• Pain - Causes, symptoms and treatment. MF.

    Pain is a signal that something is wrong with the body. This signal should be taken seriously and to find out the true cause of the pain.

    A feeling of pain arises from the irritation of sensitive nerve endings, a huge amount of which is in the skin and other parts of the body. These pain receptors recognize a variety of different stimuli, for example, fever, pressure, or stretching;the reaction caused by them can be different. Each person perceives pain in their own way, and psychological factors exacerbate this perception. In general, pain is an alarm signal that the body is at risk, is overloaded or ill.

    If you have pain

    • Pain is an alarm from our body. Take this signal seriously and try to eliminate the cause of the pain.
    • Analgesic medications can help reduce external manifestations of pain, but do not eliminate its cause.
    • Since pain that is not treated can become chronic, it must be treated.
    • If the pain does not pass, go to the doctor. The doctor should be examined also in case you can not determine the exact localization of severe pain, or you have other complaints other than pain.
    • Painkillers can have various side effects, especially if used for a long time. Consult your physician or physiotherapist about the safe use of these medications.
    • Pregnant and lactating women should not take painkillers. Many of them can cause serious violations in children. In small doses, they can be taken by infants and young children( see your doctor or pharmacist for more information).

    The definition, transmission and perception of pain

    To better understand what pain is, consider how our body perceives a pain signal and how this information is passed on and processed.

    Nerve cells receive and transmit signals. Each nerve cell has a part with which it perceives the signal and transmits it further. Short branches of a nerve cell are called dendrites, they receive stimuli. When the free end of the nerve is irritated, an electrical signal appears, which is transmitted further through the nerve cell to the axon. Axon is a long process of the nerve, often covered with myelin sheath. The myelin sheath accelerates the transmission of the electrical signal. Axon acts on the principle of a one-way road, and on it the signal goes only in one direction - to the signal-transmitting end. At the end of the nerve are located synapses, which provide signal transmission to other nerve and muscle cells.

    In the synapse, the electrical signal stimulates the release and release in the synaptic cleft of substances called neurotransmitters. Neurotransmitters fall on the receptors of a nearby nerve cell and cause the opening of ion channels. Ion channels are small holes through which certain particles can move. Charged atoms, or so-called ions, get through these channels into a cage. They have an electric charge, which causes the formation of an appropriate electrical potential and electrical signal transmission.

    When the signal reaches the spinal cord, it passes on to the brain. First, the signal enters the brain region known as the "thalamus", and thence to the sensitive areas of the cerebral cortex. Here the signal is transformed into a feeling of pain. The type and intensity of the signal determines whether it will be perceived as pain, a simple touch or not perceived at all. A signal in the spinal cord can trigger a reflex. In this case, the signal is transmitted further to the nerve cells, called motor neurons, which cause the muscles to contract. Thanks to this, we can react to pain even before we have determined by the analysis what this feeling is.

    For example, by touching the hot surface with your hand, we pull it away, not yet having realized that the surface is hot.

    The brain continuously receives a huge amount of information from all the sensors in the body. Most of this information is filtered out and does not reach consciousness. Only in this way can you concentrate on important things in every situation.

    If you wear shoes for a certain time and do not concentrate on sensations, then gradually stop to notice them. But if the shoes are uncomfortable and cause pain, it becomes difficult to pay attention to something else.

    Types of pain

    Pain can be of different intensity and cause different sensations - from tingling to burning and rippling. If the patient is able to determine the source of pain and describe its appearance, it is much easier to establish its cause.

    Types of pain depending on location:

    Somatic pains come from the skin, muscles, joints, bones and connective tissues.
    The source of visceral pain is internal organs, for example, their stretching, spasms or inflammation.
    Neuropathic pains occur with excessive irritation or damage to nerve cells.

    Acute and chronic pain

    Acute pain lasts for a limited period of time and can quickly pass, so it is easier to transfer, even if it is more intense
    Chronic pain can be either prolonged( back pain, pain caused by swelling), or repeated( migraine, angina pectoris).Chronic pain is difficult to tolerate.

    . Psychological pain.

    . Not all types of pain arise from irritation of pain receptors. Pain can also be a manifestation of psychological disorders. Such pain is not imaginary, it causes a real signal of pain.

    Pain memory

    In the absence of adequate treatment, the pain signal continues to flow and can cause irreversible changes in nerve fibers. Nerves become too sensitive, and even an insignificant touch or a change in temperature gives rise to a feeling of pain. Thus, an acute pain that is easily treatable can become difficult to bear chronic.

    Pain is closely related to the individual threshold of pain perception. Each person reacts in his own way to pain. The pain threshold is also influenced by a specific situation, for example, fear aggravates the perception of pain, and concentration on some other subject softens it.

    Pain intensity

    The intensity of pain can not be measured, because each of us has a threshold of pain perception. Therefore, to assess the intensity of pain, use a different questionnaire.

    The easiest way to measure pain is visual analogue scale. The patient is asked to describe the intensity of pain by selecting the appropriate number of points from 0 to 10, where 0 is "no pain" and 10 is "unbearable pain."This scale is often supplemented by a more detailed description of the level of pain or pictograph. For young children, along with this scale, use a diagram with different expressions of the child's face that convey the shades of pain

    Description of the intensity of pain with the words

    0 Pain is missing 2 Light pain 4 Moderate pain 6 Moderate pain 8 Severe pain 10 Intolerable pain

    Facial scale Wong-Baker

    Scale of pain tolerance

    0 Pain absent 2 Pain can be ignored 4 Disrupts activity 6 Prevents concentration 8 Does not interfere with basic needs 10 Bed rest is needed

    Other questionnaires include a questionon the localization of the pain sensations and accurate description. An accurate description of the pain helps with the diagnosis. In some situations and cases of disease, more detailed analysis is needed. There are several types of standard questionnaires that help to establish the severity of the disease and its impact on the quality of life. Patients are asked if they are able to cope with everyday activities, for example, to get dressed, washed, etc.

    With the help of modern methods one can observe the activity of different parts of the brain and determine the level of activity of nerve cells, but there is no method by which one can establish how bad the patient feels due to perceived pain.

    Pain and inflammation

    Pain and inflammation are often closely related and can form an enchanted circle: inflammation increases pain, and pain stimulates the formation of inflammatory mediators.

    To understand how pain and inflammation are related to one another, consider the following example. Touching an acute object, such as a needle or knife, causes an instinctive reaction of the body: the hand is torn from the object even before we have subjected the situation to a conscious analysis. Right after that, we feel a sharp pain. The reaction of the body depends on the severity of the damage. The heartbeat is increasing, and the body is mobilized for action in a dangerous situation. The initial pain decreases in a few minutes or hours. The next day on the wound site changes are visible: it is reddened and sometimes hot. Changed and the feeling of pain: acute pain replaced by diffuse. In addition, even an easy touch to the intact, reddened skin next to the wound can be painful.

    The cause of these changes is the onset of the inflammatory process. Pain as a result of injury stimulates nearby tissues, where inflammatory mediators are formed, which in turn cause the enlargement of small blood vessels. To the tissues comes more blood, which explains their reddening and feeling of heat. Mediators of inflammation also increase the sensitivity of nerve cells, so even a mild touch, which under normal conditions would not cause discomfort, is painful in the wound site.

    Pain provokes inflammation, and inflammation increases the intensity of pain, so often the treatment of pain and the treatment of inflammation are two sides of the same coin.

    Pain management

    Pain can be a consequence of various factors and manifests itself with different intensity, so there is no one optimal way of treating all cases of pain, moreover, the response to treatment for each patient is individual. Because of this, treatment should be specific. The main goal is to eliminate the cause of the pain.

    Remedies for Pain:

    mild and moderate action

    NSAIDs( diclofenac, ibuprofen, naproxen)


    Light opioids
    Strong opioids

    Drug therapy

    pain, depending on the intensity of pain and its localization using differentmedicines or groups of medicines. To alleviate acute pain, it is often used primarily for paracetamol-containing drugs. Paracetamol has no pronounced anti-inflammatory effect, it spares the stomach, but can cause serious disturbances in the activity of the liver. Patients with liver problems should consult their physician before taking these medications.

    Drinking alcohol simultaneously with paracetamol can be very dangerous and even fatal.

    The group of non-steroidal anti-inflammatory drugs( NSAIDs) includes many different drugs. The most widely used medicines contain diclofenac, ibuprofen or naproxen. All NSAIDs reduce pain and inflammation. NSAIDs can damage the stomach or intestines and even cause bleeding. Patients suffering from gastric ulcers should consult their physician before using these medications.

    Acetylsalicylate( AspirinĀ®) is a special representative of the NSAID group, as it reduces blood coagulability. To reduce blood clotting, it is given in small doses to patients who have had a heart attack or stroke, or to patients with a high risk of cardiovascular complications. The side effect of this medication, which, in addition, can cause problems with the stomach, is in this case a desired effect. In therapy, acetylsalicylic acid is often replaced by other NSAIDs that have a lower risk of gastrointestinal side effects.

    Metamiazole is a strong NSAID that is given to patients with severe pain. But it can cause blood problems, for example, a decrease in the number of leukocytes and red blood cells. Because of this additional risk, the doctor must evaluate the relationship between the benefits of therapy and the risks of using this medication. Metamiazole can only be used when it was prescribed to a patient.

    Tramadol is an opioid with a pronounced mild effect, which in rare cases causes breathing problems. But it has, and most of the side effects of opioids, for example, can have a calming effect or cause dizziness and nausea. Patients taking medications containing tramadol are prohibited from driving a car and working with machinery. Just like all opioids, tramadol can cause dependence and tolerance( decrease in the desired effect over time).Tramadol is used in cases where other NSAIDs are not effective enough, and it can only be used as directed by a doctor.

    All light and strong opioids have similar side effects, they cause dependence and tolerance. Opioids weaken the function of transferring a neural signal from one nerve cell to another, but at the same time disrupt the transmission of other signals between nerve cells. Opioids are characterized by life-threatening side effects, for example, respiratory depression and a decrease in gastrointestinal activity. Opioids are substances whose circulation is strictly controlled and which are used only in special cases, for example, to facilitate post-operative or tumor-induced pain. Antiepileptic medicines and vitamin B in the treatment of neuropathic pain are more effective than classic painkillers.


    A medicine that works wonders with your neighbor does not necessarily help you. It can even be dangerous, because you have other risk factors. Talk to your doctor or pharmacist if you decide to change the way you deal with pain.

    Simultaneous use of multiple medicines may increase the risk of side effects. Do not change your therapy yourself and do not take medications that are stored in your home or that you purchased without first consulting your doctor or pharmacist.

    Non-drug pain treatment

    Non-drug treatment methods can be used alone or in combination with medications. Just as in the case of drug therapy, each patient reacts to different methods in his own way. The doctor can advise various therapies, but only the patient can evaluate their effects. To understand which method is most effective, it is worth trying several techniques.

    Physiotherapy helps in the treatment of the cause of pain, as muscles are trained and the amplitude of movements improves. Physiotherapy( massage, warming, cooling) helps to relax, so it is recommended to reduce painful symptoms.

    The basis of electrotherapy is a feature of the transmission of the nerve signal as electrical. Targeted electrical stimulation helps to balance the signal system of pain transmission.

    Methods such as hypnosis, biofeedback and relaxation change the perception of pain in patients with chronic pain and help improve quality of life.

    The effectiveness of any method of treatment, with or without medication, can best be assessed by the patient himself. Everyone has individual needs and desires, which should be discussed with the attending physician. It will be advisable to try another kind of treatment, if used at the moment does not bring the desired relief. The list of the types of therapy listed here is far from complete. Perhaps your doctor will suggest other alternatives.

    How can I avoid undesirable side effects?

    Each medication with any effect can cause side effects. The doctor carefully evaluates the benefits and possible risks of therapy in order to minimize unwanted side effects to a minimum.

    When choosing a specific medicine to treat a patient, the doctor thinks not only about maximum efficiency, but also possible side effects. The doctor should always assess the ratio of the desired effect and risks. The risk of occurrence of undesirable phenomena is not equally great in all patients, but depends on the disease, age, sex, other medications taken and other risk factors.

    Various forms of medicines are available: injections, tablets, suppositories or preparations with external application, for example, gels, patches or pencils. This allows you to coordinate therapy with individual needs.

    To reduce individual side effects, you can simultaneously take additional medications. With prolonged use of NSAIDs, therapy is supplemented with gastroprotectors - the so-called proton pump inhibitors. These medications reduce the risk of gastrointestinal bleeding, which can be the result of prolonged use of NSAIDs.

    You can help your doctor choose the most suitable medicine if you tell him about other medicines that you take, although they were not prescribed to you. The doctor should be informed of all the risk factors and your desires in order to prescribe the best treatment for you.