Monthly Archives: August 2022

LDN and CFS/Long Covid/ME

The Courier Mail had an article about the use of Naltrexone (LDN) in the treatment of CFS. They claim this as a breakthrough by Qld researchers. I have been using this successfully for many years, with good results. This is the link to the article : https://www.couriermail.com.au/news/national/gamechanging-new-test-and-treatment-for-long-covid/news-story/c0e9894c5731cbac66104542237ea704

I am really pleased that LDN is at long last being recognised as an effective treatment for a whole range of diseases.

Menopause and frailty

Later menopause onset linked to lower risk of frailty: review

Maintenance of oestrogen may be a key factor, researchers say, but evidence in the literature is limited

Later age at menopause is associated with a reduced risk of prevalent frailty, with the delay in hormonal changes thought to play a pivotal protective role, a new analysis shows.

Results from the first systematic review and meta-analysis of its kind suggest that for each one-year increase in age of menopause onset, there is a 2% lower risk of prevalent frailty.

 “These findings enhance our understanding of pathophysiology of frailty development and, possibly, sex disparity of frailty,” the Japanese-led researchers say.

Writing in Maturitas, the investigators reported results from their meta-analysis of four studies — from the UK, US, Canada and South Korea — that involved a total of nearly 26,000 women (mean age range 48-50).

The follow-up period for the two longitudinal studies examining incident frailty was four and 18 years, respectively, while the other two included studies looked at cross-sectional associations between

Two studies showed frailty prevalence of 11.6% and 11.2%, respectively.

In addition to the main finding linking later onset of menopause to lower likelihood of frailty, the researchers found that surgical menopause did not predict frailty risk.

However, they said this “counterintuitive” finding could be the result of the limited number of studies, as well as the potential initiation of menopausal hormone therapy (MHT) after surgery.

The single study providing data on use of MHT showed that frail women were significantly less likely to use the medication than non-frail women (7% vs 19%).

“Further studies with appropriate adjustments for important related factors, such as [MHT] or reasons for surgery, [are] warranted,” wrote the authors, led by Professor Tomohiko Urano at the International University of Health and Welfare in Chiba.

Although the specific underlying mechanisms linking menopause and frailty were yet to be established, Professor Urano and colleagues suggested that oestrogen deficiency postmenopause was the likely culprit.

“One possible explanation for the association … is loss of oestrogen’s protective effects on muscles,” they wrote.

“Oestrogen receptors are found in the nuclei of human [muscle] fibres and capillaries, and some evidence suggested that oestrogen preserves muscle mass, strength and functions.”

In addition, oestrogen had a role in immune and inflammatory processes.

“Emerging evidence showed that a decline in oestrogen is closely associated with systemic chronic inflammation and increased risks of cancer, cardiovascular disease, neurodegeneration and stroke.”

The review was limited by the small number of papers suitable for inclusion, only one of which was a prospective study

Sore throats suck. Do throat lozenges help at 

Shutterstock

Sore throats suck. Do throat lozenges help at all?

Published: July 14, 2022 2.53pm AEST

Author

  1. David King Senior Lecturer in General Practice, The University of Queensland

Disclosure statement

David King does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

CC BY NDWe believe in the free flow of information

Republish our articles for free, online or in print, under Creative Commons licence.

It’s hard to get through a winter without suffering sore throat, but luckily they normally get better within a few days.

Sore throat is a common symptom of COVID and its newer variants. And of course, many sore throats are caused by viral colds or flu, so they can be treated at home.

The most common treatment is probably throat lozenges – but do they really work any better than sucking on a hard lolly?

Why does my throat hurt so much?

A sore throat can fall anywhere between slight discomfort to a sensation of “swallowing razor blades”. Occasionally it hurts so much to swallow that people dribble saliva from their mouths, rather than swallowing it.

Bacteria and viruses can invade the thin moist skin (mucosa) lining the throat. This kills many lining cells and triggers inflammation, which appears as redness, swelling and increased secretions.

Infections in the nose also cause thick mucus to travel down the back of the throat and cause further irritation. This is referred to as “post-nasal drip”. A blocked nose causes reliance on mouth breathing, which tends to dehydrate the already inflamed throat. Ouch.

woman lies sick in bed with remedies and medications at bedside
Post nasal drip can be one cause of a dry, sore throat. Shutterstock

Read more: When RAT-testing for COVID, should you also swab your throat?


What do lozenges do?

Lozenges are a solid medication intended to be dissolved or disintegrated slowly in the mouth. They consist of one or more active ingredients and are flavoured and sweetened to make them pleasant tasting. Hard lozenges are generally formed using sucrose or other sugars similar to the process for hard candy confections.

There are many active ingredients added to lozenges, including antiseptics; pain relievers; menthol and eucalyptus oil; cough suppressants such as dextromethorphan and soothing compounds. “Cough drops” and sore throat lozenges are almost identical but may contain different proportions of these ingredients.

Different brands of lozenges advertise a confusing choice of formulations. It is more common now to see brands with “triple action” ingredients that promise to be anaesthetic (to numb pain), antiseptic (to kill germs) and anti-inflammatory (to reduce redness).

Unfortunately, clinical trials directly comparing the benefit of different medication types for most common conditions (head to head trials) are rarely undertaken. This is likely due to the added complexity of such trials compared with placebo controlled trials, and medication research often being funded by the pharmaceutical manufacturer of the products. So, we have to rely on indirect comparisons instead.

The traditional approach to treating sore throat is to assume lozenges or gargling with antiseptics will reduce sore throat by treating the infection causing it.

However, a limited number of trials of antiseptic lozenges (such as Strepsils and Betadine lozenges) produced only a small reduction in sore throat pain (a difference of one unit in a ten-point pain scale compared with placebo). So they do seem to provide a small degree of relief, and continue to be sold.

More and more brands are including other medications beyond antiseptics in their range of throat lozenges

woman gestures to sore throat.
A sore throat can make swallowing painful. Shutterstock

Read more: Health Check: do cough medicines work?


Checking the effects

There are some other explanations for the apparent effectiveness of any treatment for a self-limiting infection. How do we know if the symptom or infection would have lasted longer if we hadn’t used that treatment? To tell, we’d need a control group who didn’t receive the treatment, and a large sample size to overcome the role of chance causing the difference.

Relief might come from something other than the active ingredient. After all, sucking on a sweet, hard lozenge could soothe a dry throat by increasing saliva release. To test this effect, we’d need a true placebo medication – identical in every respect apart from the active ingredient.

Several well-designed and well-conducted controlled clinical trials show some active ingredients provide significantly better pain relief than placebo lozenges. These medications fall into two main groups: local anaesthetics (such as benzocaine) and anti-inflammatory agents (flurbiprofen).

A study comparing benzocaine lozenges, (now offered in many brands of lozenges) to placebo lozenges found quicker pain relief (20 minutes for benzocaine compared to more than 45 minutes for the placebo). More study participants felt relief using the medication, though very few reported complete pain relief.

A systematic research review found nine studies that supported the benefit of flurbiprofen lozenges (available in Australia in Strepfen Intensive lozenges) for a range of sore throat conditions. In one of the reviewed studies, flurbiprofen produced greater reductions in sore throat pain (47%) as well as difficulty swallowing (66%) and swollen throat (40%) over the first 24 hours compared with placebo.

One of the common sore throat treatments sold in Australia is Difflam, which contains the anti-inflammatory medication benzydamine. One clinical trial found a greater than two point reduction in the ten point pain scale by day three in those using benzydamine versus placebo.

young person sprays throat
Some people prefer throat sprays. Shutterstock

Are lozenges better than sore throat sprays?

A study using radioactive labelled medication demonstrated more prolonged and complete delivery of medication in the mouth for lozenges compared to spray and gargle. This seems to be the basis for the claim that sprays are less effective than lozenges.

However, drawing conclusions from such evidence is less accurate than a study that directly compares the effectiveness of the various modes of delivery on actual pain. One study compared flurbiprofen and found similar pain relief benefit between lozenges and spray.

So the choice of delivery method can be based on personal preference, including the taste of the product.

The takeaway

Sore throat lozenges and sprays provide some additional relief for the pain of sore throat, particularly those with anti-inflammatory or local anaesthetic ingredients. They are often combined with an antiseptic agent, which may or may not add any significant benefit.

Used as directed, these agents seem safe and have negligible adverse effects. They are also affordable and readily available.

But this shouldn’t stop us using other treatments we know also soothe sore throats, such as a small spoonful of honey.

Playing games with your pelvic floor could be a useful exercise for urinary incontinence

Playing games with your pelvic floor could be a useful exercise for urinary incontinence

Published: May 30, 2022 2.29pm AEST

Author

  1. Mischa Bongers Sessional Lecturer, CQUniversity Australia

Disclosure statement

m.bongers@cqu.edu.au is the Founder and Principal Physiotherapist at Pelvic Fix Physiotherapy. She is affiliated with CQUniversity as a Sessional Lecturer, Curtin University as a Physiotherapy Clinical Supervisor, and Queensland Health as a Senior Women’s Health Physiotherapist.

CC BY NDWe believe in the free flow of information

Republish our articles for free, online or in print, under Creative Commons licence.

Many of us have heard of “Kegels” or pelvic floor exercises, and probably have a vague sense we should be doing more of them. For many women, our social media news feeds are full of ads for the latest gizmos and gadgets for exercising our pelvic floors. There are brands with game-like apps including Perifit and Elvie, and there are Kegel balls for sale too.

As technology advances and the need for pelvic floor rehabilitation after pregnancy, childbirth and menopause continues, the demand for innovation in these devices has increased. Then there is the global pandemic that has restricted access to face-to-face medical treatment – prompting many of us to take our health into our own hands.

But what exactly are these devices used for, and do they actually work? The short answer: pelvic floor strengthening; and, it depends.

4 things the pelvic floor does and why it often fails

The pelvic floor is a group of muscles that run from our pubic bone to tailbone, and between our sit-bones, lining the base of our pelvis. Contrary to popular belief, you don’t have to lie on the floor to exercise your pelvic floor.

The role of the pelvic floor muscles is to:
  1. keep all our organs (bladder, uterus, bowel) inside the pelvis
  2. keep the sphincters to our bladder and bowel closed (until we’re ready to relax them on the toilet)
  3. provide sexual sensation
  4. work together with other deep core muscles to help with trunk stability.

The pelvic floor doesn’t always work the way it’s meant to. Bladder leakage (also known as urinary incontinence) and pelvic organ prolapse are common pelvic floor complaints for women of all ages.

About one in three women will experience urinary incontinence at some point in our lives, especially if we’ve had a baby. Other risk factors include repetitive heavy lifting, straining due to constipation, carrying extra weight, pelvic surgery, and hormonal changes.

doctor points to muscles sitting within the human pelvic bones
The pelvic floor helps hold organs inside the pelvis. Shutterstock

Read more: ‘Are Kegel exercises actually good for you?’


Getting the pelvic floor into shape

Pelvic floor muscle training is recommended as the first line of treatment for incontinence and prolapse, along with lifestyle changes such as healthy bladder and bowel habits, good general fitness, and weight management.

Pelvic floor physiotherapists are health professionals specially trained to give you individualised advice for your pelvic floor symptoms based on an assessment and your circumstances. They will likely recommend daily exercises that may include rapid contractions of the pelvic floor muscles, coordination tasks and longer holds.

Those who have trouble sticking to the prescribed exercises, or who don’t have access to a suitable physio for geographical or financial reasons, may be interested in trying biofeedback devices. These devices and their associated apps are designed to give you more information on how and when to do your exercises, remind you to do them, and help you to stick with the program.

Maintaining motivation can be tough. Research shows it usually takes at least 6–12 weeks of regular pelvic floor training to see results (just like visiting the gym, we can’t build muscle overnight).

bright pink shapes with long handles
There are many types of pelvic floor trainers on the market. Shutterstock

Read more: Urinary incontinence can be a problem for women of all ages, but there is a cure


Do pelvic floor biofeedback devices work?

There’s some evidence to suggest pelvic floor reminder apps and biofeedback devices can be helpful for improving pelvic floor function and bladder control. This might be superior to pelvic floor exercises alone. Then again, it might not make a difference.

Some women do not find the use of technology helpful for pelvic floor training. Barriers can include connectivity or set-up issues, need for privacy, tech being distracting, and price. Insertable devices also require caution for use, as most are not appropriate during pregnancy, within the first six weeks after having a baby or pelvic surgery, or when there is unexplained bleeding, pain or active infection. If in doubt, it’s always best to consult your medical provider.

The benefits of pelvic floor trainers with game-like apps that sync with an inserted device include:

  • giving real-time feedback on the screen for pelvic floor performance and correct technique
  • allowing women to work with their physio remotely
  • measuring and tracking strength, endurance and coordination improvements over time
  • providing reminder prompts via phone notifications to complete workouts
  • adjusting the workout difficulty of each session based on how the body is responding (this accounts for time-of-day fluctuations and fatigue)
  • entertaining the user with a variety of games and tasks, making them more likely to stick with their pelvic floor program!
woman lying on exercise mats
You do not have to do pelvic floor exercises lying down – or with special equipment. Shutterstock

Read more: Why you shouldn’t make a habit of doing a ‘just in case’ wee — and don’t tell your kids to either


The bottom line

The evidence definitively supports pelvic floor exercises for incontinence and prolapse, and this is best done with the support of a suitably trained professional such as a pelvic floor physiotherapist.

While early research looks promising, the evidence for commercially marketed pelvic floor feedback devices has not yet caught up to their hype. But if you are keen to try a pelvic floor biofeedback device or app to improve pelvic floor tone for better bladder control, prolapse symptoms, or sexual function – then go for it (especially if your specialist physio agrees).

After all, the best kind of pelvic floor exercise regime is the one you’ll stick with.