Pain types of pain and causes. Pain, pain syndrome: causes, types, diagnosis, treatment

The vast majority of diseases are accompanied by pain. Pain is an unpleasant, painful feeling associated with some kind of tissue damage. Pain is one of the main, common and leading symptoms that force the patient to seek medical help from various medical specialists.

Pain is not just a symptom of a disease, it is a complex complex of pathological reactions and patient sensations.

Having arisen as a defensive reaction to pathological stimuli, pain is a signal of trouble and makes us understand that the body is in some kind of danger. While experiencing pain, a person immediately tries to find a way to overcome these negative feelings, to stop the pain. Thus, pain as a symptom is always a marker of any health problem. Pain, even minor, cannot be ignored and its symptoms cannot be ignored. Unfortunately, there are diseases that do not always manifest themselves as pain at an early stage. But in this case, you can almost always turn to other, equally important signs of the disease and consult a doctor.

For an objective assessment of pain, specially developed scales are used, with the help of which, when interviewing a patient, it is possible to clarify the intensity and severity of the pain syndrome. The degree of pain is not always directly proportional to the severity of the sufferer's condition, although such a relationship certainly exists.

To assess the intensity of pain, there is a visual technique based on the patient's assessment of the pain scale on a ten-point system. The numbers from 0 to 10 consistently represent the transition from mild to moderate, and finally to severe pain. Moreover, the number "10" on the scale means unbearable pain, which cannot be tolerated. The patient is asked to show on the scale the figure that corresponds to his feelings of pain. The patient's assessment of the intensity of pain may vary depending on the effectiveness of treatment, after taking an analgesic drug.

Another pain assessment method uses the pain tolerance scale. Thus, "mild pain" is assessed as pain that can be ignored. "Severe pain" - complicates the basic needs of a person, "unbearable pain" - forces the patient to be on bed rest. The sensations of pain can vary significantly for different patients.

Causes and types of pain syndrome

Throughout life, a person encounters pain. There are many reasons for the occurrence of pain, since the vast majority of ailments, among other symptoms, are accompanied by pain.

The pain can be acute or chronic. Acute is a pain syndrome lasting less than three months. Accordingly, pain syndrome becomes chronic if its duration goes beyond this time interval. Acute pain can be stopped after the elimination of the cause that causes it, or become chronic.

Not always an acute, difficult situation is accompanied by acute, severe pain, therefore, the manifestations of the pain syndrome should always be assessed simultaneously with other complaints and symptoms of the disease.

Chronic pain is accompanied by anxiety, depressive symptoms, hypochondria, anxiety, indifference to other problems, a person's personality changes. Chronic pain syndrome often occurs in cancer (acute pain is not excluded), chronic rheumatic processes in the joints and connective tissue, in the spine and other diseases. In patients with chronic pain, sleep and appetite are disturbed, the range of interests is narrowed, everything becomes subordinate to pain. There is a dependence of a person with pain syndrome from others, from pain and taking medications.

Acute and chronic pain can be of varying intensity (from mild pain syndrome to unbearable excruciating pain). Pain syndrome may differ in origin, have a different mechanism of development.

Acute and chronic pain can accompany and be a symptom of diseases of the joints, internal organs. The pain can be with painful spasms and inflammatory processes of any localization, with increased pressure and spasm in the hollow organ, with tissue edema, the effect of the pathological process directly on the sensitive nerve fiber, and so on. There are many reasons for pain, but all types of pain can be divided into the following several types.

Nociceptive pain

Nociceptive pain is a pain syndrome that occurs when painful stimuli act on pain receptors. For example, this type of pain is observed with a variety of inflammatory processes, traumatic injuries, bruises, edema of tissues and organs, sprains and tissue ruptures.

With a decrease in blood circulation in the organ, hypoxia, dismetabolic shifts in the surrounding tissues, nociceptive pain also occurs. Typically, nociceptive pain can be clearly localized. The pain can radiate, that is, give to other places.

Nociceptive pain is observed in various inflammatory diseases of the joints (arthritis, arthrosis), muscles, ligamentous apparatus, muscle spasm, in the postoperative period. The listed types of pain are referred to as somatic pain.

If pain impulses come from the internal organs (heart, gastrointestinal tract), then such pain is called visceral pain. In this case, the nerve fiber itself is not damaged, and pain is perceived by a sensitive neuron, which is affected by damaging factors. Examples of visceral nociceptive pain can be sore throat, pain with exacerbation of peptic ulcer disease, pain with biliary and renal colic, pain syndrome with insufficient blood circulation in the affected limb.

The mechanism of development of nociceptive pain is associated with the fact that, due to damage to cells and tissues, a large number of special substances (pain mediators) are formed, which cause a painful unpleasant sensation called pain. These biological substances include bradykinin, prostaglandins, histamine and acetylcholine. In addition, during inflammation, protective blood cells of the leukocyte series (leukocytes, lymphocytes) rush to the pathological focus, additionally releasing inflammatory factors into the surrounding tissues. This contributes to an even greater pain response and pain degree.

Complaints of patients with nociceptive pain are in the nature of cutting, pressing, shooting pain. Often this pain is perceived as throbbing, squeezing, stabbing, aching, sawing. After the termination of the pathological effect that led to pain, pain tends to rapidly fade and stop. The intensity of pain can increase with movements, turns, and body position disturbance. Conversely, as a rule, pain syndrome (with nociceptive pain) decreases somewhat at rest (not always).

Another type of pain syndrome is neuropathic pain.

Neuropathic pain

Neuropathic pain is mediated by the damaging effect of various factors directly on the functional units of the peripheral and central (spinal and brain) nervous systems. At the same time, the possibility of pathological excitation of nerve cells increases sharply, which can lead to the fact that various, non-painful stimuli are perceived as pain. This type of pain is not protective, but at the same time, it brings patients a lot of suffering and dramatically reduces the quality of life of a sick person. As a rule, this pain is long-term, chronic.

Neuropathic pain is perceived by patients as a feeling of painful tingling, burning unbearable pain, or sensation of needles or pricks, "as if an electric shock". In some patients, neuropathic pain is boring, shooting, baking in nature, can disturb during the day and at night. Often the pain is accompanied by a feeling of crawling, paresthesias, numbness, burning sensation. Quite often the sensation of cold or heat joins the neuropathic pain, there may be sensations as from a blow with nettles. Neuropathic pain syndrome can occur after suffering from herpes zoster ( depriving), due to compression of a part of the spinal cord, with neuropathy as a result of chronic hyperglycemia (diabetes mellitus of both types). Postherpetic neuropathic pain (after suffering herpes zoster) can bother the patient for several months or more, when the blistering rash is no longer detected.

Neuropathic pain is often combined with impaired sensory functions, an increased pain threshold.

Neuropathic pain is classified into two types.

Peripheral neuropathic pain is formed with various neuralgias, polyneuropathies , neuritis, damage to the nerve trunks with tunnel syndromes (compression of the nerve trunk in natural anatomical formations), neuropathies of various origins, shingles.

Neuropathic pain that develops after an acute violation of cerebral circulation, with multiple sclerosis, myelopathy and traumatic lesions of the spinal cord, is called central.

Another type of pain is dysfunctional pain - pain symptoms associated with impaired sensitivity to pain due to an imbalance between the level of pain stimulus and the response to it. In this case, the control of pain by the nervous system is impaired. With this type of pain, there is a "dysfunction" of the central nervous system.

The principles of treatment and diagnosis of pain syndrome

Often a patient may have pains of both neuropathic and nociceptive genesis, since the same person, especially in old age, may have several diseases. It can be difficult to understand which type of pain prevails in this case. Therefore, a doctor or a team of doctors should be involved in pain management.

If pain occurs, you cannot self-medicate, you must contact a specialist of the appropriate profile. There is no universal medicine that would have the same analgesic effect in all patients.

In addition, the approaches to the treatment of acute and chronic pain, the methods of therapy and the drugs used can be completely different.

In the treatment of pain syndrome, both doctors providing emergency care (traumatologists, surgeons, resuscitators) and other specialists (therapists, neuropathologists, endocrinologists, and others) can take part.

When treating pain, it is necessary to find the cause of the ailment, and along with the correction of the pain syndrome, to treat the disease that caused the pain. Taking painkillers without a doctor's prescription, without affecting the cause of the pain, the disease can go into a stage that will be difficult to influence, and sometimes it is already impossible.

Diagnosis of the causes of pain syndrome includes the entire range of necessary analyzes and studies required in this case, which are prescribed only by a doctor.

Therefore, it is very important at the first manifestations of pain syndrome as soon as possible to seek the help of a doctor. Given the nature and mechanism of the development of pain in this patient, the doctor may prescribe various drugs that have analgesic activity. Currently, painkillers are represented by several groups that affect various links in the pathogenesis of pain. However, analgesics that are successfully used in the treatment of nociceptive pain may be ineffective in neuropathic pain. In some cases, the simultaneous use of various drugs is possible, as prescribed by a doctor.

Thus, the treatment of pain and pain syndrome seems to be a complex task, in the treatment of which doctors of various profiles can participate. It is important to prevent the transition of acute pain syndrome to chronic, when, despite the possibilities of pharmacotherapy, the patient has to constantly take painkillers.

Pain is the human body's response to a disease or injury. Although pain is an unpleasant feeling, it plays an important role - it is a warning signal that we are not all right. When we feel pain, we try to eliminate the factor that caused it.

Different people react differently to pain. Our pain perception depends on the severity and extent of the injury, as well as on our psychophysiological status of pain perception.

Did you know?

Pain should be treated, even if it is the result of an illness. Timely use of pain relievers helps faster recovery.

What should everyone know about pain?

There are several types of pain. People describe their feelings in different ways. For example, sometimes there is a strong but short-term headache in the temple area. Also, as a result of a spasm, pain in the abdomen may occur, but it is difficult to tell exactly where it hurts. Injuries can provoke pain in knee joints ... And there are a lot of such descriptions of pain.

Where does the pain arise?

Somatic pain Is pain that occurs in the skin (superficial), muscles, bones, joints, or connective tissue (deep). Pain that occurs in internal organs is called visceral.

How long does the pain last?

Pain that lasts a short period of time is classified as acute pain. In most cases, it is caused by inflammation. When the inflammation is eliminated, the pain goes away. But when the pain goes on for a long time, we talk about chronic pain.

What types of pain can you treat yourself?

You can self-manage mild to moderate acute somatic pain. Choose the method that suits you best:

• physiotherapy or chiropractic
• massage
• acupuncture
• stress management
• medicines

You can try several different pain management options in order to find the one that suits you completely.

When should you see a doctor?

• if the pain is very strong
• if acute pain lasts more than 10 days
• if there is a fever that lasts more than 3 days
• if it is impossible to determine what is causing the pain or if the pain occurs in internal organs (visceral pain)

Why do you need to know about pain?

Controlling the intensity and nature of the pain will allow you to better know it and thus help to avoid it. Your doctor will need as much information as possible about the nature of your pain in order to find the right therapy for you. This is easier to achieve if you have Pain diary.

Why is there pain?

There are several reasons for the pain:

• diseases, injuries, surgical interventions
• pinched nerve
• violation of the integrity of the nerve (injury or surgery)

Sometimes the cause of the pain is unknown.

Various influences (for example, cuts, bone fractures, etc.) lead to irritation pain receptors... From these receptors, an impulse is transmitted along nerve fibers to the central nervous system. At this moment, we feel pain.

At the same time, so-called local inflammatory factors are formed in the area of \u200b\u200bdamage. These substances additionally irritate nociceptors. We say that the damaged area begins to hurt us. Some factors (for example, prostaglandins) are also involved in pain and inflammation.

What medicines to choose for pain relief?

Drugs that reduce pain are called analgesics ... The term "analgesic" is of Greek origin and means "no pain".

There are several types of analgesics. However, only those analgesics that are intended to treat mild to moderate pain can be used for self-medication. These drugs rarely cause side effects or their side effects are minor.

For this purpose, non-steroidal anti-inflammatory drugs (NSAIDs) are most often used. This is a group of medicines that have analgesic, antipyretic and anti-inflammatory effects.

NSAIDs interfere with the synthesis of prostaglandins, which are inflammatory mediators that can result in pain.

The Krka company produces a drug that belongs to the NSAID group.

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

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

What is Acute Pain?

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

• Medical manipulations and surgical intervention (without anesthesia);
• Bone fractures;
• Dental treatment;
• Burns and cuts;
• Childbirth in women;

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

What is chronic pain?

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

Common types of chronic pain are:

• Headache;
• Abdominal pain;
• Back pain and in particular - back pain;
• Side pain;
• Cancer pain;
• Arthritis pain;
• Neurogenic pain arising from nerve damage;
• Psychogenic pain (pain that is not associated with previous illnesses, injuries or any internal problems).

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

2. Doctors who treat pain

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

3. Diagnosis of pain

There are various methods to help determine the cause of the pain. In addition to the general analysis of pain symptoms, special tests and studies can be carried out:

• Computed tomography (CT);
• Magnetic resonance imaging (MRI);
• Discography (examination to diagnose back pain with the introduction of a contrast agent into the vertebral disc);
• A myelogram (also done with the injection of a contrast agent into the spinal canal to increase the X-ray capabilities. A myelogram helps to see the compression of the nerves caused by herniated discs or fractures);
• Bone scans to help identify bone abnormalities due to infection, trauma, or other reasons;
• Ultrasound of internal organs.

4. Pain treatment

Depending on the strength of the pain and its causes, the treatment of pain can be selected in different ways. Of course, self-medication is not worth it, especially if the pain is severe or does not go away for a long time. Symptomatic pain management may include:

• OTC pain relievers, including muscle relaxants, antispasmodics, and some antidepressants
• Nerve block (blockage of a group of nerves with an injection of a local anesthetic)
• Alternative methods of pain treatment such as acupuncture, hirudotherapy, apitherapy and others;
• Electrical stimulation;
• Physiotherapy;
• Surgical pain management;
• Psychological help.

Some pain medications work best when combined with other pain treatments.