PAIN AND GUILT: RELIGIOUS ASPECTS OF PAIN AND GUILT

You may say to yourself, “I am not a religious person, so this section does not concern me.” But the idea which I wish to discuss is religious in the widest sense, and applies to us all. It is like this. We have within us a number of very simple, primitive ideas which form a basis of our conduct of life as humans. Our sense of right and wrong is one such idea. The question of the origin of these ideas is beyond our present study, but they are ideas that are common to people of all religions including atheism. The particular idea that concerns us now is the feeling that sin is punished. I have referred to this as a- feeling, because, with many of us, it is vague and

ill-formulated, and is never really thought of in clearly logical terms. In fact, when we come to examine the idea logically, we are inclined to think that it is not sensible, and that we never really held such an idea. But it is there within us just the same. Our wickedness is punished. Wrongdoing brings pain. Then when we suffer pain, we think back, and ask ourselves, “What have I done wrong?” The idea is reflected in the expression which all doctors hear every day, “But what have I done to deserve this? Why should this happen to me?”

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TREATMENT OF ULCERS: DRUGS PREVENTING ACID FORMATION

Q. What is the most widely used form of treatment at present?

A. Just now, probably the most popular form of therapy is the use of a family of drugs called the histamine IT receptor antagonists. The most widely used one is called cimetidine, although the doctor will probably give you a prescription using the trade name, ‘Tagamet’. These are tablets taken orally which act on the acid producing cells of the stomach wall, and prevent acid production. In turn, this inhibits the production of the other important stomach chemical, pepsin. Therefore, with no acid and pepsin present, the cause of the ulcer vanishes, and symptoms vanish as the ulcer gradually heals.

Q. How long does it take for symptoms to disappear?

A. Many patients report that symptoms, especially abdominal pain, disappear within a few days! This seems remarkable, especially with those in whom pain had been intermittently present for months or even years. It may be dramatic.

Q. Does cessation of pain mean the ulcer has healed completely?

A. Certainly not. It means acid production is stemmed, and the pain from acid irritation on the exposed nerves has stopped. It takes at least from four to six weeks for the stomach lining to grow over the ulcer site.

Unfortunately, many patients thinking that pain cessation means ulcer healing, foolishly stop medication. The results are then bad, for often within a few more days, the pain naturally recommences as acid production starts up again. Once the physician has ordered a course of treatment it is imperative that it be taken exactly as prescribed, and for the total number of tablets.

Q. What is the usual dosage?

A. Generally, 400 mg is taken morning and night. Many doctors now find that one single evening dose of 800 mg is preferable. It is easier to remember, and seems to give very satisfactory results. The aim is to keep acid at a low level during the day, and the higher bedtime dose is aimed at keeping it low throughout the night. Remember, nocturnal pain due to acid build up is the hallmark of the ulcer patient — and a very disturbing symptom. This dosage method is different to multiple doses which were originally recommended.

Q. What is the value of this altered dose routine?

A. First of all, doctors have found that the results are often as good or better with this system. Also, by making the tablet swallowing routine less frequent, a strange phenomenon called ‘patient compliance’ is far higher.

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SCIATICA: INVESTIGATIONS AND SURGICAL TREATMENTS

While the vast majority of instances of sciatica and lower back pain will respond to fairly simple treatment within a matter of weeks -or even much more quickly than that – there will always be some that will be more intractable, either not responding at all to just rest and analgesics or responding so little that it becomes evident that other treatments have to be considered. When that happens, a patient will usually be referred by his doctor to a specialist at the out-patient department of his local hospital.

Your initial consultation with a specialist will generally follow a similar pattern than when you first saw your own doctor: a history of the problem will be taken, additional questions will be asked, and there will be a further physical examination, this then probably followed by yet more questions.

At the end of your consultation, your specialist may well ask for various tests or other investigations to be done before making his diagnosis. Depending upon the circumstances, the purpose of these tests may be three-fold:

To specifically identify the cause of your troubles, if that’s not already known; and

To eliminate other disorders which may be marked by similar symptoms; and

In those comparatively rare instances where an operation appears indicated, to help pinpoint exactly what approach is likely to work best. Tests and investigations commonly used include:

X-rays. While radiography is widely used in the diagnosis of many other disorders, its results are unfortunately often disappointing when back problems are being investigated, the difficulty being that many of the subtle changes in the spine that cause pain simply fail to show up clearly enough, especially during their early stages. Additionally, it takes a pretty large dose of radiation to X-ray the spine, and this is something that is best avoided unless truly indicated.

Computerised tomography (or CAT- or CT-scan). Using much smaller doses of X-rays, this scanning method records the different thicknesses of tissues, translating these findings through the intermediary of a computer on to film that provides a cross-sectional image.

Magnetic resonance imaging (or MRI). Producing images rather like those from a CAT-scan, this technique uses very powerful electromagnets instead of X-rays, so making it free of the risks that can accompany radiation.

Myelogram. This is a specialised method of X-ray examination in which radio-opaque contrast medium is injected beforehand into the subarachnoid space in the spinal cord. Although this method is of particular value in recognising tumours of the spinal cord (as well as other conditions in which the cord or nerve roots are compressed), it needs to be accepted that this investigation represents a major intervention in itself and that therefore the patient should be made aware of the risks and side-effects that can be involved.

Blood tests. These can provide information about a wide range of disorders, including many different types of rheumatic diseases.

While all these tests – and several others – are potentially available, it is highly unlikely that all will be requested or that even more than just one or two will be done.

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