Urolithiasis (stones in the urinary tract) is a common medical problem with a prevalence of around 23% in the general population.(Srisubat 2009) Fifty per cent of patients with previous urinary stones have a recurrence within 10 years (Portis 2001 ), and they are at least twice as common in men as in women.(Pearle 2007)
The clinical definition of male infertility is the presence of abnormal semen parameters in the male partner of a couple who have been unable to conceive after 1 year of unprotected intercourse (Dohle 2010).
The menopause, defined as the end of the last menstrual period, occurs at a median age of 53 years (Hardy 2005). The change in hormone levels during the perimenopause and menopause, particularly the decline in levels of oestrogen, can cause acute menopausal symptoms; for example, about 30-70% of women in Western countries will experience vasomotor symptoms, such as hot flushes and night sweats (Freeman 2007; Melby 2005).
Migraine is a primary headache disorder manifesting as recurring attacks, usually lasting for 4 to 72 hours and involving pain of moderate to severe intensity (IHS 2004).
Around 100,000 people in the UK have multiple sclerosis (MS) (MS Society 2012), an autoimmune disorder of the central nervous system (Compston 2006). Most patients with MS present with a relapsing-remitting disease that, over years, typically leads to a progressive phase of permanent and increasing disability (secondary progressive disease) (Hawkins 2000).
Many patients undergoing chemotherapy experience nausea and vomiting (Gralla 1999; Hesketh 1998). The symptoms can be severe, impairing a patient’s quality of life (Osoba 1997), causing emotional distress (Love 1989), and aggravating cancer-related symptoms such as cachexia, lethargy and weakness (Griffin 1996; Roscoe 2000).
Neck pain is one of the three most frequently reported complaints of the musculoskeletal system. Twenty-six to 71% of the adult population can recall experiencing an episode of neck pain or stiffness in their lifetime. Neck pain is usually a benign and self-limited condition, but can be disabling to varying degrees. As such, it has a large impact on healthcare expenditure, due to visits to healthcare professionals, and sick leave, disability and the related loss of productivity.(Trinh 2010).
Neuropathic pain results from damage to, or dysfunction of, the system that normally signals pain. The International Association for the Study of Pain (IASP 2007) defines neuropathic pain as follows: Pain initiated or caused by a primary lesion or dysfunction in the nervous system. Peripheral neuropathic pain occurs when the lesion or dysfunction affects the peripheral nervous system. Central pain may be retained as the term for when the lesion or dysfunction affects the central nervous system. A review of the epidemiology of chronic pain found that there is still no accurate estimate available for the population prevalence of neuropathic pain.(Smith and Torrance 2010)
Around 60% of adults in England are either overweight or obese (DOH 2011), and 2% are morbidly obese (Body Mass Index (BMI) above 40kg/m2) (Information Centre 2008). In fact, if present trends continue, 60% of all men, 50% of all women, and 25% of all children will be obese by 2050.
Pregnancy is a physiological state, but even when a woman has an uncomplicated pregnancy she may suffer with back and pelvic pain, nausea, indigestion or emotional problems such as anxiety and depression.
Osteoarthritis involves damage to articular cartilage and other structures in and around joints, with variable levels of inflammation.(Hunter 2006) The most commonly affected joints are the knee and the hip.
Palliative care is the active holistic care of patients with advanced progressive illness, such as those with advanced cancer, end-stage renal disease, AIDS, and chronic obstructive pulmonary disorder (COPD)(WHO 2002). Management includes treatments for pain and other symptoms (e.g. fatigue, nausea and vomiting, breathlessness, anxiety, depression, vasomotor symptoms, xerostomia), as well as the provision of psychological, social and spiritual support (NICE 2004). Up to 457,000 people in the UK need good palliative care services every year but around 92,000 people are not being reached (Hughes-Hallett 2011).
Parkinsons disease (PD) is a progressive neurodegenerative condition. In the UK, around 1618 in every 10,000 have Parkinsons disease.(Mutch 1986) It is loss of dopamine-containing cells in the substantia nigra area of the brain that results in the typical symptoms of rigidity, bradykinesia, tremor and postural instability.(Mutch 1986) Parkinsonism can also be caused by drugs, and conditions that are less common than PD. These include multiple cerebral infarction and degenerative conditions such as progressive supra-nuclear palsy (PSP) and multiple system atrophy (MSA).(NICE 2006).
Polycystic ovarian syndrome (PCOS) is the most common female endocrine disorder. Up to one-third of women in the UK have polycystic ovaries (i.e. 10 or more follicles per ovary detected on ultrasound), and around a third of these are thought to have the syndrome.(DTB 2001) PCOS is strongly associated with hyperandrogenism, ovulatory dysfunction and obesity.(Stener-Victorin 2008) The syndrome also increases the risk for metabolic disturbances such as hyperinsulinaemia and insulin resistance, which can lead to type 2 diabetes, hypertension and an increased likelihood of developing cardiovascular risk factors and impaired mental health later in life.(Stener-Victorin 2008).
Pain after surgery is common, often severe and largely unnecessary. Effective relief of post-operative pain is vital, and not just for humanitarian reasons. Such pain probably prolongs hospital stay, as it can affect all organ systems, including: respiratory (e.g. reduced cough, sputum retention, hypoxaemia); cardiovascular (e.g. increased myocardial oxygen consumption, ischaemia); gastrointestinal (e.g. decreased gastric emptying, reduced gut motility, constipation); genitourinary (e.g. urinary retention); neuroendocrine (e.g. hyperglycaemia, protein catabolism, sodium retention); musculoskeletal (e.g. reduced mobility, pressure sores, increased risk of DVT); and psychological (e.g. anxiety, fatigue). There is now evidence that post-operative pain relief has significant physiological benefit (Charlton 1997).
Post-traumatic stress disorder (PTSD) is a severe, long lasting psychological reaction to a distressing event, which can cause significant impairment (Reed 2012). It can develop after a major traumatic event (such as a serious accident, a violent personal assault or military combat), and can affect people of all ages.
Most women of reproductive age experience at least mild premenstrual symptoms at some time in their lives (OBrien 1987). However, around 210% of women have premenstrual symptoms that severely disrupt daily living (OBrien 1987, DTB 1992, Wittchen 2002). These more troublesome symptoms are usually termed premenstrual syndrome (PMS), if they comprise recurrent psychological and/or physical symptoms that occur specifically during the luteal phase of the menstrual cycle and usually resolve by the end of menstruation (OBrien 1987).
The puerperium covers the 6-week period following birth, during which time the various physiological changes that occurred during pregnancy revert to the non-pregnant state Guzman 2010). Although for most women, the postnatal period is uncomplicated, care during this time needs to address any departures from expected recovery after birth.
Raynauds phenomenon is caused by episodic vasospasm and ischaemia of the extremities (especially the fingers and toes) in response to a fall in temperature (even taking a cold milk bottle out of the fridge or a cool wind on a hot beach (RSA 2012)) or an emotional stimulus.(Goundry 2012) This response results in a characteristic colour change in the extremities from white, to blue, to red. In about 89% of people, Raynauds occurs in direct response to a stimulus and there is no known underlying cause. In the other 11%, it results from an underlying condition, most commonly a connective tissue disease such as systemic sclerosis, mixed connective tissue disease.(Goundry 2012).
Rheumatoid arthritis is a chronic condition that can cause pain, stiffness, progressive joint destruction and deformity, and reduce physical function, quality of life and life expectancy.(Östör 2009; DTB 2008) Estimates indicate that around 0.5-1.0% of the UK population have rheumatoid arthritis.(NICE 2008) The condition involves synovial joint inflammation.(Smolen 2003); both T- and B-cells are implicated in the underlying immune pathology, as is the over-production of pro-inflammatory cytokines, including tumour necrosis factor alpha (TNF-?), interleukin-1 (IL-1) and IL-6.(NICE 2008; Panayi 2005; Smolen 2003).
Sciatica, more accurately termed lumbar radiculopathy, is a syndrome involving nerve root impingement and/or inflammation that has progressed enough to cause neurological symptoms (e.g. pain, numbness, paraesthesia) in the areas that are supplied by the affected nerve root(s) (Tarulli 2007). Posterior sciatica involves pain that radiates along the posterior thigh and the posterolateral aspect of the leg, and is due to an S1 or L5 radiculopathy.
Each year, around 2% of the UK population consults their GP about a suspected sinus infection (Ashworth 2005). Most people with acute sinusitis recover with or without treatment within 10 days of seeing a GP (Williamson 2007), but about 92% are prescribed an antibacterial, even though it makes little difference to outcome.
Sports injuries are common, and vary from minor toe injuries to major complex trauma. Usually, only soft tissue is damaged, but there can also be fracturing of bone. Soft tissue injuries include sprains, strains and bruising. A sprain is a partial or complete rupture of a ligament, a strain is a partial tear of muscles and a bruise is a rupture of tissue leading to a haematoma. Any soft-tissue injury can lead to a tenderness, swelling, haematoma, scarring, fibrosis and loss of function.
Up to half a million people in the UK experience work-related stress every year, which often results in illness.(Health and Safety Executive 2011) Other factors that affect stress levels include alcohol, smoking, exams, pregnancy, divorce, moving, death in family, lifestyle, drugs, poor nutrition and unemployment.
Stroke is defined as a neurological deficit of sudden onset which results from cerebrovascular disease and persists for longer than 24 hours (DTB 1998). Stroke is very common, with, for example, around 110,000 people each year in England alone experiencing a first or recurrent episode (DH 2007). Consequences of stroke can include disability and early death, and the condition costs the UK economy around £7billion annually (NICE 2008).
In the UK, the prevalence of substance misuse is around 9 per 1,000 of the population aged 15-64 years, and around 3 per 1,000 inject drugs, in most cases opioids (NICE 2007). In 2005/6, around 181,000 people were using drug treatment services in England and Wales (Commission for Healthcare Audit and Inspection 2006). Also, research in England in 2005 estimated that 7.1 million people, or 23% of the adult population, could be categorised as hazardous or harmful alcohol users (Drummond 2005). Indeed, in England, 150,000 hospital admissions annually result from acute or chronic alcohol use, and alcohol use is implicated in 33,000 deaths each year (Academy of Medical Sciences 2004).
Tennis elbow (lateral epicondylitis) is characterised by pain and tenderness over the lateral epicondyle of the humerus. In the UK, the annual incidence of lateral elbow pain in general practice is around 4/1000 to 7/1000 people.(Hamilton 1986) It is most common in people aged between 40 and 50 years (Allander 1974); for example, the incidence is as much as 10% in women aged 42 to 46 years.(Chard 1989; Verhaar 1994).
Thyroid disease includes hypothyroidism, a clinical consequence of deficient secretion by the thyroid gland, and hyperthyroidism, where overproduction of thyroid hormone leads to a state of thyrotoxicosis, (Weetman 2003).
Tinnitus is the perception of sound in the ear or head that does not arise from the external environment, from within the body (e.g., vascular sounds), or from auditory hallucinations related to mental illness. Up to 18% of the general population in industrialised countries are mildly affected by chronic tinnitus and, for 0.5%, tinnitus has a severe effect on their ability to lead a normal life (Coles 1984).
Type-2 diabetes (adult-onset or non-insulin-dependent diabetes) is a common metabolic disorder in which the body is unable to regulate the amount of glucose in the blood. The condition affects nearly 1.5 million people in the UK (Diabetes UK, 2004), and may be undiagnosed in as many as a million more. It develops when insufficient insulin is produced by the body, or when the body’s cells no longer respond to insulin (insulin resistance).
Urinary incontinence affects around 3.5 million people of all ages in the UK (DoH 2000; the Continence Foundation 2000). For many, urinary incontinence severely restricts their routine activities and damages their quality of life and self-esteem. It can be due to several problems, the most common being urge urinary incontinence and stress urinary incontinence.
People with vertigo have the illusion that the environment is moving about them, or that they are moving with respect to the environment.(DTB 2009) The condition usually originates in the peripheral nervous system, for example, due to a disorder of the inner ear such as Ménière’s disease, benign paroxysmal positional vertigo (BPPV), or labyrinthitis and vestibular neuritis. It can also be due to pathology in the CNS (central vertigo), such as haemorrhages, ischaemia, or CNS tumours, infection or trauma. Neck pathology can also cause vertigo.