[Brett Thurston]

I know this thread has shifted away from the alcohol drinking mentioned earlier, but I just thought I would chime in with a little personal experience of my own.

I was a very heavy drinker up until about 1 year, 5 months and 11 days ago (not that I'm counting!). You can read into that the obvious fact that it wasn't entirely under control, and that my doctor might have been warning me about it. (As was my wife!).? And yes I have fallen asleep in a gutter. Things are rather different now.

Anyway I digress. What I wanted to mention is that when my drinking was at its heaviest, my gout was at its worst. I was drinking strong alcohol beer (8% – 10%) and also strong scrumpy cider (8%). Hardly anything else, but of course anything would do!

I can't put the disappearence of my gout entirely down to stopping the alcohol, but I can tell you that after about a month of stopping drinking my gout attacks went away and have never come back. I also made a lot of changes to my diet at the same time so it is no doubt a combined effect. But the amount of alcohol I was drinking was huge, and removing this from my diet and my life would have to be a significant factor.

If you are a heavy drinker then apart from the other obvious reasons for cutting it out, getting rid of your gout should be high up on your list of reasons to stop!

[Brett Thurston]

Oh dear ? I didn't mean to cause a family rift. I never knew frozen water could be so controversial

Keith said:

Before I start, may I just say a huge thank you to Brett for adding to the gout debate in a constructive manner without abusing us with promotions for his own website. I know he is not alone in making real contributions, but he is the first website owner to start a discussion for it's own sake, and not for self-advancement.?

Well as much as I'd like to say that I am very surprised that I am the first, unfortunately I'm not surprised at all. It just seems to be the way things are on the net at the moment ? everybody looking out for themselves, and not respecting the work that others are already putting in. I don't have any right at all to come stomping in here all over Keith's work, and why others think they do is beyond me.

Keith also said:

All advisers fall into one of two camps. You either manage gout pain, or you manage it's cause ? uric acid.

I'm not quite sure that I agree with this. Mainly because I have one (gout-free) foot in each camp.

I take a view of short term pain relief, coupled with long-term uric acid reduction. Ice and NSAIDs did the trick for me during the worst times, but obviously reducing the UA levels was the chief thing I needed to do (and did do)

In my research yesterday, which I posted about above, I also came across something else interesting. I wish I'd noted the URL down, but if I find it again I'll post it here.

Basically it said that people's reaction to ice could perhaps help doctors differentiate between gout and other forms of arthritis. If they reacted favourably to ice/cold, i.e. it soothed their pain, then it was more likely they had gout than any other form of arthritis.

Clearly this doesn't work in every case, as evidenced by what toofast had to say above

toofast: All I know is for me ICE was the devil and for many others?so just be careful.

?

Regarding the impact of icing a joint and urate crystallisation? I'm aware that cold helps uric acid to crystallise and hence this is why icing would be a concern. But I'm wondering if anybody has seen any medical evidence that short-term icing of the joints during an acute attack has a negative effect on the long term prognosis of a gout sufferer.

In other words? sure there is a risk of more crystals being formed, but does the benefit of the reduced swelling in the acute attack outweigh this risk?

I don't know the answer to that, and I've not seen any medical evidence that points one way or the other. But very interested in seeing anything that is out there.

Keith said:

Distraction therapy is probably useful for many people, but amongst the best non-medical treatments for most types of pain (not just gout) is anxiety therapy. I'm still researching that one, but it seems that the thought of pain is much worse than pain itself.

I'm all for these sorts of therapies. There was a recent article on Zen meditation and pain which said that “Zen meditators still feel pain, but they don't think about it as much”!? It went on to say “The observation could have a bearing on the treatment of chronic pain among patients struggling with the impact of conditions such as arthritis and back pain.”

So yes ? there's a lot more to this pain thing than meets the eye.?

OK ? I'll sign off for now. Sorry about the long post

Now that I've crashed the party I'll go and find a quiet place to introduce myself properly.

Cheers

Brett

[Brett Thurston]

Thanks for your input odo. I should have clarified my original post by stating that I am talking about acute gout pain management i.e. when the attack is just starting out and is in the first day or so.?

So I am not talking about the long term treatment, but what the sufferer can do right now to relieve their pain.

Ice is used in soft tissue injuries for the reduction of swelling, not as anaesthesia. It was in this context that I was comparing soft tissue injuries with gout attacks – i.e. the need to reduce the swelling that is causing the pain.

Soft tissue injuries, like gout, don't heal with ice treatment. Both sitations need blood flow to finish the healing process.

It is the swelling that exists in the initial stages of gout that I am talking about, not the ongoing issues after the attack has subsided. Perhaps bringing soft tissue injury into the conversation was a red herring… I really was only talking about the swelling.

As a result of coming across Keith's opinion, and also from your feedback too, I thought I'd better take a look and see if I could find out more. I don't want to be telling people the wrong thing.

I came across several sites which recommended ice/cold as a first treatment for gout. Now these aren't just any sites.. they were arthritis.org (The Arthritis Foundation), nhs.uk (National Health Service), bupa.co.nz (An aged care provider), and clinicalconnection.com (which has a lot of information on clinical studies).

I can provide the links if people are interested. I didn't want to pepper this post with links for fear of disappearing into the moderation or spam queue.

One particularly relevant quote from clinicalconnection.com I saw:

Ice may be applied for 20?30 minutes several times a day.
There are concerns that uric acid crystallization is accelerated by low
temperature, but in a 2002 study in the Journal of Rheumatology patients who
used ice packs had better relief of pain with no negative
side effects. Keeping the affected area elevated above the level of the heart
may help as well.

Please don't get me wrong here. I am not trying to be antagonistic or anything. I'm just trying to get to the bottom of this gout/ice question. I've long recommended icing as an effective treatment in an acute attack. When I saw Keith's opinion that this might promote monosodium urate crystal production I was a bit worried that I had been wrong all this time.

All the best

Brett

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