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This state of mind, which is not altogether uncommon, may increase our feeling of pain, but at the same time it helps us to endure it.

But remember that this is a pathological sequence of thought which is engendered by the psychological mechanisms which we have already discussed. If you find yourself thinking along these lines, concentrate on this. Yes, you have done wrong. We all have. And now you are suffering from pain. The pain has a real cause whether it be organic or psychological, and is in no way punishment for past misdeeds.

The Masochistic Embellishment of Pain.-Just as pain can become associated with the idea of punishment, it can also become associated with the feeling of pleasure. This rather complicated psychological reaction has its origin in sexual experience. The man is active. He is vigorous. His movements are forceful and may cause pain. Thus the ideas of sexual pleasure and causing pain may become associated. This is known as sadism. On the other hand, woman is passive. He does it to her, perhaps forcefully; and feelings of sexual pleasure are intermingled with pain. In these circumstances the pain itself may become tinged with pleasure. This is known as masochism. By various complex psychological reactions either man or woman may become sadistic or

masochistic, and the feeling of pleasure in giving or receiving pain may be transferred from sexual experience to the ordinary affairs of everyday life.

However, it is masochism, or the feeling of pleasure involved in experiencing pain, which concerns us in our present discussion. We could find many simple examples of this. When we scratch ourselves perhaps we get a strange feeling of pleasure as we actually injure the skin. There is often a great temptation to pick at the scab on a healing wound. As we pick it, there is a feeling of it hurting, but at the same time there is a pleasurable sensation. People often toy with a little piece of loose skin at the base of a fingernail in much the same way. Many people who discipline themselves very sternly are masochistic. This sometimes applies to those who swim every morning in winter, finding pleasure in the extreme cold. These examples merely serve to show that minor degrees of masochism are accepted as ‘normal behaviour.

Under some circumstances this same psychological mechanism of masochism can become stimulated and applied to pain of either functional or organic origin. In a perverse way the pain becomes tinged with a pleasurable feeling. This helps the sufferer to tolerate his pain, or if the condition is more fully developed he may really grow to enjoy the pain. However much this may help the individual to cope with his pain, we must remember that such a process is a gross perversion of the normal senses, and if allowed to develop to meet some particularly painful situation it is likely to lead to complications in other aspects of life.

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Q. Sometimes the tongue turns a bright red and becomes awfully sore.

A. This is termed glossitis and a red, raw, painful tongue can occur. Often there is no obvious cause. Simple measures usually bring relief but if they do not, within a few days, see the doctor. The physician will check for underlying causes. A sore tongue may be a symptom of another disorder which needs treatment. Regular mouth rinses with warm, salty water every hour or two often bring relief. (One teaspoonful of common salt to a glass of warm water. Rinse and spit out.) Addition of a few drops of mild antiseptics and anaesthetics to the fluid sometimes may give added comfort.

Vitamin C, 1,000 mg 2-3 times a day, and the Vitamin B Complex (e.g., one high potency B complex, mineral tablet or capsule once or twice daily) has its adherents and may assist. See the doctor if these are not quickly successful. Many complaints such as food allergies, dental disorders, anaemias, nutritional disturbances, diabetes, etc., can cause the symptoms.

Q. The lips are an awfully important part of the body. Not only are they readily obvious to anyone who looks at your face but they may become awfully tender. They often become cracked, specially in cold, windy weather. How can people treat and prevent this?

A. It is common for the lips to crack and become tender at the

corners and discharge. Superimposed infection with bacteria and

fungi is common and this prolongs the discomfort.

Simple chapping of the lips is common in cold weather or if

exposed for a period to hot dry or cold winds.

Cleanse the corners of the lips regularly with warm water or a

weak antiseptic solution (such as pink-only Condy’s solution).

Repeat every few hours. Then apply a simple cream. Ordinary

toilet lanoline often helps.

If this is ineffective see the doctor. He may recommend cleansing with liquid paraffin then applying a steroid cream, particularly one containing anti-bacterial and anti-fungal additives, such as Kenacomb or Pimafucort cream.

Vitamin C, Vitamin B complex, and minerals often help. For simple chapping of the lips, either lanoline or any lanoline based lip-stick is good. It usually takes several days to heal. Avoid winds and excessive exposure to the elements. This is important to promote healing and prevent recurrences.

Q. Is it possible for cancer to develop on the lips?

A. Yes. Leukoplakia. As the name implies this is a whitening of the mucous lining of the lips or tongue. It is usually fairly apparent. This needs prompt medical attention. It is a precursor to cancer and there is no simple way of knowing when the cells are becoming cancerous. Never neglect this symptom. Any persisting sore on the lips may be an early cancer. Avoid lip sunburn.

Q. I believe that thrush can infect the mouth, specially in children. What are the symptoms and the treatment?

A. This is a white, patchy discolouration that commonly occurs on the tongue and inside the cheeks of babies and small children. It may occur anywhere in the oral cavity. Surrounding mucous membrane is often red and bleeding occurs if an attempt is made to remove the curd-like patches. It may be painful. It is caused by an organism called Candida albicans, which is present in about one third of normal mouths. It gets out of hand under certain circumstances, such as when receiving broad spectrum antibiotic therapy and in states of malnutrition. But it can also occur for no obvious reason. Very healthy, well cared for babies are often victims. Diagnosis is usually obvious. The old fashioned and hideous looking (but very effective) remedy of painting the inner part of the mouth with gentian violet has now passed. Placing a few drops of Natamycin (1%) suspension into the child’s mouth after each feed is generally successful (Pimafucin suspension). This is usually given by the doctor.

Q. What about ulcers around the lips and gums and on the tongue and inner parts of the cheeks? So many people seem to develop these horrid sores.

A. There are two fairly common types, aphthous ulcers and Vincent’s angina.

Apthous ulcers are shallow yellowish lesions that may occur on the tongue, inner part of the cheek, the lips and gums. They are usually very painful and are surrounded by a red margin. The lymph glands under the jaw usually swell and are tender. Sometimes a fever occurs.

The cause is unknown but nuts, chocolates, citrus and other fruits are often blamed and are avoided during treatment. Bland mouth washes are usually ordered (such as hot, salty water every few hours. Adding Ora-sed may assist). Vitamins are often

advised, such as Vitamin C 1,000 mg with each meal, and the Vitamin B Complex.

See the doctor, as these ulcers may persist for days and weeks making eating, drinking and the use of salty or spiced foods uncomfortable.

The doctor may prescribe lozenges containing hydrocortisone. One of these sucked two or three times daily (placed between the cheek and gum, well back in the oral cavity) can effect a cure in a short period of time (Corlan pellets). These must be used under medical supervision for they are potent preparations. They may be used at the first sign of recurrence.

The anti allergy powder sodium cromoglycate (Intal) applied locally often helps.

Medical hypnotherapy sometimes cures these with one session. This may indicate there is a psychosomatic basis for their occurrence.

Q. What about the other kind you mentioned, the Vincent’s angina?

A. Vincent’s angina is an ulceration of the back part of the throat (the oropharynx). It may be caused by the herpes simplex virus or a spirochaetal infection. Until the advent of metronidazole, 200 mgm tablet 8 hourly for 3-4 days (Flagyl), treatment was usually ineffective. Tinidazole (Fasigyn) is also effective. This may be prescribed by the doctor. Simple mouth rinses, plenty of fluids and simple, easy-to-swallow foods assist in the acute stages.

Q. Are there any other kinds of ulcers that we should know about?

A. Certainly. Breaks in the mucous lining of the lips, mouth and tongue can occur for numerous other reasons. Simple biting is a common cause. This is often seen in adolescents of school age, particularly if emotional conflicts are present. It may be a nervous reflex habit, much like nail-biting and hair-pulling. It can lead to the production of chronically sore and ulcerated areas.

Poor dental hygiene, such as broken teeth, is also a common cause of ulcers and sores in the mouth. Any persisting sore in the oral cavity, on the lips or tongue should be checked out by the physician. Cancer of the tongue, although not common, still may occur and can be a lethal disease if untreated.

In these days of increasing social permissiveness, syphilis is increasing in incidence. Mouth ulcers may be an indication of this disease and it necessitates prompt diagnosis and therapy.

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As with every other ailment, it is naturally better to prevent back pain and sciatica from arising in the first place than having to cope with it afterwards.

Protecting your back from unnecessary or avoidable strain or stress is an important part of overcoming any existing problems as well as preventing possible future ones. Taking sensible precautions will help you cope v. ith your condition in three key ways:

The first and most obvious benefit is that just treating your back more kindly may be enough by itself to stop the back pain or sciatica altogether.

Even when precautionary measures fail to relieve your symptoms totally, these will almost certainly be greatly eased.

And, perhaps most important of all, protecting your back may stop further damage from taking place.

Setting aside difficulties arising from injury, accident or disease, back problems arise in general because one of two scenarios, or a combination of these:

A specific event during which you put your back under greater strain than it can cope, without something giving way – this could be lifting something that was just too heavy for you, or bending down awkwardly, or even perhaps just spending a long time sitting or working in a position that placed extra strain on your back.

An ongoing sequence of events that gradually strained your back, none of these events being harmful enough to cause serious trouble by themselves, but their cumulative effect eventually

adding up to a back that’s become troublesome.

Although at first glance it might appear from the above that precautionary measures to protect your back could be divided into two main groups – those aimed at preventing specific events harming you and those that deal with more general precautions – it’s not that easy to classify them that way because they often overlap to a great extent. For example, while it’s obvious that everyone – even people with no signs of back problems – should be careful and sensible when lifting or picking up anything heavy, this is advice that should be followed at all times, not merely when you think the item you’re lifting is particularly heavy, or when you think your back is getting ready to ‘play up’ once again. It’s a fact that it’s just as possible to strain your back badly when lifting something comparatively light, but doing this incorrectly, than when picking up something heavier.

But it’s not just lifting that puts your back at risk. Says the Osteopathic Information Service: “Many other common activities such as ironing, vacuuming, gardening, making a bed, and driving a car, if carried out incorrectly, can also lead to problems.

“Lifting, however, is particularly hazardous. Most people know the theory but forget to apply it in the heat of the moment. Remember: stand as close as you can; bend at the knees and keep your back straight; try to avoid lifting and twisting at the same time; get some help if you need to lift a heavy piece of furniture. Similarly, it should be a case of all things in moderation when you are stretching. Stand on a firm chair or ladder rather than stretching too far to dust or paint the ceiling and, conversely, kneel rather than bend down to reach low shelves or dust the skirting-boards.

“For many energetic activities – and housework or gardening can fall into this category if you approach them enthusiastically — it is best to work up gradually. Tackle lighter jobs first to warm up and loosen the joints before taking on more demanding bending and stretching tasks.

“As a general rule, use smooth, controlled movements rather than jerky ones and, if you do feel pain at any time, stop. Avoid the temptation to do ‘just that last little bit’. Pain is a vital warning sign and should not be ignored.”

However, it’s not just when you’re active that your back may be at risk. Poor posture or bad seating can equally contribute to making your problems all the worse. And your bed, of course, plays a vital role in keeping you and your spine rested (for more inforrnation about sleeping arrangements

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