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Diseases pain of varying intensity and. Pain syndrome

23.06.2020 -
Feet care

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.

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Neuropathic pain, unlike ordinary pain, which is a signal function of the body, is not associated with disorders in the functioning of any organ. This pathology has recently become an increasingly common disease: according to statistics, 7 out of 100 people suffer from neuropathic pain of various degrees of severity. This kind of pain can make even the simplest of tasks excruciating.

Kinds

Neuropathic pain, like “normal” pain, can be acute or chronic.

There are also other forms of pain:

  • Moderate neuropathic pain in the form of burning and tingling. Most often felt in the limbs. It does not cause particular concern, but it creates psychological discomfort in a person.
  • Pressing neuropathic pain in the legs. It is felt mainly in the feet and legs, can be quite pronounced. Such pain makes it difficult to walk and brings serious inconvenience to a person's life.
  • Short term pain. It may last only a couple of seconds, and then disappear or move to another part of the body. Most likely caused by spasmodic phenomena in the nerves.
  • Oversensitivity when exposed to the skin of temperature and mechanical factors. The patient experiences discomfort from any contact. Patients with such a disorder wear the same habitual things and try not to change positions during sleep, as a change in position interrupts their sleep.

Causes of neuropathic pain

Pain of a neuropathic nature can occur due to damage to any parts of the nervous system (central, peripheral and sympathetic).

We list the main factors of influence for this pathology:

  • Diabetes. This metabolic disease can lead to nerve damage. This pathology is called diabetic polyneuropathy. It can lead to neuropathic pain of various nature, mainly localized in the feet. Pain syndromes are aggravated at night or when wearing shoes.
  • Herpes. The consequence of this virus may be postherpetic neuralgia. Most often, this reaction occurs in older people. Neuropathic post-herpes pain can last for about 3 months and is accompanied by severe burning in the area where the rash was present. There may also be pain from touching the skin of clothing and bedding. The disease disrupts sleep and causes increased nervous excitability.
  • Spinal injury. Its effects cause long-term pain symptoms. This is due to damage to the nerve fibers located in the spinal cord. It can be strong stabbing, burning and spasmodic pain in all parts of the body.
  • This severe brain damage causes great damage to the entire human nervous system. A patient who has undergone this disease for a long time (from a month to a year and a half) can feel pain symptoms of a stabbing and burning nature in the affected side of the body. Such sensations are especially pronounced when in contact with cool or warm objects. Sometimes there is a feeling of freezing of the extremities.
  • Surgical operations. After surgical interventions caused by the treatment of diseases of internal organs, some patients are disturbed by discomfort in the suture area. This is due to damage to the peripheral nerve endings in the surgical area. Often such pain occurs due to the removal of the mammary gland in women.
  • This nerve is responsible for facial sensation. When it is compressed as a result of injury and due to the expansion of a nearby blood vessel, intense pain can occur. It can occur when talking, chewing, or touching the skin in any way. More common in older people.
  • Osteochondrosis and other diseases of the spine. Compression and displacement of the vertebrae can lead to pinched nerves and neuropathic pain. Compression of the spinal nerves leads to the occurrence of radicular syndrome, in which pain can manifest itself in completely different parts of the body - in the neck, in the limbs, in the lumbar region, and also in the internal organs - in the region of the heart and stomach.
  • Multiple sclerosis. This lesion of the nervous system can also cause neuropathic pain in different parts of the body.
  • Radiation and chemical exposure. Radiation and chemicals have a negative effect on the neurons of the central and peripheral nervous system, which can also be expressed in the occurrence of pain sensations of a different nature and intensity.

Clinical picture and diagnosis in neuropathic pain

Neuropathic pain is characterized by a combination of specific sensory disturbances. The most characteristic clinical manifestation of neuropathy is a phenomenon referred to in medical practice as "allodynia".

Allodynia is a manifestation of a pain reaction in response to a stimulus that does not cause pain in a healthy person.

A neuropathic patient may experience severe pain from the slightest touch and literally from a breath of air.

Allodynia can be:

  • mechanical, when pain occurs with pressure on certain areas of the skin or irritation with their fingertips;
  • thermal, when pain manifests itself in response to a thermal stimulus.

Certain methods for diagnosing pain (which is a subjective phenomenon) do not exist. However, there are standard diagnostic tests that can be used to evaluate symptoms and develop a therapeutic strategy based on them.

Serious help in diagnosing this pathology will be provided by the use of questionnaires for pain verification and its quantitative assessment. Accurate diagnosis of the cause of neuropathic pain and identification of the disease that led to it will be very useful.

For the diagnosis of neuropathic pain in medical practice, the so-called method of three "C" is used - look, listen, correlate.

  • look - i.e. identify and evaluate local disorders of pain sensitivity;
  • listen carefully to what the patient says and note the characteristic signs in the description of pain symptoms;
  • correlate the patient's complaints with the results of an objective examination;

It is these methods that make it possible to identify the symptoms of neuropathic pain in adults.

Neuropathic pain - treatment

The treatment of neuropathic pain is often a lengthy process and requires a comprehensive approach. In therapy, psychotherapeutic methods of influence, physiotherapy and medication are used.

Medical

This is the main technique in the treatment of neuropathic pain. Often this pain is not relieved by conventional painkillers.

This is due to the specific nature of neuropathic pain.

Treatment with opiates, although quite effective, leads to tolerance to the drugs and can contribute to the formation of drug dependence in the patient.

Most commonly used in modern medicine lidocaine(in the form of an ointment or patch). The drug is also used gabapentin and pregabalin- effective drugs of foreign production. Together with these drugs, sedative drugs for the nervous system are used, which reduce its hypersensitivity.

In addition, the patient may be prescribed drugs that eliminate the effects of diseases that led to neuropathy.

Non-drug

plays an important role in the treatment of neuropathic pain physiotherapy. In the acute phase of the disease, physical methods are used to relieve or reduce pain syndromes. Such methods improve blood circulation and reduce spasmodic phenomena in the muscles.

At the first stage of treatment, diadynamic currents, magnetotherapy, and acupuncture are used. In the future, physiotherapy is used that improves cellular and tissue nutrition - exposure to a laser, massage, light and kinesitherapy (therapeutic movement).

During the recovery period physiotherapy exercises is given great importance. Various relaxation techniques are also used to help relieve pain.

Treatment of neuropathic pain folk remedies not particularly popular. Patients are strictly forbidden to use folk methods of self-treatment (especially warming procedures), since neuropathic pain is most often caused by inflammation of the nerve, and its heating is fraught with serious damage up to complete death.

Permissible phytotherapy(treatment with herbal decoctions), however, before using any herbal remedy, you should consult your doctor.

Neuropathic pain, like any other, requires careful attention. Timely treatment will help to avoid severe attacks of the disease and prevent its unpleasant consequences.

The video will help you understand the problem of neuropathic pain in more detail:

Pain I

In the description of patients, pain sensations by their nature can be sharp, dull, cutting, stabbing, burning, pressing (squeezing), aching, pulsating. By duration and frequency, they can be constant, paroxysmal, associated with the time of day, seasons of the year, physical activity. , posture of the body, with certain movements (for example, with breathing, walking), eating, acts of defecation or urination, etc., which makes it possible to suspect the localization and pathology that causes pain. The features of emotional reactions accompanying pain are also of diagnostic value, for example, the feeling of fear of death that accompanies retrosternal B. in angina pectoris, myocardial infarction, and pulmonary embolism.

A certain diagnostic orientation is given by the differentiation of somatalgia, i.e. pain caused by irritation of the fibers of the somatic nerves, and vegetalgia (sympathology) that occurs when the sensory fibers of the autonomic innervation are involved. Somatalgia (permanent or paroxysmal) are localized in the zone of innervation of peripheral nerves or roots and are usually not accompanied by autonomic disorders, or the latter (with very intense pain) have a character (general, increased blood pressure, increased heart rate, etc.).

With vegetalgia, disorders of vegetative functions are observed as a rule and are often local in nature, expressed as local spasms of peripheral vessels, changes in skin temperature, goosebumps, impaired sweating, trophic disorders, etc. Sometimes vegetalgia reaches the degree of causalgia (Causalgia) , often with reflected pain of the type of repercussion (Repercussion) with the appearance of pain in the Zakharyin-Ged zones. Perhaps the appearance of pain in one half of the body (), which is observed, in particular, with damage to the thalamus. The high frequency of repercussion with the appearance of pain in areas distant from the affected organ should be borne in mind in the differential diagnosis of diseases of internal organs, blood vessels, bones, and joints. for example, with myocardial infarction (myocardial infarction), B. is possible not only in the sternum with irradiation to the left hand, but also B. in the thoracic spine, B. in the lower, in the forehead, in the right hand, in the abdomen (abdominal form), etc. With all the variety of manifestations of pain repercussion, the total characteristic of B. helps to highlight features that are typical or atypical for any process in the region of internal organs. for example, a dissecting aortic aneurysm is similar in many characteristics to myocardial infarction, but B.'s spread along the spine with irradiation to the legs, which is characteristic of a dissecting aneurysm, is not typical of myocardial infarction.

The behavior of the patient during painful paroxysms also has diagnostic value. for example, with myocardial infarction, the patient tries to lie still, the patient with an attack of renal colic rushes about, takes various poses, which is not observed with a similar localization of B. in a patient with lumbar sciatica.

In diseases of the internal organs, B. occurs as a result of blood flow disorders (, thrombosis of the mesenteric or renal artery, atherosclerotic stenosis of the abdominal aorta, etc.); spasm of smooth muscles of internal organs (stomach,); stretching of the walls of hollow organs (gall bladder, renal pelvis, ureter); the spread of the inflammatory process to areas supplied with sensitive innervation (to the parietal pleura, peritoneum, etc.). substance of the brain is not accompanied by B., it occurs when the membranes, venous sinuses, and intracranial vessels are irritated. Pathological processes in the lung are accompanied by B. only when they spread to the parietal pleura. Strong B. arise at a spasm of vessels of heart. B. in the esophagus, stomach, and intestines often occurs when they are spastic or stretched. Pathological processes in the parenchyma of the liver, spleen, kidneys do not cause pain if they are not accompanied by acute stretching of the capsule of these organs. Pain in the muscles occurs with bruises, myositis, convulsions, arterial circulation disorders (in the latter cases, B. proceeds according to the type of sympathalgia). At defeat of a periosteum and bone processes B. have extremely painful character.

It must be borne in mind that pain in diseases of the internal organs may not occur for a long time and grow like an avalanche only at an incurable stage of the process (for example, with malignant neoplasms). After curing a somatic disease, persistent pain is possible associated with the consequences of damage to the nerve trunks, their ischemic changes, adhesions, changes in the functional state of the nodes of preganglionic autonomic innervation, as well as with psychogenic fixation of pain.

The elimination of pain as one of the most painful manifestations of the disease for the patient is one of the priorities solved by the doctor in the process of determining treatment tactics. The best option is to eliminate the cause of the pain, for example, removal of a foreign body or squeezing, reduction of dislocation, etc. If this is not possible, preference is given to influences on those links of pathogenesis with which pain is associated, for example, taking alkalis to relieve pain in duodenal ulcers, nitroglycerin for angina pectoris, antispasmodics (see Antispasmodics) and anticholinergics (see Anticholinergics) - with hepatic and renal colic, etc. With the ineffectiveness or impossibility of causal and pathogenetic therapy, they resort to symptomatic treatment of pain with the help of analgesics (Analgesics) , the effect of which may be enhanced by the simultaneous use of neuroleptics (Neuroleptics) or tranquilizers (Tranquilizers) . However, with an unspecified nature of the somatic disease, especially with unclear abdominal pain, the use of analgesics is contraindicated due to the possible modification of the clinical picture, making it difficult to diagnose the disease, in which urgent surgical intervention may be indicated (see Acute abdomen) . With local pain, incl. with some neuralgia, local anesthesia is sometimes appropriate . With persistent debilitating pain in patients with chronic diseases and the low effectiveness of analgesics, symptomatic surgical B. is used - radicotomy, cordotomy, tractotomy, and other methods.

Bibliography: Valdman A.V. and Ignatov Yu.D. Central mechanisms of pain, L., 1976, bibliogr.; Grinshtein A.M. and Popova N.A. Vegetative syndromes, M., 1971; Erokhin L.G. Facial pains, M., 1973; Kalyuzhny L.V. Physiological mechanisms of regulation of pain sensitivity, M., 1984, bibliogr.; Karpov V.D. nervous diseases, M., 1987; Kassil G.N. Science of pain, M., 1975; Kryzhanovsky G.N. Determinant structures in the pathology of the nervous system, M., 1980; Nordemar R. Back pain, . from Swedish., M., 1988; Shtok V.N. , M., 1987, bibliogr.

Rice. 1. Scheme of the occurrence of projected pain. Nerve impulses caused by direct stimulation (indicated by the arrow) travel along afferent fibers in the spinothalamic tract to the corresponding zone of the cerebral cortex, causing a sensation of pain in that part of the body (hand) that is usually caused by irritation of nerve endings: 1 - part of the body with pain receptors; 2 - sensation of pain at the location of the corresponding pain receptors; 3 - brain; 4 - lateral spinothalamic tract; 5 - spinal cord; 6 - afferent nerve fiber.

Rice. 2. Scheme of the occurrence of referred pain. Pain sensations from the internal come to the spinal cord, individual structures of which synaptically contact the nerve cells of the spinothalamic tract, on which nerve fibers terminate, innervating a certain segment of the skin: 1 - skin; 2 - the trunk of the sympathetic nervous system; 3 - back spine; 4 - lateral spinothalamic tract; 5 - spinal cord; 6 - front spine; 7 - internal organ; 8 - visceral nerve.

II

an unpleasant, sometimes unbearable sensation that occurs mainly with strong irritating or destructive effects on a person. Pain is a signal of danger, a biological factor that ensures the preservation of life. The occurrence of pain mobilizes the body's defenses to eliminate painful stimuli and restore the normal functioning of organs and physiological systems. But at the same time, pain brings a person severe suffering (for example, Headache, Toothache), deprives him of rest and sleep, and in some cases can cause the development of a life-threatening condition - Shock a.

Usually the pain is stronger, the heavier the skin, mucous membranes, periosteum, muscles, nerves, i.e. the higher the intensity of the stimuli. In case of violations of the function of internal organs, the pain does not always correspond in its strength to the degree of these violations: relatively minor disorders of intestinal function sometimes cause severe pain (colic), and serious diseases of the brain, blood, kidneys can occur with little or no pain.

The nature of the pain is varied: it is assessed as acute, dull, stabbing, cutting, pressing, burning, aching. The pain can be local (felt directly at the site of the lesion) or reflected (occurs on a more or less distant part of the body from the site of the lesion, for example, in the left arm or shoulder blade in case of heart disease). A peculiar form is the so-called phantom pain in the missing (amputated) parts of the limbs (foot, fingers, hand).

Often the cause of pain of a different nature are diseases of the nervous system. The so-called central pain may be due to diseases of the brain. Particularly severe pain is observed after a stroke, when it is located in the visual tubercle; these pains extend to the whole paralyzed half of the body. The so-called peripheral pain occurs when pain endings (receptors) are irritated in various organs and tissues (myalgia - muscle pain, arthralgia - joint pain, etc.). According to the variety of factors acting on pain and causing them, the frequency of peripheral pain is also high in various diseases and intoxications (myalgia - with influenza, arthralgia - with rheumatism, rheumatoid arthritis, etc.). With damage to the peripheral nervous system, pain is a consequence of compression, tension and circulatory disorders in the root or nerve trunk. Pain associated with damage to the peripheral nerves usually increases with movement, with tension on the nerve trunks. Following the pain, as a rule, there is a feeling of numbness, a violation of sensitivity in the area where the pain was experienced.

Pain in the region of the heart, in the left half of the chest or behind the sternum, can be stabbing, aching or squeezing, often radiates to the left arm and shoulder blade, appears suddenly or develops gradually, is short-term or long-term. Sudden sharp compressive pains behind the sternum, radiating to the left arm and shoulder blade, occurring during exercise or at rest, are characteristic of angina pectoris (Angina pectoris). Often, pain in the region of the heart is caused by functional disorders of the nervous apparatus of the heart in case of neuroses, endocrine disorders, various intoxications (for example, in smokers and alcohol abusers).

Pain in the region of the heart can also occur in school-age children, for example, due to the increased emotional stress of the child. The pain is usually mild and short-term, occurs suddenly. A child who complains of pain in the region of the heart should be put to bed, given a sedative (for example, tazepam, sibazon 1/2 tablet), analgin 1/2-1 tablet, no-shpu 1/2-1 tablet. In cases where these measures do not have an effect, an ambulance should be called. If pain in the region of the heart recurs among seemingly complete health, you need to see a doctor and examine the child.

Abdominal pain occurs in many diseases, including those requiring urgent surgical treatment (see Belly).

 III

1) a peculiar psycho-physiological state of a person, resulting from the impact of super-strong or destructive stimuli that cause organic or functional disorders in the body; is an integrative function of the body, mobilizing a variety to protect the body from the effects of a harmful factor;

2) (dolor; . sensation of pain) in the narrow sense - a subjectively painful sensation that reflects the psychophysiological state of a person, which occurs as a result of exposure to superstrong or destructive stimuli.

Anginal pain(d. anginosus) - B. of a pressing, compressive or burning character, localized behind the sternum, radiating to the arm (usually the left), shoulder girdle, neck, lower jaw, occasionally to the back; a sign of angina pectoris, focal myocardial dystrophy and myocardial infarction.

Altitude pain- B. in the muscles, joints and behind the sternum, which occurs when flying at high altitude without special equipment as a sign of decompression sickness.

headache(cephalalgia; syn.) - B. in the region of the cranial vault, arising from various diseases as a result of irritation of pain receptors in the membranes and vessels of the brain, periosteum, and superficial tissues of the skull.

The pain is hungry- B. in the epigastric (epigastric) region, arising on an empty stomach and disappearing or decreasing after eating; observed, for example, with duodenal ulcer.

Pain is two-wave- B. with two periods of pronounced increase in intensity; observed, for example, in intestinal dyspepsia.

Chest pain(d. retrosternalis) - B., localized behind the sternum; a sign of coronary insufficiency or other diseases of the mediastinal organs.

Pain radiating- B., transmitted to an area remote from the pathological focus.

Pain alveolar(d. alveolaris) - B., localized in the alveolus of the tooth during an inflammatory process that develops after tooth extraction.

Pain intermenstrual(d. intermenstrualis) - B. of a pulling nature, localized in the lower abdomen and lower back; usually occurs during ovulation.

Neuralgic pain(d. neuralgicus) - paroxysmal intense.

Pain with neuralgia of sensitive and mixed nerves, often accompanied by hyperemia, sweating and swelling of the skin in the area of ​​​​its localization.

Girdle pain- B. in the epigastric (epigastric) region, radiating to the left and right, covering at the level of the lower thoracic and upper lumbar vertebrae; observed in cholecystitis, pancreatitis, duodenal ulcer and some other diseases.

The pain is acute(d. acutus) - B., suddenly starting and rapidly increasing to maximum intensity.

Pain reflected(syn. B. repercussion) - B. that occurs in organs and tissues that do not have morphological changes, due to the involvement of the sympathetic nervous system in a process localized elsewhere, more often in any internal organs.

It is necessary to determine the types of pain in order to prescribe an adequate treatment for the syndrome. The nature of the pain allows you to identify a possible pathology. Localization of pain allows you to determine the location of the pathological lesion. Potential causes of pain are the direction in which the main measures for the treatment of the disease are carried out.

We offer you a material that describes the main types of pain.

Pain is a psychophysiological reaction of the body that occurs with strong irritation of sensitive nerve endings embedded in organs and tissues. This is the oldest defensive reaction in evolutionary terms. It signals trouble and causes the body's response, aimed at eliminating the cause of pain. Pain is one of the earliest symptoms of some diseases.

There is the following localization of pain in patients:

  • Somatic superficial (in case of damage to the skin);
  • Somatic deep (with damage to the musculoskeletal system);
  • Visceral (with damage to internal organs).

If the localization of pain does not coincide with the site of injury, the following are distinguished:

  • Projected pain (for example, when the spinal roots are compressed, the pain is projected into the areas of the body innervated by them - it “shoots” in the arm, leg, etc.);
  • Reflected pain (occurs due to damage to internal organs and is localized in distant superficial areas of the body).

By damage to the structures of the nervous system:

Pain that occurs when the peripheral nerves are damaged is called neuropathic, and when the structures of the central nervous system are damaged, they are called central.

The nature of the pain

When making a diagnosis and choosing a method of treatment, it is necessary to determine the nature of the pain.

acute pain is a new, recent pain that is inextricably linked to the injury that caused it, and is usually a symptom of some disease. It disappears when the damage is repaired.

chronic pain often acquires the status of an independent disease, continues for a long period of time even after the elimination of the cause that caused acute pain. The most acceptable period for assessing pain as chronic is its duration of more than 3 months.

Types of pain

Types of pain that the pharmacist most often encounters in his practice:

Headache(migraine, beam or cluster headaches, chronic paroxysmal hemicrania and muscle tension headaches; secondary or symptomatic - a consequence of a traumatic brain injury, vascular pathology of the brain, tumors, etc.);

  • Pain associated with inflammation of the elements of the musculoskeletal system (articular pain, discogenic radiculitis, myofascial pain, myalgia);
  • Abdominal pain (abdominal pain);
  • Pain in trauma, dislocations);
  • Pain in skin lesions (abrasions, burns);
  • Toothache and pain after dental interventions;
  • Pain with angina pectoris;
  • menstrual pain;
  • Pain in cancer patients.

Causes of pain

Before deciding which pain relievers will help and recommending an over-the-counter remedy, the pharmacist should ask the following questions:

How long does the pain bother and what is its nature (pain for more than 7 days indicates the need for medical intervention)?

What is the likely cause of the pain (eg, exercise-related muscle and joint pain can be managed with over-the-counter analgesics)?

Can the patient clearly localize and describe the pain (if the pain is difficult to localize, it is more likely to be reflected in diseases of the internal organs, which requires a medical consultation)?

Identifying possible causes of pain is sometimes not easy.

Has the patient been examined for joint diseases?

With pain in the joint: are there swelling, local increase in temperature, increased pain when touched? If so, it may be infectious arthritis or a rheumatic disease. The use of analgesics in these cases may delay the correct diagnosis.

Has the patient previously taken any prescription or over-the-counter drugs? This should be known to account for potential drug interactions, treatment complications, and allergic reactions.

If the patient's condition is not severe and the pain is not a symptom of a more serious illness, over-the-counter drugs should be recommended. However, the pharmacist/pharmacist should advise to see a doctor when the pain lasts more than 7 days or symptoms recur after a few days of temporary improvement.

Prescribing painkillers

The sequence of actions of the doctor when prescribing painkillers:

1. The doctor carefully interrogates and carefully examines the patient. Finds out the effectiveness and duration of previously taken drugs, the presence of concomitant diseases and drug complications. The doctor must determine the leading peripheral component of pain (tendon-muscular, neurogenic, etc.), find out the presence of psychosocial and emotional stress precursors of chronic pain syndrome. An analysis of the data obtained will allow you to choose the main, patient-specific drug group (non-steroidal anti-inflammatory drugs (NSAIDs), sodium or calcium channel blockers, monoamine reuptake inhibitors, etc.) and draw up a treatment regimen.

2. In prescribing painkillers, the doctor usually adheres to the rational sequence of prescribing painkillers, which means the following:

  • It is possible to use several drugs that support analgesia;
  • Use of an adequate period of time to evaluate the effectiveness of the drug (perhaps several weeks);
  • The use of a combination of drugs;
  • warning of their side effects.

3. Only a doctor can recommend the rational use of drugs as a component of complex pain therapy, i.e. appoint additional sessions of physiotherapy, blockade with local anesthetics, and possibly recommend the use of neurosurgical methods.

Warning: chronic pain! A very serious medical problem is chronic pain - an independent syndrome that develops with progressive diseases and persistent dysfunction of organs and systems, in which etiotropic therapy is not effective enough or impossible.

acute pain

Acute pain plays a protective role and contributes to the maintenance of life. It signals damage, which helps the body protect itself from further injury. Acute pain optimizes behavior by promoting wound healing (eg, laying down or immobilizing the injured limb). Thus, it has a protective value for the body. Special care is required for acute pain.

chronic pain

Chronic pain (more than 6 months), unlike acute pain, is devoid of a signaling and protective function and does not contribute to optimizing the patient's behavior aimed at healing the injury. Chronic pain becomes an independent painful condition, as it leads to mental exhaustion and social maladaptation. The patient may experience irritability, weakness, a narrowing of the circle of interests and a decrease in social activity. Treatment of chronic pain requires a preliminary examination of the patient and finding out the causes of this syndrome.

The significance of chronic pain is determined not only by the severe suffering of patients who experience this painful symptom for a long time, which inevitably leads to physical and social maladjustment. But - at present, this is no longer in doubt - chronic pain is an independent factor that significantly worsens life prognosis.

Note to supervisor

Therapy of chronic pain is an extremely difficult test for the doctor. Physician-patient interactions must include many factors: pain relief, stress reduction, resumption of normal activity, return to professional status. Often the treatment of chronic pain requires the participation of several specialists, but for the result to be successful, it is necessary that the patient also has a stake in the success.

Counseling a visitor with chronic pain

Usually visitors with chronic pain are frequent visitors to the pharmacy. Unfortunately, counseling such visitors presents some difficulties, since a long-term pain syndrome turns healthy and strong people into neurasthenics, distrustful, suspicious and very dependent on the doctor. Although a visitor with chronic pain usually purchases drugs by prescription, the participation of a pharmacist certainly has a positive effect on the correctness of taking medications. To do this, the patient and the pharmacist must establish friendly contact, i.e. the latter must have good communication skills, even despite the negative changes in the former's character caused by chronic pain.

Irritability with pain

An effective visitor-pharmacist relationship is possible if the latter is able to be a source of understandable information. It must be understood that the patient may experience irritability with pain, which depletes his mental and adaptive forces.

The pharmacist must remove barriers in communication with the patient related to his educational, socio-economic and cultural level, interests and habits. In addition, the patient must be sure of the strict confidentiality of all information discussed with the pharmacist.

The pharmacist should first determine the patient's level of awareness. In the course of communication, it is necessary to use easy-to-understand words and avoid complex medical terms.

Effective communication occurs when the recipient of the information hears and understands what is being communicated to him. This can be achieved through active listening. irritability with pain can be stopped with mild sedatives.

Do not forget that pain exhausts the patient not only physically, but also mentally. A patient with chronic pain is focused only on his own body, so you should not independently initiate a conflict with him. Remember that according to the Code of Ethics, "the main duty of the pharmacist is to look after the welfare of each patient and put his interests above his own interests."

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 time. 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 viewed 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 when these pathways appeared 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 maladjustment - 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. As well as the pain sensitivity system, the anti-pain system has a complex multi-level 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 the pain and its intensity, depending on the strength and duration of exposure to the irritating factor.



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