Treatment of chronic pain

General information

Since the phenomenon of chronic pain is at the junction of physiology and psychology, the approach to the treatment of this series of diseases must be complex. The individual treatment plan should cover three areas: the general strengthening of the body, increasing endurance to physical and mental stress, the development of skills for self-analysis and self-control. For this purpose, the following methods are used:

Pharmacological treatment (analgesic and sedative drugs). It should be understood that drug pain relief has a side effect of addiction.

Physical methods of treatment include manual therapy, percutaneous electro neuro stimulation, physical therapy, massage, less often thermal procedures – electrostimulation of the spinal cord and brain. Their effectiveness largely depends on the reasons that served as the background for the development of chronic pain.

Psychological treatments are most effective (behavioral therapy, yoga, cognitive-behavioral therapy, keeping a diary of well-being). It is noticed that in such patients the degree of pain syndrome is inversely proportional to the significance of their suffering for others. In this regard, by itself, any psychological help gives a positive result, because the patient sees a serious attitude to his problem. On the part of loved ones, support may consist in attentive attitude to each next attack.

In no case can one question the reality of chronic pain and convince the patient that it is the result of self-suggestion. Neglect only enhances chronic pain syndrome. On the contrary, patients who have the opportunity to share changes in their condition have a good chance to completely get rid of this ailment.

Recently, eating disorders such as anorexia and bulimia have been heard more and more often, and far beyond the limits of medicine, whereas a few decades ago these diagnoses were discussed almost exclusively by experts in the field of psychoneurological sciences. A number of factors contributed to this unhealthy popularity: the hysterical fashion of anabolic Hollywood heracles and girls of “model appearance” (once one world famous fashion designer wittily, with deep knowledge of the subject, but somewhat cynically noted that the stick is ideal for a fashion designer female figure), a certain satiety and availability in the developed countries of the most diverse food, even if not completely natural, as well as initially communicative, aesthetic, hedonistic (bringing joy and pleasure), soci flax-psychological role that plays for human food consumption.

The term “bulimia” in translation means “bullish hunger”; synonyms – hyperphagia (overeating, unintelligible gluttony), kinorexia (wolfish or, more precisely, canine appetite), cytomania (irresistible food craving), estiomania (uncontrollable passion for the process of eating), etc.

The true prevalence of bulimia is very difficult to assess. This pathological symptom, or its individual manifestations, occurs within the framework of various diseases and in absolutely healthy people, at almost any age, on all continents, in men and women, regardless of race or nationality. The cases of latent bulimia, which remain outside of medical statistics, are practically incalculable. In addition, the diagnosis of bulimia itself (in its various variants) appeared in the international classifications of diseases only in the 1980s, and this phenomenon has not yet been fully studied. In the epidemiological reports there are indicative, approximate frequencies of occurrence: 2-4% of the total population with tenfold (according to other estimates, only six times) the predominance of females. The age interval, in which bulimia is most often detected as a pathology, lies in the range from 14 to 20 years.

The reasons

The causes and risk factors for bulimia are extremely diverse and numerous; as a rule, they are reduced to several large groups.

A certain role is played by hereditary predisposition and congenital individual features of the organization of higher nervous activity as a function of the central nervous system. Another significant factor is family education and pedagogical imbalances, as well as the contempt of a teenager by peers for thinness and frailty. There is a great patoplastic effect of situations of chronic stress, constitutional and personal characteristics, congenital and acquired disorders of neurohumoral regulation or metabolism. Finally, bulimia can be one of the signs of a serious gastroenterological, neurological or mental pathology.

Symptoms and Diagnostics

The leading symptom of bulimia is, by definition, the absorption of abnormally large amounts of food, completely redundant in terms of physiological needs and feasibility.

As a rule, such episodes are paroxysmal in nature and are accompanied by a complex bouquet of extremely uncomfortable experiences (for people with bulimia, feelings of guilt, reduced self-esteem, unsuccessful will, suicidal tendencies, etc.) are very characteristic. In some cases, bulimia is combined with the “reverse side of the medal”, that is, with the mirror-opposite eating disorder – anorexia: patients cause artificial vomiting or profuse diarrhea after the “feast”, try to eat nothing until the next “breakdown”. Sometimes anorexia, on the contrary, acts as a primary disorder, and bulimia turns out to be a “forced” reaction of a constantly starving and exhausted (in some cases to a dangerous degree) organism.

There are many forms and clinical variants of bulimia. So, emotiogenic bulimia acts as a means of “coping with stress”, loneliness, internal conflicts; so-called “Night food syndrome” is usually rationalized as a “cure for depression.” Nervous bulimia is a fairly typical neurosis of obsessive-compulsive type (irresistible, uncontrollable will obsession); seasonal bulimia is still little studied, but also constitutes a relatively independent type of eating disorder.

Diagnosing bulimia can be quite a challenge. It requires productive and trusting contact with the patient and his relatives; It is important to inform the doctor as much as possible about the characteristics and deviations in relation to food and nutrition (in particular, the tendency to eat completely inedible substances may be the key to identifying latently progressive mental disorder). In a number of cases, experimental psychological research, consultations and examinations of specialized specialists have been shown and are necessary.

Treatment

Therapy of behavioral disorders (including eating disorders) requires, respectively, the correction and modification of existing behavioral stereotypes. As a rule, a serious psychotherapeutic course, often conducted with drug support (antidepressants, anxiolytics, tranquilizers, appetite inhibitors, correctors of behavior, anticonvulsants, in severe cases – neuroleptics) is needed. An individual diet is developed, measures are taken to normalize lifestyles, the patient is trained in introspection techniques and effective self-control (using the example of the first small victories, it is extremely important to “make it clear” and “prove” to the brain that the situation is not hopeless and can be controlled completely.

With timely treatment for help and the start of treatment of bulimia in the early stages, the prognosis is favorable. In cases of chronic bulimia, sometimes taking place over decades, severe complications develop (from the gastrointestinal tract, heart, lungs, endocrine, excretory systems), which can ultimately be fatal.