Неврозы – Neuroses

The best form of treatment available for post-herpetic neuralgia is the early administration of antidepressant medication such as Prothiaden or Tolvon (particularly useful in the elderly) and Rivotril. Other anticonvulsant medications have also been successfully used.

In recent years the early administration of the anti-viral drug Zovirax also appears to reduce the severity of the rash and subsequent pain in this condition, and the related conditions of Herpes Simplex Type I causing cold sores, and Type II which causes genital herpes.

Another new medication is a cream which contains capsaicin — a derivative of chili peppers — which appears to selectively exhaust substance P, a pain-causing natural chemical in the nerve endings. This cream, known as Capsig in Australia, must be applied at least 3-4 times per day for periods of up to 3 months to be of any long term effect.

Physical therapy may be of use in the early stages of the disease. Accordingly, acupuncture and perhaps TENS may have a role in the early treatment of post-herpetic neuralgia.

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Psychiatrists sometimes also like to play a variation of the game: ‘After you’ve cleared up the physical problem, send him to me for his emotional one!’

Such splitting of the mind and body is impossible, as any successful healer knows.

The ‘nobody will touch me’ game sounds as if it’s a patient-directed one. But this has been found to be rare. Despite much talk about doctors wanting their patients back from specialists, neurosurgeons and pain specialists, they do not go about it in a way that will achieve this. Some doctors treat patients who have major neurological problems like lepers. This can often happen with those suffering intractable pain and those who are failures of traditional medical and surgical therapy, and patients with implanted stimulators. (Implanted stimulators include dorsal column stimulation,in which wires are placed inside the vertebral column to directly stimulate the spinal cord to produce pain relief.) This is an extremely expensive, and sometimes painful, procedure which often fails to produce pain relief for more than six months.

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Fight or flight? Stand your ground or cut and run to fight another day.? Fear, stress, pain and suffering have been the companions of homo sapiens since the days of the cave-men. But the terrors of winged dinosaurs, giant cave-bears and lurking sabre-tooth tigers have been replaced by the even more menacing stresses and tensions of the roar of the morning rush hour to start another working day in the twentieth century jungle.

A stress may be congenital, muscular, immunological, infectious, neoplastic, chemical, degenerate, emotional, psychological, or even environmental, such as accident or shock.

Why the pressure’s on

Unlike our ancestors, who picked up a rock and hurled it at a menacing animal, it’s a lot harder for a New Technology tribe member to pick up a computer terminal and hurl it at the menacing deadline pressures, at a tyrannical boss pacing up and down for a late report, to hit back blindly at creative burnout when a sales strategy/adver-tising campaign for a truly awful product is demanded.

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The currently accepted definition of pain from the Taxonomy Subcommittee of the International Association for the Study of Pain — I ASP — in its 1979 report reads: ‘An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.’ In addition it is noted that pain is always a subjective experience — that is to say that pain is only experienced by the person suffering it.’

Each individual learns the application of the word through experiences related to injury in early life. In an earlier definition of pain Dr Harold Merskey, the Canadian psychiatrist working in the pain area, drew attention to the fact that pain was almost always associated with some form of visible or audible behaviour. Califor-nian psychologist Richard Sternbach had already proposed that pain had three components: a component pointing to the pain source as a harmful stimulus signalling possible tissue damage: a pattern of responses permitting recognition of the pain by an observer; and, finally, the subjective or private feeling of hurt.

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There are two forms of urticaria which differ mainly in their timing. The type which troubled Kustner (see p22) is acute urticaria, which comes on very rapidly and usually clears within 24 hours. It is usually accompanied by other symptoms, such as feverishness, faintness or nausea. Chronic urticaria, the other form, is a persistent rash, or one which comes and goes over a much longer period of time.

The blame for acute urticaria can usually be pinned on a food that was eaten just before the attack began, although there are other causes of acute urticaria, including insect stings, drugs (notably penicillin), and, more rarely, something that was applied to the skin. Whatever the cause, the reaction is usually so prompt and unequivocal that the patient easily makes the correct diagnosis.

With chronic urticaria, things are not so simple. Only about 20 or 30 per cent of people with this distressing problem are likely to discover the underlying cause. Two-thirds of those afflicted do not have high IgE levels, nor any other allergic illness, and it is not at all certain what causes their symptoms. However, those that can identify the source of their problem very often find that there are several triggers, including food or food additives. Whether they are acting as allergens, or have a drug-like effect, is an open question.

The subject of urticaria will come up again in Chapter Five, because even when the rash is truly allergic it can be caused in more than one way.

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