NEVER IGNORE PERSISTENT JOINT AND BACK PAIN
There are few more reliable ways of being labelled a malingerer than pitching up at a doctor’s surgery claiming to be afflicted by back pain and chronic exhaustion for which there is no objective evidence: X-rays, scans and blood tests all normal.
It happened to an acquaintance, a medical student who came to dread the daily hospital ward round. After 20 minutes in the consultant’s entourage, moving slowly from one bed to another, “I had the fantasy”, she recalls,” I just wanted to turf the patient out of bed and lay down on those clean white sheets”. She would wake too every night with her back so stiff and painful she was forced to get up, take painkillers and move about. Little wonder she was exhausted.
She did eventually turn out to have something seriously amiss. An astute physician diagnosed the rheumatic condition of the spine ankylosing spondylitis (AS) where inflammation of the joints and ligaments (the spondylitis bit) progresses, if untreated, to the back becoming stiff and unbending (the ankylosing bit).
It can indeed be difficult to distinguish AS (especially in its early stages) from the several other causes of back pain resulting in “an average delay of eight years from the onset of symptoms” notes Nicola Goodson, a rheumatologist, in the BMJ.
The diagnosis would be made more expeditiously, she suggests, by greater awareness of the several features that increase the probability of AS being the likely cause: persistence (lasting more than three months); age (less than 35); being woken at night by the pain; improvement with movement and prompt relief with anti-inflammatory drugs. Those who fulfil these criteria warrant referral to a specialist for further investigation and, if the condition is confirmed, treatment with potent “disease modifying anti-rheumatic drugs”.
Food preservatives can cause allergies too
The lady featured in this column with a “scalding” sensation of the tip and sides of her tongue progressing to a dry mouth where “all foods taste like cardboard”, has prompted several useful observations. This constellation of symptoms notes a reader is characteristic of burning mouth syndrome most commonly a result of disturbed functioning of the sensory nerves. Hers however turned out to be sensitivity to the common chemical ingredient of toothpaste sodium lauryl sulphate. Switching to a different brand “solved the issue”.
For another woman troubled intermittently by scalded tongue, patch testing revealed allergy to the widely used group of food preservatives, the benzoates labelled on food packaging as the E Numbers 210-219 inclusive. Since avoiding these along with food and drinks kept after opening for any length of time (mayonnaise and fruit squashes) her tongue is now “comfortable most of the time”.
Also of note is that both a fungal infection and the cholesterol lowering statins have been implicated in causing “burning mouth”. This would account for the improvement reported by one reader with regular application of the antifungal Daktarin gel and by another after discontinuing her statins.
And finally
There can be no ready explanation for the query posed recently in this paper’s correspondence column – much commented on – “Why is it that a tune gets stuck in one’s head and won’t go away?” Still it is relevant in making sense of ‘repetitive tune syndrome’ that brain scans reveal the area of the auditory cortex activated when listening to music is the same as that when we consciously imagine doing so.
The musical are particularly prone. “Whole passages of symphonies enter my brain out of the blue and repeat themselves endlessly”, writes a pianist, “I hear them completely intact, each instrument playing its part in perfect pitch”. The intrusiveness of these repetitive tunes can be mitigated by, variously, ‘distraction’ (listening to the radio) ‘engaging’ by singing along or ‘dislodging’ it with another. “My father would sing Onward Christian Soldiers at the top of his splendid voice” a reader recalls.
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2025-04-24T18:03:41Z
