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DRUGS FOR MIGRAINE TREATMENT: L-TRYPTOPHAN AND CLONAZEPAM

admin — Sat, 09 Jul 2011 14:24:46 +0000

L-Tryptophan. Although release of serotonin, 5-hydroxy-tryptamine (5HT), by blood platelets is an important factor in initiating migraine attacks, a lowering of 5HT in the brain may lessen tolerance to pain. In the brain, the nerve cells producing 5HT are generally inhibitory, i.e. they damp down nervous activity; this may explain why a lack of 5HT increases pain sensitivity. An obvious way to combat this would be to increase the concentration of 5HT but, unfortunately, when taken by mouth, it does not enter the brain. Another amino acid, L-tryptophan, does enter the brain where it is turned into 5HT by enzymes so that a large amount of L-tryptophan increases 5HT levels. (Mice fed on a diet deficient in L-tryptophan become intolerant to pain and dislike bright lights; this can be compared to the photophobia that causes migraine sufferers to wear tinted spectacles.) L-tryptophan is now being tried in the treatment of migraine; results are encouraging and further trials are planned. One great advantage of the drug is that there are no side-effects (except occasional drowsiness).
Clonazepam. This substance was first introduced as an anti-epileptic drug but is effective in migraine, particularly migrainous neuralgia where one tablet taken at night will alleviate the headache which often wakes people. The following case history demonstrates this point:A 50-year-old, large man was under a good deal of pressure at work and was also active as secretary of a number of voluntary organizations. One Christmas, he began to have attacks of severe pain behind the right eye, which went red, and his nostrils were blocked. The pain woke him and lasted for half an hour. He was unable to go to sleep again and was becoming increasingly tired.The initial treatment was ergotamine three times daily for a limited period to try to break the pattern, but to no avail. Following this it was decided to try a trial of steroids, and Prednisolone was given three times daily (as this form of treatment sometimes works in this condition). This form of therapy can only be used for a short time and the course was stopped three weeks later; he was free of headaches for three weeks when they returned. He then took Clonazepam and the next day felt as if he were very drunk and was unable to move; on the following day he was still very sleepy but had not had a headache. He continued treatment on a smaller dose and the headaches disappeared, the only adverse effect being that he could be woken from his sleep.Clonazepam can also be used in the treatment of acute attacks of common or classical migraine. There are some unwanted side-effects, the commonest being drowsiness. As well as having a direct and immediate sedative effect, it also increases the brain levels of 5HT but whether this is the reason why it is helpful in migraine is uncertain.
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PSYCHOLOGICAL AND PSYCHOSOCIAL ASPECTS OF PAIN CONTROL: PSYCHOLOGICAL ISSUES-DEPRESSION

admin — Fri, 10 Jun 2011 14:28:24 +0000

• The diagnosis and treatment of depression will aid pain control. The symptoms upon which a diagnosis of depression is made in physically healthy individuals. In patients with cancer, the significance of the somatic symptoms is questionable as all can be caused by the cancer itself. The somatic symptoms may be considered significant if they are clearly out of proportion to the physical illness. Other criteria which have been advocated include persistent tearfulness, persistent irritability, a sense of hopelessness, perceiving the illness as punishment and a sense of worthlessness or being a burden. Symptoms of depression can occur as part of the normal response to a crisis, in reactive depression, as part of a major affective illness or in association with an organic brain syndrome. ‘Normal, depression-Episodes of depression and anxiety occur as part of a normal psychological stress response at times of crisis such as treatment failure. These reactions last one to two weeks during which significant symptoms of anxiety and depression may occur. They resolve spontaneously with time and appropriate supportive care from family, friends and the treatment team. Short term use of a hypnotic at night and an anxiolytic by day can be of benefit in severe cases. Reactive depression-Reactive depression is an adjustment disorder which differs from the normal self limited stress response in either degree or duration. The symptoms last longer (more than two weeks) or are more severe. Reactive depression is frequently associated with some degree of anxiety, and the patient may demonstrate an obsessive concern with symptoms. Major or endogenous depression-Compared to reactive depression, the symptoms are usually more severe and the mood is incongruent with the disease outlook and does not respond to support, understanding or distraction. Delusional thoughts and hallucinations, features of psychotic depression, are rare except in patients with organic brain syndromes. Organic brain syndromes-Patients with acute confusional states (delirium) or early dementia may exhibit features of depression. Examination of the patient’s mental state will reveal evidence of organic brain dysfunction. Treatment-The treatment of depression in patients with cancer depends on the duration and severity of the symptoms and needs to be carried out in the context of the patient’s overall illness and prognosis. If an organic brain syndrome is present it is treated appropriately. Patients with more severe depression can benefit from treatment with both psychotherapy and antidepressants. Psychotherapy should be of short duration (4 to 6 weeks), supportive, and directed at clarification and resolution of problems pertaining to the patient’s medical situation, the goals and expectations of treatment and fears about suffering and death. Family members can participate in this type of therapy. Relaxation therapy may be included to reduce anxiety. Antidepressants are considered for any patient with significant depression although side effects are common and can be clinically troublesome, especially in elderly or frail patients. The various tricyclic antidepressants cause varying degrees of sedation, anticholinergic and cardiovascular side effects. Monoamine oxidase inhibitors (MAOI) should be avoided in patients with cancer because of the need for dietary restrictions and the frequency of interactions with other drugs. Mianserin (Tolvon) is moderately sedating but has fewer anticholinergic or cardiac effects. Fluoxetine (Prozac) has little sedative, anticholinergic or cardiac side effects, but it can cause anxiety and insomnia as well as anorexia and weight loss.*79\55\2*

ALTERNATIVE TREATMENTS THAT CAN HELP TO TREAT SCIATICA: BACH FLOWER REMEDIES

admin — Wed, 29 Apr 2009 10:13:13 +0000

The Flower Remedies were created during the 1930s by Dr Edward Bach, a noted homoeopathic physician and bacteriologist, to treat ‘emotional imbalances’. Although originally formulated primarily to supplement homoeopathic preparations, the remedies have since been used for all kinds of health problems. Similar to the Flower Remedies – of which there are 38 different varieties, all created by Dr Bach – are the Flower Essences which were developed later by followers of Dr Bach.

Much of the evidence about the efficacy of these remedies is anecdotal, but many people with back problems have reported that their symptoms were eased by the formulations. While the remedies are available without prescription in many health shops and pharmacies, it is no easy matter to select the right one, and it is therefore best to first consult a qualified practitioner.

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