Thermography is used to assess many conditions, in particular, breast cancer, disorders of the blood vessels in the limbs, skin diseases, and disorders of the testicles.

It has been used extensively overseas in sports medicine, particularly in the early diagnosis of stress fractures. It has also been used in the diagnosis and management of arthritis and of chronic or recurrent headaches, particularly cluster headaches.

The entire process only takes an hour and involves the patient sitting for 15 minutes until the body temperature stabilises. Then, three sets of pictures are taken at fifteen minute intervals, again for the body to settle down.

Thirty to 50 images are collected on to the infra-red equipment linked to a computer. They are stored on a floppy disc and then replayed on a high resolution TV monitor.

They can be studied and photographed with a single-lens reflex camera. A series of colour transparencies is produced. These are studied using a light box and a magnifying glass.

Pictures true to the original transparencies can be produced on instant film for the referring physician.

Chronic pain of any origin appears to cause cooling in the adjacent skin and the picture of the body that thermography gives shows the temperature of the different areas of the skin. Certain diseases, injuries and chronic pain cause changes in skin temperature. Also:

• Inflammation causes increased heat.

• Muscle spasm causes increased heat.

• Cutting a peripheral nerve (the final nerve pathway) causes increased heat in the skin supplied for up to five months. This is followed by cooling in the area.

• Nerve root irritation usually causes cooling in the appropriate area of skin supplied by the affected specific nerves.

Thermography is gaining increasing acceptance and is a highly effective, alternative way to diagnose the increasing number of soft tissue injuries.

Because the assessment is photographically reproducible, it adds an extra dimension to the doctor’s ability to diagnose or establish that there is, or is not, a basis for the pain. While the principles of thermography have been available for some time, it is only recently that the teaming of computer technology with infra-red imaging techniques has made modern thermography possible.

Thermography is a totally safe investigation because no radiation is involved in the process. There are no side-effects whatever and the only inconvenience is the need to remove clothing from the affected area. For example, if the painful area is in the upper part of the body, the patient has to strip off to the waist. This is necessary because the thermogram is so accurate that even the smallest garment will show up.

*89\37\8*

He believed that there was a physical cause for the pain and he was anxious to find suitable treatment for it. He was also extremely concerned about the effect the lost time was having on his career.

On assessment by the in-patient team the use of alternative medication was investigated and he was prescribed the antidepressant Sinequan in a therapeutic dosage. Next, it was decided to increase the dosage of Sinequan to even higher levels and also put him on high doses of Valium three times a day to reduce his muscle spasm.

As an alternative to his narcotics, he was given an amino-acid, L-Tryptophan (which activates the brain’s natural pain defences) to help control pain. He was advised to take up to ten a day because, being a natural product, they could not do him any harm. Recently L-Tryptophan containing preparations have been withdrawn in Australia and the United States due to the occurrence of blood disorders in patients taking L-Tryptophan for pain or sleep disorders.

However despite strong evidence to the contrary he still believed his pain had a physical cause. He was told he would have to be withdrawn from opiates to establish whether alternative pain control mechanisms could work. This would also help to get him to a stage where if an operation was necessary it would be psychologically successful.

Michael then stopped the Omnopon by using TENS therapy and relaxation tapes. It was recommended that no surgical treatment should be performed until all attempts at alternative pain control were made.

After a month of constant supervision he was taking the major tranquilliser Largactil and mild sleeping tablets and was coping without narcotics. He now had a positive attitude. However, he still thought that as his pain was very localised it had a physical cause.

Another two months saw a further marked improvement. He was still taking high dosages of antidepressants and tranquillisers to change his awareness of pain. One positive improvement was that his pain was now limited to an even smaller area on the left side of the lower back.

Three months later he still expressed the view that he would probably need to have surgical treatment. But he was now considering going back to work on a part-time basis.

Some months later, he returned to hospital practice to continue his training. He had just come to terms with the fact that he would always have some pain. But his situation was vastly better than before and he was off narcotics which he believed would have slowly destroyed him.

*68\37\8*

As one patient remarked ‘ I’ve tried to become physically active in the past but I only felt more pain. It became easier to sit or lie down as it was the only way to avoid the pain.’ In measuring this type of pain, the use of personality assessment and anxiety profiles is of prime importance. Such questionnaires help the pain specialist by indicating whether a patient is depressed or anxious and to what extent. They help in evaluating the possibility of the effectiveness of specific treatments. Thus someone significantly depressed would not be given hypnosis until their depression is controlled.

*45\37\8*

The traditional approach simply does not work. It assumes that pain is just a signal that something is wrong with the body.The newer concepts of pain acknowledge the role that the emotions, the environment and the patients’ past experiences play in the total experience of pain. ”

Most doctors who encounter patients with chronic pain are frustrated both by the patient and by the failure of traditionally prescribed treatments. Doctors often write these patients off as hopeless cases, beyond medical help. Sensing the doctor’s hostility, patients may respond in similar vein. Often expecting some miraculous cure, they do the merry-go-round of doctor after doctor in a futile effort to find relief.

*23\37\8*