All people have felt pain at one time or another. The pain can range from mild to severe, appear once, be constant, or come and go periodically. There are many types of pain, and often pain is the first sign that something is wrong with the body.

Most often, doctors are consulted when acute pain or chronic pain occurs.

What is acute pain?

Acute pain begins suddenly and is usually described as sharp. It often serves as a warning about a disease or a possible threat to the body from external factors. Acute pain can be caused by many factors, such as:

• Medical procedures and surgery (without anesthesia);
• Bone fractures;
• Dentistry;
• Burns and cuts;
• Childbirth in women;

Acute pain can be moderate and last literally seconds. But there is also severe acute pain that does not go away for weeks or even months. In most cases, acute pain is treated for no longer than six months. Typically, acute pain disappears when its main cause is eliminated - wounds are treated and injuries heal. But sometimes constant acute pain develops into chronic pain.

What is chronic pain?

Chronic pain is pain that lasts longer than three months. It even happens that the wounds that caused the pain have already healed or other provoking factors have been eliminated, but the pain still does not disappear. Pain signals can remain active in the nervous system for weeks, months, or even years. As a result, a person may experience pain-related physical and emotional conditions that interfere with normal life. The physical effects of pain are muscle tension, low mobility and physical activity, decreased appetite. At the emotional level, depression, anger, anxiety, and fear of re-injury appear.

Common types of chronic pain are:

• Headache;
• Abdominal pain;
• Back pain and in particular lower back pain;
• Pain in the side;
• Cancer pain;
• Arthritis pain;
• Neurogenic pain due to nerve damage;
• Psychogenic pain (pain that is not associated with past diseases, injuries or any internal problems).

Chronic pain may begin after an injury or infectious disease and for other reasons. But for some people, chronic pain is not associated with any injury or damage at all, and it is not always possible to explain why such chronic pain occurs.

Our clinic has subject matter experts on this issue.

(9 specialists)

2. Doctors who treat pain

Depending on what and how it hurts, and what causes the pain, the diagnosis and treatment of pain can be carried out by different specialists - neurologists, neurosurgeons, orthopedic surgeons, oncologists, therapists and other doctors of specialized specialties who will treat the cause of the pain - a disease, one one of the symptoms of which is pain.

3. Diagnosis of pain

There are various methods, helping to determine the cause of pain. In addition to a general analysis of pain symptoms, special tests and studies may be performed:

• Computed tomography (CT);
• Magnetic resonance imaging (MRI);
• Discography (examination to diagnose back pain with the introduction contrast agent into the vertebral disc);
• Myelogram (also performed with the introduction of a contrast agent into the spinal canal to improve opportunities x-ray examination. A myelogram helps to see nerve compression caused by herniated discs or fractures);
• Bone scan to help identify abnormalities bone tissue due to infection, injury or other reasons;
• Ultrasound internal organs.

4. Pain treatment

Depending on the severity of the pain and its causes, pain treatment may vary. Of course, you should not self-medicate, especially if the pain is severe or does not go away. for a long time. Symptomatic treatment pain may include:

• Over-the-counter pain relievers, including muscle relaxants, antispasmodics, and some antidepressants;
• Nerve block (blocking a group of nerves with an injection local anesthetic);
• Alternative Methods pain treatments such as acupuncture, hirudotherapy, apitherapy and others;
• Electrical stimulation;
• Physiotherapy;
• Surgical treatment pain;
• Psychological assistance.

Some pain medications work better when they are combined with other pain treatments.

Pain from a medical point of view

From a medical point of view, pain is:

• reaction to this sensation, which is characterized by a certain emotional coloring, reflex changes in the functions of internal organs, unconditioned motor reflexes, as well as volitional efforts aimed at getting rid of the pain factor.
• unpleasant sensory and emotional experience associated with real or perceived tissue damage, and at the same time the body’s reaction, mobilizing various functional systems to protect it from the effects of pathogenic factors.

Prolonged pain is accompanied by changes in physiological parameters (blood pressure, pulse, pupil dilation, changes in hormone concentrations).

International definition

Nociception is a neurophysiological concept that refers to the perception, conduction and central processing of signals about harmful processes or influences. That is, this physiological mechanism transmission of pain, and it does not affect the description of its emotional component. Important has the fact that the very conduction of pain signals in the nociceptive system is not equivalent to the felt pain.

Types of physical pain

Acute pain

Acute pain is defined as pain of short duration of onset with an easily identifiable cause. Acute pain is a warning to the body about the existing at the moment danger of organic damage or disease. Often persistent and acute pain is also accompanied by aching pain. Acute pain is usually concentrated in a specific area before it somehow spreads wider. This type of pain is usually highly treatable.

Chronic pain

Chronic pain was originally defined as pain that lasts about 6 months or more. It is now defined as pain that persistently persists beyond the appropriate length of time during which it would normally end. It is often more difficult to heal than acute pain. Special attention required when addressing any pain that has become chronic. In exceptional cases, neurosurgeons may perform complex operation to remove parts of a patient's brain to treat chronic pain. Such an intervention can relieve the patient from the subjective sensation of pain, but since signals from the pain focus will still be transmitted through neurons, the body will continue to react to them.

Skin pain

Skin pain occurs when the skin or subcutaneous tissue is damaged. Cutaneous nociceptors end just below the skin, and thanks to high concentration nerve endings provide a highly precise, localized sensation of pain of short duration.

Somatic pain

Somatic pain occurs in ligaments, tendons, joints, bones, blood vessels and even in the nerves themselves. It is determined by somatic nociceptors. Due to the lack of pain receptors in these areas, they produce a dull, poorly localized pain that is longer lasting than that of skin pain. This includes, for example, sprained joints and broken bones.

Inner pain

Internal pain arises from the internal organs of the body. Intrinsic nociceptors are located in organs and internal cavities. An even greater lack of pain receptors in these areas of the body leads to more dull and prolonged pain, compared to somatic pain. Internal pain is particularly difficult to localize, and some internal organic injuries represent “attributed” pain, where the sensation of pain is attributed to an area of ​​the body that is in no way related to the site of the injury itself. Cardiac ischemia ( insufficient content blood in the heart muscle) is perhaps the best known example of attributed pain; the sensation may be located as a separate feeling of pain slightly higher chest, in the left shoulder, arm or even palm. The pain attributed may be explained by the discovery that pain receptors in internal organs also excite spinal neurons that are excited by skin lesions. Once the brain begins to associate the firing of these spinal neurons with stimulation of somatic tissues in the skin or muscle, pain signals coming from the internal organs begin to be interpreted by the brain as originating from the skin.

Phantom pain

Phantom limb pain is a sensation of pain that occurs in a lost limb or in a limb that is not felt through normal sensations. This phenomenon is almost always associated with cases of amputation and paralysis.

Neuropathic pain

Neuropathic pain (“neuralgia”) may occur as a result of damage or disease to the nerve tissues themselves (eg, toothache). This may interfere with the sensory nerves' ability to transmit correct information thalamus (part of the diencephalon), and from here the brain incorrectly interprets painful stimuli, even if there are no obvious physiological reasons pain.

Psychogenic pain

Psychogenic pain is diagnosed in the absence of an organic disease or in the case when the latter cannot explain the nature and severity of the pain syndrome. Psychogenic pain is always chronic and occurs against the background mental disorders: depression, anxiety, hypochondria, hysteria, phobias. In a significant proportion of patients important role psychosocial factors play a role (dissatisfaction with work, desire to obtain moral or material benefit). Especially close ties exist between chronic pain and depression.

Pathological pain

Pathological pain- altered perception of pain impulses as a result of disorders in the cortical and subcortical parts of the central nervous system.

Disturbances can occur at any level of the nociceptive system, as well as when the connection between nociceptive ascending structures and the antinociceptive system is disrupted.

Heartache

Mental pain is a specific mental experience that is not associated with organic or functional disorders. Often accompanied by depression and mental illness. Most often it is long-lasting and associated with the loss of a loved one.

Physiological role

Despite its unpleasantness, pain is one of the main components of the body's defense system. This is the most important signal about tissue damage and the development of a pathological process, a constantly operating regulator of homeostatic reactions, including their higher behavioral forms. However, this does not mean that pain is only protective properties. Under certain conditions, having played its informational role, pain itself becomes part of a pathological process, often more dangerous than the damage that caused it.

One hypothesis is that pain is not specific physical sensation, and there are no special receptors that perceive only pain stimulation. The appearance of a feeling of pain can be caused by irritation of any type of receptors, if the force of irritation is strong enough.

According to another point of view, there are special pain receptors characterized by high threshold perception. They are excited only by stimuli of damaging intensity. All pain receptors do not have specialized endings. They are present in the form of free nerve endings. There are mechanical, thermal and chemical pain receptors. They are located in the skin and in internal surfaces such as the periosteum or articular surfaces. Deeply located internal surfaces are weakly associated with pain receptors, and therefore sensations of chronic, aching pain are transmitted unless organic damage occurs directly in this area of ​​the body.

It is believed that pain receptors do not adapt to external stimuli. However, in some cases, the activation of pain fibers becomes excessive, as if painful stimuli continue to be repeated, leading to a condition called hypersensitivity to pain (hyperalgesia). In fact, there are people with different pain sensitivity thresholds. And this may depend on the emotional and subjective characteristics of the human psyche.

Nociceptive nerves contain primary fibers of small diameter that have sensory endings in various organs and fabrics. Their sensory endings resemble small branched bushes.

The two main classes of nociceptors, Aδ- and C-fibers, transmit fast and slow pain sensations, respectively. The class of Aδ-myelinated fibers (covered with a thin myelin coating) conduct signals at speeds of 5 to 30 m/s and serve to transmit signals quick pain. This type of pain is felt within one tenth of a second from the moment the painful stimulus occurs. Slow pain, whose signals travel through slower, unmyelinated (“naked”) C-fibers, at a speed of 0.5 to 2 m/s, is aching, throbbing, burning pain. Chemical pain (whether it be poisoning through food, air, water, accumulation in the body of alcohol residues, drugs, medical supplies or radiation poisoning, etc.) is an example of slow pain.

Other points of view

The study of pain has expanded in recent years into various fields from pharmacology to psychology and neuropsychiatry. It was previously impossible to even imagine that fruit flies would be used as an object for pharmacological studies of pain. Some psychiatrists are also trying to use pain to find a neurological "substitute" for human awareness, since pain has many subjective psychological aspects beyond pure physiology.

Interestingly, the brain itself lacks nociceptive tissue, and therefore cannot feel pain. Thus, headaches cannot possibly originate in the brain itself. Some theorize that the membrane surrounding the brain and spinal cord, called the dura mater, is lined with nerves containing pain receptors, and these dural nerves are stimulated. meninges) nociceptors, and they are likely to be involved in the “production” of headaches.

Alternative medicine

Surveys conducted by the US National Center for Complementary and Alternative Medicine (NCCAM) found that pain is a common reason why people turn to complementary and alternative medicine. CAM). Among American adults who used C.A.M. in 2002, 16.8% wanted to cure back pain, 6.6% - neck pain, 4.9% - arthritis, 4.9% - joint pain, 3.1% - headache and 2.4% were trying to cope with recurrent pain.

One such alternative, Traditional Chinese Medicine, views pain as a blockage of "Qi" energy, which is similar to resistance in an electrical circuit, or as "blood stagnation", which is theoretically similar to dehydration, which impairs the body's metabolism. The traditional Chinese practice, acupuncture, has been found to be more effective for non-traumatic pain than for pain associated with injury.

In recent decades, there has been a tendency to prevent or treat pain and diseases that create painful sensations with proper nutrition. This approach sometimes involves taking dietary supplements (dietary supplements) and vitamins in huge quantities, which from a medical point of view is considered a harmful attempt at self-medication. The work of Robert Atkins and Earl Mindel pays much attention to the relationship between the activity of amino acids and the health of the body. For example, they claim that the essential amino acid DL-phenylalanine promotes the production of endorphins and has an analgesic effect, but not addictive. But in any case, they urge you to always consult a doctor.

See also

Notes

Links

• Virtual reality relieves phantom pain Compulent

Emotional Processes
Emotions
Feelings	Agape · Antipathy · Gratitude · Reverence · Guilt · Attraction · Infatuation · Admiration · Hostility · Indignation · Pity · Envy · Interest · Love · Tenderness · Hatred · Rejection · Resentment · Disgust · Contempt · Disdain · Attachment · Irritation · Frustration · Repentance · Jealousy · Sympathy · Sorrow ·

The localization of abdominal pain indicates which organ of the gastrointestinal tract has a problem. In order to more accurately determine the cause of the pain, try to understand in which part of the abdomen the discomfort is felt.

Right side
Appendicitis
Symptoms: in acute form – sudden pain in the solar plexus area or above the navel, pain in the abdominal area without a specific localization is also possible, then it shifts to the right iliac. The pain is constant, moderate, intensifies with coughing, movement, and changing body position.
Vomiting with appendicitis develops as a reflex to pain, accompanied by a decrease in appetite, often one-time. The temperature rises, but does not rise above 37.0–38.0 C. Dyspepsia in the form of constipation, more often diarrhea, occurs against the background of frequent urination, the color of the urine is intense, dark.
Diagnostics: during palpation, muscle tension is noted in the right iliac region, soreness and increased pain when pressing with a sharp release of the fingers.

Pressure is applied:
on the stomach in the area of ​​the right ilium; at several points, to the right of the navel; at several points along a diagonal line from the navel to the right iliac tubercle (this is bony prominence pelvic bones determined anteriorly in the iliac region).

Liver
Symptoms: dull pain under the right rib; heaviness in the right side after eating fatty and spicy foods; skin itching; allergic reactions; frequent constipation and diarrhea; yellow coating on the tongue; dizziness and fatigue; red urine (like tea); increase in body temperature to 37.0–38.0 C; nausea and loss of appetite; light yellow stool.

Diagnosis: in cases where the pain is associated specifically with problems in the liver, it is permanent, may be replaced by a feeling of severe heaviness in the right side, a pulling sensation and acute colic. The pain may radiate to the lumbar region and intensify immediately after eating or with sudden movements. Relief of the situation occurs at a moment of rest, when a person lies down on his right side and provides himself with warmth, but with the adoption of a vertical position, the pain resumes again.

It is worth remembering that the liver begins to hurt in cases of damage to other organs, for example, the pancreas, or the pain is caused by the passage of a stone through bile ducts, inflammation of the gallbladder. Dull pain characterized by acute inflammatory diseases liver, while chronic processes generally pass without any pain.

Sharp pain in the right hypochondrium, accompanied by heaviness and nausea, radiates to the right shoulder - most likely it is biliary (hepatic) colic. May indicate the presence of gallstones.

Dull pain accompanied by loss of appetite is most likely biliary dyskinesia. But it can also occur during exacerbation of hepatitis C, or acute hepatitis A or B, liver cirrhosis.

Left side
Pancreas
Symptoms: sharp pain girdling nature, which can be localized in the umbilical region (at the onset of the disease) or spread to the back. Such pain is felt almost constantly or the intensity of the pain only intensifies - this is why pain with pancreatitis is fundamentally different from the symptoms that arise from other inflammatory processes in the abdominal organs.

Simultaneously with the appearance of pain, heaviness in the abdomen, bloating, nausea and vomiting occur, which usually does not bring relief. In addition, a lack of pancreatic juice enzymes provokes indigestion, which is manifested by severe diarrhea.

Symptoms of inflammation of the pancreas often coincide with signs of osteochondrosis, herpes zoster, acute pyelonephritis and stomach ulcers. Also, pain in the left hypochondrium can occur from bleeding from a stomach or duodenal ulcer.

Diagnostics: the pain intensifies after eating, lying on your back. When leaning forward in sitting position the pain subsides, as with fasting, applying cold umbilical region left.

Complete exclusion of any food for at least 24 hours - the absence of stress on the cells of the pancreas helps to inhibit the production of enzymes and relieve the organ;

Place a cold heating pad or ice pack on the abdomen (umbilical area) - this slows down the development of edema in the inflamed pancreas;

Taking alkaline mineral water improves the conditions for the outflow of bile and pancreatic secretions - the patient should drink at least 2 liters of liquid without gas per day;

Taking antispasmodics, preferably in the form of an injection.

Stomach
Pain in the very top center, under the stomach, indicates gastritis, but may be a symptom of a heart attack (especially if the pain radiates to the right hand), or appendicitis.
Pain in the middle of the abdomen most often occurs when overeating, but may indicate dysbiosis.

Pain under your belly button may indicate irritable bowel syndrome. Sometimes it is a consequence of a viral infection.

Kidneys
Symptoms:
pain in the kidney area: in the back, in the lower back;
changes in urination: burning and pain, infrequent or, on the contrary, frequent, excessive urination - nocturia, polyuria, urine with blood or change in the color of urine;
swelling of the legs and arms – the kidneys are not doing their job of removing excess fluid from the body;
skin rash, which is the result of increased concentrations of toxins in the blood;
changes in taste and smell of ammonia in the mouth;
fever, nausea, vomiting and fatigue.
loss of appetite, weight loss;
blurred vision.

Diagnostics:
To distinguish renal pathology for back pain, the doctor does next appointment: taps the edge of the palm lumbar region. In case of kidney disease, effleurage is accompanied by the appearance of dull internal pain.

It is important to remember that such pain can be caused by problems with the back and spine, inflammation of the ovaries, osteochondrosis or appendicitis.

Pain in the right side at the waist level may be renal colic, which can be caused by urolithiasis, kinking of the ureter or inflammation.


Bladder
Symptoms: when acute inflammation – frequent urge to urination, accompanied by pain, while urine does not come out completely (even with a strong urge, urine comes out in small droplets). But signs of the disease can simply be pain in the lower abdomen and a burning sensation.
The danger is that these signs can end as suddenly as they began. This can happen in just a couple of days, even without treatment.

Diseases of the reproductive system
Chronic pulling, It's a dull pain in the ovaries, lower abdomen and lumbar region.
It occurs in the form of attacks. Pain in the ovary radiates to the lower back, to the leg (if the right ovary is affected - to the right, if the left ovary is affected - to the left).
Menstruation disorders. Sometimes periods can be excessively heavy and prolonged, or absent altogether.
Some women develop symptoms characteristic of premenstrual syndrome: marked sudden changes mood, swelling in the legs, engorgement of the mammary glands, pain in the lower abdomen. But similar pain sensations can also be caused by cystitis, endometriosis, ectopic pregnancy or just constipation.

This information is taken from medical sources, but is for informational purposes only; consultation with a doctor is required.

Pain is an important adaptive reaction of the body, which serves as an alarm signal.

However, when pain becomes chronic, it loses its physiological significance and can be considered a pathology.

Pain is an integrative function of the body, mobilizing various functional systems to protect against the effects of a damaging factor. It manifests itself as vegetosomatic reactions and is characterized by certain psycho-emotional changes.

The term "pain" has several definitions:

- this is a unique psychophysiological state that occurs as a result of exposure to super-strong or destructive stimuli that cause organic or functional disorders in the body;
- in a narrower sense, pain (dolor) is a subjective painful sensation that arises as a result of exposure to these super-strong stimuli;
- pain is a physiological phenomenon that informs us about harmful effects that damage or pose a potential danger to the body.
Thus, pain is both a warning and a protective reaction.

International Association on the study of pain gives following definition pain (Merskey, Bogduk, 1994):

Pain is an unpleasant sensation and emotional experience associated with actual and potential tissue damage or a condition described in terms of such damage.

The phenomenon of pain is not limited exclusively to organic or functional disorders at the site of its localization; pain also affects the functioning of the body as an individual. Over the years, researchers have described an untold number of adverse physiological and psychological consequences no pain relief.

Physiological consequences untreated pain of any location can include everything from deterioration of gastrointestinal tract function and respiratory system and ending with increased metabolic processes, increased growth of tumors and metastases, decreased immunity and prolongation of healing time, insomnia, increased blood clotting, loss of appetite and decreased ability to work.

The psychological consequences of pain can manifest themselves in the form of anger, irritability, feelings of fear and anxiety, resentment, discouragement, despondency, depression, solitude, loss of interest in life, decreased ability to fulfill family responsibilities, decreased sexual activity, which leads to family conflicts and even to a request for euthanasia.

Psychological and emotional effects often influence the patient's subjective response, exaggerating or downplaying the significance of pain.

In addition, the degree of self-control of pain and illness by the patient, the degree of psychosocial isolation, the quality of social support and finally, the patient's knowledge of the causes of pain and its consequences.

The doctor almost always has to deal with developed manifestations of pain - emotions and pain behavior. This means that the effectiveness of diagnosis and treatment is determined not only by the ability to identify the etiopathogenetic mechanisms of a somatic condition manifested or accompanied by pain, but also by the ability to see behind these manifestations the problems of limiting the patient’s usual life.

A significant number of works, including monographs, are devoted to the study of the causes and pathogenesis of pain and pain syndromes.

Pain has been studied as a scientific phenomenon for over a hundred years.

There are physiological and pathological pain.

Physiological pain occurs at the moment of perception of sensations by pain receptors, it is characterized by a short duration and is directly dependent on the strength and duration of the damaging factor. The behavioral reaction in this case interrupts the connection with the source of damage.

Pathological pain can occur in both receptors and nerve fibers; it is associated with prolonged healing and is more destructive due to the potential threat of disruption of the normal psychological and social existence of the individual; the behavioral reaction in this case is the appearance of anxiety, depression, depression, which aggravates somatic pathology. Examples of pathological pain: pain at the site of inflammation, neuropathic pain, deafferentation pain, central pain.

Each type of pathological pain has clinical features, which make it possible to recognize its causes, mechanisms and localization.

Types of pain

There are two types of pain.

First type- acute pain caused by tissue damage, which decreases as it heals. Acute pain has a sudden onset, short duration, clear localization, and appears when exposed to intense mechanical, thermal or chemical factors. It can be caused by infection, injury or surgery, lasts for hours or days and is often accompanied by symptoms such as rapid heartbeat, sweating, paleness and insomnia.

Acute pain (or nociceptive) is pain that is associated with the activation of nociceptors after tissue damage, corresponds to the degree of tissue damage and the duration of action of the damaging factors, and then completely regresses after healing.

Second type- chronic pain develops as a result of damage or inflammation of tissue or nerve fibers, it persists or recurs for months or even years after healing, does not carry protective function and becomes the cause of the patient’s suffering, it is not accompanied by signs characteristic of acute pain.

Unbearable chronic pain has negative impact on the psychological, social and spiritual life of a person.

With continuous stimulation of pain receptors, their sensitivity threshold decreases over time, and non-painful impulses also begin to cause pain. Researchers associate the development of chronic pain with untreated acute pain, emphasizing the need for adequate treatment.

Untreated pain subsequently leads not only to a financial burden on the patient and his family, but also entails enormous costs to society and the healthcare system, including more long terms hospitalizations, decreased ability to work, multiple visits to outpatient clinics (polyclinics) and points emergency care. Chronic pain is the most common common cause of long-term partial or total disability.

There are several classifications of pain, one of them, see table. 1.

Table 1. Pathophysiological classification of chronic pain

Nociceptive pain 1. Arthropathy (rheumatoid arthritis, osteoarthritis, gout, post-traumatic arthropathy, mechanical cervical and spinal syndromes) 2. Myalgia (myofascial pain syndrome) 3. Ulceration of the skin and mucous membrane 4. Non-articular inflammatory disorders (polymyalgia rheumatica) 5. Ischemic disorders 6. Visceral pain (pain from internal organs or visceral pleura) Neuropathic pain 1. Postherpetic neuralgia 2. Trigeminal neuralgia 3. Painful diabetic polyneuropathy 4. Post-traumatic pain 5. Post-amputation pain 6. Myelopathic or radiculopathic pain (spinal stenosis, arachnoiditis, radicular syndrome by type of gloves) 7. Atypical facial pain 8. Pain syndromes (complex peripheral pain syndrome) Mixed or indeterminate pathophysiology 1. Chronic recurring headaches (with increased blood pressure, migraine, mixed headaches) 2. Vasculopathic pain syndromes (painful vasculitis) 3. Psychosomatic pain syndrome 4. Somatic disorders 5. Hysterical reactions

Classification of pain

Proposed pathogenetic classification pain (Limansky, 1986), where it is divided into somatic, visceral, neuropathic and mixed.

Somatic pain occurs when the skin of the body is damaged or stimulated, as well as when deeper structures are damaged - muscles, joints and bones. Bone metastases and surgical interventions are common causes of somatic pain in patients suffering from tumors. Somatic pain is usually constant and quite clearly limited; it is described as throbbing pain, gnawing pain, etc.

Visceral pain

Visceral pain is caused by stretching, compression, inflammation or other irritation of internal organs.

It is described as deep, compressive, generalized and may radiate into the skin. Visceral pain is usually constant, and it is difficult for the patient to establish its localization. Neuropathic (or deafferentation) pain occurs when nerves are damaged or irritated.

It may be constant or intermittent, sometimes shooting, and is usually described as sharp, stabbing, cutting, burning or an unpleasant sensation. In general, neuropathic pain is the most severe and difficult to treat compared to other types of pain.

Clinically pain

Clinically, pain can be classified as follows: nocigenic, neurogenic, psychogenic.

This classification may be useful for initial therapy, however, in the future, such a division is impossible due to the close combination of these pains.

Nocigenic pain

Nocigenic pain occurs when skin nociceptors, deep tissue nociceptors, or internal organs are irritated. The impulses that appear in this case follow the classical anatomical pathways, reaching the higher parts nervous system, are reflected by consciousness and form the sensation of pain.

Pain when internal organs are damaged is a consequence fast contraction, spasm or stretching of smooth muscles, since smooth muscles themselves are insensitive to heat, cold or cut.

Pain from internal organs having sympathetic innervation, can be felt in certain areas on the surface of the body (Zakharyin-Ged zones) - this is referred pain. The most famous examples of such pain are pain in the right shoulder and right side neck with gallbladder damage, pain in the lower back with disease bladder and, finally, pain in the left arm and left half of the chest due to heart disease. The neuroanatomical basis of this phenomenon is not entirely understood.

A possible explanation is that the segmental innervation of internal organs is the same as that of distant areas of the body surface, but this does not explain the reason for the reflection of pain from the organ to the body surface.

Nocigenic pain is therapeutically sensitive to morphine and other narcotic analgesics.

Neurogenic pain

This type of pain can be defined as pain due to damage to the peripheral or central nervous system and is not explained by irritation of nociceptors.

Neurogenic pain has many clinical forms.

These include some lesions of the peripheral nervous system, such as postherpetic neuralgia, diabetic neuropathy, incomplete damage to the peripheral nerve, especially the median and ulnar nerve (reflex sympathetic dystrophy), and separation of the branches of the brachial plexus.

Neurogenic pain due to damage to the central nervous system is usually due to cerebrovascular accident - this is known under the classical name of "thalamic syndrome", although studies (Bowsher et al., 1984) show that in most cases the lesions are located in areas other than the thalamus.

Many pains are mixed and clinically manifest as nocigenic and neurogenic elements. For example, tumors cause both tissue damage and nerve compression; in diabetes, nocigenic pain occurs due to damage to peripheral vessels, and neurogenic pain occurs due to neuropathy; for hernias intervertebral disc, compressing the nerve root, the pain syndrome includes a burning and shooting neurogenic element.

Psychogenic pain

The assertion that pain can only be psychogenic origin, is debatable. It is widely known that the patient's personality shapes the pain experience.

It is enhanced in hysterical individuals, and more accurately reflects reality in non-hysterical patients. It is known that people of different ethnic groups differ in their perception of postoperative pain.

Patients of European descent report less intense pain than American blacks or Hispanics. They also have lower pain intensity compared to Asians, although these differences are not very significant (Faucett et al., 1994). Some people are more resistant to developing neurogenic pain. Since this tendency has the aforementioned ethnic and cultural characteristics, it appears to be innate. Therefore, the prospects for research aimed at finding the localization and isolation of the “pain gene” are so tempting (Rappaport, 1996).

Any chronic disease or illness accompanied by pain affects the emotions and behavior of the individual.

Pain often leads to anxiety and tension, which themselves increase the perception of pain. This explains the importance of psychotherapy in pain control. Biofeedback, relaxation training, behavioral therapy and hypnosis, used as psychological interventions, have been found to be useful in some stubborn, treatment-refractory cases (Bonica 1990, Wall and Melzack 1994, Hart and Alden 1994).

Treatment is effective if it takes into account psychological and other systems ( environment, psychophysiology, behavioral response), which potentially influence pain perception (Cameron, 1982).

Discussion psychological factor Chronic pain management is based on the theory of psychoanalysis, from behaviourist, cognitive and psychophysiological positions (Gamsa, 1994).

G.I. Lysenko, V.I. Tkachenko

In the entire history of mankind, only 20 cases have been described in which people had absolutely no pain sensitivity. This phenomenon is called analgia. People suffering from this genetic disorder receive large number injuries, in early childhood they develop multiple scars on the tongue and mucous membranes of the mouth: when teething, the baby begins to bite his tongue and cheeks. Later fractures and burns appear. It is very difficult for such people to live and they have to regularly examine their body for damage. That is, pain is actually a useful phenomenon, it allows a person to understand: harmful processes are going on in the body, you need to find out what’s wrong, or, if the pain is sharp, you need to quickly change behavior (for example, remove your hand from the hot iron).

What causes pain

The nature of pain is not always the same. In the simplest case, if pain sensitivity is normal, pain occurs as a result of infection, metabolic disorder, or injury. Tissue damage activates pain receptors, which transmit a signal to the brain. Such pain - also called physiological - easily goes away after eliminating its cause and treating with painkillers. It happens that a diseased organ cannot be cured quickly and completely, and then treating pain becomes an independent task.

Another cause of pain is damage to the nervous system itself. This pain is called neuropathic. Damage can affect individual nerves and areas of the brain or spinal cord. This is the pain of herpes, and toothache, and known to tennis players and people working at the keyboard, carpal tunnel syndrome. Neuropathic pain is often associated with sensory abnormalities. It happens that the most common stimuli (heat, cold, touch) are perceived as painful. This phenomenon is called allodynia. Hyperalgesia is an increased pain response to a weak painful stimulus.

The perception of pain depends on many factors. For example, on gender (on average, women are more sensitive to pain) and religiosity (religious people find it easier to cope with pain than atheists).

Phantom pain

As early as 1552, the French surgeon Ambroise Pare described the complaints of wounded people about pain in amputated limbs. Today such pains are called phantom pains. It has been established that all people who have had an arm or leg removed and half of the women who have had breast amputation complain of phantom pain. One year after surgery, only two thirds of patients experience pain.

It cannot be said that the causes of phantom pain are known. It is now believed that in different parts of the central nervous system a system of foci is formed that generate pathological pain impulses.
There are more than 40 treatments for phantom pain, but only 15% of patients are completely cured. Since the specific part of the nervous system responsible for the appearance of phantom pain has not been identified, surgical methods treatments are ineffective. Local administration painkillers help only a few patients. The electrical stimulation technique is considered quite effective. motor cortex brain. It can be carried out without surgical intervention- on the surface of the head - or by implanting an electrode for constant direct stimulation of areas of the cortex.

Hangover pain

One of the effects of ethyl alcohol is to suppress the production of the pituitary hormone, which is responsible for fluid retention in the body. With a deficiency of this hormone, excessive secretion of water by the kidneys begins and dehydration occurs. Alcohol also stimulates the production of insulin, which helps the tissues take up glucose. When drinking liqueurs and sweet wines, insulin synthesis is doubled. As a result, blood sugar levels drop, which can also cause headaches. It can also be provoked by impurities, which are especially abundant in dark-colored drinks: red wine, cognac, whiskey.

The World Health Organization recommends treating cancer pain according to the pain ladder. First step of the ladder - mild pain, for the treatment of which non-steroidal anti-inflammatory drugs are used. When first-stage medications stop helping, in Russia they use the weak opioid analgesic tramadol, which is not a narcotic. At the third stage, for severe unbearable pain, narcotic analgesics are used.
When using narcotic drugs You may experience weakness, which usually goes away after a few days. Constipation may occur because opioids suppress intestinal motility. Over time, the dose of analgesic prescribed by the doctor ceases to help. This happens because the pain has gotten worse or because resistance to the drug has developed. In this case, the doctor will recommend increasing the dose of the medication or prescribing another analgesic. Developing resistance does not mean becoming dependent on the drug. Opioid analgesics, when prescribed for the treatment of pain and used correctly, do not cause psychological dependence.

An opioid overdose can cause breathing problems, so increasing the dose of the medication is only possible under the supervision of a doctor. Stopping opioids abruptly is also dangerous, but with the help of a doctor, you can gradually reduce the dose of the drug and avoid unpleasant symptoms.

Pain not caused by injury

The American Journal of Cardiology in 1989 published data from a survey of more than seven thousand patients with heart pain admitted to the emergency department. According to the survey results, only 4% of patients suffered from myocardial infarction, in half one could suspect a heart attack, and 40% of people who applied had completely healthy heart. Many parents have had to deal with a situation where a child, cheerful and active on weekends, collapses on Monday before school and complains of a stomach ache. And this is not pretense: the stomach really hurts, and yet everything is in order with the stomach and other organs.

Headache, pain in the heart, stomach, back, which arose without organic damage tissues and nerves is called psychogenic. The cause of psychogenic pain is psychological trauma, depression and intense emotional states: grief, anger, resentment. Anxious and suspicious people, as well as people prone to demonstrative behavior, are most susceptible to psychogenic pain.

In this condition, the functioning of the nervous system and its sensitivity change: impulses that are usually not perceived as painful begin to be interpreted as such.

Despite the fact that psychogenic pain is not caused by a malfunction of the organs, it must be taken seriously. Firstly, it is important to make sure that this is psychogenic pain and not dangerous disease. Secondly, psychogenic pain, like any other, worsens the quality of life. You need to cope with this condition with the help of psychotherapy.

How to understand that a person is in pain

There are times when a sick person cannot tell his loved ones that he is in pain. But for those caring for him, it is important to determine the appearance and severity of pain. Often such problems arise when caring for small children, frail patients, or people who do not speak due to severe depression.

A sign that a person is in pain may be crying, groaning, or a grimace of suffering on the face. But these signs are not always reliable. If we are talking about long-term chronic pain, then there may be no tears or grimaces of suffering. In this case, you need to pay attention to changes in behavior: the sick person either freezes in a forced position, in which pain is felt the least, or, conversely, rushes around to find the most comfortable position. He avoids movements that could cause pain. It happens that a person suddenly becomes apathetic and loses interest in his surroundings. This is also a likely signal that he is in pain. Doctors can use graphic scales to assess pain: compare different behavioral characteristics, physiological manifestations and, in accordance with accepted standards, draw a conclusion about how severe the patient’s pain is. To do this, for example, it is necessary to perform a test with an analgesic, paying attention to the respiratory rate, pulse, blood pressure and general behavior of the person.