Lithium, a light metal, acts on nerve fibres by being substituted for potassium which occurs naturally in the body and has an important role in the conduction of impulses along nerves. Lithium carbonate has been used in the treatment of mood changes for some years. It can be highly effective but the dose which controls severe depression is near to that at which unwanted effects appear, particularly shaking of the hands (tremor). For this reason, the level of lithium in the blood has to be carefully monitored.More recently, success has been claimed for the use of this drug in much smaller doses (too small to affect depression) in the treatment of chronic migrainous neuralgia, the maximum success being achieved after about 30 weeks of treatment. It cannot yet be recommended for general use.When a person is stimulated with a flashing light the brain produces a visual evoked response. If the intensity of the stimulus is increased, the brain can respond in one of two ways: the electrical response of the brain can increase (i.e. be augmented) or it can decrease (be reduced). Looked at simplistically, people can be divided into ‘augmented, who might be expected to be adversely affected by outside stimuli, and ‘reducers’, in whom the brain’s response is damped down. In patients with manic depression there is a relatively high proportion of augmenters. Augmentation or reduction is not an inbuilt programmed form of response and treatment with lithium can turn an ‘augmented into a ‘reducer’. The change occurs at the same time as any improvement in the previous mental state. Work is now being done to see whether migraine patients in general turn out to be augmenters.
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Pain Relief-Muscle Relaxers Comments Off
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Pain Relief-Muscle Relaxers Comments Off
In previous chapters, we have looked at various examples where damage to tissue is followed by inflammation. The quality of the pain and what to do about it changes. In postoperative pain, the initial acts of tissue damage were carried out under anaesthesia and the patient wakes up to sense only the later stages where the body attempts repair. In slow-onset diseases, such as arthritis, pain escalates as the disease process extends. Pain may grow in sudden jumps as in some cancer pains where the tumour has expanded into new territory and blocks the normal flow of blood, the contents of the intestines, urine or nerve impulses. Intermittent pains grow with each episode.Someone in their sixties or seventies walking uphill may be struck by a chest pain. Once you stop walking, the pain goes. This is angina of effort, an announcement by the heart that it can no longer pump enough blood around the body in response to the energy demand of walking uphill. As time goes by, the arteries continue to clog and their maximum blood flow drops. As this proceeds, the steepness of the hill that can be climbed drops, the amount of exercise that pain permits drops, and rest periods prolong. Eventually, if untreated, the angina forbids even standing up. These are expected reasons why pain may persist or escalate that we may be able to attack at source. However, there are a series of quite different changes that accompany pain which we must now examine because they play an important role in pain intensity.*76\219\2*
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