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DR ELLIE CANNON: I'm losing sleep over back ache

By Dr Ellie Cannon for The Mail on Sunday

Published: 16:11 EST, 24 October 2015 | Updated: 03:37 EST, 26 October 2015

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One reader asks Dr Ellie Cannon to recommend remedies that could help with pain, which is so bad it is causing sleep loss (stock image)

Q. I am 78 and have recently been diagnosed as having ankylosing spondylitis. I am in constant pain and the only remedy I have been given is to regularly take painkillers in the form of codeine and paracetamol. I am trying not to take too many as I am concerned about the long-term effects. This is all worrying enough, but another concern is that the pain is interrupting my sleep, making me bad-tempered and irritable. Are there any other remedies that would help?

A. Ankylosing spondylitis (AS) is a significant diagnosis to receive at any age – it is usually diagnosed in young men.

It is a rheumatological condition causing an arthritis specifically of the spine and lower back joints with inflammation and fusion of the vertebrae.

The main feature of AS is back pain which is generally worse with rest – unlike a simple back pain which gets better with rest.

Patients will often describe being woken up at night by the pain, but it gets better with movement and exercise.

The other main feature of the condition is stiffness within the spine, particularly in the mornings.

Good pain relief is an essential part of the treatment. Paracetamol and codeine would not usually be the first choices, but rather anti-inflammatory drugs (ibuprofen or naproxen) that target the inflammation as well as the pain.

These drugs may not be initiated in elderly patients due to the risks of bleeding; however it is always worth weighing up the risks and benefits of using anti-inflammatories, as the pain relief achieved may far outweigh any small risks.

Movement and exercise are another fundamental part of AS treatment and all patients should see a physiotherapist to learn the best techniques. Regular exercise can ease pain and slow the extent of any deformity that may ensue from the fusion of the vertebrae.

Referral to a specialist is important for patients newly diagnosed with AS, particularly in light of new treatments that are available.

New biological therapies have been shown to be very effective in AS, as with other rheumatological conditions, and this is certainly a discussion worth having.

When pain is bad enough to disturb sleep, it is imperative to find an answer as the knock-on effects of sleep deprivation will worsen the pain. It’s worth trying heat pads, a TENS machine or, in some cases, a specialist doctor can offer injections. A pain clinic referral from a GP may be necessary to find long-term solutions.

Q. About a year ago after routine blood tests, my husband, who is in his mid-60s, was told he had ‘stage three chronic kidney disease’. His blood pressure was very high and he was prescribed statins for his cholesterol.

This all seemed very sudden as only a couple of years before, all was normal. The blood pressure is now controlled but we are rather left in the dark about the kidney disease and what this means.

I would so appreciate some information and advice.

A. Chronic kidney disease (CKD) is a newly described condition that has been widely diagnosed over the past few years. At least one person in ten in the UK has it, apparently.

It is actually relatively controversial among doctors, particularly GPs, who have seen a plethora of patients labelled with a disease which would in fact be more aptly named a ‘state’ or ‘concern’.

In essence, CKD means the kidneys are ageing and their functions of removing waste and regulating blood pressure are less efficient than before. It is a normal part of the ageing process, highlighted by the fact that it is seen in more than 50 per cent of people aged 75.

DO YOU HAVE A QUESTION FOR DR ELLIE?

Email DrEllie@mailonsunday.co.uk or write to Health, The Mail on Sunday, 2 Derry Street, London, W8 5TT. Dr Ellie can only answer in a general context and cannot respond to individual cases, or give personal replies. If you have a health concern, always consult your own GP.

This ageing of the kidneys is seen earlier in those with certain conditions such as diabetes and high blood pressure.

The importance of CKD as a condition is not that there is kidney disease that requires treatment, but rather that scientific evidence shows it is a risk factor for other diseases, namely heart disease and strokes.

This is the fundamental reason why so many people are being told they have it: being aware of the higher risk from the CKD allows doctors to work together with patients to lower other risk factors such as cholesterol.

There are grades of the condition from one to five, and the majority of those diagnosed will have mild or moderate CKD – stage three – requiring annual monitoring from their doctor.

Calling it a disease has led to a great deal of anxiety among patients, especially as GPs don’t always have the time to explain the true nature of the condition.

The death of two-year-old Jacob Jenkins, who choked on a grape in his Pizza Hut dessert, will have struck fear into every parent.

These things happen in a very sudden, frightening way, and knowing first aid is the only possible protection. Would you know what to do?

If the answer is not an absolute yes, go on a course. It takes just a few hours. There are fantastic trainers at St John Ambulance and Millie’s Trust, a charity set up by parents who also lost a toddler to choking, offering low-cost lessons.

Oprah's sensible choice in war with weight

Part of Oprah Winfrey’s enduring success is that she isn’t afraid to appear vulnerable, especially when it comes to her very public fight with her weight.

We know she struggles, just as we have. And she’d be the first to admit in recent years she’s been losing the battle.

Part of Oprah Winfrey’s enduring success is that she isn’t afraid to appear vulnerable, especially when it comes to her very public fight with her weight

Last week Oprah announced she was going on another diet. But rather than embrace the latest Hollywood-inspired fad, the plan she has embraced will be familiar to millions of women: WeightWatchers.

As a doctor, I think she’s made a great choice in terms of health. The programme, based on exercise and portion control, has proven itself to be sensible and trials have shown it is more workable than the crash diets that I know from personal, disappointing experience are never the answer.

But the success of slimming clubs is in the group mentality, as members spur each other on and thrive on the mutual support, which is undoubtedly why Oprah feels the brand is a good fit.

I’m sure she will feel more than welcome at my local weigh-in, should she ever be in the area.

Mindfulness is the buzz-therapy of the moment. Alongside apps and an endless slew of books, lessons in the meditation-like practice are now being offered to bankers, the military – and 60 of the country’s most violent segregated prisoners, in an effort to calm them down.

I don’t doubt it has a role in reducing stress. But there is a danger of such things being seen as a panacea, and, there are other ways to temporarily shift our focus away from personal worries. Sport, dancing, playing a musical instrument, even keeping a pet have all been shown to have similar relaxing effects.

It’s called having a hobby!