Chronic pain

Chronic pain is not a temporary phenomenon and is not a continuation of acute pain, but a situation that requires an individual approach to the choice of treatment. With prolonged pain, changes in the central and peripheral nervous system develop, bearing, depending on the severity, transient or irreversible.

It is known that at the level of the spinal cord in the trunks of the bolus-conducting system with severe chronic pain, “plastic” changes can occur. In a similar degree, it is possible to extend the projection areas of the painful areola in the diseased brain to neighboring areas. Based on these pathophysiological changes, which have been experimentally confirmed in animal studies, it can be concluded that only with the conservative treatment of pain can one prevent the occurrence of chronic pain syndrome (illness) from the very beginning.

Many types of pain, remaining without proper attention, are chronicled, leading to the development of chronic pain disease, but some pains have a chronic nature from the very beginning. They are able to transform into painful disease: headaches, facial pain, pain in the back and spine, musculoskeletal pain, autonomic reflex dystrophy, muscular, postoperative pain, pain caused by the use of drugs, neuralgia due to shingles, phantom pain in a cult, neuropathy, cancer and psychogenic pains, other pains of a deafferentation origin.

Its a tough diagnosis to process

For patients with chronic pain disease are characteristic:

  • long history of pain,
  • repeated and unsuccessful treatment attempts
  • frequent changes of doctors
  • difficulties with drugs
  • possible operations
  • algogenic psycho syndromes,
  • psychosocial effects.

The elimination of pain in cancer patients is one of the most complex and very significant procedures; it is especially difficult to eliminate the pain associated with changes in the bones. Treatment of chronic pain syndrome is quite a serious problem. There are many medications for the treatment of pain, but the problem does not lose relevance. Depending on the intended type and intensity of CBS, various approaches are used to eliminate it. The most optimal is the method of complex pharmacotherapy, based on the use of peripheral and central analgesics of varying potency in combination with adjuvant drugs. The method is effective, simple and accessible for independent use by seriously ill patients in the presence of non-invasive (oral, rectal) dosage forms of drugs and can be used both in inpatient and outpatient settings.

In the traditional version, recommended by the WHO expert committee for the treatment of CBS of increasing intensity, non-narcotic and narcotic analgesics are used according to a three-step scheme (Fig. 1). This method consists in the sequential use of analgesics with increasing intensity of action as the intensity of pain increases, and the beginning of pharmacotherapy at the first signs of pain is an important condition until the entire complex chain reaction characterizing CBS has developed.

According to the World Health Organisation (WHO): non-narcotic analgesics (1st stage) are prescribed for low pain, with a rise to moderate pain, they go to weak opioids (codeine) for the second stage, and to strong opiates (morphine) for strong CBS at the third stage. Unlike the traditional one, this scheme provides, with the ineffectiveness of non-narcotic therapy of the 1st stage, a transition to tramadol (instead of codeine), and with further increase of CBS – to buprenorphine (instead of morphine).

Members of WHO proposed to use an alternative scheme

Mild pain:

  • – non-narcotic analgesic
  • – adjuvant therapy
  • Moderate pain:
  • – tramadol
  • – non-narcotic analgesic
  • – adjuvant therapy

Strong pain:

  • – buprenorphine
  • – non-narcotic analgesic
  • – adjuvant therapy