The most common form of treatment is a combination of physical therapies and non-steroidal anti-inflammatory drugs such as Dolobrid, Indocid, Brufen, Naprosyn, Voltaren, Orudis, Clinoril and Feldene. Aspirin and Paracetamol are also useful as pain killers and as drugs controlling inflammation. Specially coated or slow-release forms of aspirin have been developed to reduce the gastric problems associated with long term aspirin usage. These include Ecotrin, a specially coated tablet which releases its aspirin into the small intestine and not the more sensitive and fragile stomach lining.

Other drugs used in the treatment of arthritis include the cor-tico-steroid or steroid drugs such as Prednisolone and Depo-Medrol. These can be taken by mouth or injected directly into the joints.

Physiotherapy has a major place in the treatment of pain associated with arthritic conditions. Gentle mobilisation of affected joints together with the application of heat and cold to the joints will help keep those with advanced arthritis mobile.

Water-based exercise in the form of hydrotherapy and the more vigorous aqua-aerobics takes the strain of gravity from the painful and stiffened joints.

In the later stages, when joints are burnt out, surgical procedures are carried out to help those with artificial joints or to fuse joints which are too painful to move.

*70\37\8*

Some build their lifestyle around their pain. They actually enjoy their poor health. While every day and night is an ordeal ranging from discomfort to downright agony, they at the same time find it as comfortable as putting on an old pair of slippers. Their pain has the comforting ring of normality. Relieving the pain actually disrupts their attitude-behaviour system. At the very least, pain behaviour is a mindless bad habit. It can be broken, but, it can also become an addiction.

*47\37\8*

Recent research confirms that dietary manipulation may be possible. Certain natural substances appear to be the forerunners of brain chemicals important in pain control. For example, the amino acid L-Tryptophan is a substance that is converted to Serotonin (also called 5HT), a brain transmitter substance involved in pain perception. When taken orally, it may help to modify the experience of pain and to encourage natural sleep. Some caution in the administration of L-Tryptophan may be necessary.

At the time this book was written disturbing reports of abnormally increased number of eosinophils (white blood cells) due to L-Tryptophan have been received in the United States and in Europe. This has led to the withdrawal of L-Tryptophan containing preparations in America and Australia. Another amino acid, D-L Phenylalanine, blocks the destruction of the natural opiates — endorphins — produced by the brain.

*25\37\8*

80 per cent of cases. Millions more suffer other chronic pain conditions such as the excruciating facial pain of trigeminal neuralgia,TMJ (temporo-mandibular joint dysfunction syndrome) affecting the jaw joint, post-herpetic neuralgia and phantom limb pain. Many cope with headaches, arthritis and other musculo-skeletal problems without excessive invalidism, medication, or health care. Unfortunately, a significant number of chronic pain sufferers have a complex variety of feelings, thinking and behaviourial symptoms.The financial costs of chronic pain may well be the highest of any health problem.

It includes the costs of social security payments, treatment, workers compensation and the loss of productivity. In New South Wales, 1984-85 figures showed that ’sprains and strains’ accounted for 49.5% of claims for workers compensation, a total of 48,751 cases. The NSW compensation payout had risen from $286 million in 1980 to $666 in 1984-85. Australian Bureau of Statistics (ABS) figures quoted in a leading article on pain in The Bulletin magazine showed that over 20% of compensation claims in Australia were for the condition of Repetitive Strain Injury (RSI) consisting of work related synovitis, bursitis and myofascial pain disorders. A further 20% had other problems of the musculoskeletal system and connective tissues. Apart from industrial deafness at 42% of claims, no other condition exceeded more than 4% of the total.

The ABS survey showed that headache due to unspecified or trivial causes was the most common Australian complaint. Some 10% said they had suffered one in the two week survey period. According to the Arthritis Foundation of Australia, one person in 12 in this country suffers from arthritis. This means that 1.3 million Australians have pain as a major disability. Arthritis accounts for more lost work days (over 7.5 million man hours) than any other medical condition and exceeds those lost due to industrial strikes.

The social costs of chronic pain are even more tragic, with so many young sufferers incapacitated for life, and the subsequent disruption to the family, the individual and society as a whole. Rather than brand sufferers as ‘neurotic and hysterical’, a more enlightened approach is called for, with early treatment, research and ultimately prevention.

Chronic pain in Australia is also a major issue in law suits and disability-benefit decisions. Whether or not a pain sufferer is typical of a hospital’pain clinic, or of a private practice population, the behaviour of pain patients gradually becomes less consistent with organic pathology.

*3\37\8*