LIVING WITH PAIN 1

BACK PAIN Some do’s and don’ts

helpful websites + beating gout + exercising safely

MIGRAINE Triggers &

Treatments

GETTING A GOOD NIGHT’S SLEEP

We show you how

Arthritis Exercises to keep

you moving

WITH COMPLIMENTS FROM YOUR PHARMACIST OR HEALTH PROVIDER

WINTER 2014$4.95 inc GST

PAINLivingwith

magazine

A Beginner’s Guide to Pain What does it all mean?

PROBIOTICSThe wonders of

good bacteria

www.sigvaris.com

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Contents

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Medically tested travel support socksTRAVENO will come in handy wherever you go. Scientific studies have proven that TRAVENO reduces swelling of the legs on long-haul flights and lowers the risk of thrombosis 1.

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LIVING WITH PAIN WINTER 2014

IN BRIEF4 News and views

HEARTBURN6 Managing the discomfort

SLEEP7 12 tips for better sleep

BACK PAIN10 Some do’s and don’ts

ARTHRITIS12 Managing a flare-up

34 Exercises to keep you moving

EXERCISING SAFELY14 Tips for avoiding injury

PAIN MEDICATION16 What’s in your

medicine cabinet?

MIGRAINE18 Triggers and

treatments

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2 LIVING WITH PAIN Winter 2014

LIVING WITH PAINEditor: Sara CarberyEmail: [email protected]: Rose Miller at Kraftwork Proofreader: Stella Clark

ADVERTISING Sales manager: Debbie BishopPhone: 09 535 5585 or 021 340 360Email: [email protected]

PRINTERMcCollams Print

PUBLISHERPublished three times a year by Hawkhurst Media Services LtdPO Box 25679, St Heliers, Auckland 1740Phone: 09 528 0128

Member of the Magazine Publishers Association.Member of the Audit Bureau of Circulation

ISSN: 2324-2213

Disclaimer: Every effort is made to ensure accuracy but Living with Pain accepts no liability for errors of fact or opinion. Information in this publication is not intended to replace advice by your health professional. If in doubt check with your pain specialist, GP, nurse, dietitian or other health care professional. Editorial and advertising material does not necessarily reflect the views of the Editor or publisher. Advertising in Living with Pain does not constitute endorsement of any product.Living with Pain is an independent publication and is in no way affiliated with or endorsed by any organisation. © All rights reserved. No article in whole or part should be reprinted without permission of the Editor.

INTERVIEW22 A beginner’s guide to pain

STROKE24 Recognising the signs

GOUT27 What you can do

IRRITABLE BOWEL SYNDROME30 The role of good bacteria

ORAL HEALTH36 Prevention is better

than cure

NATURAL HEALTH38 The A to Z of arnica

ENDPOINT40 Useful snippets

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in brief

NEWS AND VIEWS

Although aimed at health professionals, the NZ-based Healthskills blog provides thoughtful commentary and a lot of valuable information for chronic pain sufferers. It’s written by Occupational Therapist Bronwyn Thompson who has a Masters in Psychology and has worked in the field of chronic pain management, helping people develop self-management skills, for 16 years. http://healthskills.wordpress.com/

If you suffer from migraines, you might like to download an online migraine diary from The Migraine Trust. The diary helps you keep track of your migraines and identify any patterns or triggers – valuable information for you and your doctor.www.migrainetrust.org

Since it was launched three years ago, the Manage My Pain app has helped thousands of people record, track, analyse and share their pain with doctors, insurance companies and government agencies, says app founder Tahir Janmohamed.“Between 20-30% of the population suffers from chronic pain, and one of the biggest challenges for them is getting people to understand what they’re going through,” he says. “Doctors, on the other hand, have the unique challenge of treating something that is based on a patient's subjective self-assessment. This communication gap between chronic pain sufferer and doctor is really what we try to bridge with our app – it provides a common language to describe pain.”The app is currently available for Android, with plans to launch it on the web and for the iOS platform in the future. It can be downloaded for free from either Google Play or Amazon’s appstore, and there is a Pro version available for $4.99 NZD, which allows users to see more than 10 records at a time.www.managinglife.com

The New South Wales-based ACI Pain Management Network has launched a new website designed to help people gain a better understanding of pain. Built on the latest scientific evidence on how to manage chronic pain, it includes practical tools and resources and a number of video episodes. For adolescents, there is a section called ‘PainBytes’, with seven episodes that can be viewed like a TV series.www.aci.health.nsw.gov.au/chronic-pain

Worth checking out


Causes of chronic painAlongside arthritis, the most common forms of chronic pain in New Zealand are musculoskeletal pain disorders such as lower back pain (with or without leg pain and/or sciatica), neck pain (with or without arm pain) and whole-body pain (fibromyalgia), according to the Health Report on Chronic Pain put out by Pfizer and Arthritis New Zealand. Of those respondents who said they experienced chronic pain, 47% said it was from a diagnosed health condition such as arthritis or an inflammatory condition, 38% said it was from a specific event such as an accident or operation and 10% said the source of their pain was unknown to doctors.

Good news for osteoarthritis sufferersResearch at a Polish hospital has found that treating sufferers of osteoarthritis with a patented CO2-stabilised oil from New Zealand’s very own greenshell mussel Perna canaliculus significantly improved both their pain symptoms and quality of life.

Just one of 20 research papers demonstrating the effectiveness of Lyprinol PCSO-524™, the double-blind study compared the effectiveness of PCSO-524™ with fish oil on patients who suffer from osteoarthritis of knee and/or hip joints.

Jacek Szechinski and Marek Zawadzki from the Clinic of Rheumatology and Internal Medicine at Poland’s Academic Clinical Hospital concluded, “Reduction of pain was statistically evident at four weeks among the subjects who took capsules that contained PCSO-524™. Practitioners can expect quicker long-term results with less risk of side effects for their osteoarthritis patients when they recommend products that contain PCSO-524™, compared with fish oil.”

They found that patients treated with fish oil showed significantly less improvement and a greater level of physical discomfort caused by the fish oil during the study.

“No side effects were observed with the patients who took PCSO-524™.”

Over a dozen studies have also found PCSO-524™ to be effective in treating asthma, allergic inflammation and lung function. Scientists believe the potent anti-inflammatory action of PCSO-524™may be due to the fact the extract contains up to 91 fatty acid components and contains furan acids, which have been shown to possess more potent anti- inflammatory activity than the omega-3 fatty acid EPA (www.expert-review.com).

Did you know? 18% of adult New Zealanders suffer from chronic pain.

LIVING WITH PAIN Winter 2014 5

THE PAIN OF HEARTBURN

If you have a burning pain or uncomfortable feeling in your stomach or chest just after eating, you’re probably suffering from heartburn.

MOST CASES of heartburn are caused by

a weak lower oesophageal sphincter (LOS) muscle, the tube that runs from the back of the throat to the stomach. Working like a valve, the LOS opens to let food into the stomach, and closes to prevent acid leaking back up into your oesophagus.

Exactly what causes the LOS to weaken is not always known, but there are a number of risk factors. These include:• Being overweight or obese (this can put increased pressure on your stomach, which can weaken the LOS)• Having a diet high in fatty foods (it takes longer for the stomach to get rid of stomach acids after digesting a fatty meal)• Consuming tobacco, alcohol, coffee, or chocolate (these substances are thought to relax the LOS)• Being pregnant (changes in hormone levels can relax the LOS)• Having a hiatus hernia where part of the stomach pushes up through the diaphragm • Stress

Things you can do• If you are overweight, losing weight may help.• Eat smaller meals more often, rather than three big meals a day and aim to eat dinner 3-4 hours before going to bed. • Pinpoint foods that make your heartburn worse, eg alcohol, coffee, chocolate, tomatoes, fatty or spicy food, and remove these from your diet to see if your symptoms improve. • Raise the head of your bed by around 20cm by placing pieces of wood or phone books under it. • Quit smoking.• If you are taking medication for another health condition, check with your GP to make sure this isn’t contributing to your heartburn. • Over-the-counter medicines can help relieve symptoms. Talk to your GP or pharmacist for advice.

heartburn


sleep

12 TIPS FOR BETTER SLEEPO sleep! O gentle sleep! Nature’s soft nurse – Shakespeare

Often described as ‘Nature’s healer’, sleep is a vital component of a healthy lifestyle. But when you’re in pain (and yearn most for the escape sleep can bring), drifting off and getting back to sleep when you wake can be a real challenge.So what can you do to get a better night’s sleep?

Manage your Pain – Talk to your GP or pain specialist about pain medication and

try to take it at a time that allows you to get the best night’s sleep possible.

Structure your Day – What you do during the day significantly impacts on how well you sleep at

night. It’s important to put some structure into your day, especially if you’re not working. Aim to get up at the same time and have things planned at specific times. Go to bed when you feel sleepy, at roughly the same time every night.

Get Outside – As soon as possible after you wake, get outside. Spend time outdoors every day, even if it’s

just reading. Sunlight suppresses melatonin, the hormone which helps regulate our sleep/wake cycle, and stimulates the production of serotonin, the ‘feel-good’ neurotransmitter which wakes us up and helps to lift our mood.

Get Moving – Move as much as your pain allows; this will help you sleep better. However, avoid

any vigorous exercise in the evening.

Establish Good Habits – Follow the commonsense advice you hear to give yourself the best chance of a

good night’s sleep. Avoid caffeine (tea, coffee, coke, chocolate) in the afternoon and evening, eat earlier rather than later and don’t eat too much, avoid alcohol and give up smoking.

Shut Down – Turn off all screens including your laptop, I-pad, smartphone and (ideally) your TV at

least 30 minutes before going to bed, preferably an hour or more. The blue light emitted from computer screens limits our production of melatonin, the hormone we need to get to sleep.

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Wind Down – Make the hour before you go to bed a relaxed, soothing one. Read,

do a puzzle, listen to quiet music, do breathing exercises or some gentle yoga.

Warm Up – You’ll find it easier to sleep if you’re warm, but not too hot. It’s best not to

have a bath or shower just before going to bed; an hour or so before is ideal. Don’t have more bedclothes on than you need.

Get Comfortable – Make sure your bedroom is as quiet and as dark as possible. You want it

to be a peaceful sanctuary so avoid having stressors such as computers or unfinished work in the room. Use pillows to make yourself comfortable. If you have lower back pain, try sleeping with a pillow under your knees, or if you like to sleep on your side, try sleeping with a pillow between your knees.

Accept – Accept that you will wake at night; everyone does, we just don’t remember waking

if we fall back to sleep within 1-2 minutes. Remember: it’s not the waking that’s the problem, it’s the going back to sleep, so try not to get wound up when you wake. Putting your clock out of sight and out of reach will help.

Relax – If you wake at night, try abdominal breathing, progressive relaxation or mindful meditation.

You’ll find instructions on how to practise these techniques on the internet. Console yourself with the fact that you can always have a nap during the day if you feel tired. Napping (10-20 minutes) can really help, especially if you feel sleepy and have to drive somewhere. As long as you wake before about 2.30pm, a nap shouldn’t impact on your ability to sleep that night. Any later in the day, though, and it probably will.

Get Up – If you’re still tossing and turning after 20 minutes or so, get out of bed and do something you find relaxing. Take some deep breaths,

write down anything that’s worrying you and, if passed by your doctor, take some medication if you’re in pain. Keep the lights dimmed, don’t drink or eat or tackle any projects; just sit and relax. Go back to bed after 15 minutes or so and give the relaxation techniques another go.With thanks to Dr. Alex Bartle from The Sleep Well Clinic www.sleepwellclinic.co.nz

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back pain

BACK TO BASICS

Are you one of the many New Zealanders who experience the odd back ache or niggle? Claire Hodds from Physiotherapy NZ talks us through some back pain triggers and offers advice on what to do treatment-wise.

not due to a serious disease or health condition, and it can be helped. Research now clearly demonstrates that simply staying active can reduce your pain and shorten your recovery time in many instances.

The most common type of back pain is often called non-specific which means it doesn’t have a clear cause. That said, there are a number of risk factors that

A NATIONWIDE survey by Physiotherapy New Zealand showed that

90% of us will experience some type of back pain, with heavy lifting (35%) and poor posture (32%) listed as the top causes or triggers.

If you’ve experienced back pain then you’ll know it can impact on all sorts of daily activities at home and work. The key things to remember are that most back pain is

can contribute to your risk of developing pain, or increasing any current pain that you have. • Sitting for long periods at a time (without taking a break) • Poor posture • Feeling stressed or anxious • Smoking • Not getting the recommended 30 minutes of exercise a day • Being overweight • Having a trip or fall.


For non-specific back pain, there are a number of simple steps you can take to improve and manage your pain.

1 Stay active It’s important to get back into your usual daily routine as soon as you can. You may need to take it easy at first with tasks like lifting and bending but it’s great to keep doing some gentle exercise like walking or swimming. Bed rest can make your back pain worse, so get up and about. A physio can advise you on appropriate exercises.

Although pain can make you feel like keeping to yourself, it’s important to catch up with friends and continue with your hobbies and interests as much as possible.

2 Get back to work Getting back to work keeps you involved with others, gets you into a routine and helps you focus on something other than your back pain. If you can’t manage full days at work immediately, talk to your employer about easing back into your job. This could involve working fewer hours each day at first, or it could mean that for a time you avoid doing those parts of your job that will aggravate your pain, such as heavy lifting.

If your work involves lots of sitting, make sure you get up and stretch regularly. It’s good to do this whether or not you have a sore back!

3 Avoid bed rest Research shows that people with back pain should avoid bed rest. Staying active can help reduce your pain and shorten recovery time in most cases. A physio can advise you on the right level of activity for you.

4 Ease your pain There are over-the-counter medications available to help you manage your back pain so don’t try to ‘tough it out’. Talk to a health professional about what might work best for you.

5 Take action If you’re not feeling better after a few weeks then seek additional treatment from your doctor or health professional.

TREATMENT – HOW TO GET BETTER

Disclaimer: The information in this article is not designed for people with a serious back injury – seek advice from a health professional if you are unsure. The content is not intended as a substitute for care from a health care professional.

Physiotherapy New Zealand has a free ebook called ‘Taking Care of Your Back’

– the truth about the treatment and prevention of back pain. For more

information or to download it, visit: www.physiotherapy.org.nz

TAKING CARE OF YOUR BACK

A physiotherapy guide to treating and preventing back pain

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arthritis

ARTHRITIS MANAGING A FLARE-UP If you have arthritis, you’ve probably experienced a flare-up at some stage. Your disease may seem to be well under control for a while, and then suddenly your joints become inflamed and painful and you may feel unwell and over-tired.

In their downloadable book on exercise for arthritis sufferers, Physiotherapy

New Zealand and Arthritis New Zealand have combined their expertise and come up with some helpful advice for managing a flare-up. • During a flare-up, avoid doing exercises that put extra load or added exertion on the affected limb or joint, as this could make things worse.• Protect the affected joint by using a splint or other support, and avoid adding any strain or increase in weight. However, if pain and swelling allow, try to maintain the range of movement in the joint.• It’s important to use appropriate pain relief medication while experiencing a flare-up. You may need to consult your GP, rheumatologist or registered nurse for advice.• Once the flare-up has settled, try to return to normal levels of activity. Long periods of inactivity or reduced movement lead to decreased strength, increased stiffness and faster deterioration of the joints.

Cold packs sometimes provide relief. You can buy one from a chemist or use a bag of frozen peas wrapped in a damp tea towel. Place the bag over the affected area for 10-15 minutes, two to four times a day to reduce swelling or heat. (Note: This is not recommended for people with Reynaud’s phenomenon.)

Relaxation techniques can be an effective way to reduce long-term physical tension. While some muscle tension is normal, extreme tension is not, and relaxation can help you cope with stress and pain. One simple relaxation technique is focusing on your breathing. Breathing in through your nose and out through your mouth can encourage deep, slow, regular breathing. Take your breaths from your abdomen rather than your chest, and it may help to count while you breathe. Breathe in, count 1, 2, breathe out, count 3, 4, 5. Speak to your registered health professional to find out more about suitable relaxation strategies.

Protect your joints. When planning exercise and daily activities, make sure you protect your joints. Joint protection is about using your body in different ways to reduce the amount of stress on sore joints.

Conserve energy. Respect pain. If you feel pain during an activity, stop and take a rest. If you still feel pain two hours after doing an activity, you’ve done too much.

THINGS THAT MIGHT HELP


Pace yourself and incorporate rest periods in between activities

PLAN Write down a plan for your day and include rest periods. Consider your energy levels and plan your most active tasks for when you have the most energy. Try to alternate light and heavy activities.

THE 5 P’s Other tips to help you conserve energy during a flare-up

PRIORITISE While writing your plan, rank the importance of your day’s tasks. If an activity is low on the list, let it go!

PACE Pace yourself and incorporate rest periods in between activities. Spread your workload out into manageable bites, rather than trying to tackle all your tasks at once.

PROTECTION Do your best to avoid strain or staying in the same position for too long.

POSTURE Maintaining good posture helps conserve energy, while bad posture will make you feel more tired. Consider how you’re holding your body when sitting, standing, doing exercise and other activities.

With thanks to Physiotherapy New Zealand and Arthritis New Zealand. For a copy of Arthritis: Exercises to keep you Moving, go to www.physiotherapy.org.nz and search ‘arthritis exercise book’ or visit the Arthritis New Zealand website: www.arthritis.org.nz/resources/free-brochures/

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exercising safely

READY, STEADY, GO!Keen to exercise but worried about doing yourself an injury? Here are some tips on how to exercise safely.

1. Start off slowlyIt can be tempting to go all out when you first start, but it’s important to gradually increase the time and intensity for whatever activity you are doing.

2. Balance between training and recoveryEmbrace rest days. Take the time to recover so that your muscles and connective tissues have a chance to repair.

3. Don’t train through painListen to your body and don’t ignore the signals it's sending you. If you are in a lot of pain, don’t just push through. Your body is telling you to slow down.

4. Warm up and stretchWarming up your muscles is a great step to injury prevention and as a bonus, it can also improve your performance. 5. Cross trainCross training can help prevent injuries, keep boredom at bay and increase your overall fitness, so mix it up! The trick is to combine different types of exercise, for example you might consider a plan that incorporates running (cardio), with free weights (strength training) and yoga (flexibility).

6. Get the right gearHaving the right equipment is really important. If you’re a runner, this might be shoes that support your running style.

7. HydrateThe amount of water needed varies from person to person, so work out what is right for you. Your goal should be to remain hydrated throughout the whole day, rather than just gulping down a bottle after exercise. Sports drinks can be useful if you’re training at a high intensity for longer than an hour but if you’re just going for a short walk, stick to water.

If you do pick up an injury then make sure you see a health professional early. Don’t wait until it develops into something bigger. With thanks to Physiotherapy New Zealand www.physiotherapy.org.nz

Warming up your muscles is a great step to injury

prevention and as a bonus, it can also improve your

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pain medication

YOUR MEDICINE CABINETOpen your medicine cabinet and chances are you’ll find a collection of pain relief medication. But do you know what kind of pain each one is best suited to, who can take them and when they should be avoided? We talk you through the four most common pain relievers.

Paracetamol• Paracetamol relieves mild to moderate pain.• It lowers high temperature (fever).• Paracetamol is commonly used for infants and children. Use the liquid forms made for children and give the exact dose for the child’s age, no more often than suggested. Do not continue regular doses for more than 24 hours without talking to your pharmacist or doctor. Paracetamol doesn’t cause sleepiness and

shouldn’t be used to help children sleep unless pain is causing sleeplessness.• Paracetamol is suitable for people sensitive to aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs) and people with stomach problems. It’s a good choice for pain management in the elderly.• Paracetamol has fewer side effects than most pain relievers, but it is harmful to take too much. In adults, overdosage is more than 4g of paracetamol in a 24-hour period.

Codeine• Codeine relieves mild to moderate pain, but is too constipating for regular use so do not use for more than three days at a time.• It is sometimes given with aspirin, paracetamol or ibuprofren to improve pain relief for dental pain, headaches, period pain and migraine.• Codeine helps to reduce coughing and may be added to cough and cold remedies.• It can cause sleepiness.• Codeine is misused by a small number of people which means some preparations are pharmacist-only medicines. Your pharmacist will need to talk with you before selling codeine and records of the sale will be kept.


Non-steroidal anti-inflammatory drugs (NSAIDs)• NSAIDs (eg ibuprofen, diclofenac and naproxen) relieve mild to moderate pain, reduce inflammation and lower temperature during a fever.• They relieve headache, muscle and joint pain, dental pain and period pain.• NSAIDs are useful for pain associated with inflammation, eg sports injury. However, for soft tissue injuries like sprains and strains, treatment with NSAIDs is best delayed for the first 24-48 hours. This allows the body’s initial, and beneficial, inflammatory response to kick-start the healing process. Paracetamol can be used for this initial period, along with Rest, Ice, Compression and Elevation (RICE). Avoid HARM (Heat, Alcohol, Running (exercise) and Massage. You can use NSAIDs after the first 24-48 hours.• Talk to your pharmacist or doctor before taking NSAIDs to check they are safe for you. NSAIDs may not be suitable if you are taking certain medicines, have (or have had) a stomach ulcer or any other stomach disorder, are asthmatic and sensitive to aspirin or other NSAIDs, or if you have other health problems such as kidney or heart disease.

Aspirin• Aspirin is a type of NSAID and can be used for headache, minor muscle and joint pain and period pain. It also lowers high temperature.• Low doses (50-150mg) can decrease the chance of clots forming in your blood and reduce the chance of heart attack or stroke. Always check with your doctor first before taking aspirin for this reason.• Products containing aspirin should not be taken during pregnancy, or if you have stomach pains or gout.

• Aspirin may cause a reaction in people who have asthma or allergic conditions.• You should avoid taking aspirin if you are taking medicines, such as warfarin, to reduce blood clotting. Check with your doctor first.• Aspirin should not be given to children under 12 unless recommended by a doctor. Also avoid giving aspirin to children under 16 who have a viral illness such as the flu.• Aspirin should not be taken for several days before surgery, including dental surgery.

With thanks to the Pharmaceutical Society of New Zealand. For more information about pain relief medication, talk to your doctor or pharmacist. Look for the Pain Relief fact card on the Self Care stand at your pharmacy or ask the staff if they have Self Care fact cards. Around 60% of New Zealand pharmacies are Self Care members.

Important things to remember:• Pregnancy and breastfeeding: Paracetamol is usually considered the pain relief of choice for pregnant and breastfeeding women, but check with your pharmacist or doctor before taking any pain relievers during this time.• Check ingredients: Always check the ingredient list when buying medicines so that you don’t double-up. Ask your pharmacist for advice if you’re in doubt.• If things get worse: See your doctor if your pain becomes worse or lasts more than 2–3 days or more than 24 hours in a young child.


migraine

SPOTLIGHT ON MIGRAINE

MIGRAINE IS an incredibly difficult topic to

sum up because everyone’s experience of it is so different. Some people only have a handful of attacks during their lifetime, for others it’s a weekly or monthly occurrence. Some sufferers know strong perfumes will precipitate an attack, while others pinpoint chocolate as their trigger. Some experience an aura (loss of vision and flashing lights), others nausea and vomiting.

Really, the only common feature in all migraine attacks is the headache and even this varies greatly in its severity.

“The severity of the headache varies from a mild ache to an unbearable discomfort,” says neurologist Dr Jon Simcock, Medical Adviser with the Neurological Foundation of New Zealand. “During a severe attack, some people feel they would rather be dead.”

Migraine TriggersAlthough there is a strong family predisposition to migraine (75% of sufferers have a first-degree relative who also has migraine), the underlying causes remain unknown. There is however, a long list of possible triggers, including glare, noise, strong smells, bending over, a blow to the head, strenuous exercise, missing a meal, dehydration and over-tiredness.

“The number of different factors which can precipitate migraine is one of the most frustrating features of the disorder,” says Dr Simcock. Whether or not certain foods trigger migraine is a controversial subject but chocolate is commonly incriminated, as are alcohol, food colourings or flavourings, dairy products, gluten and MSG.

The relationship of migraine to hormonal changes in women is well-recognised and it is relatively common for an attack

to start around the onset of a period. Migraine often improves during pregnancy but for a small proportion of women it becomes worse during the first trimester. It isn’t uncommon for migraine to improve or disappear during menopause.

Psychological factors can also play an important role in migraine. “Factors such as having too much to do and too little time to do it in, emotional pressures generated by a catch-22 situation, unrealistic parental expectations and many other circumstances do seem to be the underlying cause of migraine in some people,” says Dr Simcock.

Lifestyle Changes If you suffer from migraine, there are some lifestyle changes you can make that may help. As a starting point, here are a few questions to ask yourself.• What am I eating (and how often)? Reviewing your

Identified by the World Health Organisation as one of the four most disabling chronic medical disorders, migraine occurs in about 18% of women (mainly between the ages of 15 and 55) and 12% of men.


diet is a good first step to take in managing migraine. While elimination diets can be difficult to maintain, with persistent headaches it is worth looking at significant restriction of dairy products and gluten, says Dr Simcock. Also, make sure you’re eating regularly.• Am I getting enough sleep? Sleep deprivation can be a migraine trigger so look at improving your sleep hygiene (see page 7 for tips) or talk to your doctor about appropriate medication. Underlying stresses resulting in worry at night time can be helped with counselling.• Am I stressed? Making time for yourself and not trying to be all things to all people all of the time require a change in outlook, and often understanding and practical help from spouses and other family members, says Dr Simcock. “All too often, the migraineur has been unable to change the psycho-social stressors despite their best efforts and may say to the doctor ‘cure my headaches and I will be alright’ when they really know that they have not come to terms with their problems.”• Is it my hormones? Hormonal manipulation is helpful only in a few people, but continuing to take the combined oral contraceptive pill for three months rather than having the headaches each month on stopping the

pill, changing to a progestogen-only pill, using the injection of progestogen or a Mirena IUD may be appropriate in certain cases, says Dr Simcock. Talk to your doctor or specialist about this option.

• Am I calm? Find a technique that helps to calm you. For some people, strenuous exercise for half an hour on at least three occasions a week helps, while for others yoga or meditation works.

Migraine Treatment Paracetamol, codeine, triptans, non-steroidal anti-inflammatory agents… whatever medication works for you, it is important you take it early on in a migraine attack. For medication to be effective, it is better to take

a full dose at the onset of a migraine rather than seeing whether a modest dose will be enough and then taking another dose if it is not.

Talk to your pharmacist, doctor or specialist about what medication will be best for you.

For many people, particularly children, a simple analgesic and bed rest is sufficient. Other things that might help during an attack include a quiet, darkened room; the use of a hot or cold pack (or alternating hot/cold packs); firm pressure over the temples; slow diaphragmatic breathing and sleep (although, conversely, some people find caffeine helps).

Depending on the frequency and severity of attacks, it may be best to take regular medication to prevent the attacks occurring. “The fact that a number of different medications have been used, indicates that no one medication is particularly effective,” says Dr Simcock. Again, seek medical advice to find out what might work for you.

With thanks to Sue Giddens and Dr Jon Simcock from the Neurological Foundation. Dr Simcock has written a handbook, Migraine: A Patient’s Guide, which is available from the Neurological Foundation’s website www.neurological.org.nz/resources

Yoga or meditation can help to calm you


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interview

BEGINNER’S GUIDE TO PAINWe all know what pain feels like, but why do we feel it and how do we feel it? We asked Dr Gwyn Lewis, a member of the New Zealand Pain Society Council and Senior Lecturer in Physiotherapy at AUT University, to shed some light on the subject.

Q: What is the purpose of pain? Pain serves a purpose of telling us that there has been an injury or tissue damage somewhere. Therefore, pain is usually useful for our survival and general well-being. The sensation of pain needs to be unpleasant so that it attracts our attention and we stop what we are doing. If we kept on running on a sprained ankle, we would do more damage to our ligaments, so we need pain to tell us to stop, rest, and recuperate. As the injury heals, the pain goes away and we are able to get up and move again. This is physiological pain as it serves a useful purpose. There are also some types of pain that are pathological and are not beneficial for us. Pathological pain is normally associated with long-term pain conditions and may indicate that something has gone wrong in our pain system. Pathological pain can have a marked detrimental impact on our physical function and psychological health.

Q: What is the difference between acute and chronic pain?Acute pain is short-term pain that arises in direct response to injury or damage. It is the physiological pain described above. Chronic pain is pain that persists for three months or more. It may or may not be associated with injury, but is often pathological.

Q: How does the pain system work? We have sensors in our body (the skin, muscle, joints, and most internal organs) that detect tissue damage. When they are activated, the sensors send a message into the spinal cord and then up to the brain. There is a network of areas within the brain that interpret these signals as pain. The experience of pain is literally ‘in our head’, as this is where our brain is and where the pain sensation arises.Q: What increases and decreases pain symptoms?There are many factors that can increase and decrease the experience of pain.

Inflammation associated with an injury makes our pain sensors more sensitive, so the amount of pain we experience is increased. Rubbing a painful area can reduce pain through activation of a neural circuit in the spinal cord. Our thoughts, feelings, and mood can also modify pain. For example, if we are unhappy, anxious, or stressed, we may experience more pain.

Q: Can chronic pain be cured, and if so, what is the best approach? Chronic pain can often be managed very effectively. We may not be able to reduce or cure chronic pain in some people, but there are ways to reduce the impact of pain on a person’s lifestyle and well-being. Facilitating people to undertake their daily activities and occupations is generally a more important goal than curing their pain. The best approach to management of chronic pain is with a multidisciplinary team, for example, a team of doctors, physiotherapists, nurses, occupational therapists, psychologists and social workers all working together with the


patient, their family, and possibly their employer.

Q: Does chronic pain always have an obvious cause? No, it often doesn’t, and this can be one of the most frustrating aspects of chronic pain. Sometimes chronic pain arises from an initial injury that heals but the pain does not go away. Chronic pain can also arise spontaneously without any obvious physical damage to the body. This is still pain! Often spontaneous pain will mean there has been some damage or dysfunction in our pain system, but this can be very difficult to detect.

Q: Pain doesn’t just affect the body physically does it?Pain is both a sensory and emotional experience. When the pain signals reach our

brain, they go to areas that are involved in our emotions, thoughts, and behaviours. This means that feeling unpleasant, upset, or scared is part of the pain experience. Many chronic pain conditions are also associated with changes in other body systems, such as movement control, memory, skin temperature, sweating, and touch sensation.

Q: It’s easy for sufferers of chronic pain to feel isolated and unheard. Why is that?One of the biggest frustrations for people with chronic pain is the feeling that they are not believed and that their pain is not real. Pain is purely subjective – there is no test for pain so if someone says it hurts, it is pain – so when there is no

obvious physical cause for the pain, it is often assumed that they are making it up. Chronic pain can also stop people from participating in their jobs, social functions, or family responsibilities, so they commonly feel isolated from family, friends, and colleagues.

Q: Is there promising research happening? Can we hope for a future without chronic pain some time down the track?We are definitely looking at better ways to manage pain. There is also lots of new research into the changes that occur in the pain system in people with chronic pain. These studies may provide insight into the best treatment methods for each individual.


UNDERSTANDING STROKE If someone asked you ‘what is a stroke?’ could you tell them?

Strokes are the third leading cause of death in New Zealand, claiming around 2500 lives each year, and the number one cause of serious adult disability. Every day around 24 people suffer a stroke, the effects of which can be devastating. It’s estimated there are around 60,000 stroke survivors in New Zealand, many of whom are disabled and in need of significant daily support.

stroke

DOES IT HURT?While some people may suffer from headaches, hemiplegic shoulder pain and neuropathic pain following a stroke, in most cases strokes don’t directly cause physical pain. This is because the brain itself has no pain receptors; it merely senses pain in other parts of the body. Most incidents of pain in stroke survivors are related to issues of immobility, pressure sores, falls and the like rather than the actual damage to the brain.

If you are suffering from chronic pain, talk to your GP. They can help you access multidisciplinary care, such as physiotherapy and occupational therapy, or refer you to a specialist pain management clinic. Talking to friends and family about your pain and asking for support will also help.

And, contrary to popular belief, not all of these people are elderly. Nearly a quarter of strokes are experienced by people younger than 65, including around 40 children each year.

The good news, though, is that strokes are largely preventable.

Here are some simple things you can do to reduce your risk.

WE’VE ALL heard of strokes, but how many of us

actually know what they are and, more importantly, what we can do to prevent them?

Put simply, a stroke – or a cerebrovascular accident (CVA) – is a brain attack, a sudden interruption of blood flow to part of the brain. This interruption causes the brain to stop working and eventually damages brain cells.


UNDERSTANDING STROKE Use the FAST check to tell if someone is having a stroke.

Face SMILE (is one side drooping?)

ArmsRAISE BOTH ARMS (is one side weak?)

SpeechSPEAK A SIMPLE SENTENCE (slurred? Unable to?)

TimeLost time could be lost brain – dial 111 and get to hospital FAST

ACT FAST

Stroke is always a medical emergency. Even if the symptoms go away quickly or don’t cause pain, call 111 immediately.

Get your blood pressure checked – A person with high blood pressure is up to seven times more likely to have a stroke than someone with normal or low blood pressure. Get yours checked and control it if it’s high.Stop smoking – Smoking quadruples the risk of strokes because the chemicals and gases in tobacco smoke harden the arteries and tighten blood vessels, reducing blood flow. Smoking also makes the blood more likely to clot, especially inside damaged blood vessels.

If you smoke and have high blood pressure you are 18 times more likely to have a stroke than a non-smoker the same age with normal blood pressure.

Exercise regularly – Being physically inactive over a long period is linked to high blood pressure.Limit your alcohol intake – Drinking any more than two small glasses of alcohol a day increases stroke risk by as much as three times. A drinking binge increases it by as much as five times. Regular heavy drinking can raise blood pressure and increase the risk of haemorrhage in the brain.Eat a healthy diet and reduce salt intake – The dietary culprits are fat, which can harden the arteries, and salt, which can raise blood pressure. Lower your cholesterol – Keep on top of cholesterol

levels by having a blood test and changing your eating habits if necessary.Find out if you have atrial fibrillation – People with atrial fibrillation, a type of irregular heartbeat, are five times more likely to have a stroke. See your doctor if you’re concerned. Control your weight – Being overweight strains the entire circulatory system and leads to higher cholesterol levels, high blood pressure and diabetes – which all increase your risk of stroke.

For more information, visit the Stroke Foundation online: www.stroke.org.nz


DO YOU THINK SNORING’S A JOKE?

For thousands of New Zealanders who snort, snuffle and gasp their way through the night it really is no laughing matter.

To find out more visit www.edensleep.co.nz or call 0800 333675

Sleep apnoea affects thousands of New Zealanders and costs the country millions of dollars in loss of productivity, associated increased health costs and preventable motor vehicle accidents.

What if the hospital paid YOU a visit? That's exactly what Edensleep does. "We will conduct over-night sleep studies in the comfort and convenience of your own home, so you don't have to waste time and money juggling work and responsibilities," says Tim Stephenson, (Director), of the New Zealand owned and operated company. If you have sleep apnoea or just snore there are treat-ment options for you but getting the right diagnosis first is a very important step.

For the past ten years, they have been conducting sleep tests for GPs, specialist doctors and the general public. All testing is done by qualified physiologists and their work is overseen by their specialist doctors.

The testing for sleep apnoea is simple and affordable and if proved positive they can direct you to safe and effective treatments that take away the risk and allow you to enjoy your life to the full-est. Symptoms of sleep apnoea include snoring, daytime tiredness, morning headaches, poor memory and mood swings—if you have some or all of these then we may be able to help.

gout

ALL ABOUT GOUT Caused by an accumulation of uric acid crystals in the body, gout is one of the most common forms of arthritis, and possibly the most painful. Some people say an attack feels like their joint is caught in a piece of machinery. Ouch! But while it’s a life-long disease which needs to be carefully monitored, happily there’s a lot you can do to control gout and ease the symptoms when an attack occurs.

He had a few key messages to share during his visit to NZ, including:

Gout isn’t your fault. In his experience, patients tend to be ashamed of having gout. “Gout has a really bad reputation because people believe it is a self-inflicted and well-deserved disease.” But genetics is the key cause of gout, he says. While you know it might be healthier to drink less and not eat as much of the wrong foods, Dr Bardin acknowledges that, unfair as it may seem, others around you may have a lifestyle that’s much worse and yet they escape gout-free “because they don’t have the bad genes”.

He says lifestyle

New Zealand is known as ‘the Gout Capital of the World’, and as such attracts overseas experts such as Professor Thomas Bardin from France who visited New Zealand in March to discuss and promote the treatment of gout as a serious chronic disease.

Professor Bardin is a member of medical societies such as the American College of Rheumatology, the British Society for Rheumatology and the task force responsible for the European League Against Rheumatism (EULAR) guidelines for the treatment of gout and for many years has served as President of the French Society of Rheumatology.


modifications are important but probably more for the prevention of gout in people with a genetic predisposition than as a means to get uric acid levels down. Dr Bardin says lifestyle modifications will rarely, if ever, reduce uric acid levels enough to make a difference.

In terms of diet, Dr Bardin’s advice is very simple. Gout sufferers have three enemies: beer, spirits and non-diet fizzy drinks, such as Coke.

He believes too much emphasis is put on managing gout attacks or flares and not enough

on treating the “silent, chronic disease” that lies underneath the attacks causing serious long-term effects. “Flares are only the tip of the iceberg.”

Between gout attacks, high levels of uric acid and the associated uric acid crystals which form are damaging the joints, bones, kidneys and heart which can lead to serious health complications. For example, people with gout have a significantly increased risk of cardiovascular death (58%) compared to people without gout.

Dr Bardin says the aim of

treatment is to reduce uric acid which in turn will dissolve the uric acid crystals and reduce the long-term effects of gout including gout attacks.

What does a gout attack look like?Attacks often come on during the night and within 12-24 hours there is severe pain and swelling in the affected joint. The skin over the joint may also become red and shiny. Without treatment, an attack usually goes away within 7-10 days.

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Important things to remember:• Gout can damage your joints, bones, heart and kidneys if it is not treated.

• A uric acid test is quick and easy from your doctor or nurse.

• If you are prescribed a gout preventer medicine, you need to take it every day, even when you’re feeling well.

How to treat gout attacksSee your doctor for pain-relief medication as soon as possible.

Protect the part of your body that hurts. Rest, put an ice pack on the sore joint, and raise it. It’s often the big toe that’s affected, but gout also affects the ankles, knees, wrists and fingers. Sit where people won’t bump into you and put a chair beside your bed to hold up the sheets and blankets so you are comfortable.

Keep taking your prescribed gout medicine every day.

See your doctor if you’re not feeling better after 24 hours.

Gout TreatmentIt is likely your doctor will prescribe a gout preventer (allopurinol, febuxostator or probenecid) to lower the level of uric acid in your blood. Once you start on a gout preventer, you should keep taking it every day, even when you feel well.

Your doctor can check the level of uric acid in your blood by taking a blood sample. It is good to have your uric acid level checked at least once a year. The aim is to keep your uric acid level below 0.30 – 0.36 millimoles per litre (mmol/L).

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irritable bowel syndrome

GUT INSTINCT An estimated 7% to 10% of the world’s population suffers from Irritable Bowel Syndrome (IBS), a gastrointestinal disorder which causes abdominal pain, bloating, cramping, constipation and/or diarrhoea. Could probiotics – ‘good’ bacteria that benefits the host – be the answer?

Pharmacist Nicola Johns discovered probiotics 25 years ago when she began importing probiotics for her own use. Through word of mouth and repeat visits from satisfied fellow IBS-sufferers, the probiotics side of Nicola’s pharmacy grew to such an extent that she founded Probiotics NZ, importing Natren products from the US.

Almost every day she hears anecdotes from customers that reinforce her belief that the key to good health is good bacteria. “The foundation of health is the state of a person’s microbiota which

is positively influenced by taking a probiotic, diet and exercise,” she says.

Around 100 trillion live bacteria live in our intestinal tract, creating a complex ecosystem unique to each of us. While scientists still have a lot to learn about these internal microbiota, it is now widely accepted that achieving a balance between good bacteria (notably lactobacilli and bifidobacteria) and bad bacteria is crucial for maintaining a healthy digestive tract and strong immune system.

As well as IBS and other digestive disorders, a bacterial imbalance can exacerbate or cause skin conditions, sore throats, lactose intolerance, fever, headaches, repeated respiratory infections, allergies and excessive fatigue, candida and other yeast infections, weight management issues, gluten sensitivity and oesophageal reflux.

The brain-gut link is widely recognised as well, and we now know that intestinal imbalances can affect us mentally, causing mild depression, mood swings and anxiety. And Nicola says new research suggests that disease-forming bacteria may be implicated

The brain-gut link is widely recognised as

well, and we now know that

intestinal imbalances can affect

us mentally


6336_NZ NL Living with pain probiotic ad.indd 1 1/08/14 8:26 am

in a whole host of serious diseases, including obesity, heart disease, autoimmune disease, cancer, Alzheimer's, arthritis and autism.

But getting our gut in tip-top condition is no simple task, given our good bacteria and under constant attack from sugar, processed foods, pasteurisation, pollution, agricultural chemicals and, of course, antibiotics.

THE FODMAP DIETWhile supplementing with a high-quality probiotic is vitally important, Nicola also recommends IBS-sufferers take an essential fatty acid supplement, such as evening primrose oil and/or fish oil, and follow a low carbohydrate and low FODMAP diet.

Developed by the research team at Melbourne’s Monash University, the FODMAP diet focuses on a group of

carbohydrates that are often poorly absorbed in the small intestine. “The FODMAP diet does not look at the question of what causes IBS; rather it says that certain foods trigger digestive symptoms in people who suffer from intestinal pain and dysfunctional motility – the speed and strength of the contractions of the muscles within the digestive tract,” explains Nicola. “FODMAP also helps inflammatory bowel disease such as Crohn’s and Ulcerative Colitis – because of their similar symptoms.”

In many people, poorly-absorbed carbohydrates are fermented by gut bacteria to produce gas which contributes to IBS symptoms. The aim of a low-FODMAP diet is to eliminate these carbohydrates in order to starve the bad bacteria in the gut, allowing health-giving bacteria to flourish and gradually tip

the balance in their favour. For more information on

the FODMAP diet, visit the Monash University website www.med.monash.edu/cecs/gastro/fodmap/ Ideally, consult with a pharmacist, doctor or dietitian for assistance.

What to look for when buying probiotics• Choose probiotics packaged in dark glass bottles with tin lids.• Choose a probiotic that is an appropriate strain, has guaranteed potency for each strain listed and has been made by a reputable company. Because some strains inhibit the activity of other strains, you’re best to opt for a single strain probiotic, or at most, a combination of three strains separated by something such as an oil matrix to eliminate competition.


• Read the label to ensure the supplement has its supernatant (culturing medium) with it. While keeping the bacteria and supernatant together is more expensive, it increases the therapeutic benefits of the probiotic by up to 50%.• Avoid probiotics with FOS (fructooligosaccharide) as this can exacerbate bloating and pain.• Fermented foods like buttermilk, sauerkraut, miso and live yoghurt also contain probiotics, but not enough to right an intestinal imbalance without supplements. • The frequency of doses is more important than the quantity so aim to take probiotics morning and night or three times a day if needed. Take away from medicines or antibiotics (ideally two hours apart).

Who needs probiotics?Nicola believes everyone would benefit from a daily high-quality probiotic supplement. However, if you have poor skin, bloating, candida or other vaginal yeast infections, flatulence, bad breath, bad body odour, lactose intolerance, and/or a low resistance to infections on a regular basis, supplementing would be particularly beneficial.Supplementing with probiotics during (take probiotic supplements two hours after each antibiotic dose) and following a course of antibiotics (double the amount of probiotic supplementation for at least 3 weeks) makes good sense and taking the correct species and strains of properly selected probiotics during pregnancy helps to

To find a suitable probiotic, email Nicola at [email protected],

visit www.probiotics.co.nz or talk to your GP,

pharmacist or natural health practitioner.

ensure babies start life with a healthy gut. Nicola also recommends giving babies (especially those born by caesarean) B infantis bacteria.

Irritable Bowel Syndrome StudyIrritable Bowel Syndrome (IBS) causes abdominal pain, bloating and constipation and/or diarrhoea with other general digestive discomfort. The reason is unknown.This study aims to test the effect of Phloe™, a natural product made from Kiwifruit, in improving constipation and abdominal pain and other symptoms associated with IBS. It will be compared to a control (placebo).If you are interested in participating in a 3 month trial and:o Are aged between 18 and 65 yearso Have been diagnosed with the constipation type of IBS (IBS-C)o Have had symptoms for the last 3 months which started at least 6 months ago

Go to www.ibsclinicaltrial.com for more information and to register your interest. This study complies with National Ethics Advisory Committee and has been approved by HDEC Northern.


Shoulders

1 Tuck your elbows in to your waist and put your hands in front of you, palms facing each other and your thumbs pointing towards the ceiling.

Bring the palms of your hands towards you, keeping your elbows tucked in. Then move your palms outwards and away from your body, keeping your elbows tucked in. Repeat 3 to 5 times.

arthritis

Exercises to keep you moving

1a 1b 1c

Neck

2 Sit with a straight back, chest up, squeezing your shoulder blades down.Lengthen the back of your neck and

bring your chin towards your neck, to make a ‘double chin’. This is a slight stretch with quite a small movement. Hold for 10 to 20 seconds and repeat 3 to 5 times.

3Lift your chest, brace your shoulder blades downward, tuck your chin in and bring your

head forward until you feel a stretch at the back of your neck or your chin touches your chest. Hold for 10 to 20 seconds and repeat 3 to 5 times.

2a 2b 3a 3b

If you have arthritis, you’ll know the importance of appropriate exercise. Here are some stretches and strengthening exercises you can do from the comfort of your favourite chair.With thanks to Physiotherapy New Zealand and Arthritis New Zealand.For a copy of Arthritis: Exercises to keep you Moving, visit the Arthritis New Zealand website www.arthritis.org.nz/resources/free-brochures/


Upper back

4 Sit up straight, fold your arms and keep your chin tucked in. Arch your upper back, lifting

the front of your chest and keeping your feet on the floor. Hold for 10 to 20 seconds and repeat 3 to 5 times.

5 Clasp your hands in front of your body with your arms out straight, widen your shoulder blades, bring your head

down, keep your chin tucked in and curl your upper back while reaching forward. Hold for 10 to 20 seconds and repeat 3 to 5 times.

4a 4b 5a 5b

6 Reach one arm over the side of your head. Place the other arm down by your side and stretch it

towards the floor. You'll feel a stretch on the opposite side of your body. Hold for 10 to 20 seconds and repeat 3 to 5 times on both sides of your body.

6a 6b

7 Sit up straight and fold your arms. Rotate your upper back to the right

and lift your chest, keeping your chin tucked in. Repeat this exercise 3 to 5 times on both sides of your body.

7a 7b

If you are unsure which type of exercise is best for you, consult your health professional before beginning. If you experience pain that doesn’t go away immediately after finishing any of these exercises, we recommend you get an assessment from a registered health professional, such as a physiotherapist. To find a physio visit www.physiotherapy.org.nz/findaphysio.


oral health

OPEN WIDE! Whatever the cause - trapped food, dental abscess, impacted tooth, gingivitis, damaged filling or nerve pain – oral pain is distracting at best and excruciatingly painful at worst. But, unbearable as it may be, this oral pain serves an important function. It’s telling you all is not well and you need to call a dentist.

What You Can Do While you wait for your appointment, there are a few things you can do to help relieve the pain:• Take over-the-counter pain relief. But remember, even if this helps, you still need to see your dentist. If you medicate and don't get treatment, the infection can spread. It could even become life threatening. • Rinse your mouth with warm salt water every hour or so. Mix one-half teaspoon of salt in 1 cup of water. This won't heal an infected tooth, but it may ease the gum swelling.

• If the pain is caused by stuck food, brushing and using dental floss in the area may remove it. • There are a range of treatment options for sensitive teeth, from over-the-counter pastes to dentist-provided care. Ask your dentist what he/she recommends for your particular tooth sensitivity problem.• If you’re planning a trip, try to get dental treatment before travelling by plane as the changes in cabin pressure may make the pain worse.

Prevention is Better than CureThe best way to avoid oral pain is to keep your teeth and gums healthy.

1. Brush twice daily, especially once before bedtime. Make sure that all the surfaces (outer, inner and chewing surfaces) of teeth and gums are cleaned for effective plaque removal

2. Use fluoride toothpaste and after brushing spit the toothpaste out. Avoid rinsing the paste from your mouth after brushing as this will wash the fluoride away from your teeth

3. Floss or use interdental brushes once daily to clean between your teeth

4. Avoid eating sugary, sticky and acidic foods and drinks in between meals

5. Eat a wide variety of nutritious foods

6. Visit your dentist for regular check-ups. Your dentist can spot and stop any problems with your teeth and gums at the early stages.

Source: www.healthysmiles.org.nz

DID YOU KNOW?

Only around

65% of adult

New Zealanders brush their

teeth at least twice a day

Thanks to the New Zealand Dental Association and Colgate for their assistance.


For there was never yet philosopher that could endure the toothache patiently – William Shakespeare (Much Ado About Nothing)

Don’t wait until you feel pain to visit the dentist – dental disease is often well-advanced by the time pain occurs. Booking in for regular dental check-ups will minimise your chances of needing expensive dental treatment so is money well spent.


natural health

THE A TO Z OF ARNICA Arnica is one of the most commonly administered homeopathic remedies in New Zealand, and it was seeing how well arnica works that first attracted registered nurse Ann Gulley to homeopathy over 20 years ago.

“WHEN A visiting child jammed her

fingers in the door, I saw how arnica reduced the swelling and bruising within 30–45 minutes and resulted in a child who was no longer screaming with pain. I thought ‘I need to find out more!’” says Ann. A couple of decades on and with an advanced diploma to her name, Ann is now a registered homeopath working at the East West Natural Health Clinic in New Lynn, West Auckland.

She says arnica is a useful remedy following any injury as it reduces bruising or bleeding and can help alleviate the symptoms of shock. “A really useful indicator for arnica is when someone is in pain but doesn’t want to be touched,” she says.

Arnica is available in liquid form (drops or spray) or tablets, with the most common potency being 30c. Arnica cream can be used externally to help reduce swelling and bruising, but not on broken skin. If the skin is broken, Ann recommends calendula cream, “the sister of arnica” (both are from the daisy family).

Any substances containing camphor or eucalyptus (such as Vicks) could antidote remedies so should be avoided during treatment.

Remedies are best stored in a cool, dark place away from strong-smelling substances and out of the reach of children “as they usually love to take them!” says Ann.

Homeopathy is considered a safe, natural and effective health option. To find out more, or to locate a homeopath in your area, visit the New Zealand Council of Homeopaths at www.homeopathy.co.nz


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We have long known the importance of exercise in the treatment of arthritis. Now research and clinical trials from Johns Hopkin University confirms this. Researchers found that although the therapeutic importance of exercise and physical activity in the management of arthritis is not always recognised, it has many benefits.• Regular exercise can help keep the muscles around the joints strong, decrease bone loss and help control joint swelling and pain. • Strengthening the muscles surrounding affected joints helps to relieve pressure on the joint and cartilage. • Regular exercise helps replenish lubrication of the cartilage of the joint and reduces stiffness and pain. • Lack of physical activity is associated with increased muscle weakness, joint stiffness, reduced range of motion, fatigue and general deconditioning. • Exercise needs to be directed at the entire body

Protect Those Arthritic Jointsand not just the joints that are affected with arthritis.

However, on cold or wet days it’s harder to get outside to exercise. So it’s worthwhile looking at indoor options to keep our muscles strong and joints moving – not only in our legs but in our hands and lower back too.

There are many different types of exercise equipment available but one of the easiest to use is the Aircycle circulation booster while sitting enjoying a cup of tea, chatting on the phone, reading the paper or watching TV. It is so convenient you can use it almost anywhere – at the office, at a meeting, at bridge and on long-haul flights.

Many people have success in relieving pain, increasing circulation and joint flexibility, reducing swollen ankles and night cramps and improving their leg strength, balance and mobility by keeping this little exerciser beside a comfortable chair and using it several times a day for short periods. Results are often surprisingly fast.

Aircycles are available from pharmacies for around $35 and come with a lifetime guarantee. For more information or to order, visit www.aircycle.co.nz or phone 04 569 5013.

Arthritis New Zealand receives $5 for each direct order. Mark your order “Arthritis” and post $37.50 to Aircycle, PO Box 45 105, Waterloo, Lower Hutt 5042.

The Aircycle is helpful for:• Arthritis• Diabetes• Parkinson’s• Aching legs • Convalescing• Night cramps • Varicose veins• Swollen ankles• Travelling – DVT • Sore hands & feet• Stroke rehabilitation• Circulation problems


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USEFUL SNIPPETSIt has been fascinating putting together Issue #1 of Living with Pain. We’ve learnt so much, including…

That psychological factors play a big part in

migraines PAGE 18

That bad posture makes you feel

more tired PAGE 13

That raising the head of your bed can help prevent heartburn PAGE 6

That the key cause of gout is genetics.

PAGE 28

That being up and about and moving is a far better treatment than bed rest for back pain PAGE 10

That 25% of all stroke sufferers are younger than 65, and around 40 children per year

in New Zealand suffer a stroke PAGE 24

That pain is literally ‘in our

head’ but not in the way people

sometimes imply PAGE 22

That napping before 2.30pm shouldn’t affect how well you sleep that night, but any later in the day and it could PAGE 7

That 18% of New Zealanders

suffer from chronic pain

PAGE 5

That the health of your gut can affect your mood PAGE 30


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Family Winter Wellness

Kaloba® provides support against winter ills and chills

For more information phone 0800 657 876 Mon-Fri 9am-5pm or email [email protected] www.pharmahealth.co.nzSupplementary to and not a replacement for a balanced diet. Always read the label. Use only as directed and if symptoms persist, see your health professional.

Kaloba® – First choice. Natural recovery.Soothes the nose, sinuses, throat and bronchi

Suitable for all including children 1 year old and over

Supports respiratory health & immune defences

Natural pharmaceutical-grade, concentrated formula

Kaloba®, recommended by paediatricians and doctors worldwide, is a must for the whole family to help with seasonal ills and chills.

Take Kaloba® with confi dence knowing that over 30 research studies have established both its value and credible safety profi le.

1-5 yr old20mls gives 40 doses (Equiv to 13 days use)50mls gives 100 doses (Equiv to 33 days use)

Adult20mls gives 13 doses (Equiv to 4.4 days use)50mls gives 33 doses (Equiv to 11 days use)

Standard dosage usage:

Available from leading Pharmacies & Health Shops

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Tots To Teens Review Comments• Very impressed! • Good stuff •• It is making a diff erence • Invaluable • • Love this stuff • Very eff ective •• Give me peace of mind •

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LIVING WITH PAIN 1