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To be treated as scientifically correct (valid) anastrozole 1 mg amex, the same answer must be repeated under exactly the same conditions by other researchers discount 1mg anastrozole with mastercard. There are broadly five kinds of scientific research being undertaken in relation to MS: • The systematic study of the distribution and patterns of MS in different communities and countries – usually known as epidemiological research – might involve asking questions about whether MS is more common in one geographical area than 187 188 MANAGING YOUR MULTIPLE SCLEROSIS another generic 1mg anastrozole with mastercard, or is decreasing or increasing in a particular population over time order 1mg anastrozole otc, and what factors might explain these differences. People with MS may be asked if they wish to participate in a clinical trial, for example to test a new drug. In the absence of a cure, much of this research is investigating how, for example, physiotherapy or speech therapy can reduce the impact of symptoms, or how far psychological support or counselling can help people to manage their symptoms better. Each of these approaches uses scientific methods to understand MS, and assist people with the disease. However, the most common form of scientific method you are likely to come across personally is the clinical trial. Epidemiological research As we have said, epidemiological research primarily focuses on the distribution of MS in specific populations and countries. In Chapter 1 we talked about some distribution patterns that had led to important lines of inquiry about possible causes of the disease. Thus the facts that MS is found largely in temperate regions of the world and more amongst women, and that there appear to be geographical ‘hotspots’ of the disease, all seem to explain something about MS. The problem with epidemiological research is that there are many, many reasons why such patterns could occur. Most patterns are misleading in that they either disappear when subjected to detailed investigation, or are explained by RESEARCH 189 another factor not related to MS. Quite a number of people with MS have found several others with the condition in their area, or have had some job or other life experience in common. It is tempting to jump immediately to the conclusion that there must be some link that has caused the MS. Usually such patterns occur just by chance – even when very odd things happen, such as two or three unrelated people with MS living in the same street. In such cases the findings of epidemiological research are primarily suggestive, and must be supported by other kinds of research. At present two of the most interesting, although very time-consuming, types of epidemiological research, are those trying to detect and assess all people with MS in a particular area, and those measuring the distribution in the population of certain genetic ‘markers’ linked with MS. In the former studies, findings are indicating that there are more people with MS than we had previously thought, and the latter findings are suggesting increasingly firm associations between particular genetic markers and types of MS. Laboratory research There is a very wide spectrum of research in this area; it is usually undertaken on individual cells or cellular processes, often in animals. Much of this research is linked to understanding how the body’s immune system in MS seems to attack itself. Many scientists believe that the body’s failure to distinguish between ‘foreign invaders’ in the form of bacteria, viruses and so on (which it should attack), and its own tissue (which it should not attack), is the root explanation of why MS occurs. This kind of research has identified many of the different types of cell in the immune system, how they work, and what happens when they fail or become disrupted. Studying how immune systems work both in animals and in people with MS, who also have other diseases thought to be immune related (such as rheumatoid arthritis), gives a clearer idea of what is happening in people with MS. For example, in the late 1980s, research on a disease model in animals (called EAE – experimental allergic encephalomyelitis), thought to be similar to MS in humans, revealed promising clues to therapies that might prevent EAE in animals, and thus possibly prevent MS in humans. However, it turned out that the human immune system was far more complicated than that of laboratory animals. As a parallel development a number of fierce immunosuppressant therapies were devised, in the hope that, by suppression of the activities of the immune system, then at least no 190 MANAGING YOUR MULTIPLE SCLEROSIS further ‘autoimmune’ attacks would occur on the body’s own tissue. However, many of these therapies suppressed all immune system activity, and so led to major infections and complications, in which often the intended ‘cures’ produced worse symptoms than those of the disease they were supposed to help. Nevertheless, from these studies have come some interesting develop- ments – and one of these developments is work on what are called ‘cytokines’. These are chemical messengers associated with the regula- tion of immune system activity; understanding these cytokines has already proved rewarding.

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Wegner buy 1mg anastrozole visa, reported finding microscopic changes in the nuclei of biopsied muscles from back pain patients suggesting oxygen deprivation in “Morphologie und Pathogenese des Weichteilrheumatismus buy anastrozole 1mg free shipping,” Z cheap anastrozole 1mg fast delivery. For additional evidence on the critical role of oxygen in TMS we are indebted to a group of research workers who have demonstrated in their laboratories in recent years that muscle oxygenation is low in patients suffering from a disorder known as primary fibromyalgia order anastrozole 1 mg line. Typical of these reports is one published in the Scandinavian Journal of Rheumatology in 1986 (Vol. What this means for the etiology (cause) of TMS, as I have long maintained, is that fibromyalgia, also known as fibrositis and myofibrositis (and to some as myofasciitis and myofascial pain), is synonymous with TMS. I have treated a large number of patients who came with the diagnosis of fibromyalgia; their medical histories and physical examinations were consistent with severe TMS. Therefore, it is reasonable to maintain that the finding of mild oxygen deprivation in the muscles of patients with fibromyalgia supports the hypothesis that the cause of pain in TMS is the same—oxygen debt. As mentioned earlier, TMS manifests itself in many ways, both qualitatively and quantitatively, and it is clear that what is called fibromyalgia is one of the ways in which TMS occurs. These patients are among those who suffer the most severe conditions, for they tend to have pain in many different muscles and to suffer from insomnia, anxiety and depression as well as generalized fatigue. All these manifestations are interpreted as evidence of a higher level of repressed emotionality, primarily anger and, therefore, more severe symptoms. Most contemporary medical investigators cannot accept such an explanation since it violates their basic presumption that the etiologic explanation for physical abnormalities must be in the body itself. They cannot conceive of the idea that something like back pain might originate in the brain. And therein lies a great tragedy for the patient, for as long as this conceptual recalcitrance persists the patient will continue to be misdiagnosed. It is responsible for the excruciating pain that people experience when they are having an acute attack, as described in the first chapter. In the thousands of patients I have examined through the years I have rarely found the involved muscles to be in spasm. Wolfe in a paper published in 1952 titled “Life Situations, Emotions and Backache,” published in Psychosomatic Medicine (Vol. It is of great interest that both muscle spasm and this chemical buildup can be observed in long-distance runners, whose muscles suffer from oxygen deprivation. The presence of muscle pain, either felt spontaneously or induced by the pressure of an examiner’s hand, means that the muscle is mildly oxygen deprived. The Physiology of TMS 65 Trigger Points The term trigger points, which has been around for many years, refers to the pain elicited when pressure is applied over various muscles in the neck, shoulders, back and buttocks. There is some controversy over what precisely is painful, but most would agree that it is something in the muscle. Rheumatologists, who have taken the lead in studying fibromyalgia (TMS), appear to avoid using the term, probably because of its association with other diagnoses through the years. I neither use it nor avoid it, for I have concluded that these points of tenderness are merely the central zones of oxygen deprivation. Further, there is evidence that some of these points of tenderness may persist for life in TMS-susceptible people, like me, though there may be no pain. In the first chapter the point was made that most patients with TMS will have tenderness at six key points: the outer aspect of both buttocks, both sides of the small of the back (lumbar area) and the top of both shoulders. These tender points, trigger points, call them what you will, are the hallmark findings in TMS and they are the ones that tend to persist after the pain is gone. It is an important part of the physiology of TMS to know that the brain has chosen to implicate these muscles in creating the syndrome we know as TMS. If the brain intends to create a state of oxygen deprivation it will do so regardless of how oxygen-rich the blood is. It is likely that oxygen debt causes nerve pain because the reduced level of 66 Healing Back Pain oxygen threatens the integrity of the nerve, as it does not in muscle. In other words, muscle can withstand a lot of oxygen debt before it will be damaged, far beyond that which occurs in TMS. More sensitive nerve tissue, however, is more easily damaged and in order to warn the brain that something is wrong, pain begins with very mild oxygen deprivation. The person may experience feelings of numbness, tingling, pins and needles, burning, pressure and others less common.

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It is important to make a distinction between a coping mechanism and a defense mechanism anastrozole 1mg with visa. In the examples provided anastrozole 1 mg discount, the individuals employed a rigid discount 1 mg anastrozole mastercard, unconscious style of thinking to protect themselves from anxiety 1 mg anastrozole fast delivery, 43 Defense Mechanisms and the Norms of Behavior whereas a coping mechanism implies a desire to meet the troubles and con- tend with them on a conscious or, at worst, a preconscious level. A mal- adaptive defense mechanism is never utilized deliberately or consciously, while a coping mechanism can be called upon to master the problem rather than masking it. We are now ready to examine adaptive adjustment through a discussion of how behavior develops in typical and predictable sequences and how these stages apply both to art therapy and to defense mechanisms. For example, Wilhelm Reich (1949) found a relationship be- tween character and defense formation, while Meissner, Mack, and Sem- rad (1975) have grouped select defenses according to developmental phases. Malerstein and Ahern (1982) in their discussion of character structure had this to say about defense mechanisms: The psyche of a person is not a disjunctive aggregate, but, over the years, has developed into an organized, integrated, abiding system of approaches.... These mechanisms will have certain coherence with each other as well as with the other functions of a person’s psyche. Thus, the whole of the individual must be taken into ac- count, and this includes their nonverbal communication. To this end, art therapy allows the nonverbal expression of unconscious defense mecha- nisms. However, if we now employ the use of developmental theory and couple this with the ensuing defense mechanism, we can arrive at a very accurate clinical picture and create a treatment plan that will benefit the whole person as he or she approaches the world. As stated in the example, the client’s verbalizations, though 45 Defense Mechanisms and the Norms of Behavior abundant, were merely rationalizations about her sexual abuse. She parented her mother and sister to make up for the guilt she felt over having taken away the husband and father. All the difficulties that this client exhibited were dealt with outside of herself. Thus, when the stress, humiliation, and shame mounted, she would act out (ultimately on the two people she was parenting—her sister and mother), purge herself of her shame through aggression, and then become the symbol of perfection. She formed a pestle and mortar (penis and va- gina), exploding crowns on the trees, a bodiless person, and on and on. In this client’s case her inductive reasoning surrounded the belief that if bad things happen it is because you are bad. Overall, shame and humilia- tion are prominent as the child begins to struggle with complex problems. Thus, fixated as she was at the intuitive stage of development, rationaliz- ing was her main verbal defense, which made traditional therapy ineffec- tive. Yet with art therapy the thoughts and feelings she had hidden from consciousness were allowed symbolic expression, and the defense mecha- nisms of conversion and reaction formation were then articulated. In the end it is the typical and predictable sequences of behavior that I utilize to guide my use of the art, choice of media, and the ensuing direc- tives. For without a cornerstone to guide us we would be hard pressed to in- terpret the artwork in any manner other than a haphazard one. The art of art therapy is less about how pleasingly the drawing is ren- dered and more about the elements that are either drawn or disregarded. It has been suggested in psychological as well as art literature that individuals project their personality into their drawings. Lowenfeld and Brittain (1982) state, "The child draws only what is actively in his mind. Therefore the drawing gives us an excellent record of the things that are of importance to the child during the drawing process. In the same manner any person, regardless of age, whether versed or not in the art of drawing, utilizes an unconscious process that allows for more freedom than verbalization affords. Other drawings that this client pro- duced showed he was capable of drawing people, places, and environments. Unfortunately, as he emotionally decompensated, his drawings increas- ingly worsened until they took on an infantile quality (which is often char- acteristic of coartated schizophrenics).

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