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Iqra Mazhar

If you feel a sharp pain in your chest and arm, you might be having a heart attack. Learn more about the symptoms and treatment of angina attack at Meri Sehat.

Doctor, Am I Having an Angina Attack?

This article or video has been recorded by a subject / domain specialists with a proven track record of excellence in their area. 

Doctor, Am I Having An Angina Attack?

Madeeha Syed

This article or video has been vetted and verified by Meri Sehat’s specialists. It contains citations and research from validated sources.

Is Acupuncture the Right Choice For You?

Overview

Acupuncture is an ancient, traditional Chinese practice. Chinese people would use this method to relieve pain and other unpleasant symptoms.

An acupuncturist inserts tiny needles on specific points on your body. These points are called &ldquo;acupoints&rdquo; where the flow of energy is redistributed and helps in healing. Acupoints help in releasing the chemicals to fight off the symptoms of illness.&nbsp;

According to research, this method has proven to be an effective way of relieving symptoms. 
&nbsp;

Acupuncture Treatment

The idea of having not one but numerous needles in your body sounds scary. But, if truth be told, most people don&rsquo;t feel a thing! Some only experience a minor discomfort while the needle is inserted. This is because the needles used in acupuncture are as thin as human hair and a pressure or aching sensation is felt only after the needle has been correctly placed.&nbsp;

During the procedure, needles could either be exposed to a gentle electric current or they could be heated.&nbsp;

Reportedly, people feel calmer and more relaxed, even energetic, after a session. 
&nbsp;

The energy that runs through the body is referred to as Qi in Chinese medicine. Practitioners of Chinese medicine hold that interruptions of Qi result in energy imbalances in the body, which causes disease.

Some acupuncture techniques use needles to prick acupuncture points (also referred to as acupoints) on various body parts in an effort to restore Qi equilibrium. The body has hundreds of acupoints located along 14 major meridians, also known as energy pathways. 
&nbsp;

The body&rsquo;s natural mechanisms are stimulated by the needles to:

<ul>
	<li>Respond to a disease or symptom</li>
	<li>Reset the body&#39;s balance</li>
	<li>Release organic substances, including the body&#39;s <a href="https://merisehat.pk/article/the-right-approach-to-painkillers">natural painkillers</a> endorphins and neurotransmitters, which regulate nerve impulses 
	&nbsp;</li>
</ul>

Acupuncture can relieve a variety of health issues, but majority of the people use it to treat long lasting pain, including:&nbsp;

<ul>
	<li>Back pain&nbsp;</li>
	<li>Muscle pain</li>
	<li>Neck pain</li>
	<li>Joint pain</li>
	<li>Migraines</li>
	<li>Menstrual pain</li>
	<li>Sports Injury 
	&nbsp;</li>
</ul>

Acupuncture is also used to treat conditions like:

<ul>
	<li>Nerve pain</li>
	<li>Side effects of cancer treatment</li>
	<li>IBS (irritable bowel syndrome)</li>
	<li>Pregnancy issues</li>
	<li>Hot flashes and menopause symptoms 
	&nbsp;</li>
</ul>

Acupuncture may have side effects in some people, just like any other form of medical care. They are:

<ul>
	<li>Pain and bleeding at the insertion site</li>
	<li>Nausea</li>
	<li>Infections</li>
	<li>Allergic response&nbsp;</li>
	<li>Skin rash</li>
	<li>An area of bruising around the needle puncture site&nbsp;</li>
	<li>Dizziness 
	&nbsp;</li>
</ul>

Serious side effects include:

<ul>
	<li>Blood vessel and nerve damage&nbsp;</li>
	<li>Issues from the needle breaking during therapy&nbsp;</li>
	<li>Organ injuries</li>
	<li>Brain and spinal cord injuries 
	&nbsp;</li>
</ul>

Rarely, acupuncture complications could prove fatal.&nbsp;

Remember, you should always consult a doctor before getting acupuncture. Also, make sure that a skilled healthcare professional is performing the procedure using sterile, disposable needles to decrease the chances of negative effects. 
&nbsp;

Bottom Line

Although acupuncture&rsquo;s exact mechanism of action is unknown, research suggests that it might alter the autonomic nervous system and release endorphins. It could be helpful in treating various health concerns, including mental health illnesses, pain, inflammatory diseases, stress, and skin appearance. But you need to exercise caution because for some people, acupuncture could result in minor or major side effects.

If you have difficulty in managing pain and other health conditions, you could consider getting an acupuncture done. It&rsquo;s always a good idea to check with your healthcare provider to find out what&rsquo;s the right choice for you!

Namwer Rao

A. JABBAR DENTAL CLINIC

Sadia Khan

This article or video has been viewed by many visitors, and is popular.

A Guide to Essential Vitamins and Micronutrients and Should you be Taking Them?

Types

The booming health and fitness industry, diets (fad or otherwise), and holistic living practices have introduced plenty of terms in our daily life that may sound like gibberish to the common man. What is nutrition? What is a nutrient?&nbsp; Nutrition is anything you put in your body allowing it to repurpose it for survival, development and help it function normally. This is delivered via nutrients which are of two kinds:&nbsp;<span style="font-size: 12pt; font-family: &quot;Times New Roman&quot;; color: rgb(0, 0, 0); background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;">

Macronutrients

<h5 style="line-height:1.295;margin-top:0pt;margin-bottom:0pt;">Macronutrients:</h5>Proteins, fats and carbohydrates. As can be understood by the name, they are needed in bulk and are necessary for the growth and functions of a human body.

Micronutrients

<h5>Micronutrients:</h5>

Vitamins and minerals. Only needed in trace quantities, these play a crucial role in many essential bodily functions.

&nbsp;

Micronutrients and what they do

Vitamins

<h5 style="margin-top: 0pt; margin-bottom: 0pt; line-height: 1.295;">Vitamins:</h5>Vitamins are organic compounds our bodies can’t produce on their own. Your body needs 13 of these in total. These can be either fat soluble (A, D, E and K) or water soluble (All eight types of vitamin B and C). Let’s quickly dive into what these vitamins do for us:

Vitamin A

<h5 style="line-height:1.295;margin-top:0pt;margin-bottom:0pt;">Vitamin A:</h5>Widely known for its major role in fortifying our vision, this is also necessary for immune function, bone health, fetal development and fighting certain cancers. Found in fish meat liver, eggs, milk, vegetables such as squash, carrots and spinach. Vitamin A rarely runs out since most foods contain this compound, but if it does ever happen such as in low-income countries like Nigeria, it will lead to night blindness.

Vitamin D

&nbsp;

<h5><a href="https://merisehat.pk/disease/vitamin-d">Vitamin D</a>:&nbsp;</h5>

This &lsquo;sunshine vitamin&rsquo; is absorbed through the skin. It&rsquo;s necessary for bone strength and deficiency at any stage of life can have detrimental effects. Rickets in the young and osteomalacia in the elderly, both of which lead to a loss of structural integrity of bones. Salmon, butter and milk are great resources to get this from and so is regular exposure to sunlight.&nbsp;

&nbsp;

Vitamin E

<h5 style="line-height:1.295;margin-top:0pt;margin-bottom:0pt;">Vitamin E:</h5>An antioxidant that functions mainly to protect other vitamins and certain molecules from being damaged. It has been known to help in Alzheimer’s disease. You can get this from vegetable oils, leafy greens, whole grains and nuts.&nbsp;

Vitamin K

<h5 style="line-height:1.295;margin-top:0pt;margin-bottom:0pt;">Vitamin K:</h5>This plays a major role in blood clotting. Cabbage, liver, broccoli and kale are rich in this, and bleeding occurs if there’s a deficiency.

Vitamin Bs

<h5 style="line-height:1.295;margin-top:0pt;margin-bottom:0pt;">Vitamin B1, B2, B3, B5, B6, B7, B9, B12:</h5>Essential for energy, red blood cell production, healthy skin, nervous system function and hormone production. These can be obtained from salmon, soy products, whole grains, leafy greens, poultry, mushrooms, potatoes, peanut butter, broccoli avocadoes, tomatoes, fish chicken eggs legumes bananas. A lack of B6 and B12 can lead to anemia whereas if you’re low on B1 and B3 you might experience mental confusion.

Vitamin C

<h5>Vitamin C:</h5>We all remember how this one found its popularity at the beginning of the Covid19 pandemic. This was owing to the fact that it fights infections. Apart from this, it helps grow and repair tissues, protects against certain cancers and cataracts and has antioxidant properties. Get it from peppers, broccoli, guavas, papaya, kiwi, oranges and strawberries. Deficiency may lead to a disease called Scurvy. You can get bleeding gums, loss of teeth, brown spots on your skin and even death may occur if it’s severe enough.

Minerals

Minerals are chemical elements, hence less likely to be degraded by cooking, boiling etc. We have two types of these on the basis of how much our body needs these. Some of the major mineral are calcium, magnesium, phosphorus, sodium, potassium, chloride. Trace minerals are iron, zinc, iodine, selenium, copper, manganese, fluoride etc. They take part in all kinds of bodily functions such as:&nbsp;<ul></ul><ul><li style="line-height: 1.295; margin-top: 0pt; margin-bottom: 0pt;">Water balance</li><li style="line-height: 1.295; margin-top: 0pt; margin-bottom: 0pt;">Blood cell production</li><li style="line-height: 1.295; margin-top: 0pt; margin-bottom: 0pt;">Cognitive benefits</li><li style="line-height: 1.295; margin-top: 0pt; margin-bottom: 0pt;">Blood sugar regulation</li><li style="line-height: 1.295; margin-top: 0pt; margin-bottom: 0pt;">Immune function</li><li style="line-height: 1.295; margin-top: 0pt; margin-bottom: 0pt;">Bone health</li><li style="line-height: 1.295; margin-top: 0pt; margin-bottom: 0pt;">Nerve conduction</li><li style="line-height: 1.295; margin-top: 0pt; margin-bottom: 0pt;">Hormone production</li><li style="line-height: 1.295; margin-top: 0pt; margin-bottom: 0pt;">Enzyme activation and so much more.</li></ul>Some of the natural resources of these minerals are dairy products, tofu, kale, fish meat eggs poultry nuts cheese, salt, nuts beans, whole grains and legumes.&nbsp;&nbsp;

The growing conscientiousness about health in the general public has led to almost everyone consuming some kind of a multivitamin supplement. It’s mostly bought for all the claims we see on the packaging. These claims range from “fights oxidative stress” to “improves immune system” and “supports cardiovascular health”. There are several reasons why that might not be the case however:&nbsp; <ul></ul><ul><li style="line-height: 1.295; margin-top: 0pt; margin-bottom: 0pt;">Gives you a false sense of security where you might feel like now that you have everything in this little pill, you don’t ever need to buy another vegetable ever again.&nbsp;</li><li style="line-height: 1.295; margin-top: 0pt; margin-bottom: 0pt;">They might interfere with the effectiveness of some drugs such as insulin, Xanax etc.&nbsp;</li><li style="line-height: 1.295; margin-top: 0pt; margin-bottom: 0pt;">Fat soluble vitamins may build up in local fat stores and lead to trouble down the road.</li><li style="line-height: 1.295; margin-top: 0pt; margin-bottom: 0pt;">They are not FDA approved! Yes. These supplements are not highly regulated and any one can manufacture and market them as they please with all kinds of lofty claims.</li><li style="line-height: 1.295; margin-top: 0pt; margin-bottom: 0pt;">There has been research that suggests linkage between cancer and high dosages of certain vitamins.&nbsp;</li><li style="line-height: 1.295; margin-top: 0pt; margin-bottom: 0pt;">Some of these vitamins and minerals, when taken together can be counterproductive to each other.&nbsp;</li><li style="line-height: 1.295; margin-top: 0pt; margin-bottom: 0pt;">Research has shown that rates of cancer, heart attack and mental decline were found to be similar in people who take vitamins and those who don’t.&nbsp;</li><li style="line-height: 1.295; margin-top: 0pt; margin-bottom: 0pt;">The very real risk of toxicity. It might seem far-fetched but such cases are well documented in medical literature. This is especially true for vitamin E and beta carotene (A) supplements.&nbsp;</li></ul>

Now there are certain situations in which it makes sense to consume these supplements such as:&nbsp;<ul></ul><ul><li style="line-height: 1.295; margin-top: 0pt; margin-bottom: 0pt;">Your doctor found out you have a deficiency for a certain vitamin, such as a Vitamin D deficiency is quite common.</li><li style="line-height: 1.295; margin-top: 0pt; margin-bottom: 0pt;">You have a condition that doesn’t allow your body to absorb vitamins and minerals from your food (malabsorption syndrome).&nbsp;</li><li style="line-height: 1.295; margin-top: 0pt; margin-bottom: 0pt;">You’re pregnant. Pregnancy increases the nutritional demands of the body. Pre-natal supplements and folic acid helps replenish the resources that are essential for the healthy development of the baby.&nbsp;</li><li style="line-height: 1.295; margin-top: 0pt; margin-bottom: 0pt;">You’re vegan. Chances are you might be running low on your vitamin B12 stores and it’s wise to obtain it from an alternate source.</li></ul>

Bottom line

So, bottom line, if you do want to start living a healthier lifestyle it would be smart to start with consuming a healthy diet overall. Naturally replenishing your vitamin and mineral stores eliminates much of the trouble that comes with these synthetic cocktails. If you still think you’re lacking something then it would be wise to consult your doctor before buying the first multivitamin that your guy at the pharmacy raves about.

Conclusion

In the end, it’s always better to be safe and careful with what you put inside your body.

Dr. Safia Mehmood

Medilink Consultant clinic

ZAKA CLINIC GULBERG LAHORE

Saad Ullah Siddiqui

What’s Triggering My Migraine?

Introduction

A migraine refers to a severe headache in a focused region of the cerebrum that is frequently accompanied by queasiness, spells of vomiting, and an incontinent aversion to light. It can last hours to days. Not all <a href="https://www.merisehat.pk/disease/migraines-73">migraines</a> are linked to a trigger. 
&nbsp;

If you are one of those people who are affected by what they eat, then one of the most reliable methods to not aggravate the already painful headache is to identify your triggers and avoid these as much as you can. For some individuals, that implies avoiding specific food sources.

&nbsp;

Scientists and doctors alike have been unable to trace the specific reason for migraines. Specialists concur that short, immediate, and abrupt changes in your cerebrum movement and activity are likely to blame. These also have an unpleasant influence on your veins and nerve signals. The outcome: a pounding headache that can persist for an unpredictable period, ranging from a few hours to days. 
&nbsp;

Numerous things can cause migraines, like the medication you take, an unprecedented imbalance of hormones, and an absence of rest. Your eating regimen can also have an impact. In around 10% of individuals with migraines, food is a major trigger.

&nbsp;

Understanding migraine, its common triggers and treatment

As indicated by the Migraine Research Foundation, food sources may trigger migraines. However, any trigger overall is profoundly individualized, making conclusive findings more obscure and difficult to reach. To date, there has not been any such thing as a widespread migraine trigger. Yet, there are a few normal triggers that can cause or add to migraine episodes in certain individuals.

&nbsp;

<h5>1. Caffeine</h5>

We realize that some of you are most likely disappointed when you see caffeine leading this list, yet research demonstrates that unnecessary caffeine consumption can set off headache assaults. Moreover, recent studies propose reducing those daily espresso shots to decrease migraine recurrence<a href="#accordion">[1]</a>. 
&nbsp;

If you heavily rely on caffeine for that morning boost and cannot imagine beginning your day without an espresso, certain studies suggest that a moderate dosage may help hinder migraines<a href="#accordion">[2]</a>. Therefore, it is important to note that excessively devouring coffee will not do you much good.&nbsp; We realize that the caffeine boost can feel like a lifeline at times, so we will not ask for a total ban. However, try to restrict yourself to under two cups each day<a href="#accordion">[3]</a>. 
&nbsp;

<h5>2. Chocolate</h5>

This list may contain some of your favorite foods and snacks, which is why it should not come as a shock that chocolate ranks so high within our list of food triggers. According to recent research, 22% of migraine patients held chocolate as the responsible culprit for worsening symptoms<a href="#accordion">[2]</a>. Another study claimed that 42% of their subjects blamed chocolate for triggering their migraine attacks<a href="#accordion">[4]</a>. 
&nbsp;

This is understandable as chocolate contains beta-phenylethylamine, a compound that is also found in caffeine and has been associated with triggering headaches in non-migraine patients. And to perfectly mirror the dialogue of a typical brown mom, there are fruits that you could consume in place of chocolates.&nbsp; 
&nbsp;

<h5>3. Additives&nbsp;</h5>

It is perhaps a no-brainer that any chemical enhancements or excessively processed items will have negative impacts on your health. Some of the most common additives you should avoid in the supermarket are: 
&nbsp;

<ul>
	<li>Monosodium Glutamate (MSG): MSG is a popular flavour enhancement found in canned and frozen foods, such as soups, snacks, seasonings, etc. It is the primary heading within the ingredients label in soy sauce and meat tenderizers. The chemical is occasionally labelled on preserved food sources as a natural preservative or a hydrolyzed protein. Reports demonstrate it can set off a migraine within 20 minutes of consumption. An estimated 10-15% of people suffering from migraines are affected by MSG<a href="#accordion">[5]</a>. 
	&nbsp;</li>
	<li>Nitrates And Nitrites: These synthetic substances are present in many restored and handled meats, like sausages. They release a compound called nitric oxide which, when gets into your system, expands your veins, and then triggers the nervous system to cause a migraine 
	&nbsp;</li>
	<li>Aspartame: Research suggests that artificial sweeteners play a crucial part in triggering migraines. These sugar alternatives are found in processed soft drinks, desserts, and many more. 
	&nbsp;</li>
</ul>

While studies have found a correlation between such processed foods and preservatives, there is not much difference in the pool of subjects and the placebo when introduced to these additives. But just to be safe, stick to natural alternates. 
&nbsp;

<h5>4. Aged Cheese</h5>

Cheese naturally contains a substance known as tyramine. It is formed once the cheese starts ageing and breaking down proteins. The age of cheese and concentration of tyramine are proportionally related. The more time it takes for the cheese to age, the greater the concentration of tyramine within the aged cheese. Since tyramine is linked to triggering headaches, people with migraines should look out for tyramine levels in cheese. Common types of cheeses with a high tyramine content include feta, parmesan, brie, gorgonzola, and blue cheese. Moreover, it&#39;s better to avoid cheeseburgers and pizzas when experiencing migraine symptoms. 
&nbsp;

<h5>5. Nuts And Seeds</h5>

Did you just find a recipe for peanut butter noodles? Are you fond of spreading almond butter over toast? Or do you like having nut butter straight from the jar? Well, unfortunately, these eating habits are likely contributing to the pounding sensation in your head. New information suggests that certain nuts are rich sources of tyramine, the same substance found in aged cheese. Avoid binge eating or snacking on nuts and seeds such as peanuts and pumpkin seeds<a href="#accordion">[7]</a>. 
&nbsp;

There may be a possibility that your food trigger has not been listed, or you may have more than just one. It is a frustrating and laborious task to find your food trigger. For sorting out your pain and migraine triggers, follow the basic idea of tracking and noting the food and beverages you devour in a day-to-day food migraine journal. Strictly monitor the progress and maintain entries in the journal. 
&nbsp;

You may assume a food to be delicate if you respond to it differently. If a specific food or beverage initiates a migraine consistently, 20 minutes to 2 hours after consumption, that should be marked as a trigger. 
&nbsp;

In any case, remember that even though it sounds easy to follow, figuring out potential food triggers may be exhausting and painful. As anything you consume would possess a risk of setting off your migraine. Although you will be in contact with and consume certain food triggers, you should not dismiss other factors that could be contributing to your perpetual headache. To analyze these risk factors, ask yourself the following questions: 
&nbsp;

<ul>
	<li>Are you sleep-deprived?</li>
	<li>Have you skipped a meal?</li>
	<li>When was your last menstrual cycle?</li>
	<li>Have you been hydrating yourself sufficiently?</li>
	<li>Has the weather changed since the start of your headache? Did it become sunnier?</li>
	<li>Is there a family history of headaches?&nbsp;</li>
</ul>

&nbsp;

While a search is still ongoing to assess the link between food triggers and migraines, it is safe to assume that no harm would come from avoiding certain foods. But it is also important to consider different aspects which may be hindering ease and causing more discomfort. Consult a doctor to find methods that work for you in a convenient and effective environment.&nbsp;

Key Points

The article was written for informational purposes rather than providing options for treatment. To summarize:<ul><li>The cause of migraines has yet not been found, but certain food triggers have been linked to aggravating them.</li><li>Foods and beverages such as caffeine, cheese, nuts, processed meats, preservatives, and citrus foods should be avoided.</li><li>Other factors also influence migraines, such as family history, menstrual cycle, sun exposure, and dehydration.</li></ul>

[1].University of Cincinnati Academic Health Center. (2022, June 21). Diet can impact migraines.

[2].Shapiro, R. E., & Cowan, R. (2017, January 10). Caffeine and Migraines. Retrieved from American Migraine Foundation:

[3].Mostofsky, E., Mittleman, M. A., Buettner, C., Li, W., & Bertisch, S. M. (2019). Prospective Cohort Study of Caffeinated Beverage Intake as a Potential Trigger of Headaches among Migraineurs. The American Journal of Medicine, Retrieved from Science Daily

[4].Gibb, C., Davies, P., Glover, V., Steiner, T., Rose, F. C., & Sandler, M. (1991). Chocolate is a Migraine-Provoking Agent. Cephalalgia, 11(2), 93–95.

[5].Diamond, M. L., & Marcus, D. A. (2016, August 13). Diet and Headache Control. Retrieved from American Migraine Foundation:

[6].Gruber, H. J., Bernecker, C., Lechner, A., Weiss, S., Wallner-Blazek, M., Meinitzer, A., . . . Truschnig-Wilders, M. (2010). Increased nitric oxide stress is associated with migraine. Cephalalgia, 30(4), 486-92.

[7].Bauer, J. (2022). Nuts and Seeds: How Food Affects Health. Retrieved from Joy Bauer:

Zarlish Kazmi

The Right Approach To Painkillers

Pain is a complex physical sensation that has both biological and psychological components. Painkillers help manage pain by reducing its intensity or duration. The way in which painkillers work may vary from person to person, but they&#39;re typically used as short-term treatments. 
&nbsp;

Approach to Painkillers

Painkillers are drugs that relieve pain. They can be taken as a pill or injected directly into the body, and they&rsquo;re usually <a href="https://merisehat.pk/doctor-now">prescribed by a doctor</a>.

Painkillers are not addictive when used in moderation, but they should be used carefully because they can cause serious side effects (like nausea or constipation) if misused. Painkillers don&rsquo;t actually cure the underlying cause of your pain; instead, they temporarily mask it until your body heals itself naturally.

Painkillers are dangerous when taken incorrectly: either too little to relieve pain or too much to become an overdose risk. 
&nbsp;

<h5>Acetaminophen</h5>

Acetaminophen (also known as paracetamol) is an over the counter (OTC) pain reliever that&rsquo;s generally considered safe to use when taken at recommended doses. This drug is often used in conjunction with other medications, including opioid painkillers like codeine or morphine. According to the National Institutes of Health (NIH), acetaminophen can be used safely in children older than two months of age, but it isn&rsquo;t recommended for use by children under the age of 12 months due to increased risk of potentially serious liver damage.

Acetaminophen overdose has become increasingly common in recent years; according to the NIH, nearly 200 Americans die every year from unintentional overdoses on this drug alone. However, a large number of these fatalities involve alcohol consumption; if you have consumed alcohol before taking acetaminophen &mdash; even just one drink &mdash; do not exceed more than four grams per day (4000 mg). This limit includes both over the counter and prescription products containing this ingredient. 
&nbsp;

<h5>Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)</h5>

NSAIDs are used to treat pain and inflammation. They&rsquo;re often used to ease the discomfort of arthritis or other inflammatory conditions but can also be taken for headaches and other types of muscle pain. They are available over the counter and don&#39;t require a prescription.

NSAIDs are non-narcotic, which means they won&rsquo;t make you feel like you&rsquo;re &ldquo;high.&rdquo; However, this doesn&rsquo;t mean they don&rsquo;t have side effects; they do have some risks associated with them, such as stomach ulcers or gastrointestinal bleeding if taken on an empty stomach (which is why it&rsquo;s important to wait at least two hours after eating before taking NSAIDs). These risks can be alleviated somewhat by taking them with food, although this only reduces the severity of these risks &mdash; it doesn&rsquo;t eliminate them altogether. 
&nbsp;

<h5>Opioids</h5>

Opioids are a class of drugs that relieve pain. They include heroin, fentanyl, morphine and codeine. Opioids can be addictive and dangerous; they are not recommended for long-term pain relief because they are associated with addiction and overdose deaths. However, opioids (particularly tramadol) may be used to treat chronic pain when other medications have failed or caused too many side effects for the patient to tolerate them.

Opioids are not the same as heroin or other illegal street drugs &mdash; but they do share some of the same effects on users&rsquo; bodies and minds as heroin does: They slow breathing down until it stops completely (which can lead to death) and cause intense euphoria while they&rsquo;re being taken that makes users want more each time, they use them. 
&nbsp;

Acetaminophen is a painkiller, but it&rsquo;s not an NSAID. Acetaminophen is not an opioid, nor does it have the potential for abuse or addiction like opioids do. In fact, you can buy it at almost any grocery store in your area without a prescription from a doctor!

But because acetaminophen is a non-controlled substance (a Schedule 1 drug), you may end up taking too much of it if you don&rsquo;t know how to use it properly. This can cause damage to your liver and kidneys over time. Aspirin also has many side effects when taken incorrectly &mdash; it can lead to ulcers or stomach bleeding if taken along with other medications that thin the blood (like warfarin). 
&nbsp;

For those suffering from pain, the use of nonsteroidal anti-inflammatory drugs (NSAIDs) is common. You might have taken NSAIDs for a headache or back pain, or to calm inflammation after exercising. These include ibuprofen and naproxen, which are most commonly used for headaches and menstrual cramps respectively. Aspirin is an NSAID as well, but its use in children has been linked to an increased risk of Reye syndrome &mdash; a rare condition where damage occurs to the liver and brain. 
&nbsp;

Painkillers can also be used as an immediate solution when dealing with more acute injuries or illnesses. For example: if you&rsquo;re sick from the flu and start vomiting every five minutes because your stomach hurts so much from dehydration &mdash; then getting some medicine into your system will help relieve those symptoms immediately. 
&nbsp;

Painkillers are a good way to treat the causes of pain, but they can have dangerous side effects. If you take too many painkillers on a regular basis, they can cause liver damage, stomach ulcers and constipation. These drugs also make it harder for your body to absorb vitamins A and K1 and 2 (which are important for healthy skin).

If you&rsquo;re taking prescription painkillers because of an injury or surgery, then it&rsquo;s important to keep taking them as directed by your doctor. However, if you&rsquo;re experiencing chronic pain that isn&rsquo;t caused by an injury or surgery (for example: arthritis), then there are safer ways than using over-the-counter or prescription drugs like ibuprofen or acetaminophen.

If someone tells me that their back hurts so bad when I ask about their symptoms; I would recommend seeing a physiotherapist instead of popping pills every day in order avoid further complications down the road. 
&nbsp;

Every medicine comes with its own set of side effects and while they are a convenient way of fixing the problem, painkillers are not your permanent solution. While the administration of OTC painkillers sometimes is fine, making a habit out of it can cause many long-term issues. The best way to deal with any sort of painful condition is to go to your physician and get it checked. Always target the root cause of the problem and practice safe medication. 
&nbsp;

Painkillers are a necessary part of our lives. They can help ease the pain of an injury, get rid of a headache or menstrual cramps, and even make it possible to sleep at night. But all drugs have side effects, and painkillers are no exception. So, when it comes time for you to take them, be sure you know exactly what kind of medication you&rsquo;re taking &mdash; not just so that you can avoid negative reactions with other medications or medical conditions but also because some types might be more effective than others depending on what kind of pain they&rsquo;re treating! Always consult your healthcare practitioner before subjecting your body to any medicine.&nbsp;

Umna Salah

Back Pain And Sleep Problems - What’s The Connection?

Back pain and <a href="https://merisehat.pk/article/are-you-sleeping-on-your-sleep-cycle">sleep</a> problems can be a vicious cycle. However, there are ways to alleviate both issues and promote better overall health.

&nbsp;

Understanding the link between Back Pain and Sleep Issues

Back pain and sleep problems are two of the most common health issues that affect millions of people worldwide.

In particular, low back pain, which is considered a primary cause of disability worldwide, is a widespread condition and it affects individuals of all ages<a href="#accordion">[3]</a>. Based on the 2015 Global Burden of Disease Study, the global prevalence of activity-limiting low back pain was 7.3%, which means approximately 540 million individuals were affected at any given time<a href="#accordion">[3]</a>.

Low back pain is more likely to occur in individuals who have certain lifestyle habits, such as engaging in physically demanding occupations, smoking, and having low levels of physical activity.

Back pain and sleep issues are often interconnected, with one affecting the other. When a person suffers from back pain, it can be challenging to get a good night&#39;s sleep. The lack of sleep can then exacerbate the pain, leading to a vicious cycle of pain and sleeplessness. Lack of sleep can also affect mood and energy levels, making it harder to cope with pain. 
&nbsp;

<h5>Understanding Back Pain</h5>

Back pain is a common problem that can be caused by a variety of factors, including injury, poor posture, and aging. The pain can range from mild discomfort to severe. Moreover, it can be localized or radiating to other areas of the body.

Some common symptoms of back pain include stiffness, muscle spasms, and difficulty moving or standing.

A study conducted on 9,611 participants using cross-sectional methodology has shown that inadequate sleep duration and poor sleep quality are linked to low back pain<a href="#accordion">[1]</a>. 
&nbsp;

<h5>Understanding Sleep Problems</h5>

Sleep problems can be caused by a variety of factors, including stress, anxiety, depression, and physical pain.

When a person experiences back pain, falling asleep and staying asleep can be difficult. Certain sleep disorders like sleep apnea can also cause back pain due to abnormal sleeping positions. 
&nbsp;

Fortunately, several strategies can improve both back pain and sleep problems. Here are some tips: 
&nbsp;

<ol>
	<li>
	<h5>Exercise</h5>
	</li>
</ol>

Regular exercise, especially low-impact activities, like walking, swimming, or yoga, can help strengthen the muscles supporting the spine and improve overall fitness. This can help reduce back pain and improve sleep quality. 
&nbsp;

<ol start="2">
	<li>
	<h5>Improve The Sleep Environment</h5>
	</li>
</ol>

Make sure the mattress, pillows, and bedding are comfortable and supportive. Keep the bedroom dark, quiet, and cool, and limit screen exposure before bedtime. Here are some additional tips for better sleep patterns with back aches. 
&nbsp;

Choosing The Right Mattress And Pillow

<ul>
	<li>Use a supportive mattress</li>
	<li>Use a cervical or ergonomic pillow to support and align the neck and spine 
	&nbsp;</li>
</ul>

Sleep Position

<ul>
	<li>Avoid sleeping on the stomach</li>
	<li>Place a pillow between the knees when sleeping on the side</li>
	<li>Use a pillow to support the spine when sleeping on the back 
	&nbsp;</li>
</ul>

Practice Good Sleep Hygiene

<ul>
	<li>Develop a consistent sleep routine, i.e., going to bed and waking up at approximately the same time every day.</li>
	<li>Avoid caffeine and nicotine in the hours leading up to bedtime</li>
	<li>Avoid large meals close to bedtime 
	&nbsp;</li>
</ul>

<ol start="3">
	<li>
	<h5>Try Relaxation Techniques</h5>
	</li>
</ol>

Meditation, deep breathing, or progressive muscle relaxation can help reduce stress and promote relaxation, which can help improve sleep quality and reduce back pain. 
&nbsp;

<ol start="4">
	<li>
	<h5>Consider Physical Therapy</h5>
	</li>
</ol>

A physical therapist can help develop an exercise program tailored to the individual needs of the person to help reduce pain and improve flexibility. 
&nbsp;

<ol start="5">
	<li>
	<h5>Consider Alternative Therapies</h5>
	</li>
</ol>

Acupuncture, chiropractic care, or massage therapy may also help reduce back pain and improve sleep quality. However, it&rsquo;s important to consult a healthcare professional before trying any alternative therapies. 
&nbsp;

<ol start="6">
	<li>
	<h5>Manage Stress</h5>
	</li>
</ol>

Stress can exacerbate back pain and disrupt sleep, so find ways to manage stress. This includes scheduling a specific time of the day to worry about everything going on in life.

Another technique is to form a habit of journaling. Writing down worries, especially anything that triggers anxiety before sleep, helps them get out in the open so that it can be addressed.

Moreover, a to-do list for the following day can help instill a sense of achievement as well as deal with all the worries before bedtime. 
&nbsp;

Back pain and sleep problems are two of the most common health issues that affect people worldwide. These issues are often interconnected, with one affecting the other. Practicing good sleep hygiene, using proper sleeping positions, engaging in regular exercise, stretching before bed, and seeking professional help can improve both back pain and sleep problems. Remember, caring for the body is essential for a healthy and fulfilling life. 
&nbsp;

Key Takeaways

<ul>
	<li>Back pain can make it difficult to get comfortable in bed, leading to sleep problems.</li>
	<li>Poor sleep can worsen back pain by causing muscle tension and reducing the body&#39;s ability to heal and repair itself.</li>
	<li>Common causes of back pain and sleep problems include poor sleeping posture, an uncomfortable mattress, a sedentary lifestyle, stress, and medical conditions.</li>
	<li>To improve sleep and reduce back pain, it&#39;s important to prioritize healthy sleep habits and address any underlying issues.</li>
</ul>

[1] Murase K, Tabara Y, Ito H, et al. Knee Pain and Low Back Pain Additively Disturb Sleep in the General Population: A Cross-Sectional Analysis of the Nagahama Study. PLoS One. 2015;10(10):e0140058. Published 2015 Oct 7. doi:10.1371/journal.pone.0140058.

[2] Vos T, Allen C, Arora M, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: A systematic analysis for the global burden of disease study 2015. The Lancet. 2016;388(10053):1545-1602. doi:10.1016/s0140-6736(16)31678-6.

[3] Hartvigsen J, Hancock MJ, Kongsted A, et al. What low back pain is and why we need to pay attention. The Lancet. 2018;391(10137):2356-2367. doi:10.1016/s0140-6736(18)30480-x.

Neelam Asad

Ismail Munir

Help! I Think I’M Having An Angina Attack

Angina, or chest pain, is not a disease but rather a sign of heart disease. There are different types of angina: stable, unstable, microvascular, and variant. 
&nbsp;

Whether we talk about the first wheel from 4000 B.C or the Roomba of the 21st century, all human inventions are focused on making our lives easier. As inventors, we tend to create things that can help us do the same work more efficiently, and with less effort. Even something as simple as getting up to switch off the lights can now be done with a single tap on the phone, all from the comfort of your bed.&nbsp; 
&nbsp;

While the evolution of technology has significantly helped the field of transportation, medicine, communication, and business, it has also led to some &#39;bad&#39; behaviours in society. Over the years, there has been a marked increase in sedentary behavior among children, teens, and adults. The reduction in physical activity, coupled with poor lifestyle choices, has led to an obesity epidemic worldwide, even in low- and middle-income countries<a href="#accordion">[1]</a>. Obesity not only increases the risk of diabetes and hypertension but also cardiovascular diseases (CVDs) which are the leading cause of death globally. 
&nbsp;

In 2019, approximately 17.9 million people died due to CVDs; 85% of these deaths resulted from stroke and heart attack<a href="#accordion">[2]</a>. The Global Burden of Disease&nbsp; study in 2019 predicts that we will experience a further increase in the prevalence of CVDs because of the increasing population and rising obesity<a href="#accordion">[2]</a>. With this rise, it will be no surprise to see more and more people complaining of <a href="https://www.merisehat.pk/disease/angina">angina</a>, one of the most common clinical symptoms of coronary artery disease (CAD). As per a Lancet study, in 2010, more than 100 million people worldwide suffered from angina<a href="#accordion">[3]</a>.

&nbsp;

Angina, or chest pain, is not a disease but rather a sign of heart disease. There are different types of angina: stable, unstable, microvascular, and variant. Unstable angina is a medical emergency as it increases the risk of a heart attack. 
&nbsp;

Atherosclerotic changes in the coronary arteries result in hardening and narrowing of the vessels. The reduced blood supply is unable to meet the increased oxygen demand of the heart muscles. As a result, the cardiac muscles face an oxygen shortage and myocardial ischemia occurs. Physical exertion, smoking, stress, and exposure to cold can trigger angina by causing vasoconstriction and reducing blood supply to the muscles.&nbsp; 
&nbsp;

The chest pain in angina is often described as pressure, discomfort, heaviness, or tightness in the chest. This discomfort can also travel to the jaw, neck, shoulders, arms, and back. Moreover, the chest pain typically lasts 1-5 minutes and is relieved by rest or nitroglycerin pills. Other than chest pain, people with angina may also complain of: 
&nbsp;

<ul>
	<li>shortness of breath</li>
	<li>anxiety</li>
	<li>sudden and extreme tiredness</li>
	<li>nausea and vomiting</li>
	<li>light-headedness or fainting</li>
	<li>sweating</li>
	<li>cold, clammy skin</li>
</ul>

&nbsp;

Understanding first aid measures for an angina attack

If you see someone having angina, follow the following steps: 
&nbsp;

<h5>1.Help the patient rest</h5>

Ask the person to stop what they are doing and make them sit in a comfortable position. A half-sitting position with the back and head supported is mostly preferred. Use a cushion to support the head. If there are no chairs or cushions available, the person can sit on the floor and lean their head against a wall. Or you can kneel behind them and support their head with your hands or arms.&nbsp;

&nbsp;

<h5>2. Give medication</h5>

If the patient has their angina medication like a sublingual nitroglycerin pill or spray, then ask them to take it as instructed by their doctor. Help the person take the medication if they are unable to do so themselves. These medications relax and widen the blood vessels. Thus, improving blood flow to the heart and providing pain relief.&nbsp; 
&nbsp;

Another dose can be taken if the pain lasts longer than 5 minutes. Assess the patient for a further 5 minutes and if the second dose also fails to relieve their pain, then take them to the hospital immediately. Moreover, people experiencing angina for the first time might not have any medications and should immediately be taken to the hospital.&nbsp;

&nbsp;

<h5>3. Calm the patient down</h5>

Stress and anxiety can worsen the pain and lead to complications. Therefore, it is important to keep the patient calm. Furthermore, open shirt buttons and loosen any tight clothing to help the person breathe better. Ask the person to take slow, deep breaths through the nose and exhale slowly through the mouth.&nbsp;

&nbsp;

<h5>4. Assess the patient</h5>

If the pain is relieved within 15 minutes of resting or taking medication, the person should be able to return to what they were doing, provided it&rsquo;s not strenuous.&nbsp;

It is important to assess the patient&#39;s breathing and circulation. In case of sudden collapse, immediately start CPR and call for an ambulance.&nbsp;

&nbsp;

<h5>5. Call the ambulance</h5>

If the pain returns, worsens or lasts for more than 15 minutes despite rest and medication, then you should call an ambulance.&nbsp; 
&nbsp;

Following are the emergency/ambulance number for the various provinces in Pakistan: 
&nbsp;

<ul>
	<li>Sindh - 115 (Edhi ambulance), 1020 (Chhipa), +92 (21) 1021 (Aman Foundation)</li>
	<li>Punjab - 115 (Ambulance)&nbsp;</li>
	<li>Khyber Pakhtunkhwa (KPK) - 091-2590846 (Emergency ambulance), 091-2214575 (Edhi ambulance), 091-2210836 (Red Crescent ambulance)</li>
	<li>Baluchistan&nbsp;- 1122 (Medical Emergency Response Centers) 
	&nbsp;</li>
</ul>

<ul>
	<li>Never leave a person having chest pain alone.&nbsp;</li>
	<li>Avoid giving any food, fluids, cigarette, coffee, or tea.</li>
	<li>Do not make the person walk or do any physical activity.</li>
	<li>Do not delay in calling for medical help.</li>
	<li>Do not wait for the symptoms to go away.</li>
	<li>Never transport a patient with chest pain in a car as it can cause additional exertion to the heart and worsen their condition.&nbsp;</li>
</ul>

&nbsp;

<h4>"All that chest pain can increase blood pressure. Check yours today with our <a href="https://www.merisehat.pk/page/sehat-scan/" target="_blank">sehat scan</a>!" </h4>

Angina is not a heart attack, but unstable angina can increase one&#39;s risk of a heart attack. Therefore, if someone is having angina, it is important to look out for the following warning signs: 
&nbsp;

<ul>
	<li>A heaviness, discomfort, or squeezing pressure in the chest, or below the sternum (breastbone)</li>
	<li>The pain may radiate to the jaw, neck, arm, or back</li>
	<li>Sweating</li>
	<li>Nausea or vomiting</li>
	<li>Dizziness</li>
	<li>Shortness of breath</li>
	<li>Weakness</li>
	<li>A rapid or irregular heartbeat</li>
	<li>Chest pain typically lasts longer than 5 minutes 
	&nbsp;</li>
</ul>

Unlike angina, symptoms of a heart attack are not relieved by rest or medications and can last for 30 minutes or longer. If a heart attack is suspected, take the person to the hospital immediately. Moreover, the person can be given 250mg of aspirin to chew while they wait for the ambulance. Before administering aspirin, make sure the person is not allergic to the medicine or suffers from any bleeding disorder. 
&nbsp;

In women, angina often presents with non-specific symptoms such as abdominal pain, stabbing chest pain instead of pressure, and discomfort in the teeth, jaw, and back. Moreover, chest pain, in both genders, can result from a variety of conditions. These include gastroesophageal reflux disease (GERD), indigestion, stomach ulcers, pneumonia, emotional stress, pulmonary embolism, and several more. However, it is not easy to determine the exact cause. Therefore, it is always best to contact an emergency healthcare service if you have unexplained chest pain. 
&nbsp;

Although angina is not a life-threatening condition, it can increase the risk of myocardial infarction (MI). Therefore, it is important to practice healthy lifestyle modifications, stay compliant with medications, and avoid risk factors associated with angina. Maintaining a healthy weight, quitting smoking, keeping blood glucose levels within range, exercising regularly, and eating a healthy diet can prevent angina and complications.&nbsp; 
&nbsp;

<ul>
	<li>Angina is a sign of heart disease and typically results from atherosclerotic changes in the coronary arteries. The chest pain can radiate to the jaw, neck, shoulders, arm, and back. It is often described as a heaviness, tightness, pressure, discomfort, or squeezing in the chest.&nbsp;</li>
	<li>If someone is having angina, you can help them by placing them in a comfortable position and calming them down. A semi-seated position is preferred. Moreover, patients can be administered medications such as sublingual nitroglycerin pills or sprays.&nbsp;</li>
	<li>If the chest pain is not relieved from rest or medications, recurs, worsens, or lasts longer than 15 minutes, it is important to seek emergency medical care.</li>
	<li>Unstable angina can increase one&#39;s risk of a heart attack. Therefore, always look out for warning signs in someone suffering from angina. These include sweating, nausea, vomiting, shortness of breath, rapid or irregular heartbeat, light-headedness, or pain in the jaw, neck, arm, shoulder, or back.</li>
	<li>These emergency/ambulance number for the various provinces in Pakistan:</li>
</ul>

1.&nbsp;Sindh - 115 (Edhi ambulance), 1020 (Chhipa), +92 (21) 1021 (Aman Foundation)

2.&nbsp;Punjab - 115 (Ambulance)&nbsp;

3.&nbsp;Khyber Pakhtunkhwa (KPK) - 091-2590846 (Emergency ambulance), 091-2214575 (Edhi ambulance), 091-2210836 (Red Crescent ambulance)

4.&nbsp;Baluchistan - 1122 (Medical Emergency Response Centers)

&nbsp;

[1].Roth, G. A. et al., 2020. Global Burden of Cardiovascular Diseases and Risk Factors, 1990–2019: Update From the GBD 2019 Study. Journal of the American College of Cardiology, 76(25), pp. 2982-3021.

[2].World Health Organization, 2021. Cardiovascular diseases.

[3].Vos, T. et al., 2012. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. The Lancet, 380(9859).

Nimrah H. Sattar

Humza Khizer

Acupuncture: Pin down the pain

<a href="https://merisehat.pk/article/is-acupuncture-the-right-choice-for-you">Acupuncture</a> is a traditional Chinese medical practice that involves inserting very thin needles in the skin at specific points on the body. It&#39;s often used as a pain relief alternative for many conditions and ailments, including chronic pain and stress-related disorders.&nbsp;

&nbsp;

Many people who have tried acupuncture say that they have experienced significant pain relief and a reduction in their symptoms. Acupuncture is often used as a pain relief alternative for many conditions and ailments, including:

<ul>
	<li>Arthritis</li>
	<li>Back pain</li>
	<li>Labor pain</li>
	<li>Osteoarthritis&nbsp;</li>
	<li>Fibromyalgia</li>
	<li>Neck injury, like whiplash</li>
	<li>Headaches, migraines, or facial pain</li>
</ul>

&nbsp;

It&#39;s important to note that not all types of acupuncture are created equal; some methods might prove to be more effective than others in any case. For example, some types of acupuncture work better for back pain as compared to others. If it&rsquo;s possible, it&rsquo;s suggested to try different types before settling on one.

&nbsp;

Also, the number of sessions vary from person to person<a href="#accordion">[1]</a>. Frequency of appointments, too, depends on the condition being treated, how long the patient has been suffering from it, and how quickly their body responds to.

&nbsp;

Understanding the Advantages and Disadvantages of the Acupuncture

Acupuncture is an alternative to medication. Acupuncture uses needles to stimulate certain energy pathways in the body, which are called meridians. There are strategic acupuncture points along these meridians in all areas of the body, which means that stimulating them can relieve pain or improve how a person feels overall. Applying pressure on these acupuncture points actually triggers the central nervous system to release chemicals into the different parts of the body that induces a healing effect on the body parts. 
&nbsp;

It&rsquo;s not just for pain relief! Acupuncture has also been shown to relieve everything from anxiety and depression to asthma symptoms and arthritis pain. And if you don&#39;t have any health issues, but just want something done about that mind-numbing stress at work (or everywhere else), acupuncture might be right up your alley. It even has a calming effect on people who aren&#39;t necessarily feeling bad<a href="#accordion">[2]</a>.&nbsp;

<div>&nbsp;</div>

When it comes to acupuncture, it&rsquo;s important to choose a licensed practitioner who knows what they are doing. With the current rise in fame of the procedure, the market is getting saturated with all kinds of people calling themselves an expert. Do not rely on them!&nbsp;

&nbsp;

Since the process involves needles and blood, also ensure that the premises use single-use disposable needles to minimize instances of infection.&nbsp;

&nbsp;

It&rsquo;s best if the practitioner is informed beforehand if the patient:

1. Takes blood thinners (chance of bruising)

2. Has bleeding disorders (chance of bleeding)

3. Has a pacemaker (might interfere with how pacemaker operates)

4. Is pregnant (might induce labor and result in preterm birth)

<div>&nbsp;</div>

The treatment starts off with the insertion of thin needles into certain spots determined by the acupuncturist on the body. This insertion may cause discomfort. Remember, every acupuncturist has their own way to go about the process and one may differ from the other. Ideally, though, the acupuncturist should examine:

<ul>
	<li>Heart beat or pulse</li>
	<li>Face&rsquo;s skin tone</li>
	<li>Shape and color of tongue</li>
	<li>Parts of the body that are in discomfort</li>
</ul>

&nbsp;

A session normally takes around 60 minutes. The frequency of the treatment varies on the issues that are being faced and the overall duration is dependent on the severity of the issues. On average, an acupuncturist gets a job done in 6-8 treatments.

&nbsp;

The needles that are used for insertion are very thin. In some cases, they cause discomfort, but in the majority of cases, it is not even felt at all by the individual. The needle is then manipulated by the acupuncturist &ndash; they would either twirl it or apply external heat or electrical pulses. After 10-15 minutes, the needles are removed from the body.&nbsp; 
&nbsp;

The current rise in fame of alternative medicine has led everyone to focus on just the pros. There are two sides to every picture and it is vital to keep in mind the both sides to make an informed decision. Here are some of the common disadvantages of acupuncture<a href="#accordion">[3]</a>:

<ul>
	<li>In some treatments, acupuncture can actually worsen symptoms. Depending on the severity of the condition, the treatment can cause more fatigue and pain.</li>
	<li>There is uncertainty in the results. While this is expected out of every other operation or procedure, the results are so varied that there is no way to know whether the procedure would really work or not.</li>
	<li>The right acupuncturist can make or break everything. The entire foundation of an effective treatment depends on the experience and knowledge of the acupuncturist. If they are not professional, they wouldn&rsquo;t just ruin an individual&rsquo;s experience, but would also fail to provide any significant result.</li>
	<li>The patient&rsquo;s safety is of utmost importance and treatment by a non licensed person can worsen matters.</li>
	<li>Patients who go in with a positive attitude tend to get better effects due to the placebo effect.</li>
	<li>The procedure may be too costly to spend on a &lsquo;chance&rsquo; of getting better or getting some relief. 
	&nbsp;</li>
</ul>

Acupuncture is a great way to relieve pain and other ailments. Make an appointment at the local health clinic or wellness center. What needs to be understood is that not everyone has the same reaction to this form of treatment: it can turn out to be really beneficial or it may not have any impact.&nbsp;

[1] Acupuncture. Mayo Clinic.

[2] Acupuncture. Johns Hopkins Medicine.

[3] Harris A. Advantages &amp; Disadvantages of Acupuncture. LEAFtv.

First Period? No Worries, We Got You Covered

Menarche &ndash; first menstrual period &ndash; is a normal phenomenon for girls. It is significant because it implies growth, both physically and socially.&nbsp; 
&nbsp;

Menstruation is the &quot;periodic discharge of blood from the uterus.&quot; It may or may not occur as a monthly cycle and continues for the entirety of the women&rsquo;s active reproductive life&quot;<a href="#accordion">[1]</a>. 
&nbsp;

Periods can be very challenging to manage, regardless of how long you have had them; but they are especially difficult the first time when you are totally unprepared for them.&nbsp; 
&nbsp;

In this article, you&#39;ll find everything you need to know about your periods &ndash; from finding the right menstrual products, including napkins and tampons, to managing pains and preserving stained clothes.&nbsp; 
&nbsp;

Puberty is the main cause of menstruation. This is the stage when the girl&rsquo;s body becomes capable of reproduction. The estrogen (female hormone) levels increase in the female body due to the beginning of the menstrual cycle, which plays an important role in the thickening of the endometrium or the inner lining of the uterus.&nbsp; 
&nbsp;

The main purpose of the endometrium lining is to aid a fertilized egg during pregnancy. In case the sperm does not fertilize the ovum (egg), the thickened lining is broken down by your body&#39;s natural mechanism and pushed out of your uterus in the form of periods. 
 
&nbsp;

<h5>When Will I Get My First Period? 
&nbsp;</h5>

Girls start menstruating when they reach the age of puberty, between the ages of 12 and 13<a href="#accordion">[2]</a>. Typically, menstruation takes place 2 years after the development of your breasts. 
&nbsp;

<h5>What Symptoms Should I Look For? 
&nbsp;</h5>

Some girls would not experience any symptoms. Their periods start abruptly and without warning. Other girls experience some symptoms in the days preceding their periods, otherwise known as Premenstrual Syndrome (PMS).&nbsp; 
&nbsp;

Symptoms of PMS include:

<ul>
	<li>Skin problems</li>
	<li>Abdominal bloating and pain</li>
	<li>Breast tenderness</li>
	<li>Pain in the lower back</li>
	<li>Constipation</li>
	<li>Diarrhea</li>
	<li>Fatigue</li>
	<li>Mood swings, feeling sensitive or irritable</li>
	<li>Food craving, especially sweets</li>
	<li>Transparent or white discharge from the vagina 
	&nbsp;</li>
</ul>

To avoid being caught unprepared when your period starts, you should start keeping a &quot;<a href="https://merisehat.pk/article/a-guide-to-period-products">period kit</a>&quot; in your bag as soon as you reach that age and feel that your body&rsquo;s changing. This kit should include: 
&nbsp;

<ul>
	<li>A pair of clean underwear</li>
	<li>Pad, menstrual cup, or tampon</li>
	<li>Cleaning wipes</li>
	<li>Over-the-counter pain relievers, such as ibuprofen 
	&nbsp;</li>
</ul>

<h5>What Should You Do For Your First Period? 
&nbsp;</h5>

Try not to panic if your menstruation has begun and you don&#39;t have anything to utilize for the blood. Until you can obtain a good pad or tampon, you can make a temporary pad out of toilet paper to tide you over. 
&nbsp;

A quick tutorial: 
&nbsp;

1. Fold the layers of a long piece of toilet paper (at least 10 squares) over one another.

2. Place this on your underwear where the napkin would be placed &mdash; down the central part of your underwear, along the piece of fabric between your legs (known as the gusset).

3. Use a second toilet paper to wrap the pad and your underwear repeatedly. This will help keep the tissue in its place.

4. Finish the wrap by tucking the tissue&#39;s end into the top. Now, you have a temporary pad that you can easily manage and remove.&nbsp;

You might think of asking your teacher /school nurse/ friends for a pad if you are at your school. It&rsquo;s nothing to feel ashamed or embarrassed about.&nbsp; 
&nbsp;

Understanding How to Deal With the First Menstrual Cycle

Your first period would continue for a few days. It takes some time for your period to become regular and consistent. Usually, periods last between 2-7 days every month when they become regular.&nbsp; How Much Blood Will Be Lost From Your Body? The first few periods are considered typically light compared to those later in your life and only bring a few patches of red-brown blood throughout the week.Once the hormones have stabilized, your cycle will follow a schedule that will be more predictable. However, it is possible to experience a strong flow in the first few months and it's not always a problem if the bleeding is heavier. But, if you believe you are bleeding too much, you need to inform your parents or consult the school nurse.You can also tell any adult whom you trust if you:<ul><li>Have to replace/change your sanitary napkin and tampon every couple of hours.&nbsp;</li><li>Feel giddy</li><li>Feel dizzy</li><li>Feel heart palpitation</li><li>A period of bleeding that lasts more than 7 days.&nbsp; </li></ul>You might need to be taken to the gynecologist by your guardian to discuss your signs. The doctor can also prescribe some medicines to help you with your symptoms.&nbsp;

In this section of the article, several menstrual products have been outlined. Your choice of product depends on a variety of factors such as flow, pain, comfort etc. It is important to bear in mind that your preferred option might change down the line.&nbsp; 
&nbsp;

<h5>Period Underwear</h5>

The concept of period underwear is quite recent. The only difference between it and conventional underwear is that it is made of a unique fabric that absorbs menstrual blood and keeps it inside the fabric. 
&nbsp;

Period underwear caters to all girls and women, i.e. they have different levels of absorbency of blood. If your first period is light, you might be able to rely solely on these. But, if you feel it&rsquo;s a heavy flow, then period underwear is a great backup; it&rsquo;s pretty helpful in preventing accidental leakage.&nbsp; 
&nbsp;

There are numerous brands available, but they all function similarly. Choose one according to your flow and comfort. 
&nbsp;

<h5>Sanitary Napkins And Panty Liners</h5>

Rectangular pieces of absorbent material that you can stick on the inside your underwear are called sanitary napkins. Every pad has a sticky strip on the underside, allowing for the pad to remain attached to your underwear. Some pads may include &quot;wings&quot; on the sides that you drape over the borders of your underwear. This aids in keeping the pad in position and also prevents leakage. 
&nbsp;

There are many different sizes of pads. Each size is specifically designed to accommodate various degrees of blood flow. The amount of blood a pad can absorb varies depending on its size and is usually indicated on the box/cover 
&nbsp;

You&#39;ll most probably use different sizes of pads within one cycle for example at the start of the cycle, you will need more absorbent pads since the flow is heavy, while towards the end of the cycle a lighter absorption pad would be adequate due to less flow.&nbsp;&nbsp; 
&nbsp;

Most women prefer using pads at night compared to tampons as it is easier to change and if left overnight will not cause any health related issues.&nbsp; 
&nbsp;

At the start of your cycle, you will notice some spotting. To prevent staining your underwear due to spotting, you can use panty liners. These are thinner and more compact. They can also be used towards the end of your periods when your bleeding could be sporadic.&nbsp; 
&nbsp;

<h5>Tampons</h5>

Tampons are menstruation products that are tube-shaped and absorbent. They are placed within the vagina to soak up menstruation blood before it gets to your underwear. 
&nbsp;

Applicator tubes made of cardboard or plastic are often sold with tampons. These tubes have been made to aid you in inserting the tampon into your vagina. A string is on one end of every tampon to help you remove it easily.&nbsp; 
&nbsp;

Tampons are available in various sizes and levels of absorbency. Beware of scented tampons, though, as your vagina might become irritated by fragrance. 
&nbsp;

When it&#39;s time to insert the tampon, carefully press it inside your vaginal canal until only the string is left exposed.&nbsp; If your tampon has an applicator, gently pull it out by holding onto the tube. You should let the tampon stay in your vagina so that it&#39;ll absorb the blood.&nbsp; 
&nbsp;

When it is time to take it out of the vagina, just pull the string till the tampon is free.&nbsp; 
&nbsp;

Please make sure to change your tampon every 4 to 6 hours, but no longer than 8 hours. If left for 8 hours, the risk of infections and&nbsp; irritation increases. You also risk developing Toxic shock syndrome (TSS), although it&#39;s rare but it always better to be safe than sorry&nbsp; 
&nbsp;

<h5>Menstrual Cups</h5>

If you are uncomfortable using pads or tampons, another option is menstrual cups. Cups are inserted into the vagina, similarly to tampons, where they collect blood before it leaves the body. 
&nbsp;

Cups normally come in two size options &mdash; small or large &mdash; generally based on the female&#39;s age and previous delivery experience, their menstrual flow, and cervix height. 
&nbsp;

The smaller variant will probably be more convenient, easy to use and more comfortable for you to insert. You should receive step-by-step instructions for your product, but you can also refer to a guide to insertion and removal.&nbsp; 
&nbsp;

One major advantage of these cups over pads or tampons is that they can be washed and used repeatedly. This implies that you only need to remove the cup, clean it, and reinstall it when it&#39;s time to replace it. 
&nbsp;

The lifespan of reusable cups ranges from 6 months to 10 years with proper maintenance depending upon the type of brand and manufacturer of it. In other words, menstrual cups are not only safe and effective, they also save you money and are eco-friendly.&nbsp; 
&nbsp;

No, not always! Before we get into the details, know that it can happen to anyone. 
&nbsp;

When you start your period, you&#39;ll be learning about how much blood will be shed from your body, the amount your menstrual item can absorb, and when your flow seems to be at its heaviest. 
&nbsp;

Keep a few cleaning wipes in your bag if you can. They can help you remove the stain until you can thoroughly wash the fabric.&nbsp; 
&nbsp;

As a temporary solution, you can tie a jacket around your waist to hide the stain&nbsp; 
&nbsp;

Try this technique to remove the stain when you reach home: 
&nbsp;

1. Soak the stained fabric in cold water as soon as possible. Do not use warm water because that would set the stain and make it impossible to get out.&nbsp;

2. Spray a stain remover if it is available. Be sure to soak the affected region thoroughly. Let it sit for the amount of time labeled on the product&#39;s packaging.&nbsp;

3. If you don&#39;t have a stain remover on hand or wish to use two different methods to make it more effective, you can rub a bar soap or dab some liquid soap into the stain-affected region to build up a thin lather.&nbsp;

4. Wash and repeat the process till the stain washes out.

5. Wash your pants in the washing machine if the stain is not completely removed. Just be certain to use cold water rather than warm.&nbsp;

6. Air dry the washed clothes since the dryer&#39;s heat has the potential to set the stain permanently.&nbsp; 
&nbsp;

<h5>Can Other People Tell That I&rsquo;m On My Period?</h5>

Not at all! You don&rsquo;t have a different appearance or fragrance. Someone could smell the blood only if you leave your napkin or period underwear on for a longer period than advised. 
&nbsp;

You should not use scented menstrual products as they can aggravate your vulva.&nbsp; 
&nbsp;

Wash your vaginal area with lukewarm water if you are worried about body odor. Another great alternative is use of baby wipes to clean your intimate regions during periods. 
&nbsp;

<h5>Can I Still Swim And Play Sports?</h5>

Swimming and other physical activities are allowed during your period. It may also have the potential to lessen cramps.&nbsp; 
&nbsp;

Choose a tampon or a menstrual cup to stop leakage in the water when you intend to swim.&nbsp; 
&nbsp;

For the majority of activities, pads or period underwear can be used.&nbsp; 
&nbsp;

<h5>What Can I Do About Cramps?</h5>

Cramps are, without a doubt, uncomfortable. But think about it this way: your body needs periods &ndash; and, therefore, cramps &ndash; to remove the uterine lining. 
&nbsp;

To feel better:

<ul>
	<li>Follow the directions on the label or advice of medical healthcare professionals for use of&nbsp; over-the-counter pain relievers such as ibuprofen.&nbsp;</li>
	<li>Put a heating pad or heating wrap as a source of heat on your lower back or stomach.</li>
	<li>Take a warm bath. 
	&nbsp;</li>
</ul>

Speak to an adult if your cramps are worsening and you feel sick and unable to get out of bed or do routine activities. In some instances, excruciating cramping could signify an underlying illness like endometriosis so don&rsquo;t ignore or take it lightly and consult a gynecologist&nbsp; . 
&nbsp;

<h5>Other Symptoms I Might Have ?&nbsp;</h5>

Besides cramps, you might also experience the following symptoms:

<ul>
	<li>Acne</li>
	<li>Abdominal bloating</li>
	<li>Sore breasts</li>
	<li>Back pain</li>
	<li>Constipation</li>
	<li>Diarrhea</li>
	<li>Fatigue</li>
	<li>Feeling sensitive or irritable</li>
	<li>Food cravings 
	&nbsp;</li>
</ul>

All these symptoms don&#39;t necessarily need to be present when you have your period. They appear or disappear depending upon the hormonal swings.&nbsp; 
&nbsp;

<h5>How Frequently will I Get It?</h5>

The period is basically one part of the menstrual cycle. This implies that your period will follow a more regular pattern over time.&nbsp; 
&nbsp;

Typically, a menstrual cycle lasts for 28 days. But it can be around 21-45 days, which is also normal.&nbsp; 
&nbsp;

Menstruation may not start consistently for about 6 years following your first period. This is because your body has to learn how to control the release of your reproductive hormones.&nbsp; 
&nbsp;

<h5>How Can I Predict When It Will Come?</h5>

It would take a few years for your periods to develop a regular pattern. But you can keep a track of your symptoms, which would prove useful in spotting patterns and getting (mentally) ready for your period till it arrives.&nbsp; 
&nbsp;

This record can also be used to discuss severe pains with the nurse or other healthcare professionals.&nbsp; 
&nbsp;

You can use signs or code words to aid you in symbolizing the start and end of your period if you don&#39;t want people to know what you are tracking. You can maintain it on paper or on a phone. Or you can download an app. Fitbit, for instance, has a tracking option; others like Flo Period &amp; Ovulation Tracker, Clue Period Tracker &amp; Calendar, and Eve Period Tracker App work, too. 
&nbsp;

<h5>Will I Have Periods Forever?</h5>

You won&#39;t have periods for your entire life, but you&#39;ll have them until menopause. The onset of menopause is directly related to the level of hormones that triggered your menarche i.e. Menopause occurs when these hormones start to decrease in your body. 
&nbsp;

Usually, menopause starts between the ages of 45 and 55. But it&rsquo;s not just the age factor; your period may stop/ become irregular due to stress and other medical conditions as well. Talk to your healthcare professional about when you miss a period. 
&nbsp;

Meanwhile, there&rsquo;s the option of hormonal birth control if you want to stop your periods for health reasons/ travel purposes. Again, it&rsquo;s better to get in touch with your doctor first regarding it.&nbsp; 
&nbsp;

You will not have any periods during pregnancy. In case you experience any bleeding or spotting during pregnancy, please consult your doctor immediately. 
&nbsp;

<h5>Can I Get Pregnant After Menstruation?</h5>

The brief answer? Yes. When the semen comes in touch with the vagina, pregnancy is a possibility. Although the start of a period is mostly considered to mark the start of your reproductive years, it is possible to conceive before your period.&nbsp; 
&nbsp;

Hormones determine everything. In some circumstances, your body may secrete ovulation-inducing chemicals before the start of menstruation. Getting pregnant is conceivable even if you have intercourse during your menstruation.&nbsp; 
&nbsp;

Ultimately, it depends on where you are in your cycle. If you want to prevent pregnancy, you can use any of the contraceptive methods suggested by your doctor.&nbsp; 
&nbsp;

Talk to a responsible adult or visit a doctor if: 
&nbsp;

<ul>
	<li>By the age of 15, you have not begun your period.&nbsp;</li>
	<li>It&#39;s been almost 2 years since you have had your periods and they are still irregular.&nbsp;</li>
	<li>Bleeding occurs in between your periods.&nbsp;</li>
	<li>You are in excruciating pain and unable to carry out routine tasks.&nbsp;</li>
	<li>You must replace your pad or tampon every 1-2 hours as you experience heavy intense bleeding.&nbsp;</li>
	<li>You experience periods longer than 7 days.&nbsp; 
	&nbsp;</li>
</ul>

Make sure you&rsquo;ve kept a record of when your last period began and ended, when did the erratic bleeding start, or any other signs you experienced during your cycle. 
&nbsp;

Women in low- and middle-income countries frequently lack access to medical information, particularly regarding menstruation-related hygienic concerns. Lack of formal guidance from the schools, cultural resistance to using alternate menstruation products, a lack of economic resources, and inadequate water and sanitation infrastructure make this natural process difficult for young girls.&nbsp; 
&nbsp;

As a result, a biological process that naturally dignifies women and girls becomes a source of embarrassment and frustration. Such societal stigmas and beliefs make post pubescent girls more susceptible to engaging in unsanitary behaviors that result in various diseases, including those of the reproductive and urinary systems. 
&nbsp;

Hence, this article aims to provide a comprehensive guide to educate young girls about safe menstrual health.&nbsp; 
&nbsp;

<ul>
	<li>It might be challenging for a parent or guardian to know how to help a child during their first period.</li>
	<li>Every woman goes through the period as part of her regular cycle.</li>
	<li>The guardian should keep it factual. Don&rsquo;t let your menstrual past, whether it&#39;s been positive or negative, influence how you think and eventually affect how your daughter feels about menstruation.</li>
	<li>There are various menstruation product options to help you with the process.</li>
	<li>Make a period kit with some underwear, stain remover, and menstrual supplies that they can conveniently put in a locker or backpack.</li>
</ul>

[1] Fingerson, L. (2012). Girls in power: Gender, body, and menstruation in adolescence. SUNY Press.

[2] Marques P, Madeira T, Gama A. Menstrual cycle among adolescents: girls' awareness and influence of age at menarche and overweight. Rev Paul Pediatr. 2022;40:e2020494. Published 2022 Jan 5. doi:10.1590/1984-0462/2022/40/2020494

Nocturnal Back Pain In Children – What You Should Know

The condition affects around 30% of the population, usually girls more than boys, but is not considered a serious problem.<a href="#accordion">[4]</a> This is probably because the pain tends to subside on its own in the majority of cases, and very few individuals actually consult a doctor for pediatric back pain.

However, if the back pain has been going on for a long period and worsens with time, if disturbs your child&rsquo;s sleep at night, and if it causes them to have a stiff back in the morning, then it is a cause for concern. 
&nbsp;

Here&rsquo;s what you need to know about nocturnal back pain in children.

Understanding nocturnal back pain in children

A recent study established that there are associations between inflammation, nocturnal back pain, and fatigue in conditions such as ankylosing spondylitis.<a href="#accordion">[3]</a>

Juvenile ankylosing spondylitis manifests around 6-12 years of age, mostly affecting girls after puberty and boys before puberty. The pain especially disturbs sleep during the second half of the night.<a href="#accordion">[5] </a>Hence, the decrease in nocturnal back pain was shown to improve fatigue. 
&nbsp;

Research also shows it is more likely for children to inherit chronic back pain than acute back pain due to genes expressed in the central nervous system.<a href="#accordion">[2]</a> 
&nbsp;

<h5>Important!</h5>

Consult a doctor immediately if your child:

<ul>
	<li>Is 4 years old or younger</li>
	<li>Is unable to do anything due to stiffness or difficulty moving</li>
	<li>Has had back pain for more than 4 weeks</li>
	<li>Presents with unintentional weight loss, loss of appetite, and a general feeling of malaise</li>
	<li>Experiences numbness or weakness</li>
	<li>Experiences a growth spurt and develops a spine curvature 
	&nbsp;</li>
</ul>

It&rsquo;s important to thoroughly evaluate and proceed with appropriate imaging studies in children presenting to the emergency department with back pain.<a href="#accordion">[1]</a> This is important because subjecting children to scans, like MRI, CT, and X-rays, is not only unpleasant, but it also means exposure to a high dose of radiation. 
&nbsp;

Here&rsquo;s what you can look out for in children with back pain:

<ul>
	<li>A muscular strain particularly affects the lower back, sometimes going down the hips and back of the thigh, and worsens when the child stretches, bends, coughs, or sneezes.</li>
	<li>Common symptoms of a spinal fracture or malformation include back pain, which is aggravated by sitting, standing, bending, or twisting and alleviated by rest. It may be accompanied by tingling, numbness, weakness, difficulty walking, and bladder or bowel problems.</li>
	<li>A stress fracture or inflammatory arthritis may lack any physical signs.</li>
	<li>Degenerative spinal issues like kyphosis and scoliosis may present with a noticeable deformity of the spine.</li>
	<li>In rare instances, children who feel unwell for more than 2 weeks, experience weight loss, or are unable to sleep at night due to pain may be diagnosed with a tumor such as osteoid osteoma. The pain typically affects the middle or lower back. It is also constant and unrelated to activity.</li>
	<li>Another rare cause of back pain in children is infection of the disc or bone in the spine, which causes generalized pain and fever. 
	&nbsp;</li>
</ul>

Back pain at night in children is a multifaceted issue that requires a comprehensive understanding of its associations to ensure early intervention and management. Long-term back pain can affect their overall well-being, leading to disability and depression, for instance. Addressing this issue necessitates a holistic approach to prevent the child from developing any complications. 
&nbsp;

<ul>
	<li>One of the types of back pain in children is nighttime back pain.</li>
	<li>Frequent pain that awakens the individual child at night is related to infections or tumors, including aneurysmal bone cyst, discitis, Ewing&rsquo;s sarcoma, osteoblastoma, osteomyelitis, leukemia, osteoid osteoma, eosinophilic granuloma, and spinal cord tumors.</li>
	<li>Immediate medical attention is crucial for nighttime back pain in children.</li>
</ul>

[1] Bhatia, N., Chow, G., Timon, S., & Watts, H. (2008). Diagnostic modalities for the evaluation of pediatric back pain. Journal of Pediatric Orthopaedics, 28(2), 230-233.

[2] Bortsov, A., Parisien, M., Khoury, S., Zaykin, D., Martinsen, A., Lie, M., … & Diatchenko, L. (2020). Genome-wide analysis identifies significant contribution of brain-expressed genes in chronic, but not acute, back pain.

[3] Hammoudeh, M., Zack, D., Li, W., Stewart, V., & Koenig, A. (2013). Associations between inflammation, nocturnal back pain and fatigue in ankylosing spondylitis and improvements with etanercept therapy. Journal of International Medical Research, 41(4), 1150-1159.

[4] Hazell DT. Back pain in children: Causes, symptoms, and treatment. Patient.info.

[5] Georgie K. Philip M. Potential causes of back pain in children and teens. Spine

Staff Writer

When Period Pain Isn’t ‘Normal’

More than half of all menstruating women experience some pain during the first three days of their period. However, for some women this pain can be extremely severe, to the point of being debilitating and can hinder activities in their daily life. It is also accompanied by other uncomfortable symptoms such as diarrhoea, nausea, vomiting, headaches and <a href="https://merisehat.pk/disease/dizziness">dizziness</a>. 
&nbsp;

Painful periods are called &lsquo;dysmenorrhea&rsquo; which can be of two different types: primary and secondary dysmenorrhea.

<ul>
	<li>Primary Dysmenorrhea is the cramp-like pain that you feel before or during your period and is mostly a natural phenomenon as the muscles and blood vessels in your uterus contract. 
	This process is mediated by chemicals called &lsquo;prostaglandins&rsquo; that are naturally high during the first two days of your period and are made by the lining of your uterus. As the uterine lining is shed, the level of these chemicals goes down and hence the pain goes away. 
	&nbsp;</li>
	<li>Secondary&nbsp;Dysmenorrhea on the other hand is because of any disorder related to the reproductive organs. This is the kind of severe pain that raises red flags. The pain not only begins a few days before your period starts but it progressively gets worse throughout your period, not going away even after your period ends in much severe cases. 
	&nbsp;</li>
</ul>

Causes Secondary Dysmenorrhea

<ul>
	<li>Endometriosis: the inside of your uterus is lined by endometrium. When this specific tissue is found in places other than your uterus, we call this phenomenon endometriosis. This rogue endometrium can be found anywhere from your ovaries to fallopian tubes or bladder and even lungs. When you are menstruating, this endometrium also undergoes the same process as the one lining your uterus and will shed and bleed. This is what causes the severe pain and can lead to formation of scars and adhesions. These adhesions can cause the organs to stick together that leads to worsening pain. 
	&nbsp;</li>
	<li>Fibroids: these are growths of smooth muscles that can form anywhere in your uterus and can be big enough to distort the uterine cavity and cause pressure symptoms including pain. 
	&nbsp;</li>
	<li>Adenomyosis: this is essentially the endometriosis of the uterus. The endometrial lining invades the muscular portion of your uterus and can cause severe pain. 
	&nbsp;</li>
	<li>Other Causes: certain congenital problems of the reproductive tract can also lead to pain and so can other conditions such as Crohn&rsquo;s disease. 
	&nbsp;</li>
</ul>

Now that you can recognise which pain is normal and which is out of the ordinary you can easily ascertain which category you fall in. If you have the severe pain of secondary dysmenorrhea then this calls for an urgent visit to the gynaecologist&rsquo;s office. 

The first step is to let your gynaecologist know about your symptoms. Depending on these, a pelvic exam will be arranged followed by an ultrasound exam and a laparoscopy in order to identify the exact pathology causing your symptoms. 
&nbsp;

Available Treatment Options

<ul>
	<li>Painkillers: The first step in the management of painful periods is always a painkiller, most likely an NSAID such as Ibuprofen. Other conservative treatment options include Vitamin B1 and magnesium supplements but the evidence of their effectiveness is mostly anecdotal and more research is needed to classify them as effective treatment. 
	&nbsp;</li>
	<li>Exercise: can also be recommended, especially aerobic workouts such as walking, jogging, swimming etc. The reason behind this is that exercise leads to production of pain-blocking chemicals in the body. 
	&nbsp;</li>
	<li>Heating Pads And Warm Baths can also help. The hormonal intrauterine device can also be used to treat extremely painful periods and comes with the added benefit of lighter periods and contraception. 
	&nbsp;</li>
	<li>Birth Control: If the physical exam and laparoscopy point towards a more sinister aetiology behind your pain such as endometriosis then birth control methods such as the pill, implants, injections or hormonal intrauterine device can be used. Certain medications such as GnRH analogues can also help relieve the pain of endometriosis but come with side effects such as loss of bone mass and vaginal dryness. 
	&nbsp;</li>
	<li>Uterine Artery Embolisation: For fibroids and adenomyosis, the first step is medication followed by birth control methods and GnRH analogues. If all else fails then uterine artery embolisation is carried out which means the blood vessel to the uterus will be blocked. This stops the fibroid mass from growing any further and can help you have normal periods. In some women, periods may stop entirely. 
	&nbsp;</li>
	<li>Surgery: If all else fails, we opt for surgery. Surgery can be carried out in all three cases. For adenomyosis, hysterectomies may be done as this condition usually occurs in older women who have already undergone childbirth. Since endometriosis can return even after surgical removal, hormonal birth control should be continued afterwards. 
	&nbsp;</li>
</ul>

Despite the blas&eacute; attitude we have about women&rsquo;s pain, it&rsquo;s certainly not normal to have extremely painful periods. If you or any woman you know is suffering from this and no home remedies or totkas have worked out so far then it might be time to visit a gynaecologist. It&rsquo;s better to be vigilant about these conditions early on as they can affect not just your reproductive health but your overall health in the long term. 
&nbsp;

Chest pain is one of the most common presentations in emergency departments (EDs) across the world. In the United States, more than 8 million ED visits each year are due to chest pain<a href="#accordion">[1]</a>.As per an analysis of ED surveillance data in Pakistan, more than 7% of all admitted patients complain of chest pain<a href="#accordion">[2]</a>. However, only a small proportion of these patients have a life-threatening condition. The cause of chest pain can vary ranging from minor indigestion to medical emergencies such as myocardial infarction (MI).&nbsp; 
&nbsp;

Approximately half of all chest pain cases have a cardiac cause while the other half are caused by gastrointestinal, pulmonary, psychological and musculoskeletal diseases. Gastroesophageal reflux disease (<a href="https://www.merisehat.pk/disease/gerd-56">GERD</a>) is the most prevalent cause of non-cardiac chest pain<a href="#accordion">[3]</a>. 
&nbsp;

The most common causes of chest pain are: 
&nbsp;

<ul>
	<li>Cardiovascular - angina, heart attack, aortic dissection, pericarditis</li>
	<li>Gastrointestinal - GERD, oesophagal rupture, peptic ulcers, gallstones, pancreatitis</li>
	<li>Pulmonary - pleuritis, pneumonia, pulmonary embolism, pneumothorax</li>
	<li>Musculoskeletal - Muscle injury, broken ribs, shingles</li>
	<li>Other - anxiety, panic attack 
	&nbsp;</li>
</ul>

Cardiac chest pain also called angina, is the most common symptom of cardiovascular disease (CVD). Chest pain is often described as discomfort, tightness, heaviness, or pressure in the chest. This pain can also occur in the jaw, neck, arms, shoulder, and back. Moreover, you may also experience nausea, vomiting, fatigue, and shortness of breath. Angina is mostly triggered by exercise, cold, or emotional stress. 
&nbsp;

Although angina signs and symptoms can vary. If your chest pain occurs on physical exertion, is relieved by rest or prescribed angina medication, and lasts 1-5 minutes, then it is likely angina. If your chest pain continues to worsen or lasts longer than 10 minutes then a diagnosis of MI, aortic dissection, or pulmonary embolism should be considered. Since angina symptoms often overlap with several other diseases, it is best to book an appointment with a doctor immediately. Remember, no type of chest pain is good.&nbsp;

&nbsp;

Angina is not a disease, but a symptom of an underlying heart condition such as coronary artery disease (CAD). The American Heart Association (AHA) defines angina as chest pain or discomfort caused by the heart muscle receiving an inadequate supply of oxygenated blood<a href="#accordion">[4].</a>&nbsp; 
&nbsp;

Atherosclerosis results in narrowing and hardening of the coronary arteries. As a result, the cardiac muscles are unable to receive sufficient oxygen-rich blood. The reduced blood supply and increased oxygen demand of the muscles then result in ischemia. During periods of increased activity or emotional stress, the heart needs to pump harder as the muscles require more blood and oxygen. However, the narrowed vessels restrict the blood flow. Thus, resulting in chest pain, or angina.&nbsp;

Understanding different types of chest pain

There are several types of angina depending on the cause or severity of the symptoms. These include stable, unstable, microvascular, and variant angina. Stable angina is the most common and typically results from physical exertion. It lasts 1-5 minutes and is relieved by rest or nitroglycerin pills. On the other hand, unstable angina is a medical emergency and is often the first sign of a heart attack. The chest pain can occur at rest, lasts longer than 10 minutes, and is not relieved by medications.&nbsp; 
&nbsp;

Microvascular angina results from coronary microvascular disease (MVD) that affects small coronary vessels. Along with chest pain, patients complain of sleep disturbances and shortness of breath. Compared to other types of angina, microvascular angina is more painful and lasts longer. 
&nbsp;

Variant angina is the rarest type and mostly occurs between midnight and early morning. Spasm of the coronary arteries leads to a painful condition.&nbsp;

&nbsp;

Doctors mostly prescribe nitrates such as nitroglycerin for treating acute episodes of angina. These medications widen and relax the blood vessels. Thus, improving blood flow to the muscles and providing immediate pain relief.&nbsp; 
&nbsp;

During an episode, it is important to stop what you are doing and rest. A half-sitting position, on the floor or chair, is preferred. If your doctor has prescribed you a sublingual nitroglycerin pill or spray, you may take it. If the chest pain does not get better, you can repeat a dose after 5 minutes. Moreover, it is important to stay calm as stress and anxiety can worsen chest pain.&nbsp;

&nbsp;

If you start having an angina attack, stop what you are doing and rest. Sit in a semi-seated position and stay calm. If the pain does not get better with rest within 5 minutes, call for an ambulance. Do not drive yourself to the hospital when experiencing any kind of chest pain.&nbsp;

&nbsp;

Angina is not a life-threatening condition. However, unstable angina can increase a person&rsquo;s risk of myocardial infarction. It is associated with a 7-8% mortality in medically treated patients<a href="#accordion">[5]</a>. Whereas chronic stable angina has a mortality rate of 4%<a href="#accordion">[5]</a>.&nbsp;

&nbsp;

Once your chest pain is relieved, it is best to book an appointment with a doctor. Moreover, a doctor&rsquo;s consultation should be sought if your angina becomes frequent, worsens in severity, or changes pattern. A doctor will be able to find out the cause of your angina and prescribe medications and lifestyle changes for your condition.

&nbsp;

To prevent a recurrence of angina, the doctor often prescribes various medications such as aspirin, beta-blockers, statins, and calcium channel blockers. However, some patients fail to respond to these medications and continue to experience chest pains. Therefore, in 2006, the FDA approved ranolazine for use in chronic angina patients. According to research, the drug not only reduces angina episodes but also improves exercise-induced angina<a href="#accordion">[6]</a>.

Remember to always consult a doctor before starting any new drug.&nbsp;

&nbsp;

In some patients, despite medications and lifestyle modifications, the chest pain continues to persist and recur. As a result, doctors may recommend procedures such as percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG).&nbsp;

<h4>"Consistently high blood pressure can damage vital organs. Check yours today with our <a href="https://www.merisehat.pk/page/sehat-scan/" target="_blank">sehat scan</a>!" </h4>

During a heart attack, or myocardial infarction (MI), a person experiences persistent chest pain that feels like a squeezing or pressure in the centre of the chest. The pain can radiate to the jaw, neck, back, shoulder, arm, and upper abdomen. Moreover, unlike an angina attack, the chest pain in an MI lasts longer than 15 minutes and is accompanied by sweating, lightheadedness, nausea, shortness of breath, and a rapid or irregular heartbeat.&nbsp; 
&nbsp;

Heart attacks are often fatal. Hence, if discomfort persists or worsens, it is best to consult a doctor immediately.&nbsp;

&nbsp;

In women, angina often presents at an older age and with atypical symptoms. These include abdominal pain, stabbing chest pain, nausea, fatigue, and discomfort in the jaw or teeth. Moreover, some women might not even experience any chest pain and instead, just have fatigue.&nbsp;

According to the American Heart Association, women (54.4%) have a higher prevalence of angina than men (45.6%). In women, angina is more often the presenting symptom of coronary artery disease<a href="#accordion">[7]</a>. And, women also frequently experience coronary microvascular disease.&nbsp;

&nbsp;

Home remedies can be effective for non-cardiac chest pains from minor causes such as heartburn, or other gastrointestinal issues. However, angina can increase one’s risk of heart attack and can be a medical emergency. Therefore, it is best to consult a healthcare professional and follow their guidance.

Approximately 10-30% of patients with angina-like chest pain will have no underlying heart disease<a href="#accordion">[8]</a>. Since their pain is poorly understood, it&#39;s hard to manage their condition. In such cases, hypnotherapy has proven effective in reducing pain intensity, but not the frequency of episodes<a href="#accordion">[8]</a>.&nbsp;

&nbsp;

A part of traditional Chinese medicine, acupuncture involves the insertion of thin needles at specific points throughout the body. These acupuncture points are meant to stimulate the central nervous system and cause the release of chemicals. As a result, the body&rsquo;s natural healing mechanism is activated. Therefore, the technique has been used to treat chronic pain, migraines, fibromyalgia, and even asthma. 
&nbsp;

Since certain acupuncture points can have an effect on cardiac health, researchers have explored its use in treating angina. The therapeutic method has an effectiveness of 80-96%<a href="#accordion">[9]</a>.&nbsp;Moreover, when compared to conventional medical treatments, acupuncture causes a quicker relief of angina and lacks adverse side effects. Therefore, making it an efficient option for regular angina treatment.

&nbsp;

Although exercise can trigger angina, it can also reduce the risk of angina. Patients are typically recommended daily, regular exercise. This helps improve the heart muscles’ circulation.&nbsp;

It is always recommended to consult your doctor before resuming any kind of activity. Any activity that puts unnecessary stress on the heart such as physical exertion should be avoided.&nbsp;

The sooner you make lifestyle changes and stick to them, the quicker you can return to your normal routine. Taking medications and avoiding risk factors can reduce one&rsquo;s symptoms.

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The most common risk factors of angina include diabetes, obesity, smoking, alcohol and hypertension. Regular exercise, a healthy diet, quitting smoking, losing weight, and learning to manage stress can all decrease your risk of angina.&nbsp; 
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[1].American Heart Association. (2020, January 29). Heart Disease and Stroke Statistics—2020 Update: A Report From the American Heart Association. Circulation, 141(9), 139-596.

[2].American Heart Association. (2021, November 8). Angina (Chest Pain). American Heart Association. Retrieved July 13, 2022, from https://www.heart.org/en/health-topics/heart-attack/angina-chest-pain

[3].Amsterdam, E. A. (2010, July 26). Testing of low-risk patients presenting to the emergency department with chest pain: a scientific statement from the American Heart Association. Circulation, 122(17), 1756-76. 10.1161/CIR.0b013e3181ec61df

[4].Chaitman, B. R. (2006, May 23). Ranolazine for the Treatment of Chronic Angina and Potential Use in Other Cardiovascular Conditions. Circulation, 113, 2462-2472.

[5].Hilton, T. C., & Chaitman, B. R. (1991). The prognosis in stable and unstable angina. Cardiology clinics, 9(1), 27-38.

[6].Jones, H., & Cooper, P. (2006). Treatment of non-cardiac chest pain: a controlled trial of hypnotherapy. Gut, 55(10).

[7].Paichadze, N., Afzal, B., Zia, N., & Mujeeb, R. (2015). Characteristics of chest pain and its acute management in a low-middle income country: analysis of emergency department surveillance data from Pakistan. BMC Emergency Medicine, 15(13). 10.1186/1471-227X-15-S2-S13

[8].Thompson, S. E., Liu, J. J., & Saltzman, J. R. (2007, September). Prevalence of Gastroesophageal Reflux Disease in Patients with Non-Cardiac Chest Pain Presenting to the Emergency Department. The American Journal of Gastroenterology, 102.

[9].Xu, L., Xu, H., Gao, W., & Wang, W. (2013). Treating angina pectoris by acupuncture therapy. Acupuncture & electro-therapeutics research, 38(1-2), 17-35. 10.3727/036012913x13831831849457