is painful, or a limb is delicate, the information can become crystallised in the brain, almost like a phobia. In these cases, it can be worth re-learning to move the body. Evidence suggests that exercise can improve the symptoms of lower back pain and chronic fatigue syndrome, which also causes pain.
Advocating these non-pharmacological approaches might sound controversial – surely no one wants to be told they just have to think positive or move more. But people with chronic pain are desperate, and most will try anything. “If you’d have told me to stand on my head and bark like a dog, I would have done it if it might help my pain,” says Payne.
What is most important is that we all recognise chronic pain for what it is – a neurological disorder in dire need of effective treatment. “These aren’t weak people – they have a physical disease in their brain and spinal cord,” says Grace.
For her part, Payne has taken matters into her own hands, seeking out talking therapies and alternative remedies to help manage her brain’s response to her pain. And while we wait for better treatments to become available to all, she advises others to read as much as they can about their condition. “One of the first things I did was educate myself about pain,” she says. “That education has brought me a certain peace of mind that I’m not going mad.”

This article appeared in print under the headline “Pain: Hitting where it hurts”

alphabetical index of subjects


For technical reasons, the months have all been grouped under the same month of the last two years. Click on 2017 and 2016. 

alcohol                                                   Dec 14
Alzheimer's                                            Sep 16
antibiotics                                              Sep 15, Apr 17
arthr                                                       Apr 14
biotics                                                    Apr 17
blood pressure                                      Mar 16
brain food                                              May 13
bread                                                     May 10, Oct 16
breakfast                                               Jul 10, Aug 12
butter                                                     Feb 12
calories                                                 Jan 12
cancer                                                   Aug 11
cheese (British)                                     Dec 12
chocolate                                              Jun 13
cholesterol                                            Mar 10, Apr 11, Nov 13
Christmas recipes                                 Dec 13
common cold                                        Oct 14 
coughs                                                  Nov 14
cravings                                                Jun 12
death                                                     Feb 17
depression                                            Feb 14
diabetes 2                                             Apr 16
diarrhoea                                              Aug 15
diet                                                       Jul 11, Jan 15
drink                                                     Dec 14
eggs                                                     Jan 16
emulsifiers                                            May 16
fat                                                         Jun 10, Nov 13
fever                                                     Dec 15
fish                                                       Jul 12
heartburn                                              Dec 16
home remedies (why do I use?)           May 15
hypertension                                         Mar 16
immune system                                    Jul 17
inflammation                                         May 14
insomnia                                              Apr 15
intuitive eating                                      Nov 16
meat (processed)                                 Feb 11, (cheap) Oct 12
milk                                                      Sep 11
minerals                                               Apr 13
mood  (food and)                                 Jul 16
number one                                         Aug 16
osteoporosis                                        Mar 17
painkillers                                            Jun 17
pesticides                                            Dec 11
protein                                                 Sep 10
roots                                                    Jan 14
salt                                                      Oct 11, Oct 15
soy                                                      Aug 13
stress                                                  Jul 14
sugar                                                  Jul 13, Jun 15, May 17
supplements                                       Feb 15 
sunscreen                                          Apr 12
Traditional Chinese Medicine             Sep 14
Throat                                                 Nov 14
Urine                                                  Aug 16
Vegetarianism                                    Nov 12
vitamins                                              Mar 13
weeds (eat!)                                       Mar 11
winter salads                                      Dec 10

June 2016: did you know?



June: did you know?


So-called Natural Killer cell, a white blood cell, part of the immune system.



A. Ten immunity killers which we should learn to avoid now, if we want to get through the next cold season healthily.
1) sugar [1] and artificial sweeteners [2]; 
2) processed carbs;
3) chemically altered and artificial fats;
4) lack of high quality protein;
5) man-made chemicals in other things than food; man-made sources of radiation;
6) pharmaceutical drugs;
7) lack of fresh air and physical activity; and lack of exposure to common microbes.
And to boost our immune system, we could do worse than eat - yes, really - animal fat and cholesterol. Raw egg yolk - a nice soft-boiled egg! - is excellent. As for vegetables, you can’t really beat onions and garlic. [3]

B. Fast food: "I grew up on it and I’m still healthy - why make such a fuss?” Why indeed. Because fast food isn’t what it used to be! See [4].

C. Insects pollinate 80% of plant species, including most fruit and many vegetables. However, there is increasingly sparse foraging for them. Growing pollinator-friendly plants makes a difference. Years of selection for showy blooms, means many flowers have lost their attraction to pollinators, but there are plenty of traditional cottage garden plants which can help.

In summer flowers are in shorter supply than in spring, so then gardens can make their greatest contribution. If you only have room for a few, choose borage, lavenders and Erysimum 'Bowles's Mauve’ - pretty and easy to grow. Plant in a sunny spot where you can enjoy watching the bees and insects. See also [5].

D. To prevent, or cope better with the following: 
1) cardiovascular problems
2) high blood pressure
3) PMS
4) depression
5) osteoporosis
6) vision loss
there is a useful website: see [6]. For osteoporosis in particular, see also [7].

E. Children’s illness: why ‘do nothing’ can be the best approach. And for grown-ups too, maybe …. See [8].

F. And for what might just turn out to be a decent summerwatercress will replenish iron and calcium lost in sweat; nuts and seeds contain fatty acids, so your skin won’t dry out.


-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

EAT
Veg: broad beans, beet, cabbage, carrots, lettuce, new potatoes, artichokes, asparagus, broccoli, mangetout, peas, cauliflower, radish, spinach, spring onions, spring greens, watercress, kohlrabi, turnips, rhubarb, redcurrants, strawberries, gooseberries.
Meat: lamb, wood pigeon [9].
Fish: grey mullet, black bream, gurnard, pollock, whiting, mackerel, lobster, whelks, clams, cockles, coley, crabs, crayfish, flounder, grouper, gurnards, herring, megrim, scallops.

SOW:
beetroot, calabrese, lettuce, french beans, kale, carrots, cauliflower (mini only), salad onions, (sugar) peas, radish, kohlrabi, mooli, turnip, chicory, Florence fennel, courgettes and pumpkins.
Sow swede and sweetcorn in early June. If the soil is above 25°C, sow crisphead, cos or little Gem only.
Plant out: courgettes, cabbage, sprouting broccoli, sprouts, celery, celeriac, ridge cucumbers, runner/french beans, pumpkins, tomatoes, sweet corn.




RECIPES

I have only two new recipes this month: for more, click on 2016 ‘June’ at the right hand side of this page and check the past six years.

BRAISED LETTUCE WITH PEAS
4 Little Gem lettuces, 1 small onion, finely chopped, 400g (frozen) peas, 4 tbsp single cream or crème fraîche, small knob butter, 200ml water/stock
Fry onion gently until soft. Meanwhile, clean the lettuces and trim: cut in half lengthways through the base. Place them with the cut side on top of the onion and cook for half a minute, then turn over and do the same. Pour over the stock, lightly season. Put a lid on, turn the heat down and cook for 10 mins.
Lift the lettuces out and strain over a bowl. Add this liquid to the pan, raise the heat and boil until the juices have been reduced by half. Add cream/crème fraîche and peas. Boil until the peas are cooked. Arrange the lettuces in a dish and pour over the pea-and-cream sauce.
If you don’t mind how it looks, you can put the lettuces back into the pan with the peas to reheat them. 
I added cashew nuts to the peas which was nice, but if they are salted, beware when you season.

We always produce plenty of potatoes, and I don’t much like buying rice or even more locally produced grains. So here is my 
POTATO-BASED CURRY
Potatoes for 4; different vegetables like cauliflower, swedes, turnips, leeks, kale, carrots, cabbage, spinach or the like. Onion, oil, 400ml coconut milk. Spices: curry powder, ginger, garlic, chili or cayenne, plus any other you fancy. Stewed apricots or chutney, peanuts or peanut butter. 
Cut the potatoes up quite small, slice/chop the onion and any harder veg which you want to add, like cauli, roots or cabbage. The idea is that they will all cook at roughly the same time.
Add minced garlic, ginger and other spices: sauté the lot in oil for a short while. Then add the coconut milk (or flakes and water), salt, and put the lid on. Cook till all is nearly done. At this point
add any quick-cooking veg like spinach. When that has wilted sufficiently, check the seasoning. Some stewed apricots are nice in it, or else chutney.
Now either mix in the peanut butter and heat through, or scatter peanuts on top. Serve! 

Otherwise:
*   It may be June and (nearly) summer, but fresh local greens are still quite thin on the ground. However, at www.bbcgoodfood.com/recipes/collection/spring-greens you can find plenty of recipes for those precious (but boring?) spring greens

*   There are also young turnips to be had: don’t peel them.  Cut off the leaves and root. Chop into chunks and boil or steam for 20 minutes, or roast for about 45 minutes, depending on the size.

  Rhubarb is another vegetable of which there is plenty. The Rhubarb Compendium tells you all, from rhubarb bars to rhubarb wine, and ‘things with rhubarb that defy simple categories’ …. www.rhubarbinfo.com/.
--------------------------------------------------------------------------------------------------------------------------


[1] But how to avoid sugar? See http://thegoodhuman.com/eliminate-sugar/, or “How to eliminate sugar”, on the right hand side of this Thought for Food page.
To get the most health benefits out of your onions or garlic, see http://therightnutritionplan.com/2011/06/hidden-health-benefits-of-garlic-and-onions/.
[8] www.thehealthyhomeeconomist.com/the-do-nothing-approach-to-illness-your-ticket-to-wellness/
[9] Wood pigeons can be roasted whole. Lightly brown with melted butter and cook for ab. one hour at 200°C. Serve with roasted red onions and roast potatoes.


NEXT MONTH: food and mood




Natural Killer cell kills cancer or virus
infected cell before it can wreak havoc.