THE BIOLOGICAL PURPOSE OF PAIN FOR SOME NOTES ABOUT PAIN: CAUSES OF EXCESSIVE PAIN

Of course it is excessive pain which we desire to control, and which is the central subject of this study. A great number of different factors may combine to make pain excessive. Some of these are organic, depending upon the nerves concerned and their connections in the central nervous system; others are psychological and depend on our general mental health, as well as the particular significance which the pain has for us, both consciously and unconsciously. Constitutional factors also come into it. Some people are undoubtedly more sensitive to pain than others.

Some parts of our body are more copiously supplied with pain nerves than other parts. Any swelling due to inflammation is much more painful in a rigid tissue than in a soft tissue. This is so because pressure develops more easily in a rigid tissue. Thus an abscess at the apex of a tooth, or under the fingernail, is very painful, whereas a similar infection in the soft tissue under the skin causes relatively little pain.

If pain is coupled with distress, it quickly becomes excessive. It can be excessive, also, if it is associated with guilt, which often acts to prolong pain. The presence of a mild psychological depression makes the pain from some organic cause more severe, and tends to make the pain persist after the organic cause has ceased to operate. In fact, unrecognized depressive illness is one of the commonest causes of persistent pain for which no adequate organic cause can be found.

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RECTUM AND ANUS

Q. So we come to the final part of the intestinal system — the rectum and anus.

A. Correct. The rectum is simply a continuation of the large bowel or colon, and is the storehouse of the remnants of the food we have eaten, minus the nutrients and water which have been sucked up by the blood stream and used by the system. Material will remain in the rectum until a convenient time arises when it may be eliminated. This is termed defaecation, and the material excreted is technically referred to as faeces, or stools. It is interesting to note that faeces comes from an ancient Latin word which means “the dregs” — for correctly, it represents the dregs which were useless to the system. It is also commonly known by a more euphonious word stools, which comes from an ancient Anglo-Saxon word “stol” which means seat — for most Australians use a seat when defaecating — although in many eastern countries they still squat.

This, in reality, is a more natural method of elimination, and allows the muscles to work far more normally and naturally. Some eastern toilets are a cultural shock to Australians who travel abroad. Foot plates are present, so is a hole in the floor, but no seat — you simply squat down and hope for the best!

Q. Isn’t cancer becoming a major hazard with the large bowel?

A. The answer is a very definite ‘Yes’. In fact, many doctors claim that numerically speaking, cancers in this situation are growing quicker than in any other organ. Cancer, or carcinoma (to use the doctor’s term) is fairly common in the colon, as well as the next part of the bowel, the rectum. It is more likely in older people, specially those 45 years and more. That is the bad news. The good news is that we have on hand extremely effective methods of diagnosis today. We use x-rays, plus an ingenious device called the colonoscope. This enables rapid, early diagnosis, and it also enables effective treatment which in many early cases is extremely effective and definitely life-saving.

Q. What about diverticulosis. We seem to hear a great deal about this today.

A. That is another disorder of the large bowel. It means that small outcroppings like little balloons occur along the walls of the colon. The condition is called diverticulosis. Sometimes, if food and germs are trapped in the pockets, they become infected. These may produce considerable pain, a bit like appendicitis. Early diagnosis and treatment are effective, but it may be recurring and cause a lot of discomfort. I might add that the modern day use of unprocessed bran — chook food (as I call it), or fibre, which sounds much more euphonious, is often effective in checking symptoms from developing.

Q. What about the anus?

A. The rectum leads into a narrow tube called the anal canal, at the end of which is the anal sphincter or valve. This opens and closes voluntarily, so that material may be excreted under one’s conscious will. Sometimes if the contents are very watery, and there is excessive bowel activity (called peristalsis) such as with severe bowel infections, it may be difficult to control the valve and accidents may take place.

This is also common in infants, and it takes babies some time — usually around 18 to 30 months — to develop voluntary control over the anal valve. Incidentally, there is a great deal of social one-upmanship on baby’s bowel actions. Many young mothers claim they have “trained” their infants by the age of six months. But they are really fooling themselves. Simply because they manage to place a potty under little Sean just as he defaecates, this is not an indication of successful training. His nervous system has not developed to this point before at least the time span given above. So, good though these efforts are, little Sean will be like most of the other little fellows in the neighbourhood, and will learn proper bowel control when Nature decrees!

Q. So that is the story of the G.I. system, and some of the events that take place on a regular basis.

A. Correct. It is a wondrous system. The remarkable fact is that despite the way in which it is abused by the owners, it will continue to function in a magical manner. Heave down a terrible array of foodstuffs and fluids, and it will continue to stoically perform year in and year out. Finally it may rebel, but usually only when major abuse takes place for many years. In the main, it functions smoothly.

Q. Well, what now?

A. We plan to discuss some of the more common and more important disorders of this wondrous system. Because it affects so many people, it is our plan to concentrate for some time on the stomach and duodenum, and speak specifically about peptic ulcers. So, stay with us, for if you are an average Australian, there are very high chances that you will be an ulcer victim. It may only be a matter of time. In fact, you — the person reading this booklet right now — probably have an ulcer gnawing at your vitals!

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THE PHENOMENON OF REFERRED PAIN

Just how difficulties in the back cause sciatic pain – this being a typical example of what is called ‘referred pain’ (medical name: synalgia), that is a pain that occurs in a part of the body other than where it might have been expected – will be explained in full in the next chapter. In the meantime, let us briefly note that referred pain is quite a common phenomenon: for example, we all know that some heart disorders can cause pain in the left arm and fingers. Equally, an abscess below the diaphragm may lead to referred pain in the shoulders. The confusion created by referred pain stems from the fact that the sensory nerves from different parts of the body share common pathways when they reach the spinal cord. To treat any referred pain successfully, its origin must be located first, because that’s where the treatment will have to be effective to bring about permanent relief.

It follows from this that the treatment of sciatica must ultimately be addressed to its source, and this is invariably in the spine, and not where the pain may manifest itself. Having said that, some local treatments applied to the site of the pain – such as heat or gentle massage – can be extremely useful in reducing its severity, but these approaches will only reduce the pain temporarily, not cure it or improve its root cause. Nevertheless, palliatives – the name given to treatments that relieve or soothe the symptoms of a disease or disorder without effecting a cure – can be of great help. Pain-killing medicines, such as aspirin or paracetamol, are essentially palliatives, their effect limited either to making the pain disappear or at least lessening it, so that it becomes more bearable. Such simple remedies can, however, have an extremely important role to play in the management of sciatica, especially when the symptoms are fairly mild and/or occur but rarely and the main purpose of treatment is to stop them from interfering with the tasks of daily life.

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