These injuries occur in otherwise healthy young athletes who continually injure a particular muscle, or muscle group. The injuries are sometimes associated with very little physical evidence and yet are totally disabling.

Treatments Conventional physiotherapy techniques are sometimes ineffective and may even lead to operations which are sometimes inadequate or inappropriate.

In recent years, the application of techniques more commonly used with chronic pain patients, such as acupuncture and TENS (Transcutaneous Electrical Nerve Stimulation), have led to an improvement in some.

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It is surprising how often pain patients are addicted to habit-forming drugs. This has become one of the behaviourial games. We have also had patients who have been easily withdrawn from the drug while in the hospital, only to go home and immediately contact three or four different doctors and get narcotics from every physician they can convince about their suffering.

Clearly the role of the chronic pain patient is to seek appropriate professional help and to make all efforts to try to become well again. However, Adelaide pain researcher Professor Issy Pilowsky has identified abnormal illness behaviour as a form of hypochondriasis. This is the condition in which a patient believes he or she is ill, without appropriate medical evidence. The patient is preoccupied with pain symptoms to the exclusion of all else and is convinced of the presence of significant illness or injury and is resistant to all medical explanations and reassurance.

Once a pain associated with tissue damage has occurred, and becomes chronic, the patient becomes filled with self-inflicted negative ideas and thoughts. All family and other stresses and problems are conveniently blamed on the pain! The sufferer may then become oblivious to family and occupational causes of tension, can gratify the need to become dependent or child-like by the adoption of the ‘sick role’ which leads to a legitimate reason for narcotic medication.

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Motorcycle accident injuries are becoming all too common because often the power of the machine is greater than the skill of the rider. The motorcycle boom has meant that nerve injury to the shoulder is becoming more frequent. On hitting any obstruction, the rider is catapulted forward and hits the road at the speed at which the bike was travelling. While crash helmets have effectively reduced head injuries, the rider’s shoulder often takes the impact, being violently wrenched down and backwards. Damage can often be severe, with painful long-term consequences. This is because the arm is supplied with a network of nerves which leave the spinal cord at the level of the lower neck and upper chest and funnel into the arms. In the most severe of these injuries, the spinal roots are avulsed — or virtually ripped out from the spinal cord. No repair is possible.

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All these factors may have an additional unsettling effect on people who are trying to cope with their pain, be it a migraine or worse. Pain always affects those surrounding the patient — both in the home and the community at large. Family breakdown is a not unusual consequence. Some of the most common causes of pain in Australia involve third parties such as Workcare and Workers’ Compensation insurers and motor car accident insurers. Selecting the top 5 per cent of matriculating students as being eligible for a career in medicine may not be the best selection method. Unfortunately, there is no present procedure to select medical students on their ability to communicate with patients. Intellectual brilliance is not necessarily the sole measure for a secondary school student to become a good medical practitioner.

Since no easy cure can be anticipated with chronic pain patients, the communication skills of the doctor are at a premium.The doctor’s attention often has to be directed at helping the patient cope with disability resulting from the pain, and the side-effects of medications, rather than identifying and treating the underlying cause.

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Usually it’s easy to show a relationship between exposure to the solvent and the headache. A headache that only begins at work may well be related to some chemical to which you are being exposed in the workplace. However, exposure at home can be more difficult to sort out. Constant low-dose exposure, especially with an allergy, can be difficult, because you may not be away from home for long enough to clear the chemical to which you are sensitive out of your system. Consider allergies as a cause if your headache goes away when you’re away from home for a few days, and returns when you return.

However, things are not always as simple as this, because the headaches may be related to family stress, which is absent when you’re away on business; or to the poor quality of your bed. Nevertheless, patiently working through the possibilities, eliminating suspect items one by one and putting them back in again after a few days may tell you what is going on quite quickly. From then on it’s a matter of eliminating those things that seem to cause you problems.

Perhaps the most difficult situation is that of the worker who gradually becomes sensitive to solvents and chemicals he uses. A typical; example is the professional painter who’s become sensitive to solvents in paint, Constant low-dose exposure, even in well-ventilated rooms, will be enough to give him headaches, often apparently at random. Other groups who experience chemical sensitivities at work include those working directly with chemicals – in the photographic industry or the pharmaceutical and petrochemical industries, for example.

There is no real treatment for solvent-related headaches other than excluding them from your environment. If you are getting pharmacological-type problems (dose-related), simply installing proper ventilation hoods and extractor fans may be all that’s necessary; but, if you are developing a true allergy, you may even need to change jobs. Homoeopathic desensitisation might just work.

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There are many different types of counselling and psychotherapy: Freudian and lungian psycho-analysis, psychotherapy, transactional analysis (TA), behavioural therapy, cognitive therapy, etc. They all have slightly different ways of tackling mental and emotional problems. Some of them – the analysis type – concentrate on .the workings of the unconscious mind; psychotherapies are more concerned with conscious events; and behavioural therapy works through teaching the client to re-learn those responses which have been incorrectly learned in the past (for example, an irrational fear of spiders, when she knows that those spiders can’t injure her).

Counselling is a complex affair, though the underlying concept remains the same – to identify those mal-adapted ideas, memories or attitudes which are contributing to the current problem. These mal-adapted responses are often based on fears and worries which have been buried in the subconscious, often because they’re too painful or too terrifying to be brought out into the conscious. The psychotherapist’s job is to allow the client to recognise these fears, bring them out into the open and examine them. When painful memories have been understood and re-interpreted they are usually much less threatening, and so the client doesn’t fear his guilt so much, and can learn to deal with similar problems in a totally different way.

A highly recommended therapy is transactional analysis (TA), which is the nearest thing to do-it-yourself psychiatry there is. It’s simple, and practical, and it helps you get to grips with your own problems. An excellent guide to transactional analysis is the book Horn to Win by Muriel James and Dorothy Jongeward.

Whatever counselling system you choose, you will almost certainly need at least some professional advice; it is impossible to be objective about yourself (and even more impossible if you’re anxious or depressed). You need the steadying, reasoned, objective assessment of a competent outsider. Otherwise you may go around trying to change (he wrong things – or the right things, but in the wrong way.

Finally, beware of the amateur shrink! Counselling is complex and difficult – and a counsellor can do damage. Although humans can’t remember physical pain (we can remember that we had it, but we can’t recall the pain itself) we can remember mental pain. We can also re-create mental pain by re-living experiences that were mentally searing. A poor counsellor can do untold harm; by trying to force you into inappropriate responses, he can hinder your recovery, and it can give you further mental pain.

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However, in practice it is not always easy to separate pharmacological and allergic effects, particularly when dealing with chemicals which are very toxic, but which still work in a pharmacological fashion, so that only tiny doses are needed to do a lot of damage.

Because pharmacological and allergic effects work on the body in different ways, it may help to know by which route a particular irritant is working. For example, antihistamines may help block an allergic effect, but are unlikely to help where a chemical is producing a direct pharmacological response.

These chemicals may produce ‘ordinary’ headaches, or act as triggers to produce migraines. Typical chemical agents that cause headaches include paint thinners; the petroleum-based products that exude out of paint after hardening; chemicals released from newly manufactured synthetic carpets; printing inks and chemicals used in photocopiers; the solvents used in dry cleaning; carbonless copying paper; duplicator ink, and, of course specific chemicals used in industrial processes.

Testing to find which chemical causes the damage must be done by careful elimination. Treatment is principally by recognising the cause and avoiding the trigger substances. Better ventilation may help considerably; extractor fans and air filters may be appropriate in some industrial processes. Wearing an over-garment that you don’t take, home will minimise your contact with splashed substances at work. Where the chemical is operating through an allergic route, anti-allergy measures will be appropriate.

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Abdominal migraine follows much the same pattern as ‘head’ migraine. The time scale is much the same; there is often sickness and nausea; but, the aura and visual disturbance don’t occur. Abdominal migraine responds to many drugs that help in adult migraine – particularly painkillers, metoclopramide (an anti-nauseant), and at times, non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen.

Only a proportion of childhood migraineurs get the abdominal form of migraine; the remainder get ‘normal’ head migraines. Nor do people with abdominal migraine continue with abdominal migraine all their lives. Often the migraine is converted to the ‘normal head form, or stops altogether.

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Because of the slightly increased chance of getting breast cancer, the mammogram (a sort of breast X-ray) should be arranged on a regular basis.

Don’t hesitate to talk to a counsellor about the psychological symptoms of the menopause (anxiety, phobias, confusion, depression, poor memory, etc.). What you experience might be natural, but it is certainly not easy or pleasant. Storing up emotions, fears and depression will most certainly cause tension headaches.

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