Professional Documents
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Pain & Aging: Run Away From
Pain & Aging: Run Away From
Pain & Aging: Run Away From
Breakthrough in fast
pain relief – pg 14
Updates on the
year’s biggest health
conference
WHAT Medicine 2009
– pg 27
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A LT E RN I TIME S J U N E 2 0 0 9 3
C OVE R STORY
You may want to read PAIN is the most common symptom for which
the elderly seek medical treatment.
this, even if you are not It affects between a quarter and half of all older
old, because if you want adults. It generally increases as we get older.
The world is aging. Most industrialised nations
to die of natural causes have more older than younger adults. Japan
is a case in point. China, because of the long
– my aim in life! – you standing one-child policy, is another example.
are going to have to get Indeed, all over the planet, older adults are set
to overwhelm the healthcare system.
old and probably have According to the latest United States Census
to feel some and, maybe, Study, about 13 percent of the population
is 65 years and older. By the year 2050,
quite a lot of pain… approximately 20.6 percent will be 65 years
and older.
Additionally, the oldest among them, those
above 85, presently account for just two
percent of the population, but are projected to
account for five percent by 2050.
This would mean that, understanding the usually aching or throbbing in quality, and is
challenges and unique needs of older adults with well localised.
pain, there is an urgent need to ensure there is Nociceptive pain is part of normal pain
effective healthcare for them in the years ahead. processing and typically responds well to
Common Sources of Pain in the Elderly traditional analgesics, such as acetaminophen,
The most common sources of pain in the elderly NSAIDS (non-steroidal anti-inflammatory drugs)
involve one or more of the following: and opioids (morphine type drugs).
- Osteoarthritis Neuropathic Pain
- Neuropathy This involves abnormal processing of sensory
- Lower back pain input by the peripheral or central nervous
- Malignancy system, and entails pathological changes in the
Additionally, the sources of pain can be broken nervous system itself.
down into two major classifications: Painful disorders such as complex regional pain
syndrome, post-herpetic neuralgia, phantom
Nociceptive Pain limb pain and post-stroke pain are examples.
This involves pain as a result from direct
stimulation of pain receptors from either Neuropathic pain is poorly localised and
visceral (organs) or somatic (bones, muscles, associated with burning, stinging, and
skin) sources. electrical type sensations. It often responds to
non-traditional analgesics such as antidepressants,
Examples include myofascial pain, inflammatory anticonvulsants, and occasionally, opioids.
disorders, and traumatic injuries. Such pain is
A LT E RN I TIME S J U N E 2 0 0 9 5
C OVE R STORY
As a pharmacy student, I was often reminded Concerns of toxicity, sedation, and drug-drug
that older adults are more susceptible to interactions are well documented in medical
adverse drug reactions from drug interactions literature.
and polypharmacy (many drugs for a
patient) as a result of the greater number of The End Point
medications taken with increasing age. The end result is simply this: good pain
management leads to greater degrees of
It is the same enzyme systems that break functionality, cognitive improvement, increased
down most drugs. When many medications self-worth, and happiness in older adults.
are competing for breakdown by the same Side effects can be intelligently anticipated,
enzyme, delayed metabolism of one or both prevented, and better managed.
drugs may occur.
When starting with opioids or other powerful
Thus, you many end up experiencing the (and thus toxic) medications, the mantra of
toxicity of one or both medications. “start low and go slow” is essential.
Drug Interaction Regular patient follow-up, communication, and
Additionally, one medication may actually symptom management are essential in catching
slow down or inhibit the enzyme required for problems early and steering clear of potentially
the metabolism of another medication. This life-threatening adverse drug reactions.
prolongs the effect of the drug.
Reject Pain
In some cases, it may speed up or stimulate the As the population continues to age, healthcare
enzyme and actually hasten the breakdown of providers and others must accept that pain
another medication. This limits its duration of is not a normal part of aging. Older adults
effect. Thus, higher than recommended doses deserve the same standard of pain control that
may be needed. one would set for their younger counterparts.
Balancing the risks and benefits of treatment A thorough risk-benefit analysis coupled with
is an important aspect of pain medicine in an appropriate understanding of each patient’s
older adults. On one hand, there are very real unique needs and a respect for the physiological
risks involved in instituting pain medications in changes associated with aging will allow for
older adults. optimal pain control and patient satisfaction.
A LT E RN I TIME S J U N E 2 0 0 9 7
PAIN
HISTORY OF HE A LTH
Today, acupuncture has even been made into Humphrey Davy suggested that the pain and
modern medicine’s most sacred sanctum – the shock of surgical operations might be relieved
operation theatre. It is used to ease the pain of if patients inhaled nitrous oxide, a gaseous
surgery. compound discovered by Joseph Priestley, the
Pain relief has also come from other techniques man who was also the first to isolate oxygen.
like chiropractic, osteopathy and similar In 1846, William G. Morton made his famous
massage techniques. demonstration of surgical anesthesia at the
Other commercial remedies contained varying Massachusetts General Hospital, using a hastily
quantities of opiates, alcohol or cocaine which rigged apparatus to deliver ether to the patient.
probably made them effective at relieving pain However, the use of anesthesia became
temporarily. common only gradually because many
physicians were accustomed to relying on “the
Breath of Relief healing power of pain” and were wary of the
The first new significant treatment for pain ethics of operating on an insensate patient.
occurred in 1846 with the use of anesthesia for
surgery. Before that, doctors and dentists used Counter Irritant
some bizarre techniques. Another popular approach to pain relief called for
An old Italian technique involved putting a the preparation of a wet plaster made from hot
wooden bowl over a patient’s head, and mustard. The plaster was applied directly to the
hammering on the bowl until the patient skin, or on a cloth that was then laid on the skin.
passed out. The heat from the mustard plaster worked on
There was also the practice of holding the principle of “counter-irritation” the idea that
children’s head over a gas stove so they would one kind of pain or sensation could cancel out
breathe the gas until they lost consciousness. another more severe pain.
They would also choke people with carotid In the medieval era, pain relief came mainly from a
compression until they passed out. wide variety of herbs, used liberally. A whole lot of
plant based remedies have been used over history.
Given that those who passed out would soon
recover, the best surgeons in those days were In addition to plant-based remedies, minerals
the fastest surgeons. were also used in the medieval pharmacopoeia.
It took a British queen to popularise the Even as recently as the early 1900s, some
concept of relieving the pain of childbirth, physicians used gold salts injected into limbs
previously thought to be an unavoidable or to treat arthritis. Today there are powerful
necessary part of motherhood. drugs that are gold derivatives used in pain
management.
Queen Victoria was the first one to have
anesthesia for childbirth – she had chloroform.
A LT E RN I TIME S J U N E 2 0 0 9 9
Breakthrough Pain Diary
at time of onset Treatment or medication used to relieve pain Comments (no
A LT E R N I TIME S J U N E 2 0 0 9 11
NATU R A L R EME DI ES
Painkiller
Bring On The Purple Stuff
RESEARCHERS believe they have found a group of vegetables and fruits that are
just as powerful as anti-inflammatory painkilling drugs.
Vegetables and fruits which are deep blue or purple – such as blueberries or
purple carrots – have the same anti-inflammatory qualities as painkillers such
as NSAIDs.
The magic ingredient appears to be a chemical found in the fruit and
vegetables called the polyacetylenes.
A LT E R N I TIME S J U N E 2 0 0 9 13
NEW PRODUCT
Professor Yves Henrotin will speak about the latest research in cartilage and osteoarthritis, the innovative
technology behind CCE 4800 and the management of inflammation, pain and arthritis on 20 June at
WHAT Medicine Conference & Exhibition. Don’t miss this opportunity! RSVP for your FREE PASS @
03-7965 2888 now, limited seats are available!
7000
6000 Cur inflammation and pain. CCE 4800 is as effective as modern
Ind
5000
Cel medicine, yet it works better than drugs. And most important,
4000
3000 CCE 4800 has a proven safety profile, with no side effects
2000
1000
compared to other conventional painkillers. This is because most
0 pain killers cannot differentiate and inhibit activities of both COX-
0 5 10 15 20
Concentration of CCE 4800 (µM) 1 and COX-2. Inhibition of COX-1 will result in many serious side
effects as mentioned earlier.
We invite you to be the 1st to experience the result of this breakthrough technology at the NACOX
Launch, 20th June 2009 @ WHAT Medicine Conference & Exhibition. Come find out more about
NACOX and enjoy exclusive member benefits available to you on that day!
A LT E RN I TIME S J U N E 2 0 0 9 15
NATU R A L R EME DI ES
WHILE we’re told that none of the over-the- he prescribes it, it is also supported by a study
counter remedies are worth the money, one that involved 896 patients.
top doctor is using an Ayurvedic treatment that
As Berkovitz pointed out in September last
seems to be doing the business.
year, it’s a successful remedy that other doctors
The remedy? Andrographis paniculata is being should be advocating, especially at a time
used by Saul Berkovitz, a consultant physician when we are overusing antibiotics.
at the Royal London Homeopathic Hospital.
Sources: British Medical Journal, 2008; 337: 476; Planta Med,
Not only does it work for the patients for whom 2004; 70: 293-8).
ALTERNI recommends
ANNALAX™
Natural herbal cough syrup traditionally used for reducing
phlegm and relief of cough, sore throat and body heatiness.
ANNALAX™ 240ml (syrup) – RM22
NATU R A L R EME DI ES
The Star of Asia
THE botanical name of the herb Centella This has been used as “a tonic for the brain and
asiatica implies it. Centella means “star” in Latin endocrine glands” and extracts of the plant are
and asiatica is, of course, Asia. Simply put, said to help circulation and skin problems.
it means “star of Asia”. Several scientific reports have documented
When eaten raw as a salad leaf, pegaga is Centella asiatica’s ability to aid the healing of
thought to help maintain youthfulness. In wounds.
Thailand, cups with gotu kola leaves is used as The herb has been widely used in the
an afternoon pick me up. traditional treatment of leprosy. Upon
A decoction of juice from the leaves is thought treatment with Centella asiatica, maturation of
to relieve hypertension. This juice is also used the scar is stimulated by the production of type
as a general tonic for good health. A poultice of I collagen.
the leaves is also used to treat open sores. The treatment also results in a marked decrease
Richard Lucas claimed in a book published in in inflammatory reaction and myofibroblast
1979 that a subspecies, “Hydrocotyle asiatica (having some of the characteristics of smooth
minor”, said to be from Sri Lanka, and also muscle cells, such as contractile properties)
called “Fo ti tieng”, contained a longevity factor production.
called “youth vitamin X”.
ALTERNI recommends
Pegaga Soap
Pegaga is one of the world’s best researched herbs for
dermological conditions.
Pegaga Soap 100gm – RM7.50
A LT E RN I TIME S J U N E 2 0 0 9 17
Alzheimer’s
STAYING SHA R P
ACCORDING to the first ever study into the Most in the activity group decided to walk
link between mental cognition and physical for 50 minutes, although some included light
activity, researchers have discovered that strength-training exercises.
regular exercise in middle-age can help
During the six months, those in the activity group
prevent dementia and Alzheimer’s.
improved their score on a cognitive test by 1.3
It’s enough to walk for 50 minutes a day, three points compared with those who were inactive.
days a week to reduce your chances of mental
By comparison, people taking the anti-
decline, researchers have found.
Alzheimer’s drug Aricept (donepezil) see an
They tested the theory on a group of 170 improvement of just 0.5 points when they used
individuals aged 50 or older, who were in the same test.
reasonable health.
The benefits continued for 18 months afterwards.
Half were assigned to minimal activity over a
24-week period, and the rest had to perform
Source: Journal of the American Medical Association, 2008;
some physical activity that lasted for at least 50 300: 1027-37.
minutes, and which they did three times a week.
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Lingzhi Extract
Our Lingzhi extract is the only Lingzhi that meets world-
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Lingzhi Extract 60s (capsule) – RM82
STAYING
Fish oil
works better than
a statin drug
THERE’S something better you could be doing “ Those who took the fish oil fared
for your heart than just popping a cholesterol-
lowering pill. marginally better than those
Fish-oil supplements work better than a
taking the statin drug.”
popular statin drug at preventing chronic heart
disease, researchers have found.
In the study, researchers tested a daily omega-3
pill against a placebo, and the statin drug Crestor
(rosuvastin) against another placebo,
on two groups.
Those who took the fish oil fared marginally
better than those taking the statin drug.
The fish oils increase the body’s HDL “good”
cholesterol levels, which also helps prevents
abnormal heart rhythms, whereas statin drugs
work on attacking “bad” LDL cholesterol.
A LT E R N I TIME S J U N E 2 0 0 9 19
PA RE NTI NG
Nature or Nurture
Parental Care
Counts More
Than Biology
SO is it all down to nurture or nature? Around a quarter of the girls were “early
maturers” and prone to delinquent behaviour,
In other words, do parents make their children
but those whose parents who took little or no
bad, or are they just born that way?
interest in their development were also more
A brave group of researchers last year decided likely to behave aggressively.
to try to answer this vexed question when
Levels of aggression rose depending on
they assessed the impact of positive parenting
parental involvement in areas of nurturing and
techniques on a group of 330 fifth-grade girls
communication.
with an average age of 11 or so.
In short, nurture was much more important
than nature.
ME DICAXLXU
Why Children And Teens Should
Stay Away From Them
THE Toronto Department of Public Health For many years, most government health
has advised teenagers and young children to agencies were dismissive of any risk.
limit their use of cell phones in order to avoid
But with more studies, a pattern is emerging
potential health risks.
that suggests people who have used their cell
The advisory is the first of its kind in Canada. phones for a long period of time are at greater
risk of certain kinds of brain tumors.
Officials have warned that because of possible
side effects from radio frequency radiation,
children under eight should only use a cell Sources: Health Zone July 12, 2008, CBC News July 12, 2008.
phone in emergencies, and teenagers should
limit calls to less than 10 minutes.
A LT E R N I TIME S J U N E 2 0 0 9 21
ME DICA L U PDATE S
Cholesterol
Buster
Affordable Options Are Available
CHOLESTEROL-lowering drugs should be Only if a patient still has a high cholesterol level
offered only as a last resort, a government- after trying all the other treatments should a
funded body has reported. Patients should statin be considered.
first be encouraged to stop smoking, exercise And, it points out, a high cholesterol level is in
regularly and improve their diet. any case a poor indicator of who will develop
These other options are far more cost effective heart disease. Most heart problems occur in
than statins, the family of cholesterol lowering people who do not have raised cholesterol.
drugs, says the NHS Centre for Reviews and The centre is also critical of pharmaceutical
Dissemination. companies which are reluctant to launch
If drugs do need to be used, doctors should lovastatin in Britain. Lovastatin is an unbranded
prescribe aspirin and beta blockers first, which (generic) and therefore cheaper statin.
are also cheaper. Prescribing it in place of the branded statins
now being used could save the government a
substantial proportion of the £113m (RM620m)
it spends each year on cholesterol lowering
drugs.
ME DICAXLXU
In Weakened Bones
Same Old Story... Make Drugs Your Last Resort
IT’S common for drugs to have a “paradoxical Researchers studied the data on 14,000 cancer
effect”. This is medicalese for stating that patients who were treated with one of two types
the drug can cause the very symptoms it’s of biophosphonates – pamidronate or zoledronic
supposed to be treating. acid – and compared their progress with 28,000
patients who weren’t given the drugs.
Another example of the paradoxical effect has
just been uncovered by researchers who have After six years, around 5.5 percent – or 770
been reviewing bone-strengthening drugs – of those taking the drugs needed facial or
known as biophosphonates which are regularly jaw bone surgery, or were diagnosed with
prescribed for osteoporosis. inflammation of the jaw bone, compared with
just 0.3 percent of the non-drug group.
In addition to helping build bone density, the drugs
are also supposed to treat cancer-related bone
lesions, and elevated calcium levels in the blood. Source: Journal of the National Cancer Institute, 2007;
What Doctor’s Don’t Tell You – 28th June 2007.
In fact, they very often do the reverse, and they
can dramatically increase the risk of jaw or facial
bone deterioration or infection.
ALTERNI recommends
A LT E RN I TIME S J U N E 2 0 0 9 23
9
ME DICA L U PDATE S
A LT E RN I TIME S J U N E 2 0 0 9 25
Expert Answers To Your Events @ 8 Avenue
Health Concerns
Q & A
25
SPEAKER
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a very small molecule. Jenny Chung
JUL TOPIC
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I am 60.
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