Scoliosis

Most people are familiar with the sudden pain of a muscle cramp. The rapid, uncontrolled contraction, or spasm, happens unexpectedly, with either no stimulation or some trivially small one. The muscle contraction and pain lasts for several minutes, and then slowly eases. Cramps may affect any muscle, but are most common in the calves, feet, and hands. While painful, they are harmless, and in most cases, not related to any underlying disorder. Nonetheless, cramps and spasms can be manifestations of many neurological or muscular diseases.

The terms cramp and spasm can be somewhat vague, and they are sometimes used to include types of abnormal muscle activity other than sudden painful contraction. These include stiffness at rest, slow muscle relaxation, and spontaneous contractions of a muscle at rest (fasciculation). Fasciculation is a type of painless muscle spasm, marked by rapid, uncoordinated contraction of many small muscle fibers. A critical part of diagnosis is to distinguish these different meanings and to allow the patient to describe the problem as precisely as possible.

Causes

Normal voluntary muscle contraction begins when electrical signals are sent from the brain through the spinal cord along nerve cells called motor neurons (Nerve cells within the central nervous system that carry nerve impulses controlling muscle movement). These include both the upper motor neurons within the brain and the lower motor neurons (nerve cells within the central nervous system that carry nerve impulses controlling muscle movement) within the spinal cord and leading out to the muscle. At the muscle, chemicals released by the motor neuron stimulate the internal release of calcium ions from stores within the muscle cell. These calcium ions then interact with muscle proteins within the cell, causing the proteins (actin and myosin) to slide past one another. This motion pulls their fixed ends closer, thereby shortening the cell and, ultimately, the muscle itself. Recapture of calcium and unlinking of actin and myosin allows the muscle fiber to relax.

Abnormal contraction may be caused by abnormal activity at any stage in this process. Certain mechanisms within the brain and the rest of the central nervous system help regulate contraction. Interruption of these mechanisms can cause spasm. Motor neurons that are overly sensitive may fire below their normal thresholds. The muscle membrane itself may be over sensitive, causing contraction without stimulation. Calcium ions may not be recaptured quickly enough, causing prolonged contraction.

Interuption of brain mechanisms and overly sensitive motor neurons may result from damage to the nerve pathways. Possible causes include stroke, multiple sclerosis, cerebral palsy, neurodegenerative diseases, trauma, spinal cord injury, and nervous system poisons such as strychnine, tetanus, and certain insecticides. Nerve damage may lead to a prolonged or permanent muscle shortening called contracture.

Changes in muscle responsiveness may be due to or associated with:

Prolonged exercise. Curiously, relaxation of a muscle actually requires energy to be expended. The energy is used to recapture calcium and to unlink actin and myosin. Normally, sensations of pain and fatigue signal that it is time to rest. Ignoring or overriding those warning signals can lead to such severe energy depletion that the muscle cannot be relaxed, causing a cramp. The familiar advice about not swimming after a heavy meal, when blood flow is directed away from the muscles, is intended to avoid this type of cramp. Rigor mortis, the stiffness of a corpse within the first 24 hours after death, is also due to this phenomenon.

Dehydration and salt depletion. This may be brought on by protracted vomiting or diarrhea, or by copious sweating during prolonged exercise, especially in high temperatures. Loss of fluids and salts--especially sodium, potassium, magnesium, and calcium--can disrupt ion balances in both muscle and nerves. This can prevent them from responding and recovering normally, and can lead to cramp.

Metabolic disorders that affect the energy supply in muscle. These are inherited diseases in which particular muscle enzymes are deficient. They include deficiencies of myophosphorylase (McArdle's disease), phosphorylase b kinase, phosphofructokinase, phosphoglycerate kinase, and lactate dehydrogenase.

Myotonia. This causes stiffness due to delayed relaxation of the muscle, but does not cause the spontaneous contraction usually associated with cramps. However, many patients with myotonia do experience cramping from exercise. Symptoms of myotonia are often worse in the cold. Myotonias include myotonic dystrophy, myotonia congenita, paramyotonia congenita, and neuromyotonia.

Fasciculations may be due to fatigue, cold, medications, metabolic disorders, nerve damage, or neurodegenerative disease, including amyotrophic lateral sclerosis. Most people experience brief, mild fasciculations from time to time, usually in the calves.

Symptoms

The pain of a muscle cramp is intense, localized, and often debilitating Coming on quickly, it may last for minutes and fade gradually. Contractures develop more slowly, over days or weeks, and may be permanent if untreated. Fasciculations may occur at rest or after muscle contraction, and may last several minutes.

Diagnosis

Abnormal contractions are diagnosed through a careful medical history, physical and neurological examination, and electromyography of the affected muscles. Electromyography records electrical activity in the muscle during rest and movement.

Treatment

Most cases of simple cramps require no treatment other than patience and stretching. Gently and gradually stretching and massaging the affected muscle may ease the pain and hasten recovery.

More prolonged or regular cramps may be treated with drugs such as carbamazepine, phenytoin, or quinine. Fluid and salt replacement, either orally or intravenously, is used to treat dehydration. Treatment of underlying metabolic or neurologic disease, where possible, may help relieve symptoms.

Alternative Treatment

Cramps may be treated or prevented with Gingko (Ginkgo biloba) or Japanese quince (Chaenomeles speciosa). Supplements of vitamin E, niacin, calcium, and magnesium may also help. Taken at bedtime, they may help to reduce the likelihood of night cramps.

Prevention

The likelihood of developing cramps may be reduced by eating a healthy diet with appropriate levels of minerals, and getting regular exercise to build up energy reserves in muscle. Avoiding exercising in extreme heat helps prevent heat cramps. Heat cramps can also be avoided by taking salt tablets and water before prolonged exercise in extreme heat. Taking a warm bath before bedtime may increase circulation to the legs and reduce the incidence of nighttime leg cramps.

All of us have experienced pain at some time in our lives - all of us except for those rare unfortunate people who were born with the inability to feel pain. Pain is the most common reason people seek medical attention; about 80 per cent of doctor visits are primarily because of some pain problem. The International Association for the Study of Pain defines pain " as an unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage". This definition makes it clear that pain is more than just a chemical or electrical signal. Pain can include diverse unpleasant sensations such as aching, tightness, burning and numbness.

Pain also have adverse effects on the body beyond the perception of pain. The physical effects of pain can include: * Poor wound healing, weakness, and muscle breakdown * Decreased movement of the affected body parts, resulting in an increased risk of blood clots in the veins and in the lungs * Shallow breathing and cough suppression, which can increase the risk of pneumonia * Increased sodium and water retention in the kidneys * Decreased gastrointestinal motility * Increased heart rate * Increased blood pressure * Weakening of the body's immune system, causing decreased natural killer cell counts * Insomnia * Loss of appetite and weight loss * Fatigue Fatigue is an important consequence of pain. This was documented in a recent review of 23 reports about the association between pain and fatigue, which found overwhelmingly that they are related and suggested that there may be a cause and effect relationship. Unrelieved pain also has adverse psychological effects. It causes anxiety, depression, fear, stress, loss of enjoyment of life, and difficulty relating to other people. It can increase marital conflict, reduce sexual desire, and cause feelings of anger and resentment. Pain is generally thought of being as either acute or chronic. Acute pain results from some trauma to the body - an injury, an operation, or an illness. It usually resolves when the underlying injury has healed or the cause has been treated. Although it is uncomfortable, acute pain serves a useful function: It signals that there is something wrong and motivates the person to get help. Because of the pain caused by an inflamed appendix, most people manage to undergo surgery before the appendix bursts, which constitutes a much more serious surgical problem. Because a heart attack usually causes severe chest pain, an increasing number of people with coronary heart disease are hospitalised early enough to benefit from procedures the prevent further damage to the heart. Acute pain IS beneficial. Acute pain usually has a clear cause. The same is true for postoperative pain. Doctors are much less reluctant to treat pain whose origin is well understood; but even now postoperative pain is often undertreated. A random sample of 250 adults who had undergone surgery were recently surveyed about their pain experience. Approximately 80 per cent of the patients experienced acute pain after surgery; of these; 86 per cent has moderate, severe or extreme pain, with more patients experiencing pain after being discharged. Experiencing postoperative pain was the most common concern of patients. The study concluded that many patients continue to experience intense pain after surgery. How Does Chronic Pain Differ From Acute Pain?

About 9 per cent of the US population suffers from consistent moderate to severe chronic pain. Several surveys in Europe show that about 18 per cent of people have chronic pain, and the prevalence increases with age. Chronic pain is not just acute pain that lasts longer than a week or a month. It differs from acute pain in several respects. it has become clear that acute and chronic pain are processed differently in the brain. The severity and extent of chronic pain may be out of proportion to the original injury and may continue long past the period in which the damaged tissue has healed. Chronic pain is pain that has outlived its usefulness and is no longer beneficial. Acute and chronic pain have different treatment goals. The primary goals of acute pain treatment are to diagnose the source and remove it. With chronic pain, the main goals are to minimise the pain and maximise the person's functioning. Diagnosis, of course, a first step, but frequently the source is either already clearly understood (for example, multiple unsuccessful back operations or oesteoarthritis of the knee) or else very poorly understood and unlikely to be better understood (for example fibromyalgia or chronic pelvic pain). In either case, the pain persists and must be treated in its own right. With chronic pain, however, treatment goals must be realistic. Complete relief of the pain is rare. A more realistic goal is to decrease the level of pain to a tolerable level that allows the person to focus on everyday activities. Returning to work is clearly a desirable goal, but in fact, only about 50 per cent of patients who undergo comprehensive multidisciplinary pain rehabilitation are able to return to work. There are many alternative treatments that you could look into, I do Pilates/Yoga and Bowen Treatment.

Movement is the key when you have pain and I know that sounds daft but the more we move the better we feel :)

Bill Crawley, Reference Librarian, Illinois Central College

According to Li Liu. Antiquity. Cambridge: Sep 1999. Vol. 73, Iss. 281; pg. 602, 12 pgs

Who were the ancestors? The origins of Chinese ancestral cult and racial myths

Ancestor worship has been a dominant religious form in ancient as well as modern China. Liu traces the unique history of ancestor worship in China