64 SAGA.CO.UK/AUG-MAG I^2018Health
- in painkillers such as
co-codamol, for example.
Nerve pain such as sciatica - typically caused by a bulging
disc rubbing on a nerve,
leading to pain that travels into
the buttock, thigh and lower
leg – tends not to respond
very well to non-steroidal
anti-inflammatory drugs
(NSAIDs) or opioids. So NICE
advises doctors prescribe
medicines specifically targeted
at neuralgias, such as
amitriptyline, gabapentin and
pregabalin (which are all
prescription only).
You can read the full guidance at
nice.org.uk
Q
What is the safest form of
hormone replacement
therapy? I am in my early
sixties and have been on HRT
for nearly a decade to help hot
flushes and night sweats.
I have tried to stop it (my GP
wasn’t very keen on me taking
it past 60), but the flushes
and sweats came back with
a vengeance.A
Hot flushes and night
sweats typically settle
within five years of the
menopause (so by late-fifties for
most women), but in at least
one in ten they can last a decade
or more. Unfortunately, the
older you are, and the longer
you have been on HRT, the
greater the risk of complications
such as stroke and heart attack.
But the overall risk is still low.
As for the safest type? There
is now evidence that transdermal
forms – patches and gels –
have fewer serious side effects.
They mimic natural hormone
release from the ovary
more closely than a once-daily
pill and they don’t seem
to increase the risk of blood
clots (DVT – deep veinBack pain is very common, so it comes as no
surprise that the National Institute for Health and
Care Excellence (NICE) decided to take a critical
look at how the problem is managed. And the
resulting guidance – for recent onset, rather than
long-term back pain – contains some surprises.ALAMYStay well with Dr Mark Porter
Rest and paracetamol are
out. There are notable
exceptions, but the best
evidence shows that carrying on
as normal, including working,
means you are likely to recover
more quickly. And research also
shows that the nation’s favourite
painkiller simply doesn’t work
in most cases of back pain. So,
what should we take instead?
It depends on the nature of
the pain. If it is a mechanical
problem caused by a strain thenanti-inflammatories such as
ibuprofen and naproxen should
be first-line. However, these
drugs are not suitable for
everyone and can have
significant side effects,
including ulceration of the gut,
bleeding and kidney problems.
If an anti-inflammatory
doesn’t work, or is not suitable
for you, then NICE suggests
trying a weak opioid such as
codeine, which is often used in
combination with paracetamolTea tree oil for fungal
nail in fections
Thickened, discoloured nails are
common in the over-55s, and
difficult to treat, even with strong
anti-fungals. Tea-tree oil (rubbed
into regularly filed nails twice
daily) is a natural alternative
treatment that is worth trying.
You need to have patience, but it
seems to work, with one trial
suggesting at least a 50% cure
rate after six months.fyi