Unlike the usual pain symptoms that go away with time, chronic pain can last from 1-3 months to many years. The patient’s suffering can be associated with an existing pathological process or a post-traumatic condition.
Chronic pain is a complex clinical problem in many fields of medicine. Gynecologists, traumatologists, neurologists, oncologists and other doctors are facing the problem of adequate analgesic therapy.
The causes of chronic pain can be:
- severe injuries and traumas
- lesions of the peripheral nervous system
- serious diseases, including cancer
The most important characteristic of chronic pain is that it is always subjective. The attending physician is not in a position to accurately diagnose or assess the emotional suffering of the patient with the help of objective scoring scales.
People are mostly capable of independently determining the degree of emotional and physical suffering. Despite the subjectivity of such assessment of pain intensity, this method most often corresponds to its actual level.
Treating physicians distinguish the following types of chronic pain:
- Nociceptive:
- somatic (damage to bones or soft tissues)
- visceral (internal damage)
- Neuropathic (overexcitation or damage to nerve structures)
- Psychogenic (emotional or muscular overload on a background of depression)
A patient may suffer from one or more types of chronic pain, each of which requires a specific approach to therapy. Classification of unpleasant sensory sensations helps to establish which medication can be most effective for a particular patient.
Treatment of chronic pain syndrome should be adapted for each individual patient. To alleviate suffering, doctors use analgesics. The choice of chronic pain killers is determined by several factors, the main ones being the etiology, intensity and type of pain, as well as the individual characteristics of the patient.
The first-line drugs in the therapy of nociceptive pain are non-narcotic analgesics, including NSAID and Paracetamol. With moderate severity of neuropathic pain symptoms, opioid analgesics are used.
A peculiarity of psychogenic pain is that it occurs without any organic damage. Many medical specialists in the diagnosis of diseases note the relationship between chronic pain and depression. Psychological factors have a significant impact on physical and emotional excitement. In turn, the psychological balance of a person depends on the degree of emotional and physical suffering.
The appearance of depression signs means that a person misunderstands the cause of physical discomfort and unreasonably considers his situation to be extremely difficult. Another reason for the onset of depression may be the fact that chronic pain significantly reduces the patient’s life quality. To overcome emotional distress, people first require the help of a psychologist or psychiatrist, while the analgesic therapy becomes a secondary measure.
Regardless of the type and severity of chronic pain, adjuvant therapy should be used together with analgesics. This is an auxiliary treatment of pain symptoms, aimed at increasing the effectiveness of analgesics. Adjuvant analgesics can be anxiolytics, antidepressants, antipsychotics, anticonvulsants and other drugs.
Problems that can arise during the therapy of chronic pain:
- opioid dependence
- side effects of drugs
- polypharmacy (unjustified intake of several analgesics at the same time)
Men and women are equally susceptible to one or another chronic pain symptom. Fibromyalgia, which is a symmetrical physical discomfort throughout the entire body, is characteristic for men. Chronic pain symptoms in fibromyalgia are local or generalized increase in sensitivity to pathological and normal stimuli.
Chronic pain in women is often caused by adenomyosis, which is a pathological proliferation of the endometrium of the uterus. Characteristic signs of adenomyosis are:
- infertility
- chronic pelvic pain
- menstrual disorder
- disorders of the pelvic organs functioning
Relief of physical and emotional suffering in pregnant women is complicated by the fact that many drugs are contraindicated in women during the period of gestation. To reduce the risk of negative effects of drugs on the mother and child, pregnant women should be prescribed analgesics in case of emergency and only under the supervision of the attending physician.
The treatment of chronic pain is an absolute necessity, because it:
- limits the person’s mobility;
- significantly reduces the patient’s life quality;
- negatively affects social activity;
- causes mental and emotional disorders, the disintegration of the central nervous system activity.
Thus, chronic pain symptoms should be arrested, regardless of the severity and causes of their onset. Adequate and timely analgesic therapy reduces the frequency of exacerbations and the emergence of unpleasant sensory and emotional experiences.