STUDY - Technical - New Dacian's Medicine
About
Pain (2).
Translation Draft
Say something else about "coincidences"...
Say something else about "coincidences"...
I
thought I couldn't finish "The Old Man" by now because of the
current events. Now I've come to believe that I haven't even
finished the pain posts because of current events... And, I
think it's too much...
Recovering "debt" jobs will take a little longer (trust me that I will) because I ended up with my mother (aged 70 at UPU)... Interesting version of my size, isn't it???
But let's go back to the post about the pain, continuing what we presented in the previous one. The normal nervous system transmits coded signals that result in pain. Thus, damage to the central or peripheral nervous system can cause a loss or deterioration of the sensation of pain. Paradoxically, damage or dysfunction of the nervous system can cause pain.
For example, damage to peripheral nerves, such as those in diabetic neuropathy, or to primary aferences, as in herpes zoster, can cause pain that is projected to the region of the body irritated by the affected nerves. Although rarely, pain can also be caused by damage to the central nervous system, especially the spinotalamic tract or thalamus. Such neuropathic pain is often severe and is known to be refractory to standard anti-algal treatments.
Neuropathic pain typically gives unusual burning sensation, tingling, electric shock and can be triggered by a very mild touch. These characteristics are rare in other types of pain, on examination being characteristic the presence of a sensory deficiency in the painful area of the patient.
A variety of mechanisms contribute to neuropathic pain. The primary damaged consequences, including nociceptors, become hypersensitive to mechanical stimulation and begin to generate impulses in the absence of stimulation. The primary damaged occurrences can give sensitivity. It has been observed that spinal neurons involved in the transmission of pain after sectioning can become spontaneously active. Thus, changes in both the central and peripheral nervous systems can contribute to neuropathic pain.
Another type of pain is sympathetic-mediated pain. There are many confirmations that a peripheral nerve injury develops a severe burning pain (causalgia) in the region innervated by that nerve.
Pain typically begins with delay of hours, days or even weeks, accompanied by inflammation of the extremity, periarticular osteoporosis and arthritic changes in the distal joints. A similar syndrome called reflex sympathetic dystrophy can be produced without obvious nerve damage through a variety of injuries, including bone fractures, soft tissue trauma, myocardial infarction and strokes.
Although the physiology of this disturbance is poorly understood, the pain can be remitted in minutes by blocking the sympathetic nervous system. This implies that sympathetic activity stimulates nociceptors, even if they are not obviously harmed. These results also suggest that the sympathetic nervous system may, in certain circumstances, play an active role in inflammation.
The ideal treatment for any pain is the removal of the cause. Sometimes this is possible, but often, after diagnosis and the start of appropriate treatments for the cause, there is a period of latency before the pain decreases in intensity.
Moreover, some conditions are so painful that rapid and effective analgesia is essential (e.g. postoperative condition, burns, trauma, cancer, sickle cell disease). Analgesic medication is the first-line treatment in these cases and the use of such drugs must be known by anyone practicing medicine.
These include aspirin, acetaminophen and nonsteroidal anti-inflammatory drugs - NSAIDs, cyclooxygenase inhibitors, drugs that are treated together because they are used for similar problems, all having anti-inflammatory actions, especially at high doses.
They are particularly effective for the removal of mild and moderate headache and for osteomuscular pain. Another group of analgesics are opioids (the strongest available at the moment) with a high degree of efficacy (the most used being codeine, morphine, methadone, etc.). They produce analgesia by action on the central nervous system (on mu receptors), usually taking intravenously.
The most important principle in the administration of all the medicines presented above is to reduce pain with as little side effects as possible. It requires questioning the patient about the effectiveness of the drug and the time of pain relief. The most common error made by doctors in treating pain is the prescription of inadequate doses, a practice that leads to unnecessary suffering.
And, here we are, the chronic pain. treatment of patients with chronic pain is intellectually and emotionally demanding, especially since the patient is difficult to diagnose. Medical treaties emphasize that the traditional medical approach to the detection of an obscure organic pathology is usually useless.
On the other hand, psychological evaluation and behavioural treatment methods are frequently used in the development of multidisciplinary pain-treatment centres. Thus, there are a multitude of factors that can cause, perpetuate or exacerbate chronic pain.
First, of course, the patient may simply have a disease that is characteristically painful, for which there is no immediate treatment. Arthritis, cancer, migraine, fibromyalgia and diabetic neuropathy are such examples. Secondly, there may be secondary maintenance factors that are initiated by a physical illness and may persist after the disease has been treated.
Examples include damage to the sensitive nerves, sympathetic efferent activity and painful reflex muscle contraction. And finally, but not least, a variety of psychological conditions can exacerbate or even cause pain.
For example, since depression is the most common emotional disorder in patients with conical pain, they will be questioned about their mood, appetite, sleep type and daily activity (remember ing major depression, which is a common, treatable but potentially fatal disease).
These landmarks may show that a significant emotional disorder contributes to the chronicization of a patient's pain: pain occurring in different, unrelated areas, recurrent but separate painful problems, with onset in childhood or adolescence, pain started in a moment of emotional trauma, such as the loss of a loved one (parent, spouse, etc.), a history of sexual abuse or physical aggression, abuse of toxic substances etc.
On examination it will be carefully observed whether the patient protects the painful area and whether certain movements or positions are avoided due to pain (discovering a mechanical component in case of pain is useful in both diagnosis and treatment). Painful areas should be examined for deep sensitivity, sensing whether it is located on muscles, ligament structures or joints.
Chronic myofascial pain is very common, and in these patients deep palpation can reveal localized trigger points, which are hard bands or nodular formations in the muscles (if injection with local anesthetics at these trigger points removes pain, the diagnosis is demonstrated).
A neuropathic component of pain is indicated by the highlighting of nerve damage, such as sensory damage, particularly sensitive skin, muscle weakness and atrophy, or loss of deep tendon reflexes.
The evidence suggesting the involvement of the sympathetic nervous system is the presence of diffuse inflammation, changes in skin coloration and temperature, and skin and joint hypersensitivity compared to the unaffected part (pain relief through sympathetic blockage is diagnosed).
A guiding principle in the evaluation of patients with chronic pain is the determination of both emotional and organic factors. The attempt to resolve from both points of view, rather than waiting to "eliminate" the organic causes of pain, leads to increased compliance, because among other things it assures patients that a psychological evaluation does not mean calling into question the validity of their problem but is something necessary to complete the picture of their problems.
For the treatment of chronic pain (in classical medicine) a multidisciplinary approach is carried out, using drugs, counseling, physical therapy, nerve blockages and even surgery. This is how antidepressant drugs are used (especially tricyclic ones, especially useful in the control of neuropathic pain, such as painful diabetic neuropathy and postherpetic neuralgia, for which there are few therapeutic options), anticonvulsants and antiarrhythmics (such as phenytoin and carbamazepine, especially useful for patients with neuropathic pain - trigeminal neuralgia, as well as lidocaine and mexiletin), as well as chronic opioid medication (accepted in patients with pain due to malignant tumors).
There would be phantom pains, those that occur, for example, in those with amputated limbs (even in some with resected organic elements), but the subject is so controversial (even if it exists, it manifests itself concretely in most individuals - 65% - who have experienced such unfortunate incidents) that I think it is good to discuss these things later.
And so much "introductive" about pain. We should just draw some conclusions from what has been presented. So pain is nothing but a wake-up call about something that goes wrong (cannot be considered a physiological reaction, because suffering cannot be considered a normal state).
Moreover, this feeling of alarm towards an inner or external aggression may, if it does not intervene on the cause that "attracted" it, turn against the body by further weakening it (in addition to what drew this manifestation of pain) instead of helping it (especially because an intense pain, such as a toothache, can take over the emotional universe and "subjugate" the nervous system by making it unable to perform other tasks).
Finally, but not least, let us not forget that pain does not always occur where there is a demanding factor which would attract the need for the sensation of pain, without referring to its irradiation. The rest, in future positions...
Recovering "debt" jobs will take a little longer (trust me that I will) because I ended up with my mother (aged 70 at UPU)... Interesting version of my size, isn't it???
But let's go back to the post about the pain, continuing what we presented in the previous one. The normal nervous system transmits coded signals that result in pain. Thus, damage to the central or peripheral nervous system can cause a loss or deterioration of the sensation of pain. Paradoxically, damage or dysfunction of the nervous system can cause pain.
For example, damage to peripheral nerves, such as those in diabetic neuropathy, or to primary aferences, as in herpes zoster, can cause pain that is projected to the region of the body irritated by the affected nerves. Although rarely, pain can also be caused by damage to the central nervous system, especially the spinotalamic tract or thalamus. Such neuropathic pain is often severe and is known to be refractory to standard anti-algal treatments.
Neuropathic pain typically gives unusual burning sensation, tingling, electric shock and can be triggered by a very mild touch. These characteristics are rare in other types of pain, on examination being characteristic the presence of a sensory deficiency in the painful area of the patient.
A variety of mechanisms contribute to neuropathic pain. The primary damaged consequences, including nociceptors, become hypersensitive to mechanical stimulation and begin to generate impulses in the absence of stimulation. The primary damaged occurrences can give sensitivity. It has been observed that spinal neurons involved in the transmission of pain after sectioning can become spontaneously active. Thus, changes in both the central and peripheral nervous systems can contribute to neuropathic pain.
Another type of pain is sympathetic-mediated pain. There are many confirmations that a peripheral nerve injury develops a severe burning pain (causalgia) in the region innervated by that nerve.
Pain typically begins with delay of hours, days or even weeks, accompanied by inflammation of the extremity, periarticular osteoporosis and arthritic changes in the distal joints. A similar syndrome called reflex sympathetic dystrophy can be produced without obvious nerve damage through a variety of injuries, including bone fractures, soft tissue trauma, myocardial infarction and strokes.
Although the physiology of this disturbance is poorly understood, the pain can be remitted in minutes by blocking the sympathetic nervous system. This implies that sympathetic activity stimulates nociceptors, even if they are not obviously harmed. These results also suggest that the sympathetic nervous system may, in certain circumstances, play an active role in inflammation.
The ideal treatment for any pain is the removal of the cause. Sometimes this is possible, but often, after diagnosis and the start of appropriate treatments for the cause, there is a period of latency before the pain decreases in intensity.
Moreover, some conditions are so painful that rapid and effective analgesia is essential (e.g. postoperative condition, burns, trauma, cancer, sickle cell disease). Analgesic medication is the first-line treatment in these cases and the use of such drugs must be known by anyone practicing medicine.
These include aspirin, acetaminophen and nonsteroidal anti-inflammatory drugs - NSAIDs, cyclooxygenase inhibitors, drugs that are treated together because they are used for similar problems, all having anti-inflammatory actions, especially at high doses.
They are particularly effective for the removal of mild and moderate headache and for osteomuscular pain. Another group of analgesics are opioids (the strongest available at the moment) with a high degree of efficacy (the most used being codeine, morphine, methadone, etc.). They produce analgesia by action on the central nervous system (on mu receptors), usually taking intravenously.
The most important principle in the administration of all the medicines presented above is to reduce pain with as little side effects as possible. It requires questioning the patient about the effectiveness of the drug and the time of pain relief. The most common error made by doctors in treating pain is the prescription of inadequate doses, a practice that leads to unnecessary suffering.
And, here we are, the chronic pain. treatment of patients with chronic pain is intellectually and emotionally demanding, especially since the patient is difficult to diagnose. Medical treaties emphasize that the traditional medical approach to the detection of an obscure organic pathology is usually useless.
On the other hand, psychological evaluation and behavioural treatment methods are frequently used in the development of multidisciplinary pain-treatment centres. Thus, there are a multitude of factors that can cause, perpetuate or exacerbate chronic pain.
First, of course, the patient may simply have a disease that is characteristically painful, for which there is no immediate treatment. Arthritis, cancer, migraine, fibromyalgia and diabetic neuropathy are such examples. Secondly, there may be secondary maintenance factors that are initiated by a physical illness and may persist after the disease has been treated.
Examples include damage to the sensitive nerves, sympathetic efferent activity and painful reflex muscle contraction. And finally, but not least, a variety of psychological conditions can exacerbate or even cause pain.
For example, since depression is the most common emotional disorder in patients with conical pain, they will be questioned about their mood, appetite, sleep type and daily activity (remember ing major depression, which is a common, treatable but potentially fatal disease).
These landmarks may show that a significant emotional disorder contributes to the chronicization of a patient's pain: pain occurring in different, unrelated areas, recurrent but separate painful problems, with onset in childhood or adolescence, pain started in a moment of emotional trauma, such as the loss of a loved one (parent, spouse, etc.), a history of sexual abuse or physical aggression, abuse of toxic substances etc.
On examination it will be carefully observed whether the patient protects the painful area and whether certain movements or positions are avoided due to pain (discovering a mechanical component in case of pain is useful in both diagnosis and treatment). Painful areas should be examined for deep sensitivity, sensing whether it is located on muscles, ligament structures or joints.
Chronic myofascial pain is very common, and in these patients deep palpation can reveal localized trigger points, which are hard bands or nodular formations in the muscles (if injection with local anesthetics at these trigger points removes pain, the diagnosis is demonstrated).
A neuropathic component of pain is indicated by the highlighting of nerve damage, such as sensory damage, particularly sensitive skin, muscle weakness and atrophy, or loss of deep tendon reflexes.
The evidence suggesting the involvement of the sympathetic nervous system is the presence of diffuse inflammation, changes in skin coloration and temperature, and skin and joint hypersensitivity compared to the unaffected part (pain relief through sympathetic blockage is diagnosed).
A guiding principle in the evaluation of patients with chronic pain is the determination of both emotional and organic factors. The attempt to resolve from both points of view, rather than waiting to "eliminate" the organic causes of pain, leads to increased compliance, because among other things it assures patients that a psychological evaluation does not mean calling into question the validity of their problem but is something necessary to complete the picture of their problems.
For the treatment of chronic pain (in classical medicine) a multidisciplinary approach is carried out, using drugs, counseling, physical therapy, nerve blockages and even surgery. This is how antidepressant drugs are used (especially tricyclic ones, especially useful in the control of neuropathic pain, such as painful diabetic neuropathy and postherpetic neuralgia, for which there are few therapeutic options), anticonvulsants and antiarrhythmics (such as phenytoin and carbamazepine, especially useful for patients with neuropathic pain - trigeminal neuralgia, as well as lidocaine and mexiletin), as well as chronic opioid medication (accepted in patients with pain due to malignant tumors).
There would be phantom pains, those that occur, for example, in those with amputated limbs (even in some with resected organic elements), but the subject is so controversial (even if it exists, it manifests itself concretely in most individuals - 65% - who have experienced such unfortunate incidents) that I think it is good to discuss these things later.
And so much "introductive" about pain. We should just draw some conclusions from what has been presented. So pain is nothing but a wake-up call about something that goes wrong (cannot be considered a physiological reaction, because suffering cannot be considered a normal state).
Moreover, this feeling of alarm towards an inner or external aggression may, if it does not intervene on the cause that "attracted" it, turn against the body by further weakening it (in addition to what drew this manifestation of pain) instead of helping it (especially because an intense pain, such as a toothache, can take over the emotional universe and "subjugate" the nervous system by making it unable to perform other tasks).
Finally, but not least, let us not forget that pain does not always occur where there is a demanding factor which would attract the need for the sensation of pain, without referring to its irradiation. The rest, in future positions...
I
wish you all the best of your healthy elders, to whom you may
give your understanding, love and gratitude!!!
Dorin, Merticaru