ARE YOUR PAINKILLERS MAKING YOUR PAIN WORSE?

Is this scenario familiar? You are in pain, so you go to your GP and he or she gives you a prescription for painkillers. They help but a few weeks later the pain feels worse again, so you go back and get a stronger dose. A while later, the pain is bad again…a year or two down the line, and you are on a lot of different painkilling medications and still in pain – in fact the pain is worse than ever and it seems that your condition is deteriorating. That may indeed be the case in some instances, but ironically, in others, the increased pain may actually be CAUSED by your painkilling medicine.

Opiate (derived from opium poppies) or opioid (synthetic opiates) painkillers include codeine, co-codamol, morphine, dihydrocodeine, tramadol and fentanyl, and they are really effective for no more than a month or two; after that you develop a tolerance to them and to achieve the same effect, the dose has to be increased. And then increased again… Sufferers understandably believe they need stronger painkillers in ever stronger doses because they are getting worse.

Taking opiate painkillers actually increases your sensitivity to pain and decreases your natural ability to tolerate pain. The body stops producing endorphins (the body’s natural painkillers) because it is receiving opiates instead. The brain increases the number of receptors for the drug, and the nerve cells in the brain cease to function normally. According to Roger Knaggs, associate professor of pharmacy at Nottingham University and a council member of the British Pain Society, opioids ‘up-regulate’ the body’s pain system so our natural painkilling chemicals, such as endorphins, become less sensitive and effective. He says “Patients affected by opioids in this way will often complain that the nature of their pain has changed or it has spread to other areas, but, in fact, this could be caused by their drugs”.

Separate from their pain-blocking interaction with receptors in the brain, opioids seem to reshape the nervous system to amplify pain signals, even after the original illness or injury subsides. A new study in rats demonstrated that an opioid sets off a chain of immune signals in the spinal cord that amplifies pain rather than dulling it, even after the drug leaves the body. The experiment induced neuropathic pain (the kind that might be experienced from traumatic nerve injury, stroke or nerve damage caused by diabetes) by loosely constricting the sciatic nerve in the thighs of rats. The rats received morphine or a saline control for five days via injections under the skin. As expected, the neuropathic pain due to sciatic nerve constriction continued for another four weeks in the rats that had received the saline, but for the rats that had received morphine, the neuropathic pain continued for 10 weeks – the five-day morphine treatment more than doubled the duration of neuropathic pain. A separate experiment in the same study showed that morphine also worsened neuropathic pain, an effect that lasted for more than a month after morphine treatment had ended.

It used to be thought that pain signalling was a dialogue between nerves, but it has now been shown that it involves glial cells, which provide nutritional support for nerves and clear away metabolic waste. Glia recognize chemical signals from nerves and respond by releasing chemical immune signals that influence communication between nerves. With abnormal pain signalling from nerves, glia respond by turning up the volume in spinal cord pain pathways. This results in the adaptations of painful sensations being exaggerated. Opioids are also a chemical signal for glia. In the study, when morphine was administered in the presence of neuropathic pain, the glial cells went into overdrive. The glia released more immune signals, keeping the ‘pain volume’ turned up higher and for longer.  After morphine, the researchers found, those pain-activated glial cells became more sensitive to the next pain stimuli. As the researchers put it, “Opioids exaggerate pain.”

Sometimes people are surprised to discover that when they stop taking opioid medicines, their pain goes away or at least is substantially reduced. Many GPs and therapists have encountered the sheer panic, distress and numerous justifications for continuance from patients when it is suggested that their pain medication is not helping and should be stopped or reduced. This is partly because the patient naturally fears the pain will get worse, but mostly because they are now physically and emotionally addicted to the painkiller.  Even the lower dose 8mg codeine or 8/500 co-codamol available to buy from pharmacies can become addictive after just three days of use.

No one should just stop taking opioid painkillers but must work out a scheduled withdrawal programme under the supervision of their GP. The degeneration of the nerve cells in the brain causes a physical dependency on an external supply of opiates, so reducing or stopping intake of the drug causes a painful series of physical changes called the withdrawal syndrome. ‘Going cold turkey’ is associated with intense withdrawal symptoms which can be prolonged, characterized by severe discomfort, including diarrhoea, abdominal pain and cramping, vomiting, runny nose, eye tearing, yawning, sweating, agitation, restlessness, twitching and tremors, back and bone pain, and intense craving for the drug. The patient takes the pills and feels better, so assumes that the medication is working, when it is only staving off withdrawal.

The use of opioids has serious side effects. Opioids affect the area of the brain responsible for respiration and some can depress the rate of breathing, occasionally leading to accidental death. Other side-effects include constipation and drowsiness, impairment of the immune system making people more prone to infections and an increased risk of heart disease. They also reduce levels of oestrogen and testosterone.

Opiate/opioid painkillers have an important place in medicine, but where they were once only prescribed short term after trauma injury or as palliative care for people dying of cancer, in recent years they have been increasingly prescribed for long term conditions such as back pain, arthritis, fibromyalgia and endometriosis. So why are GPs writing out more opioid prescriptions than ever? The trouble is that when a patient presents with pain, the hard pressed GP has few options. There is no time in a 10 minute consultation to talk to patients about lifestyle choices such as exercise, diet, physical therapies, giving up smoking or losing weight, which can all affect pain, and little option in today’s cash-strapped NHS to send people to physiotherapists or pain clinics, so the GP has to reach for the prescription pad. Now they have been advised not to prescribe non-steroidal anti-inflammatory drugs or NSAIDs to some patients because of concerns about a higher risk of gastric bleeding and heart attacks, or paracetamol, which is associated with an increased risk of gastric bleeding, cardiovascular disease and impaired kidney function, they are left wondering what they can do for patients for long-term pain.

In the USA, the latest CDC guidelines state that opioids should be avoided if possible, with the exception of cancer pain and end-of-life palliative care.

REFERENCES

https://www.spine-health.com/treatment/pain-medication/pain-killer-addiction-treatment
http://www.sciencemag.org/news/2016/05/why-taking-morphine-oxycodone-can-sometimes-make-pain-worse
Morphine paradoxically prolongs neuropathic pain in rats by amplifying spinal NLRP3 inflammasome activation http://www.pnas.org/content/113/24/E3441
http://www.dailymail.co.uk/health/article-3470091/Opioid-painkillers-make-chronic-pain-worse-Endorphins-effective-make-people-sensitive.html#ixzz4pjVcntKH
http://theconversation.com/do-opioids-make-pain-worse-60587

Natural Skin Care Workshop Fun

I love running workshops and showing people how they can use herbs not only for healing, but also in their daily lives for beauty products, personal care and around the house in various ways. Most participants are amazed at how cheap and easy it is to make their own products

We had a brilliant time at my Herbs for Personal Care and Beauty Day Workshop on Saturday, got the giggles trying face masks, whipped up batches of products, and everyone went away with a box full of goodies they had made including shampoos, hair rinses, bath bags, toothpaste, tooth powders, deodorant powders, skin toners and two types of face creams. All natural and chemical free, all organic, all vegan and made for pennies.

Rose Petal, Frankincense & Myrrh Night Cream

I love making creams. There is a kind of alchemy to it, when the oil and water emulsify and change into a creamy texture. The basic method is to prepare the oil part and the liquid part separately, before bringing them together. Most creams use a combination of pouring oils, such as grapeseed or almond, and more solid oils, such as coconut or shea butter. This is warmed separately to the ‘water’ part, which is warmed in a separate pan.  The water part is then dripped into the oil part very slowly, whisking constantly with an electric whisk until they are fully combined and emulsified. It is tricky, and the secret is to make sure that your oil mix and your water mix are the same temperature.

 10g beeswax

12 g cocoa butter or shea butter

50 ml rose petal infused oil [1]

15 ml benzoin tincture

30 ml rose petal infusion [2]

5 g emulsifying wax

10 drops frankincense essential oil

10 drops myrrh essential oil

Heat the beeswax, cocoa butter, emulsifying wax and rose infused oil together in a bain marie.(A bain marie is a double boiler. You can alternatively use a heat proof bowl over a pan of water.)

In a separate bain marie gently heat the rose infusion with the tincture but do not allow to boil.

Check both mixtures are the same temperature. Gradually and very slowly, pour the infusion/tincture mix into the oil bowl, whisking quickly with an electric whisk until thoroughly combined. This will create a creamy consistency. (If you have ever made mayonnaise it is a similar process.)

When the cream has cooled, you can whisk in the essential oil.

Spoon into sterilised jars, label and date. Will keep up to four months in the fridge.

[1] Pack fresh rose petals into a clear glass jar, cover with vegetable oil and leave on a sunny windowsill for two weeks. Strain the rose oil into a clean jar.

[2] Pour a cup of boiling water over fresh rose petals, leave to infuse for 15 minutes and strain off the liquid – this is your rose petal infusion.

SENSATIONAL SAGE

Sage is a hardy, aromatic, evergreen shrub that grows to a height of 1-3 ft. The common sage is a native of the Mediterranean. It likes a position in full sun and light, well-drained soil. Plants should be cut back after flowering. For drying purposes the leaves should be harvested just before the plant flowers. They should be dried slowly to avoid mould forming and then crumbled and stored in an airtight container.

Cooks use the leaves and stems with meats, in stews and soups, with cheese, pasta, in herb butter and in stuffings.  Make a sage honey by infusing the leaves in gently warmed honey – this is good for coughs, and can be used to dress desserts. The plant also is brewed to make tea.  Sage leaves and flowers can be frozen in ice cubes and added to summer drinks.

Add the fresh leaves to the bath for an invigorating wash. It is a natural disinfectant and deodoriser. Used as a rinse, an infusion of sage leaves benefits the hair and darkens greying hair. Sage can be made into a cleansing lotion or used in an astringent facial steam it will tighten the pores.

Sage is used for coughs and colds, or use the infusion as a gargle for sore throats, tonsillitis, and as a mouthwash for inflamed gums and mouth ulcers. Sage tea helps menopausal women with hot flushes, night sweats and other menopausal symptoms – sip the tea during the day. An infusion of the leaves is useful for the treatment of diarrhoea, depression, rheumatism, anaemia, menstrual problems, and migraine, for lowering fevers, and indigestion.  It also helps improve the memory and reduce LDL (bad) cholesterol. Externally it can be used as a wash for acne, eczema, wounds, scabs, insect bites and stings. Sage is antiseptic. The fresh leaves can be rubbed on stings or bites.

Making Cold Infused Oils

Fats and oils extract the oily and resinous properties of a herb, and these are often the antibacterial, antifungal and wound-healing components we really want.

Choose your leaves or flowers. Don’t wash them before use – not only will this destroy some of their delicate oils, but as soon as you introduce water into the mixture, you are setting it up to develop mould. (One of my friends was complaining that his nettle oil had an unpleasant odour, which it really shouldn’t, nettle has a fresh, rather lovely scent as an oil. I discovered that he had been rinsing the herbs before packing them in the jar.) To avoid this, make sure you pick your herbs on a dry, sunny day, and pick them from an unpolluted location

To make your cold infused oil, take your fresh herbs, cut them up, pack them tightly into  a glass jar, and cover with vegetable oil (olive, sunflower etc.). Leave on a sunny windowsill for 2 weeks, shaking daily. Strain into a clean, dry jar, label and keep in a cool, dark place for up to a year.

Infused herbal oils may be used as they are or thickened into salves with beeswax. Unlike essential oils, they do not need to be diluted for use.

Calendula Treats for Your Skin

Calendula has antiseptic and anti-inflammatory properties. As lotion, cream or ointment it speeds up healing and counters infection in sunburn, minor burns, insect bites and stings, acne, cuts, abrasions, inflamed rashes, nappy rash, haemorrhoids and varicose veins. Make sure you correctly identify your plant as Calendula officinalis, the pot marigold.

Calendula Infusion

1 oz. dried herb or 2 oz. chopped fresh herb

1 pint boiling water

Put the herbs in ceramic heatproof pot and pour on the boiling water. Cover (or put the lid on the teapot) and infuse for 20 minutes, covered. Strain before use. Will keep about two days in the fridge. Calendula flower infusion, applied externally, is excellent for the treatment of burns, wounds, conjunctivitis, varicose veins, bed sores, ulcers, bruises, gum inflammations, corns, warts, eczema and skin rashes. Calendula has anti-fungal actions and can be used externally for athlete’s foot pour into a foot bath and soak for 15 minutes daily), ringworm and as a douche for vaginal thrush.

Calendula Infused Oil

Calendula is good for any skin type but especially dry, acne-prone or aging skin, soothing, cooling and plumping it up. To use it, you can make a calendula infused oil. Fats and oils extract the oily and resinous properties of an herb, and these are often the antibacterial, antifungal and wound-healing components. To make a cold infused oil cut up the herb and cover with vegetable oil (olive, sunflower etc.) in a glass bottle or jar, Leave on a sunny windowsill for 2 weeks, shaking daily. Strain into a clean jar. Infused herbal oils may be used as they are, applied directly to the skin. Unlike essential oils, they do not need to be diluted for use.

Calendula Salve

You can also thicken your oil into a salve by warming it gently, and adding beeswax. When the beeswax has melted, remove from the heat and pour into clean glass jars.  The more wax you add, the harder the set. This will keep at least a year.

The Amazing Birch Tree

After the glaciers of the last Ice Age receded, birch was one of the first trees to re-colonise the land. Though it is a slender and graceful tree, it is amazingly resilient, and rarely has one species of tree been so important to so many different peoples. Our ancestors used it to make shelters, canoes and coracles, fibre, medicine, ‘paper’, magic and even brewed wine and beer from it.

As it is one of the first trees to come into leaf in the spring, it is associated with regeneration and new beginnings. In Scandinavia the appearance of leaves marked the beginning of the agricultural year and the farmers took it as a sign to sow their spring wheat. In the Northern tradition the birch (Beorc, Byarka, or Berkana) is a symbol of Mother Earth and represents the feminine powers of growth, healing and the natural world. May poles were made of birch, associating the birch with the May Day revels of sympathetic fertility magic.

The white bark of the birch also connects it with purification. The Anglo-Saxon name for the tree was beorc means ‘white’ or ‘shining’. Birch rods are used in country ritual for the driving out of the old year. Another possible derivation is the Latin ‘batuere‘ meaning ‘to strike’, referring to the birch rods use for flogging.

Birch is considered a protective tree, believed to guard those who carried a piece of it, and to keep livestock safe when attached to their barn or shelter. In some parts of England a birch was hung with red and white rags and leant against stable doors at Beltane (May Day) to prevent horses being ‘hag-ridden’, i.e. being taken out by spirits or witches and ridden.

The leaves, bark, twigs are all used medicinally.

Birch contains the natural pain reliever and anti-inflammatory salicylate, the same compound found in aspirin. This is especially useful for arthritic conditions and muscle pain. You can prepare a poultice of fresh bark and apply it directly (the inner bark against the skin) to the affected areas, or make macerated oils of the leaves or bark to apply externally. This will help to relieve both the pain and inflammation of arthritis. These same salycilates in the bark make an effective wart treatment.

As birch is a blood purifier, a decoction of the twigs or bark can be helpful when used as a wash for boils and sores. Make a tincture of birch buds for the treatment of small wounds and cuts. This has antibacterial, antiviral and cell regenerative qualities.  A decoction or macerated oil made from the bark or leaves is antibacterial and anti-inflammatory and useful for skin conditions such as eczema. Use as a skin wash or add to the bath.

Birch bark and leaves are diuretic, with the added benefit of being anti-bacterial. Taken as a decoction they help to eliminate excess fluid and toxins from the body which can help with arthritic conditions, urinary tract infections, cystitis and help to dissolve kidney stones.

The young shoots and leaves are used as a laxative, but the bark is useful in the treatment of diarrhoea.

The betulin compound found in birch bark is under investigation as a treatment for the herpes viruses, AIDS, and cancer.

An essential oil of birch bark is available. This pale yellow oil has a balsamic scent, and is extracted from the leaf-buds by steam distillation. Birch oil is good for dermatitis, dull skin, eczema and psoriasis, and also eases the pain of arthritis, rheumatism and sore muscles.  Birch oil blends well with benzoin, sandalwood and rosemary. However, it should be used with caution and highly diluted, and never when pregnant.

In magic birch is used for protection, purification, against negativity, love, new beginnings, changes, Ostara and Beltane.  It is associated with Aphrodite, Freya, Brigantia, Brighid, the Earth Mother, Thor, Frigga, Idunna, Nethus, Persephone, Sif and Venus.  It is ruled by the planet Venus, the element of water and the sign of Cancer.

Birch represents the power of cleansing and purification in preparation for the new beginnings. When the tree is opened to extract the sweet sap the essence of the tree is released to give its power to the waxing year and the strengthening sun at the vernal equinox, when the light begins to gain on the dark. This can form part of the ritual of Ostara. Honour the sun god with birch sap wine the following year.

Birch Sap Wine

8 pints birch sap (Betula spp.)

½ lb. raisins

2 lb. sugar

Juice of 3 lemons

Yeast

Boil the sap and add the sugar. Simmer for 10 minutes. Pour the liquid over the raisins and lemon juice. Cool the mixture to 20oC and add the started yeast. Ferment in a brewing bucket for 3 days, then strain into a demijohn and fit an airlock.

To obtain the sap, bore a small hole into the tree, just inside the bark, and insert a narrow tube, sloping downwards. Sap should start running from the tree (if it doesn’t, it is the wrong time of year). Put the free end of the tube into your container (eg a plastic soda bottle), which you can tie onto the tree.  Don’t take too much from one tree. When you have what you need, remove the tube, put a piece of cork into the borehole, and the birch tree will seal itself after a short while. In very early spring (late February or early March here in the UK, depending on the weather) you should be able to draw off enough sap for a gallon of wine in a day.

 I also came across this old English recipe for birch beer, though I haven’t tried it yet:

“To every Gallon of Birch-water put a quart of Honey, well stirr’d together; then boil it almost an hour with a few Cloves, and a little Limon-peel, keeping it well scumm’d. When it is sufficiently boil’d, and become cold, add to it three or four Spoonfuls of good Ale to make it work…and when the Test begins to settle, bottle it up . . . it is gentle, and very harmless in operation within the body, and exceedingly sharpens the Appetite, being drunk ante pastum.”