Diseases pain of varying intensity and. Pain - definition and types, classification and types of pain

Pain. What is this feeling - everyone knows. Despite the fact that it is very unpleasant, its function is useful. After all, severe pain is a signal of the body, which is aimed at drawing a person's attention to problems in the body. If the relationship with him is in order, then you can easily distinguish the pain that arose after exercise from the one that appeared after a very spicy meal.

Most often it is divided into two types: primary and secondary. Other names are epicritical and protopathic.

primary pain

Primary is pain that is caused directly by some kind of damage. It can be a sharp pain after a needle prick. This type is very sharp and strong, but after the impact of the damaging object stops, the primary pain immediately disappears.

It often happens that the pain after the disappearance of the traumatic effect does not disappear, but acquires the status of a chronic disease. Sometimes it can persist for so long that even doctors are unable to determine the reason why it arose in the first place.

secondary pain

Secondary pain is already pulling. At the same time, it is very difficult to indicate the place in which it is localized. In such a situation, it is customary to talk about a pain syndrome that requires treatment.

Why does pain occur?

So, a person has secondary pain. What is this syndrome? What are its reasons? After tissue damage occurs, pain receptors send an appropriate signal to the central nervous system, that is, the brain and spinal cord. This process is associated with electrical impulses and the release of special substances that are responsible for the transmission of nerve signals between neurons. Since the human nervous system is a rather complex system with many connections, in the management of sensations associated with pain, there are often failures in which neurons send pain impulses even when there are no stimuli.

Localization of pain

According to localization, the syndrome is divided into two forms: local and projection. If the failure happened somewhere on the periphery of the human nervous system, then the pain syndrome almost exactly coincides with the damaged area. This includes pain after visiting the dentist.

If a failure occurred in the central nervous system, then a projection form appears. This includes phantom, wandering pains.

Depth of pain

According to this characteristic, visceral and somatic are divided.

Visceral pain refers to sensations from the internal organs.

Somatic pain sensations are perceived as joint, muscle and skin pain.

There are symptoms that need to be addressed urgently.

Very severe, sharp pain in the head that has not been observed before

In this case, you must urgently consult a doctor. It can be both pain from a cold, and a brain hemorrhage, which is already much more serious. If there is no certainty about the reason that caused such a feeling, then you need to undergo a medical examination or call an ambulance. Treating acute pain before the cause is identified is not the best option. The main symptom is that the sensation passes before the injury heals. Correct diagnosis is very important.

Pain in the throat, chest, jaw, arm, shoulder, or abdomen

If there is chest pain, this may be a bad sign of pneumonia or a heart attack. But you need to know that with heart disease, there is usually some discomfort, not pain. What is discomfort in such diseases? Some complain of tightness in the chest, as if someone is sitting on top.

Discomfort that is associated with heart disease can be felt in the upper chest, as well as in the jaw or throat, left arm or shoulder, and in the abdomen. All this can be accompanied by nausea. So, if a person constantly experiences something like this and knows that he belongs to the risk group, you need to urgently check. After all, very often people miss time because they misinterpret the symptoms of pain. Doctors say that the discomfort that occurs from time to time should also be taken seriously. It may be associated with physical stress, emotional distress, or excitement. If this is experienced after gardening, and then passes during rest, then this is most likely angina pectoris, the attacks of which most often occur in hot or cold weather. Discomfort and pain in women with cardiovascular diseases are implicit. They can masquerade as symptoms of diseases of the gastrointestinal tract, which include discomfort in the abdomen, bloating. After menopause, the risk of these diseases increases dramatically. Therefore, you need to be attentive to your health.

Pain in the lower back or between the shoulder blades

Some doctors say it's a sign of arthritis. But there are other options to keep in mind. It could be a gastrointestinal disease or a heart attack. In a particular case, aching pain in these places may be a symptom. In people who are at risk for diseases associated with the heart and blood vessels, the integrity of organs may be violated. These people include those with excessively high blood pressure, circulation problems, as well as smokers and diabetics.

Severe abdominal pain

These include inflammation of the appendix, problems with the pancreas and gallbladder, as well as stomach ulcers and other disorders that cause abdominal pain. You need to see a doctor.

Pain in the calf muscles

Thrombosis is a very serious disease. It feels intense pain. What is thrombosis? This is when a blood clot occurs in the veins, causing discomfort. A large number of people are affected by this disease. Its danger lies in the fact that part of such a clot comes off, which leads to death. Risk factors are advanced age, cancer, low mobility after prolonged bed rest, obesity, pregnancy. Sometimes there is no pain, but only swelling. In any case, it is better to seek help immediately.

Heat in the legs

This problem is familiar to many patients with diabetes. It was through her that this dangerous disease was revealed. Some people don't know they have diabetes. So the heat in the legs is one of the first signs. There is a tingling sensation or which may indicate damaged nerves.

Scattered pains, as well as combined

A variety of physical, painful symptoms often occur in depressive states. Patients may complain of soreness in the limbs or abdomen, diffuse pain in the head, and sometimes both. Due to the fact that discomfort may be chronic and not felt strongly, patients and their families may simply ignore such symptoms. And the stronger the depressive disorder, the more difficult it is for a person to describe the sensations. Pain after psychological trauma is often difficult to explain. This can be confusing for doctors. That is why it is necessary to identify other symptoms before making a diagnosis of depression. If you lose interest in life, you can’t think and work with high efficiency, and there are quarrels with people, you need to get the help of a doctor. When something hurts, you do not need to endure silently. After all, depression is not just a deterioration in the state and quality of life. It needs to be treated very actively before it has time to cause serious changes.

All of the above types of pain are dangerous, as they can be symptoms of serious diseases. Therefore, at the slightest sign, you should immediately seek help from doctors. After all, the essence of pain lies in the fact that a person understands that something is wrong in the body. In addition to unpleasant sensations and significant changes in the human body, pain can lead to sad consequences, the worst of which is death.

Pain is an important protective biological phenomenon that mobilizes all the functional systems necessary for the survival of the organism, allowing to overcome the harmful effects that provoked it, or to avoid them.
  About 90% of all diseases are associated with pain. It is the root basis of medical terms: illness, hospital, patient.
  In various regions of the world, from 7 to 64% of the population experience pain periodically, and from 7 to 45% suffer from recurrent or chronic pain.

However, under normal conditions, a person does not feel pain due to the harmonious balance between the nociceptive (conducting pain afferentation) and antinociceptive (suppressing pain afferentation that does not go beyond physiologically acceptable limits in intensity) systems.
  This balance can be disturbed by a short but intense nociceptive afferentation or a moderate but prolonged nociceptive afferentation. The possibility of insufficiency of the antinociceptive system, when physiologically normal nociceptive afferentation begins to be perceived as pain, is discussed less frequently.

The temporal aspect of the imbalance between the nociceptive and antinociceptive systems distinguishes between:

• transient pain
• sharp pain
• chronic pain

Transient pain provoked by activation of nociceptive receptors in the skin or other tissues of the body in the absence of significant tissue damage and disappears before it is completely healed. The function of such pain is determined by the rate of occurrence after stimulation and the rate of elimination, which indicates that there is no danger of a damaging effect on the body.
  In clinical practice, for example, transient pain is observed during intramuscular or intravenous injection.
  It is assumed that transient pain exists to protect a person from the threat of physical damage by environmental factors in the form of a kind of training of the antinociceptive system for an adequate response, i.e., the acquisition of pain experience.

acute pain

acute pain- a necessary biological adaptive signal about a possible (in the case of pain experience), incipient or already occurred damage. The development of acute pain is associated, as a rule, with well-defined pain irritations of superficial or deep tissues and internal organs or a violation of the function of smooth muscles of internal organs without tissue damage.
  The duration of acute pain is limited by the recovery time of damaged tissues or the duration of smooth muscle dysfunction.
  Neurological reasons acute pain can be:

• traumatic
• infectious
• dysmetabolic
• inflammatory
• and other damage to the peripheral and central nervous system, meninges, short neural or muscle syndromes.

Acute pain is divided into:

• superficial
• deep
• visceral
• reflected

These types of acute pain vary in subjective sensations, localization, pathogenesis and for reasons.

Superficial pain, arising from damage to the skin, superficial subcutaneous tissues, mucous membranes, is felt as a local acute, stabbing, burning, throbbing, piercing. It is often accompanied by hyperalgesia and allodynia (feeling of pain with non-painful stimuli). Deep pain occurs when the nociceptors of muscles, tendons, ligaments, joints and bones are irritated. It has a dull, aching character, is localized less clearly than superficial.
  One or another localization of pain in case of damage to deep tissues is determined by the corresponding spinal segment that innervates the tendons, muscles, ligaments. Structures innervated from the same segment can cause the same localization of pain.
  Conversely, closely spaced structures, innervated by nerves originating from different segments, also cause pain that differs in localization.
  In accordance with the segmental innervation of damaged tissues, skin hyperalgesia, reflex muscle spasm, autonomic changes accompanying deep pain are also localized.

Visceral pain are caused by involvement in the pathological process of either the internal organs themselves or the parietal peritoneum and pleura covering them. Pain caused by diseases of the internal organs (true visceral pain) is unclear, dull, aching in nature.
  They are diffuse, poorly defined topographically. Often accompanied by parasympathetic manifestations: nausea, vomiting, sweating, low blood pressure, bradycardia.

Another variant of pain that occurs in the pathology of internal organs is referred pain. Reflected pains, or the Ged-Zakharyin phenomenon, are projected into dermatomes innervated by the same segments as the deeply located tissues or internal organs involved in the pathological process.
  At the same time, local hyperalgesia, hyperesthesia, muscle tension, local and diffuse vegetative phenomena occur, the severity of which depends on the intensity and duration of the pain effect.

Intense and prolonged muscle tension (“spasm”) can become an independent cause that intensifies pain, which must be taken into account in the treatment of referred pain.

chronic pain

chronic pain in neurological practice, the condition is much more relevant. There is no consensus on what is meant by chronic pain. According to some authors, this is pain lasting more than three months, according to others - more than 6 months. In our opinion, the most promising is the definition of chronic pain as pain that continues after a period of healing of damaged tissues. In practice, this may take several weeks to six months or more.

Chronic pain can also include recurring pain conditions (neuralgia, headaches of various origins, etc.). The point, however, is not so much in temporal differences, but in qualitatively different neurophysiological, psychological and clinical features.
  The main thing is that acute pain is always a symptom, and chronic pain can become essentially an independent disease. It is clear that the therapeutic tactics in the elimination of acute and chronic pain has significant features.
  Chronic pain in its pathophysiological basis can have a pathological process in the somatic sphere and / or primary or secondary dysfunction of the peripheral or central nervous system, it can also be caused by psychological factors.

Untimely and inadequate treatment of acute pain can become the basis for its transformation into chronic pain.

Nociceptive afferentation exceeding the physiological threshold is always accompanied by the release of algogenic compounds (hydrogen and potassium ions, serotonin, histamine, prostaglandins, bradykinin, substance P) into the intercellular fluid surrounding the nociceptors.
  These substances play a key role in the formation of pain caused by damage, ischemia and inflammation. In addition to the direct excitatory effect on the membranes of nociceptors, there is an indirect mechanism associated with impaired local microcirculation.

Increased capillary permeability and venous stasis contribute to the extravasation of active substances such as plasma kinins and serotonin.
  This, in turn, disrupts the physiological and chemical environment around the nociceptors and increases their excitation.
  The continued release of inflammatory mediators can cause prolonged impulses with the development of sensitization of nociceptive neurons and the formation of "secondary hyperalgesia" of the damaged tissue, contributing to the chronicity of the pathological process.

Any peripheral pain is associated with an increase in the sensitivity of nociceptors due to the release of inflammatory substances. An increase in the sensitivity of the primary nociceptor in the affected peripheral tissue leads to an increase in the activity of neurons that send impulses to the spinal cord and CNS, however, spontaneous electrical activity can be generated in the focus of neurogenic inflammation, causing a persistent pain syndrome.

Such a powerful inducer of pain sensitivity are pro-inflammatory components: bradykines, histamine, neurokinins, nitric oxide, which are usually found in the focus of inflammation. Prostaglandins themselves are not pain moderators, they only increase the sensitivity of nociceptors to various stimuli, and their accumulation correlates with the development of inflammation intensity and hyperalgesia.
  Prostaglandins, as it were, mediate the involvement of "sleeping" nociceptors in the formation of secondary inflammatory hyperalgesia and peripheral sensitization.

Concepts of secondary hyperalgesia, peripheral and central sensitization essentially reflect the pathophysiological mechanisms of chronic pain syndrome, behind which there is a whole cascade of neurophysiological and neurochemical transformations that ensure the maintenance of this state.

Hyperalgesia, which is an enhanced response to a normal noxious stimulus and is often associated with allodynia, has two components: primary and secondary.

  Primary hyperalgesia is associated with the site of tissue damage and occurs mainly in connection with local processes. Nociceptors become oversensitive due to substances released, accumulated or synthesized at the site of injury (peripheral sensitization). These substances include serotonin and histamine, neurosensory peptides (SR, CGRP), kinins and bradykinins, arachidonic acid metabolism products (prostaglandins and leukotrienes), cytokines, etc.

Secondary hyperalgesia is formed due to the involvement of "sleeping" nociceptors in the pathological process..
  With an adequate relationship between the nociceptive and antinociceptive systems, these polymodal receptors are inactive, but become active after tissue damage (under the influence of histamine, serotonin and bradykinin released as a result of mast cell degranulation following the release of neurosensory peptides).
  In the central nervous system, increased afferent impulses from sensitized and newly activated dormant nociceptors lead to increased release of activating amino acids (glutamate and aspartate) and neuropeptides in the dorsal horns of the spinal cord, which increases the excitability of central neurons.
  As a result, the peripheral zone of hyperalgesia expands. In this regard, the initially subthreshold afferentation from the tissues adjacent to the injury now becomes suprathreshold due to an increase in excitability (i.e., a decrease in the threshold) of the central neurons.
  This change in central excitability refers to the concept of "central sensitization" and causes the development of secondary hyperalgesia. Peripheral and central sensitization in chronic pain conditions coexist, are somewhat independent and, from the point of view of therapeutic measures, can be blocked separately from one another.

Mechanisms of Chronic Pain, depending on the predominant role in its genesis of different parts of the nervous system, are divided into:

• peripheral
• central
• combined peripheral-central
• psychological

Peripheral mechanisms mean constant irritation of the nociceptors of internal organs, blood vessels, the musculoskeletal system, the nerves themselves (nociceptors nervi nervorum), etc.
  In these cases, the elimination of the cause - effective therapy of the ischemic and inflammatory process, arthropathic syndrome, etc., as well as local anesthesia, leads to pain relief.
  The peripheral-central mechanism, along with the participation of the peripheral component, suggests an associated (and / or caused by it) dysfunction of the central nociceptive and antinociceptive systems of the spinal and cerebral level. At the same time, long-lasting pain of peripheral origin can cause dysfunction of the central mechanisms, which necessitates the most effective elimination of peripheral pain.

Principles of pain management

Pain management includes identification and elimination of the source or cause that caused pain, determining the degree of involvement of various parts of the nervous system in the formation of pain and the removal or suppression of acute pain.
  Therefore, based on the general principles of pain therapy, first of all, the effect is on its source, receptors and peripheral fibers, and then on the posterior horns of the spinal cord, the pain conducting systems, the motivational-affective sphere and the regulation of behavior, i.e. on everything levels of organization of the pain system.

Treatment of acute pain involves the use of several main classes of drugs:

• simple and combined analgesics
• nonsteroidal or steroidal anti-inflammatory drugs

An alternative to outdated analgesics, for example, can be considered a new generation of combined analgesics, such as Caffetin ® - one of the drugs that best meet these requirements and is designed to relieve acute pain of moderate and moderate intensity.
  The composition of the drug includes caffeine, codeine, paracetamol and propyphenazone, which have analgesic, antipyretic and mild anti-inflammatory effects.
  The mechanism of their action is associated with the ability to inhibit the synthesis of prostaglandins with an effect on the thermoregulatory center in the hypothalamus.
  Caffeine stimulates the processes of excitation in the cerebral cortex (like codeine) and increases the analgesic effect of other components of the drug. The effectiveness of such drugs is confirmed by practice: it is possible to defeat pain, it is enough just to choose the right drug.

In addition, it should be noted that Caffetin® is approved for use as an over-the-counter drug, but the simultaneous use of analgesics with hypnotics and alcohol is not recommended.

The treatment of chronic pain syndromes is a more complex task that requires an integrated approach. The first line drugs in this case are tricyclic antidepressants, among which both non-selective and selective serotonin and norepinephrine reuptake inhibitors are used. The next line of drugs are anticonvulsants.
  The experience available today has proven the need to treat patients with chronic pain in specialized centers of inpatient or outpatient type with the involvement of neurologists, therapists, anesthesiologists, psychologists, clinical electrophysiologists, physiotherapists, etc.

The main principle of the treatment of acute pain provides for a clinical assessment of the state of the neurophysiological and psychological components of the nociceptive and antinociceptive systems and the impact on all levels of organization of this system in order to prevent the chronicization of the pain syndrome, when the psychological aspects of experiencing social maladaptation become the dominant clinical component, leading to a deterioration in the quality of life.

Neuropathic pain - diagnosis, rule - "Three" C "

Pain is evaluated in terms of etiology (trauma, burn, disease), duration (acute, chronic), localization (local, diffuse), intensity (severe, moderate, weak) ...

Pain - types of pain, choice of drugs for pain treatment

One of the most common symptoms in patients of any profile is pain, since it is often its presence that forces a person to seek medical help ....

Attention! the information on the site is not a medical diagnosis, or a guide to action and is for informational purposes only.

Pain is a problem that every person faces from time to time. It can occur suddenly, or it can accompany a person for many months. Pain is one of the most common symptoms of various diseases. Today, there are a large number of drugs on the market for free sale that allow you to cope with pain. However, it is not always necessary to use them. In this article, we will look at why pain occurs, what it happens, what diseases its appearance can indicate, when it can be dealt with on its own, and when you should immediately seek help from a specialist.

Why does pain occur? Pain is a defense mechanism of the body, a signal to a person that something is wrong. The cause of pain is irritation of tissue receptors or internal organs, nerve endings that transmit this impulse through special nerve fibers to the spinal cord, and then to the brain, where this signal is analyzed. Considering that pain is a protective reaction of the body to damage, and especially if the pain is severe, you need to take this symptom seriously.

Pain in adults

pain in women

Regardless of gender and age, pain has one mechanism of occurrence, but different causes. There are no features in the pain syndrome in women compared to men, it all depends on the threshold of sensitivity and on the susceptibility of each person. According to some scientists, women have a lower threshold of sensitivity, so pain is always felt stronger for them. Perhaps this is due to the psychological coloring of pain and the emotional experience of the weaker sex (fear and anxiety - why did the pain arise, and what if it is some kind of incurable disease). As for the pain syndrome during childbirth, a woman prepares for it psychologically in advance, therefore she perceives it with patience.

Pregnancy is a special period for a woman, and pain of various origins often appears during this time. Basically, if the pregnancy proceeds well, without any serious pathologies, this discomfort is associated with the restructuring of the body and the load on it. It can be pain in the back, lower back (more precisely, in the lumbar spine), and it can also be a symptom of kidney problems.

But much more often the reason for its appearance is something else. A large load is placed on the lumbar spine, as the growing uterus changes posture and center of gravity, which is reflected in the spine. Most often, such pain appears from the second or third trimester and is eliminated either by wearing a special bandage to reduce the load on the spine, or by massage and swimming in the pool (if there are no contraindications).

But we must not forget that if lower back pain is accompanied by problems with urination and an increase in temperature, then this indicates a kidney disease (pyelonephritis of pregnant women). Also, a sharp and severe pain in the lower back, radiating to the inguinal region with pain during urination, indicates urolithiasis. In this case, you need to see a doctor.

Back pain that radiates to the leg, with an increase in intensity during movement, is a sign of a pinched nerve root, which requires an immediate appeal to a neurologist.

Pain in the legs is also a frequent companion of expectant mothers. Occurs due to increased weight. If cramps appear in the legs, then this may be a symptom of a lack of vitamins. Severe pain in the leg, accompanied by local redness and swelling of the saphenous veins, is a sign of thrombosis (formation of a blood clot in a vein and impaired blood flow in it).

Headache often appears during pregnancy, even in women who did not suffer from this before pregnancy. The cause of such pain during pregnancy can be high or low blood pressure, as well as migraine. If the headache is accompanied by swelling and the appearance of protein in the urine, this may be a sign of late toxicosis (preeclampsia).

As for the pain in the lower abdomen, here you need to be especially careful. Since during pregnancy it can be a sign of premature birth. In any case, pain during pregnancy of different localization should not go unnoticed by the attending physician. Feel free to tell your gynecologist about this.

Pain in breastfeeding mothers

The most vulnerable place in nursing mothers is the mammary gland. Breast pain when breastfeeding a baby is a sign of inflammation, especially if it is accompanied by high fever. The essence of such pain lies in the fact that with inadequate release of the mammary gland, an accumulation of excess milk (lactostasis) occurs.

And breast milk is a great breeding ground for bacteria. As a result, bacteria multiply, and an inflammatory process begins, accompanied by high fever, redness and pain in the chest. In such a situation, you should not be treated on your own, but you must urgently consult a doctor.

The mechanism of pain is not different in men and women, but the perception of this symptom in different sexes is different. According to the results of some studies, it was found that men endure pain more easily, and this is due to the presence of a larger amount of the sex hormone testosterone. This mainly concerns chronic pain, which bothers for a long time and is often associated with inflammation.

In any inflammatory process, special “macrophages” cells come into defense of the body, which try to utilize the cause. Scientists in the study found that the number of these cells depends on the amount of testosterone. Also, men are less emotionally experiencing the pain syndrome, for them the main thing is to understand where it hurts, how severe the pain is and what needs to be done to stop it. But there is an opinion that with a serious pathological process (disease), the sensitivity threshold for both sexes becomes the same, sometimes the stronger sex is even more vulnerable.

Pain in children

Some believe that children are not able to perceive the pain syndrome as adequately as adults, and that it is useful to endure pain in any area in childhood in order to build willpower. This, of course, is not true. The pain threshold in children is developed in the same way as in adults. It's just that a child, due to his age, cannot correctly describe the intensity of his sensation. It is important to note that children remember this feeling of pain for a long time and the stress that accompanies them at this moment can affect their further development and reduce the quality of life compared to healthy children.

Therefore, parents should take the situation seriously if their child complains of pain. Most often, children complain of a headache.

There are two types of reasons why a headache occurs:

• functional (emotional overstrain, heavy workload at school, long stay at the computer, lack of fresh air, sleep disturbance),
• organic, that is, associated with the disease (tumors and cysts of the brain, increased intracranial pressure, impaired blood supply to the brain). If the headache is accompanied by vomiting, convulsions, dizziness, or loss of consciousness, an ambulance should be called urgently.

There is an erroneous opinion that an infant (from birth to 28 days of life) cannot feel pain at all. In fact, by the 30th week of intrauterine development of the fetus, the baby's nervous system can already feel and evaluate the pain syndrome. Another question is that he does not know how to report it in any way, except for crying. Therefore, if your baby cries too often, refuses to eat and does not sleep, then you need to consult a doctor.

The reason for this behavior can be severe abdominal pain or headache due to

• congenital malformations,
• birth injury,
• presence of inflammation
• medical manipulations
• consequences of surgery.

A feature of the manifestation of pain in a child during this period is that the baby perceives it in a generalized way, that is, the whole body reacts and suffers, and not just the part where the pain arose. This is harmful to the child and leaves a negative imprint on the formation of the central nervous system, which can contribute to the appearance of various delayed consequences on the behavior and psychological development of the baby.

Causes of pain

The pain may be acute or chronic. Acute pain usually occurs suddenly, most often as a symptom of acute inflammation or damage to the integrity of the tissue (for example, trauma). It requires immediate treatment to improve well-being and in the future, after the elimination of the cause of its occurrence, it does not recur. With regard to chronic pain, it is long-term, recurrent (that is, recurring in time), more often aching in nature and is associated with a chronic disease.

Headache

Headache is the most common localization of pain in humans. Every person in his life necessarily and more than once experienced this syndrome. Pain may be present in the temple area, the back of the head, or spilled over the entire head.

The most common cause in this case is a decrease or increase in blood pressure. Therefore, if you often suffer from headaches, it is necessary at this moment to measure your blood pressure or consult a doctor for this.

- a special cause of the pain syndrome. Accompanied by nausea, vomiting, photophobia. Occurs in seizures. The pain is so severe that it is impossible to raise your head from the pillow. If there is a change in speech or behavior (excitation, hallucinations, memory impairment) - this is a sign of problems with blood circulation in the vessels of the brain, you should immediately call an ambulance. Chronic pain in the head may indicate an increase in intracranial pressure, a tumor process.

There are many causes of abdominal pain:

• Appendicitis is an inflammatory process in the appendix of the caecum. The most common symptom is pain in the right side. Pain at first is often localized in the stomach, and then "goes down" down. Accompanied by the appearance of nausea and vomiting, fever. But this does not always happen.
• Peritonitis is an inflammation of the peritoneum, occurs as a complication of some process. For example, with appendicitis, when therapy was not carried out, inflammation continues and damage to the integrity of the intestinal wall occurs, as a result, all the contents enter the abdominal cavity and peritonitis occurs. The pain is very strong, all over the abdomen. In this case, the patient finds for himself a forced position in which he becomes easier. The abdomen becomes hard as a board. The skin is pale, blood pressure decreases, the pulse and respiration become more frequent.
• Injury to the abdomen, resulting in damage to internal organs
• Intestinal infection - the appearance of pain is combined with nausea, vomiting, diarrhea, the temperature rises.
• Diseases of the gallbladder. Acute cholecystitis is an inflammatory process in the gallbladder. Pain appears in the right side, under the ribs, aggravated by pressure, accompanied by symptoms of nausea and vomiting of bile, bitterness in the mouth, fever. Often the pain appears after non-compliance with the diet. In cholelithiasis, acute pain occurs when either acute inflammation (acute stone cholecystitis) or obstruction (that is, closure) of the bile duct by a stone occurs. In the second case, it is accompanied by yellowing of the skin.
• Diseases of the pancreas. Acute inflammation of the pancreas, that is, acute pancreatitis, in which pain is localized in the stomach and radiates to the back, is accompanied by nausea, vomiting. A pancreatic cyst usually does not hurt. But if an inflammatory process begins in it, then acute pain develops in the abdomen. Pancreatic necrosis - necrosis (that is, death) of a part of the pancreas. It often occurs in chronic alcoholics. It is also accompanied by severe pain in the upper abdomen. This condition requires emergency care, otherwise a fatal outcome is possible, as in the case of peritonitis.
• Peptic ulcer of the stomach or duodenum - pain often occurs on an empty stomach, accompanied by belching, bitterness in the mouth, decreases after eating.
• Thrombosis of the mesenteric arteries is the occurrence of a blood clot in the arteries of the intestine, which disrupts blood flow in the vessels. As a result, intestinal nutrition deteriorates and tissue necrosis (death) occurs. In this case, the pain syndrome is very strong. The final diagnosis can only be made during surgery.
• Abdominal pain can also occur in stressful situations, without the presence of diseases. For example, in children with emotional experience, quarrels in the family, an attack of abdominal pain may occur.

Causes of chronic abdominal pain:

• Chronic bowel disease (Crohn's disease, ulcerative colitis, irritable bowel syndrome, diverticulosis)
• Chronic cholecystitis is a chronic inflammation of the gallbladder, in which, at the time of exacerbation of the process, pain occurs in the right hypochondrium.
• Chronic pancreatitis - chronic inflammation of the pancreas
• Chronic gastritis - inflammation of the stomach lining

In any case, only a doctor can determine the exact cause of the pain.

Pain in the lower abdomen in women is more often associated with gynecological diseases, and in men with the prostate gland, as well as the urinary system. Its appearance in combination with other signs may indicate the following diseases:

• Adnexitis - inflammation of the ovaries and fallopian tubes, can be unilateral and bilateral, the pain is accompanied by fever, there may be vaginal discharge
• Inflammation or rupture of an ovarian cyst - acute pain in the lower abdomen, on the right or left, depending on the location of the cyst (on the right or left ovary)
• Menstrual syndrome - pain during menstruation
• Inflammatory processes in the uterus
• Pain in the lower abdomen in pregnant women can be a sign of premature birth.
• Cystitis - inflammation of the bladder, can occur in both men and women, accompanied by frequent and painful urination, pain when urinating.
• Prostatitis - inflammation of the prostate gland in men
• Adenoma (tumor) of the prostate gland in men

Backache

The causes of back pain are most often diseases of the spine or the neuromuscular frame of the back. It can also be a symptom of a disease of other internal organs:

• Osteochondrosis - dystrophic disorders (decrease in elasticity, consistency, destruction) in the cartilage of the intervertebral discs
• Sciatica - often acute back pain associated with infringement or damage to the nerve roots of the spinal cord
• Spinal injuries - cracks and fractures of the vertebrae, including compression fractures (when the vertebrae cannot withstand pressure and break under the weight of their own body), which often occur with osteoprosis (lack of calcium in the bones)
• Herniated discs
• Tumors of the spine
• Cancer metastases from any organ to the spine
• Pain between the shoulder blades may indicate coronary heart disease (since pain in the heart often radiates to the back)
• Pancreatitis - pain in the upper abdomen radiating to the back (girdle pain)

Toothache is one of the most severe pains in the human body. With inflammation, swelling occurs in the hole where the tooth is located. The dimensions of this hole are very small, and due to edema they decrease even more, and the dental nerve is compressed. Therefore, the pain is strong and unbearable.

If you have a toothache, you must definitely consult a dentist, because by eliminating the pain for a while, you will not eliminate the cause, and if left untreated, you can lose a tooth or complications may arise. The main causes of toothache:

• Caries is damage to the enamel of the tooth with the formation of a cavity in it and the reproduction of bacteria there.
• Pulpitis is a complication of caries if it is not cured in time. Bacteria and the inflammatory process penetrate from the carious cavity deeper into the soft tissues of the tooth, where the vessels are located
• Flux - a complication of pulpitis, when inflammation penetrates even deeper and reaches the periosteum and jaw bone
• Toothache after filling or tooth extraction is not long-term (1-2 days) and most often not dangerous pain.
• Cracks in tooth enamel
• Tooth trauma

Pain in the legs

Causes of pain in the legs can be divided into 4 groups:

• Violation of arterial blood flow.

The most common cause in this group is atherosclerosis obliterans (atherosclerosis is the occurrence of cholesterol plaques in the vessels, narrowing their lumen), which leads to chronic arterial insufficiency of the lower extremities and, as a result, to pain. In the initial stages, this pain occurs when walking at different distances (depending on the severity of the process) and decreases at rest (while there are no signs on the skin of the legs), then it worries at rest (changes appear on the skin of the legs - redness, thickening, ulcers). More often this disease occurs in smokers and diabetes mellitus.

• Violation of the venous blood flow.

It occurs with varicose veins of the lower extremities (when there is a failure of special valves in the veins and the blood flows back, thereby increasing the volume of blood in the vessels, which contributes to their expansion) or after thrombosis (formation of a blood clot) in the veins. With the formation of chronic venous insufficiency, edema of the lower extremities appears, first in the evening, then in the afternoon or in the morning. Convulsions worry. Dilated veins are clearly visible on the skin of the legs, sometimes even in clusters. Later, redness, induration and ulcers appear on the legs.

• Violation of the neuromuscular apparatus of the lower extremities is polyneuropathy (when sensitive and motor innervation is disturbed).

Most often occurs with diabetes or alcohol abuse. Patients complain of tingling, burning, coldness of the lower extremities.

• Various injuries and wounds of the lower extremities

The cause of the development of acute pain in the lower back can be problems with the functioning of the kidneys and their diseases:

• - the development of an inflammatory process in the kidneys (one kidney or may be bilateral), accompanied by an increase in temperature, pain during urination.
• urolithiasis - the appearance of kidney stones, when the stone moves from the kidney, the patient complains of severe pain in the lower back, spreading to the inguinal region and pain during urination.

In women, lower back pain often appears due to diseases of the reproductive system (adnexitis, ovarian cyst).

Low back pain, which is chronic, is often the result of lumbar osteochondrosis or herniated discs.

Sore throat

First of all, the cause of sore throat are infections (bacteria or viruses) that provoke the inflammatory process:

• Pharyngitis is an inflammatory process that affects the mucous membrane of the pharynx.

Sore throat is combined with an increase in body temperature, redness in the throat, unpleasant and painful sensations when swallowing, dry cough.

• Laryngitis is an inflammation of the mucous membrane of the larynx.

This condition appears with colds or infectious diseases (scarlet fever, measles, whooping cough). A sore throat goes hand in hand with hoarseness of voice (up to the loss of the ability to speak), dry cough, sensation of sore throat, and sometimes difficulty breathing.

• Tonsillitis - inflammation of the tonsils (another name for tonsillitis).

It is characterized by intense sore throat, a significant increase in temperature, pain when swallowing, the patient's lymph nodes are markedly enlarged.

• A paratonsillar abscess occurs when purulent inflammation spreads to the tissue around the tonsil.

It may occur on one side or be bilateral. Children and adults under 30 are most often affected. Sore throat is combined with a significant increase in body temperature up to 40 degrees, weakness, sweating, chills. The lymph nodes are enlarged and it is difficult for the patient to open his mouth for examination. Treatment is carried out only by surgical intervention - opening the abscess so that pus comes out.

• Abdominal abscess.

Behind the pharynx there is a space where the lymph nodes and fiber (tissue) are located. Purulent inflammation of this space (lymph nodes, fiber) is called a pharyngeal abscess. The disease is common among children, less often in adults. The infection usually enters from the nasopharynx or middle ear, as well as in cases of influenza, measles or scarlet fever. Severe pain in the throat manifests itself more acutely when trying to swallow, the body temperature rises, the patient holds his head in a characteristic way (thrown back and tilted to the affected side).

In children, the cause of sore throat, which may be accompanied by perspiration and dry cough, may be adenoids (adenoiditis) or sinusitis. In this case, irritation of the receptors located in the throat occurs, secreted by the mucous secretion, which in such cases flows down the back of the pharynx.

Also, the cause of sore throat in adults can be other pathological conditions:

• Disease of the gastrointestinal tract (often accompanied by a kind of feeling of "coma in the throat") - esophagitis, gastritis, cholecystitis, which contribute to the occurrence of chronic pharyngitis.
• Irritation of the upper respiratory tract by smoke, when smoking
• Atrophy of the pharyngeal mucosa during radiation or chemotherapy
• Heart disease - angina ("angina pectoris"), when the pain appears behind the sternum and gives up the throat, while many feel a "lump in the throat", difficulty breathing and associate this with a throat disease.
• Deficiency of vitamins and minerals. For example, a lack of vitamin A leads to dry mucous membranes and erosions.
• Dental problems - toothache can radiate to the throat, thereby simulating an illness (pharyngitis, laryngitis)

In case of sore throat, you need to consult an otorhinolaryngologist (ENT doctor).

Side pain

Pain in the side can be localized either on the right or on the left. If its appearance was not preceded by any injury or bruise, then this is a sign of a disease of one of the internal organs that are located there.

The causes of pain in the right side can be diseases of the digestive system: appendicitis, cholecystitis, (inflammatory liver disease), cholelithiasis. Also, such pain may indicate the development of the inflammatory process of the right kidney (right-sided pyelonephritis). In women, such conditions are associated with diseases of the reproductive system (inflammation of the right ovary and fallopian tube - right-sided adnexitis).

The cause of pain in the side on the left side can be

• bowel problems (diverticulitis),
• inflammation of the left kidney (left-sided pyelonephritis),
• inflammation of the pancreas (pancreatitis),
• diseases of the spleen (with infections or oncological diseases, entailing an increase in the size of this organ),
• women have left-sided adnexitis.

Joint pain (arthralgia) can occur as a symptom of an independent joint disease, or as a symptom of some other disease. Therefore, people who think that if a joint hurts, then it's definitely arthritis, they are mistaken.

Joint pain can be different:

• acute or chronic
• affect one joint or several,
• predominantly affect large joints at the same time (for example, hip, knee, elbow) or small (joints of the fingers and toes),
• may involve symmetrical joints (on the right and left sides) or be asymmetrical.

If you are worried about frequent chronic joint pain, you need to see a doctor to determine the cause, as it can act as the first symptom of a serious illness.

The essence of joint pain is that the nerve endings located in the joint capsule are irritated. The role of an irritant can be inflammatory agents, toxins, salt crystals, allergens, own antibodies. Based on this, the reasons may be:

• Arthritis is a joint lesion that can be primary (for example, rheumatoid or septic arthritis, diseases such as gout, spondylitis, Still's disease) and secondary, that is, be the result of some other diseases (systemic lupus erythematosus, hepatitis, reactive or psoriatic arthritis).
• Bursitis - inflammation localized in the synovial bag of the joint (most often affects the shoulder joint, less often on the elbow and knee). It can be traumatic, tuberculous, syphilitic.
• Tumor conditions that cause joint pain - multiple myeloma, osteomyelitis, bone metastases, leukemia.

Diagnosis for pain

If you are concerned about pain, regardless of its location, you need to see a doctor, first to a therapist who will determine further tactics for diagnosis and treatment.

Collection of anamnesis

Taking anamnesis is one of the most important stages in the diagnosis of any symptom and disease. When interviewing a patient, the following information should be clarified:

• precise localization of pain
• how long ago did it come into being
• are there episodes without pain,
• where does this pain radiate (gives off),
• with what the patient associates this pain (errors in diet, stress, physical activity, trauma, hypothermia),
• what is the pain intensity

Further examination of the patient is necessary: ​​general (that is, measuring blood pressure and pulse, auscultation (listening with a stethoscope) of the lungs and heart, visual examination of the skin and mucous membranes).

Then, depending on where the pain is located, the immediate source is examined (if sore throat, then examination of the throat, if in the joints - examination of the joint, pain in the legs - examination of the lower extremities and measurement of pulsation, if pain in the abdomen - palpation of the abdomen) . After such an initial examination and questioning, the doctor gets the impression and a presumptive diagnosis, to confirm which further laboratory and instrumental methods of research are prescribed.

There are mandatory standard laboratory tests that must be carried out by any patient, regardless of the location of the pain. This is:

• Complete blood count - which monitors the level of hemoglobin, leukocytes (if they are elevated, then this is a sign of inflammation), erythrocytes, ESR (erythrocyte sedimentation rate), platelets.
• Urinalysis - where protein and red blood cells can be detected (with kidney disease), bacteria (with an inflammatory process), the specific gravity of urine and impurities in it are estimated
• As for the biochemical analysis, the composition of this analysis will depend on the location of the pain. Blood sugar levels, liver enzymes (ALAT, ASAT), kidney function indicators (creatinine, urea), electrolytes (sodium, potassium, chlorides, calcium, magnesium) are necessarily examined.
• If necessary, the function of blood coagulability is examined (coagulogram)
• If the patient complains of a sore throat, then it is necessary to take swabs (scrapings) from the nose and throat in order to sow the flora and determine the exact cause.
• If there is pain in the abdomen and there is a violation of the stool, then a study of feces is necessary (coproscopy, sowing feces for infectious agents)
• With pain in the lower abdomen in a woman, during the examination, the gynecologist will definitely take swabs from the vagina for examination.

Instrumental research methods

As for instrumental research methods, there is currently a wide choice. The expediency of using this or that method can only be determined by the attending physician based on the collection of anamnesis, localization of pain and data from other tests.

Research based on electrical impulse:

• An ECG (electrocardiogram) is a simple method for excluding heart pathology if you are concerned about chest pain.
• ENMG (electroneuromyography) of the lower extremities - a study of the neuromuscular system of the lower extremities with pain in the legs, will confirm or refute the diagnosis of "polyneuropathy"

X-ray examinations:

• Chest x-ray - to help rule out lung disease
• X-ray of the abdominal cavity - with pain in the abdomen, it can exclude intestinal obstruction
• X-ray of the upper and lower jaw to clarify the dental diagnosis for toothache
• X-ray of the skull - to clarify the cause of the headache
• X-ray of the joints - for pain in the joints

Ultrasound (ultrasound examination) of internal organs using an ultrasound machine and a special ultrasonic sensor:

• Ultrasound of the abdominal cavity - for pain in the abdomen of any localization. Using this method, you can examine the main organs located in the abdominal cavity (pancreas, gallbladder, liver) and the kidneys.
• Ultrasound of the pelvic organs - for pain in the lower abdomen in women to exclude diseases of the reproductive system
• Ultrasound of the prostate gland in men
• bladder ultrasound
• Ultrasound of the vessels of the lower extremities - the study of veins and arteries, is necessarily prescribed for pain in the legs.
• Ultrasound of the vessels of the head and neck - will help to exclude vascular diseases that lead to dizziness and headache
• Ultrasound of the joint - to clarify the disease of the joints

Endoscopic research methods using an endoscope (if necessary, you can take a piece of tissue for histological examination):

• FGDS (fibrogastroduodenoscopy) - an endoscope is inserted through the mouth into the esophagus and stomach, used for abdominal pain, to exclude diseases of the esophagus, stomach and duodenum.
• FCS (fibrocolonoscopy) - examination of the intestine, the endoscope is inserted through the rectum.
• Arthroscopy is a study of the joint, with which you can see the structure of the joint.

Research using computer technology:

• CT (computed tomography) or MRI (magnetic resonance imaging) is a modern research method. This method can be used for headaches - CT or MRI of the brain (which will exclude a stroke, the presence of cysts or brain tumors), for back pain - MRI of the spine (it will help to identify signs of osteochondrosis, herniated discs, tumors and cancer metastases)

Pain treatment

In the treatment of pain syndrome, three methods can be distinguished:

• Medicinal (pharmacological), that is, with the help of medications.
• Physical method - physiotherapy
• Psychological method - work with psychologists

The use of medicines

All painkillers (analgesics) that are prescribed to relieve pain can be divided into two large groups:

• Non-narcotic - NSAIDs - non-steroidal anti-inflammatory drugs (aspirin, ibuprofen, diclofenac), as well as analgin, paracetamol, dimexide.
• Narcotic - morphine, promedol, fentanyl, butorphanol.

Narcotic analgesics are prescribed and used only by a doctor, in a hospital setting and with a strong pain syndrome.

Any person in Russia can buy non-narcotic analgesics at a pharmacy without a doctor's prescription. But it should be remembered that any drug has side effects and contraindications, so it is better to take it only after consulting a specialist.

Also, antispasmodics (drugs that reduce spasm) are often used to relieve pain - no-shpa, papaverine, halidor, buscopan.

There are combined drugs (analgesic + antispasmodic), for example, pentalgin, spasmalgon.

In the treatment of injuries, joint pain, and sore throat, local painkillers are used in the form of creams, ointments, lozenges. But they include the same analgesics.

For the treatment of a particular type of pain, the following drugs can be used:

• Headache - pentalgin, spasmalgon, citramon, analgin, solpadein are used.
• Toothache - NSAIDs (ketonal, nise, nurofen) or combined drugs such as ibuclen (ibuprofen + paracetamol) are more commonly used.
• Abdominal pain - buscopan and duspatalin (specific painkillers for the gastrointestinal tract drugs).
• Joint pain - Aertal, movalis can be used.

For children, there are children's forms of drugs for pain, in most cases in the form of syrup or suppositories (panadol, nurofen).

However, in no case should you self-medicate and use medicines without a doctor's prescription. Pain is not a disease in itself, but a symptom. Incorrectly selected treatment can not only not eliminate the problem, but also make further diagnosis difficult or lead to serious complications.

How often can painkillers be used?

“Pain syndrome should not be tolerated, it is better to take an anesthetic drug.” This phrase can be considered in two ways. Why? For example, if you have a stomach ache, you do not know why, take pain medication, the pain subsides, but does not go away completely. You take the medicine again, and then you realize that you cannot do without a doctor.

But when a doctor sees you, the pain syndrome will decrease, and the clinical picture will no longer be so bright. All this makes it difficult to make a correct diagnosis. Therefore, if you have a sharp pain that did not bother you before, it is better to immediately consult a doctor.

If you know perfectly well what kind of pain it is (for example, in women during the menstrual cycle or a headache after a hard day at work), then you can take the medicine. The instructions for each drug describe how often you can use it. But usually no more than two or three days. You should always remember about side effects and contraindications. But if after taking the pill the condition has not improved, then it is better to immediately consult a doctor.

When is the use of painkillers harmful?

The use of painkillers without consulting a doctor is undesirable in any case. But there are situations when their use can cause significant harm to health.

• It is not recommended to take two painkillers at the same time or with some interval. Since one can enhance the effect of the second and cause a dangerous side effect.
• You should always read the instructions and do not increase the dose of the drug, thinking that if you drink twice as much, then the effect will be greater. This is dangerous!
• do not take medications with alcohol
• If you are a driver, then be sure to read the instructions about the effect of this medication on concentration and attention.
• In chronic diseases, many people constantly take certain medications, their interaction with painkillers should be known and it is better to consult a doctor, as this can lead to a negative effect.
• You cannot use a medicine that a doctor has prescribed for your neighbor or relative, because you are not the same person. And this does not mean that it will help you too. On the contrary, it can harm health.
• Always remember that a pharmacist in a pharmacy is not a doctor, and he does not know all your diseases, so he cannot accurately and correctly prescribe treatment for you.
• If the expiration date of the drug has expired, then in no case should you take it.
• Also, the use of painkillers is harmful during pregnancy, there are only certain drugs that can be used, but only as directed by a doctor.

There are many contraindications to physiotherapy, so this method is prescribed only by a doctor. Here are just a few common contraindications:

• If the person has or has a history of cancer (malignancy) or a benign tumor (such as uterine fibroids in women)
• Various blood diseases (anemia, when hemoglobin is low)
• Pregnancy
• Increase in body temperature
• High blood pressure (hypertension)
• Diseases of the liver and kidneys with impaired function
• Psychoses
• Epilepsy
• Acute infectious diseases, etc.

However, physiotherapy is an excellent complementary treatment for pain relief.

For back pain, two types of physiotherapy are used: physiotherapy exercises with massage (improves blood circulation and relaxes tight muscles, which reduces the intensity of pain) and electrotherapy - drug electrophoresis (delivery of the drug directly to the sore spot). Laser treatment is also used, which can also be used for damaged skin.

For headaches, electrosonotherapy is used (impact on the central nervous system with the help of a low-frequency electrical impulse), massage of the cervical-collar zone, balneotherapy (this is water treatment) - coniferous pearl baths, hydromassage, aqua gymnastics in the pool, as well as physiotherapy exercises and breathing exercises.

With toothache, electrophoresis is indicated (delivery of an anesthetic drug using low-frequency current), magnetotherapy, laser treatment.

Treatment of acute pain

Acute pain often occurs against the background of acute damage to the tissue or internal organ. Such pain requires the immediate use of painkillers. In this case, both non-narcotic analgesics (ketonal, nurofen, paracetamol) and narcotic (for fractures, major burns, severe chest pain during a heart attack) can be used, administered intramuscularly or intravenously only by a doctor.

Chronic pain is caused by a chronic disease. It is long and repetitive. The treatment of such pain requires an integrated approach and consists primarily in the elimination of the disease that caused it.

For such pain, long-term pain medications are usually prescribed, under the supervision of a doctor and under the protection of other drugs, to prevent side effects.

If there are no contraindications, then course use of physiotherapy is possible. And the most important point in chronic pain is psychological. It uses auto-training, communication with friends and family, daily walks in the fresh air, as well as creative activities. All this will help a person not to "get hung up" on the pain syndrome and the disease itself and will have a positive therapeutic effect.

Pain prevention

The best treatment for a disease is to prevent the disease from occurring (primary prevention) or to prevent the disease from recurring (secondary prevention).

The basis for the prevention of pain or the disease that caused this symptom is an annual medical examination by a general practitioner, dentist, as well as for women - an examination by a gynecologist, for men - by an andrologist (urologist) with mandatory standard studies that are prescribed by each specialist in his profile. This will prevent the disease or detect it in the early stages and cure it in a timely manner. It is also necessary to independently take a number of measures to prevent this or that type of pain:

• Toothache - personal hygiene (brushing teeth twice a day, using dental floss), visiting the dentist once a year.
• Headache - observance of the sleep and rest regimen, elimination of stress, walks in the fresh air, control of blood pressure, examination by a therapist and a neurologist.
• Sore throat - exclude hypothermia, increase immunity (take vitamin complexes 2 times a year), in case of chronic diseases, do not self-medicate, but consult an ENT doctor.
• Abdominal pain - most often the cause is diseases of the gastrointestinal tract, therefore - the correct diet, the exclusion of harmful drinks and foods (spicy, fried, salty, fatty), exclude alcohol and stress. In chronic diseases, be observed by a gastroenterologist.
• Pain in the legs - physical activity (walking), avoid smoking. If sedentary work, then a break every hour for 15 minutes with physical exercises.
• Back pain - massage and physical exercises on the spine.

The main prevention of pain is a healthy lifestyle, proper nutrition, elimination of stress, moderate physical activity, walking in the fresh air and an annual medical examination by a specialist.

This is the first of the symptoms described by the doctors of ancient Greece and Rome - signs of inflammatory damage. Pain is what signals us about some kind of trouble that occurs inside the body or about the action of some destructive and irritating factor from the outside.

Pain, according to the well-known Russian physiologist P. Anokhin, is designed to mobilize various functional systems of the body to protect it from the effects of harmful factors. Pain includes such components as sensation, somatic (bodily), vegetative and behavioral reactions, consciousness, memory, emotions and motivations. Thus, pain is a unifying integrative function of an integral living organism. In this case, the human body. For living organisms, even without signs of higher nervous activity, can experience pain.

There are facts of changes in electrical potentials in plants, which were recorded when their parts were damaged, as well as the same electrical reactions when researchers inflicted injury on neighboring plants. Thus, the plants responded to damage caused to them or to neighboring plants. Only pain has such a peculiar equivalent. Here is such an interesting, one might say, universal property of all biological organisms.

Types of pain - physiological (acute) and pathological (chronic).

Pain happens physiological (acute) and pathological (chronic).

acute pain

According to the figurative expression of Academician I.P. Pavlov, is the most important evolutionary acquisition, and is required to protect against the effects of destructive factors. The meaning of physiological pain is to reject everything that threatens the life process, disrupts the balance of the body with the internal and external environment.

chronic pain

This phenomenon is somewhat more complex, which is formed as a result of pathological processes existing in the body for a long time. These processes can be both congenital and acquired during life. Acquired pathological processes include the following - the long existence of foci of inflammation that have various causes, all kinds of neoplasms (benign and malignant), traumatic injuries, surgical interventions, outcomes of inflammatory processes (for example, the formation of adhesions between organs, changes in the properties of the tissues that make up their composition) . Congenital pathological processes include the following - various anomalies in the location of internal organs (for example, the location of the heart outside the chest), congenital developmental anomalies (for example, congenital intestinal diverticulum and others). Thus, a long-term focus of damage leads to permanent and minor damage to body structures, which also constantly creates pain impulses about damage to these body structures affected by a chronic pathological process.

Since these injuries are minimal, the pain impulses are rather weak, and the pain becomes constant, chronic and accompanies a person everywhere and almost around the clock. The pain becomes habitual, but does not disappear anywhere and remains a source of long-term irritating effects. A pain syndrome that exists in a person for six or more months leads to significant changes in the human body. There is a violation of the leading mechanisms of regulation of the most important functions of the human body, disorganization of behavior and the psyche. The social, family and personal adaptation of this particular individual suffers.

How common is chronic pain?
According to research by the World Health Organization (WHO), every fifth inhabitant of the planet suffers from chronic pain caused by various pathological conditions associated with diseases of various organs and body systems. This means that at least 20% of people suffer from chronic pain of varying severity, intensity and duration.

What is pain and how does it occur? Department of the nervous system responsible for the transmission of pain sensitivity, substances that cause and maintain pain.

The sensation of pain is a complex physiological process, including peripheral and central mechanisms, and has an emotional, mental, and often vegetative coloring. The mechanisms of the pain phenomenon have not been fully disclosed to date, despite numerous scientific studies that continue up to the present day. However, let us consider the main stages and mechanisms of pain perception.

Nerve cells that transmit pain signal, types of nerve fibers.

The very first stage of pain perception is the impact on pain receptors ( nociceptors). These pain receptors are located in all internal organs, bones, ligaments, in the skin, on the mucous membranes of various organs in contact with the external environment (for example, on the intestinal mucosa, nose, throat, etc.).

To date, there are two main types of pain receptors: the first are free nerve endings, when irritated, there is a feeling of dull, diffuse pain, and the second are complex pain receptors, when excited, there is a feeling of acute and localized pain. That is, the nature of pain sensations directly depends on which pain receptors perceived the irritating effect. Regarding specific agents that can irritate pain receptors, it can be said that they include various biologically active substances (BAS) formed in pathological foci (the so-called algogenic substances). These substances include various chemical compounds - these are biogenic amines, and products of inflammation and cell decay, and products of local immune reactions. All these substances, completely different in chemical structure, are capable of irritating pain receptors of various localization.

Prostaglandins are substances that support the body's inflammatory response.

However, there are a number of chemical compounds involved in biochemical reactions, which themselves cannot directly affect pain receptors, but enhance the effects of substances that cause inflammation. The class of these substances, for example, includes prostaglandins. Prostaglandins are formed from special substances - phospholipids that form the basis of the cell membrane. This process proceeds as follows: a certain pathological agent (for example, enzymes form prostaglandins and leukotrienes. Prostaglandins and leukotrienes are generally called eicosanoids and play an important role in the development of the inflammatory response. The role of prostaglandins in the formation of pain in endometriosis, premenstrual syndrome, as well as painful menstruation syndrome (algodysmenorrhea) has been proven.

So, we have considered the first stage of the formation of pain - the impact on special pain receptors. Consider what happens next, how a person feels pain of a certain localization and nature. To understand this process, it is necessary to familiarize yourself with the pathways.

How does the pain signal get to the brain? Pain receptor, peripheral nerve, spinal cord, thalamus - more about them.

The bioelectric pain signal formed in the pain receptor is directed to spinal nerve ganglia (knots) located next to the spinal cord. These nerve ganglia accompany each vertebra from the cervical to some of the lumbar. Thus, a chain of nerve ganglia is formed, running to the right and left along the spinal column. Each nerve ganglion is connected to the corresponding area (segment) of the spinal cord. The further path of the pain impulse from the spinal nerve ganglia is sent to the spinal cord, which is directly connected to the nerve fibers.

In fact, the dorsal could - this is a heterogeneous structure - white and gray matter is isolated in it (as in the brain). If the spinal cord is examined in cross section, then the gray matter will look like the wings of a butterfly, and the white will surround it from all sides, forming the rounded outlines of the boundaries of the spinal cord. Now, the back of these butterfly wings is called the posterior horns of the spinal cord. They carry nerve impulses to the brain. The front horns, logically, should be located in front of the wings - this is how it happens. It is the anterior horns that conduct the nerve impulse from the brain to the peripheral nerves. Also in the spinal cord in its central part there are structures that directly connect the nerve cells of the anterior and posterior horns of the spinal cord - thanks to this, it is possible to form the so-called "mild reflex arc", when some movements occur unconsciously - that is, without the participation of the brain. An example of the work of a short reflex arc is pulling the hand away from a hot object.

Since the spinal cord has a segmental structure, therefore, each segment of the spinal cord includes nerve conductors from its area of ​​responsibility. In the presence of an acute stimulus from the cells of the posterior horns of the spinal cord, excitation can abruptly switch to the cells of the anterior horns of the spinal segment, which causes a lightning-fast motor reaction. They touched a hot object with their hand - they immediately pulled their hand back. At the same time, pain impulses still reach the cerebral cortex, and we realize that we have touched a hot object, although the hand has already reflexively withdrawn. Similar neuroreflex arcs for individual segments of the spinal cord and sensitive peripheral areas may differ in the construction of the levels of participation of the central nervous system.

How does a nerve impulse reach the brain?

Further, from the posterior horns of the spinal cord, the path of pain sensitivity is directed to the overlying parts of the central nervous system along two paths - along the so-called "old" and "new" spinothalamic (path of the nerve impulse: spinal cord - thalamus) paths. The names "old" and "new" are conditional and speak only about the time of the appearance of these pathways in the historical period of the evolution of the nervous system. However, we will not go into the intermediate stages of a rather complex neural pathway, we will confine ourselves to stating the fact that both of these paths of pain sensitivity end in areas of the sensitive cerebral cortex. Both the “old” and “new” spinothalamic pathways pass through the thalamus (a special part of the brain), and the “old” spinothalamic pathway also passes through a complex of structures of the limbic system of the brain. The structures of the limbic system of the brain are largely involved in the formation of emotions and the formation of behavioral responses.

It is assumed that the first, more evolutionarily young system (the “new” spinothalamic pathway) of pain sensitivity conduction draws more definite and localized pain, while the second, evolutionarily older (“old” spinothalamic pathway) serves to conduct impulses that give a feeling of viscous, poorly localized pain. pain. In addition to this, the specified "old" spinothalamic system provides emotional coloring of pain sensation, and also participates in the formation of behavioral and motivational components of emotional experiences associated with pain.

Before reaching the sensitive areas of the cerebral cortex, pain impulses undergo a so-called preliminary processing in certain parts of the central nervous system. These are the already mentioned thalamus (visual tubercle), hypothalamus, reticular (reticular) formation, sections of the middle and medulla oblongata. The first, and perhaps one of the most important filters on the path of pain sensitivity is the thalamus. All sensations from the external environment, from the receptors of internal organs - everything passes through the thalamus. An unimaginable amount of sensitive and painful impulses passes every second, day and night, through this part of the brain. We do not feel the friction of the heart valves, the movement of the abdominal organs, various articular surfaces against each other - and all this is due to the thalamus.

In case of malfunction of the so-called anti-pain system (for example, in the absence of the production of internal, own morphine-like substances that arose due to the use of narcotic drugs), the aforementioned flurry of all kinds of pain and other sensitivity simply overwhelms the brain, leading to terrifying in duration, strength and severity emotional pain. This is the reason, in a somewhat simplified form, of the so-called “withdrawal” with a deficit in the intake of morphine-like substances from the outside against the background of long-term use of narcotic drugs.

How is the pain impulse processed in the brain?

The posterior nuclei of the thalamus provide information about the localization of the source of pain, and its median nuclei - about the duration of exposure to the irritating agent. The hypothalamus, as the most important regulatory center of the autonomic nervous system, is involved in the formation of the autonomic component of the pain reaction indirectly, through the involvement of centers that regulate metabolism, the work of the respiratory, cardiovascular and other body systems. The reticular formation coordinates already partially processed information. Particularly emphasized is the role of the reticular formation in the formation of the sensation of pain as a kind of special integrated state of the body, with the inclusion of all kinds of biochemical, vegetative, somatic components. The limbic system of the brain provides a negative emotional coloring. The process of understanding pain as such, determining the localization of the pain source (meaning a specific area of ​​\u200b\u200bone's own body), together with the most complex and diverse reactions to pain impulses, occurs without fail with the participation of the cerebral cortex.

Sensory areas of the cerebral cortex are the highest modulators of pain sensitivity and play the role of the so-called cortical analyzer of information about the fact, duration and localization of the pain impulse. It is at the level of the cortex that integration of information from various types of conductors of pain sensitivity occurs, which means the full-fledged design of pain as a multifaceted and diverse sensation. pain impulses. Like a kind of transformer substation on power lines.

We even have to talk about the so-called generators of pathologically enhanced excitation. So, from the modern point of view, these generators are considered as the pathophysiological basis of pain syndromes. The aforementioned theory of systemic generator mechanisms makes it possible to explain why, with a slight irritation, the pain response is quite significant in terms of sensations, why after the cessation of the stimulus, the sensation of pain continues to persist, and also helps to explain the appearance of pain in response to stimulation of skin projection zones (reflexogenic zones) in the pathology of various internal organs.

Chronic pain of any origin leads to increased irritability, reduced efficiency, loss of interest in life, sleep disturbance, changes in the emotional-volitional sphere, often leading to the development of hypochondria and depression. All these consequences in themselves increase the pathological pain reaction. The emergence of such a situation is interpreted as the formation of vicious circles: pain stimulus - psycho-emotional disorders - behavioral and motivational disorders, manifested in the form of social, family and personal maladaptation - pain.

Anti-pain system (antinociceptive) - role in the human body. Threshold of pain sensitivity

Along with the existence of a pain system in the human body ( nociceptive), there is also an anti-pain system ( antinociceptive). What does the anti-pain system do? First of all, each organism has its own genetically programmed threshold for the perception of pain sensitivity. This threshold allows us to explain why different people react differently to stimuli of the same strength, duration and nature. The concept of sensitivity threshold is a universal property of all receptor systems of the body, including pain. Just like the pain sensitivity system, the anti-pain system has a complex multilevel structure, starting from the level of the spinal cord and ending with the cerebral cortex.

How is the activity of the anti-pain system regulated?

The complex activity of the anti-pain system is provided by a chain of complex neurochemical and neurophysiological mechanisms. The main role in this system belongs to several classes of chemicals - brain neuropeptides. They also include morphine-like compounds - endogenous opiates(beta-endorphin, dynorphin, various enkephalins). These substances can be considered so-called endogenous analgesics. These chemicals have a depressing effect on the neurons of the pain system, activate anti-pain neurons, and modulate the activity of higher nerve centers of pain sensitivity. The content of these anti-pain substances in the central nervous system decreases with the development of pain syndromes. Apparently, this explains the decrease in the threshold of pain sensitivity up to the appearance of independent pain sensations against the background of the absence of a painful stimulus.

It should also be noted that in the anti-pain system, along with morphine-like opiate endogenous analgesics, widely known brain mediators, such as serotonin, norepinephrine, dopamine, gamma-aminobutyric acid (GABA), as well as hormones and hormone-like substances - vasopressin (antidiuretic hormone), neurotensin. Interestingly, the action of brain mediators is possible both at the level of the spinal cord and the brain. Summarizing the above, we can conclude that the inclusion of the anti-pain system makes it possible to weaken the flow of pain impulses and reduce pain sensations. If there are any inaccuracies in the operation of this system, any pain can be perceived as intense.

Thus, all pain sensations are regulated by the joint interaction of the nociceptive and antinociceptive systems. Only their coordinated work and subtle interaction allows you to adequately perceive pain and its intensity, depending on the strength and duration of exposure to the irritating factor.

Pain is the most common symptom of most diseases. The occurrence of pain in different parts of the body indicates that something is wrong with the body, the problem should be identified and treated as soon as possible.

Often, acute pain becomes chronic along with the course of the disease that caused discomfort. Therefore, it is important to pay attention to them in time and determine the problem that has arisen, until the disease is in an advanced stage.

Common pain types

Most often, people are annoyed by the following painful sensations:

• headaches;
• pain in the joints;
• sore throat and many others.

The nature of such experiences also varies depending on the disease. The pain can be sharp, throbbing, aching, and so on. In some cases, her character can directly tell about the probable disease and the stage of its development.

Important! Do not forget that in some cases, pain can "give" to healthy organs, you should always keep this factor in mind for a correct diagnosis.

Everyone experiences a headache at least once in their life. In most cases, this condition is not considered serious, but quite common. However, frequent, unusual, too intense sensations can indicate serious illness.

Headaches are different in intensity and frequency, usually this helps to determine the disease itself. However, the diagnosis is usually confirmed after examination and identification of other symptoms.

Causes

There are many reasons for pain in the head. The most common type of chronic pain, migraine, develops due to stress, constant severe fatigue, abuse of coffee and other invigorating foods.

Other triggers for headaches include:

• high or low blood pressure;
• mental illness;
• excessive physical activity;
• ear diseases;
• spine diseases and others.

Painful sensations in the head can also be accompanied by much more serious conditions, such as a cerebral hemorrhage, a brain tumor, or meningitis.

Symptoms

What features of the symptomatology should be worried and consult a specialist? After all, not all cases of headaches really need to be treated. You should be more careful in the following cases:

1. Painful sensations become literally unbearable, too intense.
2. There is tension, a feeling of pressure in the neck, shoulders, back.
3. Pain is concentrated in one part of the head.
4. Appearance of nausea, photophobia.
5. Increased pain with physical activity or even normal walking.

If seizures appear constantly, they are preceded by “flashes” of light, bright spots, “stars” before the eyes, you should definitely contact a specialist.

Also, the appearance of a headache after a head injury often indicates a concussion.

Important! Normally, the head should not hurt for no apparent reason for more than three days in a row. Otherwise, it is recommended to consult a doctor.

Many people are also worried about pain in the joints. The joints of the legs are especially often affected, pain in the knees is a fairly common reason for visiting a doctor. According to statistics, half of the world's population has experienced them at least once in their lives.

If your knees hurt, first of all, you should establish the cause, the disease that caused the discomfort. After all, improper therapy can greatly harm an already weakened joint.

Causes

Unpleasant sensations in the knees can occur due to ordinary physical overexertion or injury, but most often this is a consequence of developing joint disease. Most often, the following diseases occur:

1. Arthrosis. An inflammatory process in which the tissues of the joint are destroyed, the joint itself is deformed over time.
2. Arthritis. Inflammatory disease, sometimes the result of other problems.
3. Meniscus injury. As a rule, it occurs after an injury, sometimes minor. Can provoke arthrosis with deformation. A distinctive feature of pain experiences in case of damage to the meniscus is its severity and intensity.
4. Inflammation of the tendons - periarthritis. Most often, pain appears on the inside of the knee, occurs when climbing or descending stairs in older people.
5. Various vascular pathologies. They do not affect the joint, but the nature of the pain resembles joint diseases.

Also, knee pain can occur with arthrosis of the hip joint. In this case, she will "give" to the knee.

Important! Most knee diseases require careful diagnosis.

Symptoms

There are symptoms, the appearance of which, in the presence of pain in the knee, will accurately show whether there is a problem or discomfort - a consequence of excessive physical exertion. You should seriously worry about your health with the following signs:

• swelling, fever;
• crunch in the knee;
• aching nature of pain at night.

These symptoms can indicate serious pathologies, therefore, if they are detected, you should immediately consult a doctor and begin treatment.

Unpleasant sensations in the coccyx area when sitting or walking is a common symptom of certain diseases of the musculoskeletal system. It often appears after an injury, usually a fall. However, pain in the coccyx area may indicate a pinched intervertebral disc or a lack of calcium.

It can also appear during pregnancy. In this case, you should immediately contact your doctor, such pain may indicate the presence of various pathologies of fetal development.

Sore throat

Sore throats are also common. Contrary to popular belief, it can occur not only with a cold. Unpleasant sensations in the throat can talk about various problems of the respiratory tract and not only.

Causes

The main reason is colds and various respiratory tract infections. Also, a sore throat can occur with allergies or irritation, for example, from cigarette smoke or carbon monoxide.

The sensation of a lump in the throat is often present in cervical osteochondrosis. It may even be accompanied by a cough. This happens due to pinched nerve endings in the cervical spine.

Symptoms

Unpleasant sensations in the throat are usually accompanied by the following symptoms:

• dry cough, hoarseness;
• inflammation of the cervical lymph nodes;
• temperature increase.

If these symptoms are present, you should consult a doctor. Many respiratory diseases have unpleasant complications that require long-term treatment.

Pain is the most obvious symptom of most diseases and should never be ignored.

Pain in the head is the most common symptom that is inherent in many serious diseases. Unpleasant sensations affect both adults and children. It is definitely possible...

Pain in the throat occurs as a result of inflammation of the pharynx. The reasons for the appearance of malaise are many. The medical name is pharyngitis. There are a number of ways to eliminate pain in the throat ...

Cluster headaches are a fairly rare disorder that usually affects men between the ages of twenty and forty. This disease is often considered rather mysterious, difficult to identify ...

Headache is rarely an independent symptom, it usually occurs as one of the signs of the disease. One of the most common accompanying symptoms is nausea. Costs...

Headache can occur with severe fatigue, stress, emotional or physical overstrain, most people experience it periodically. In this case, it happens that painkillers do not ...

Headache is familiar to many, it can talk about serious health problems or, on the contrary, be a consequence of overwork and not mean the presence of a disease. Consider the main...