Pain is a warning sign. Pain, pain syndrome: causes, types, diagnosis, treatment of diseases, pain with general symptoms

This is the first one described by doctors Ancient Greece and Rome symptoms - signs of inflammatory damage. Pain is something that signals us about some kind of trouble that arises inside the body or about the action of some destructive and irritating factor from outside.

Pain, according to the well-known Russian physiologist P. Anokhin, is designed to mobilize a variety of functional systems the body to protect it from harmful factors. Pain includes such components as: sensation, somatic (bodily), autonomic and behavioral reactions, consciousness, memory, emotions and motivation. Thus, pain is a unifying integrative function of an integral living organism. IN in this case – human body. For living organisms, even without possessing signs of higher nervous activity may experience pain.

There are facts of changes in electrical potentials in plants, which were recorded when their parts were damaged, as well as the same electrical reactions when researchers caused injury to neighboring plants. Thus, the plants responded to damage caused to them or neighboring plants. Only pain has such a unique equivalent. This is an interesting, one might say, universal property of all biological organisms.

Types of pain – physiological (acute) and pathological (chronic).

Pain happens physiological (acute) And pathological (chronic).

Acute pain

According to the figurative expression of academician I.P. Pavlova, is the most important evolutionary acquisition, and is required for protection from the effects of destructive factors. The meaning of physiological pain is to reject everything that threatens the life process and disrupts the body’s balance with the internal and external environment.

Chronic pain

This phenomenon is somewhat more complex, which is formed as a result of long-term pathological processes in the body. These processes can be either congenital or acquired during life. To purchased pathological processes include the following - long-term existence of foci of inflammation that have various reasons, all kinds of neoplasms (benign and malignant), traumatic injuries, surgical interventions, outcomes of inflammatory processes (for example, the formation of adhesions between organs, changes in the properties of the tissues that make up them). Congenital pathological processes include the following - various anomalies in the location of internal organs (for example, the location of the heart outside the chest), congenital developmental anomalies (for example, congenital intestinal diverticulum and others). Thus, a long-term source of damage leads to constant and minor damage to the structures of the body, which also constantly creates pain impulses about damage to these structures of the body affected by the chronic pathological process.

Since these injuries are minimal, the pain impulses are quite weak, and the pain becomes constant, chronic and accompanies a person everywhere and almost around the clock. The pain becomes habitual, but does not disappear anywhere and remains a source of long-term irritation. Pain syndrome that exists in a person for six or more months leads to significant changes in the human body. There is a violation of the leading mechanisms of regulation of the most important functions of the human body, disorganization of behavior and psyche. The social, family and personal adaptation of this particular individual suffers.

How common is chronic pain?
According to research by the World Health Organization (WHO), every fifth person on the planet suffers from chronic pain caused by all kinds of pathological conditions associated with diseases of various organs and systems of the body. This means that at least 20% of people suffer from chronic pain of varying severity, intensity and duration.

What is pain and how does it occur? The part of the nervous system responsible for transmitting pain sensitivity, substances that cause and maintain pain.

The sensation of pain is a complex physiological process, including peripheral and central mechanisms, and having emotional, mental, and often vegetative overtones. The mechanisms of the pain phenomenon have not been fully disclosed to date, despite numerous scientific studies that continue to this day. However, let us consider the main stages and mechanisms of pain perception.

Nerve cells that transmit pain signals, types of nerve fibers.

The very first stage of pain perception is the effect on pain receptors ( nociceptors). These pain receptors are located in all internal organs, bones, ligaments, in the skin, on the mucous membranes of various organs in contact with the external environment (for example, on the mucous membrane of the intestines, nose, throat, etc.).

Today, there are two main types of pain receptors: the first are free nerve endings, when irritated, a feeling of dull, diffuse pain occurs, and the second are complex pain receptors, when excited, a feeling of acute and localized pain occurs. That is, character pain directly depends on which pain receptors perceive irritant effect. Regarding specific agents that can irritate pain receptors, we can say that they include various biologically active substances (BAS), formed in pathological foci (the so-called algogenic substances). These substances include various chemical compounds - these are biogenic amines, and products of inflammation and cell breakdown, and products of local immune reactions. All these substances, completely different in chemical structure, can have an irritating effect on pain receptors of various locations.

Prostaglandins are substances that support the body's inflammatory response.

However, there are a number chemical compounds involved in biochemical reactions that themselves cannot directly affect pain receptors, but enhance the effects of substances causing inflammation. This class of substances, for example, includes prostaglandins. Prostaglandins are formed from special substances - phospholipids, which form the basis of the cell membrane. This process proceeds as follows: a certain pathological agent (for example, enzymes form prostaglandins and leukotrienes. Prostaglandins and leukotrienes are generally called eicosanoids and play important role in development inflammatory reaction. The role of prostaglandins in the formation of pain in endometriosis, premenstrual syndrome, and painful menstrual syndrome (algomenorrhea) has been proven.

So, we looked at the first stage of the formation of pain - the effect on special pain receptors. Let's consider what happens next, how a person feels pain of a certain localization and nature. To understand this process, it is necessary to become familiar with the pathways.

How does the pain signal enter the brain? Pain receptor, peripheral nerve, spinal cord, thalamus - more about them.

Bioelectric pain signal formed in the pain receptor along several types of nerve conductors (peripheral nerves), bypassing intraorgan and intracavity ganglia, heading towards spinal nerve ganglia (nodes) located next to the spinal cord. These nerve ganglia accompany every vertebra from the cervical to some lumbar. Thus, a chain of nerve ganglia is formed, running to the right and left along the spinal column. Each nerve ganglion is connected to the corresponding part (segment) of the spinal cord. The further path of the pain impulse from the spinal nerve ganglia is sent to the spinal cord, which is directly connected to the nerve fibers.

In fact, the spinal cord is a heterogeneous structure; it contains white and gray matter (as in the brain). If the spinal cord is examined in a cross section, the gray matter will look like the wings of a butterfly, and the white matter will surround it on all sides, forming the rounded outlines of the boundaries of the spinal cord. So, the back part of these butterfly wings is called the dorsal horn of the spinal cord. They carry nerve impulses to the brain. The front horns, logically, should be located in front of the wings - and this is what happens. It is the anterior horns that conduct nerve impulses from the brain to the peripheral nerves. Also in the spinal cord in its central part there are structures that directly connect the nerve cells of the anterior and posterior horns spinal cord - thanks to this, it is possible to form a so-called “short reflex arc”, when some movements occur unconsciously - that is, without the participation of the brain. An example of how a short reflex arc works is when a hand is pulled away from a hot object.

Since the spinal cord has a segmental structure, therefore, each segment of the spinal cord includes nerve conductors from its own area of ​​​​responsibility. In the presence of an acute stimulus from the cells of the posterior horns of the spinal cord, excitation can abruptly switch to the cells of the anterior horns of the spinal segment, which causes a lightning-fast motor reaction. If you touched a hot object with your hand, you immediately pulled your hand back. At the same time, the pain impulse still reaches the cerebral cortex, and we realize that we have touched a hot object, although our hand has already been reflexively withdrawn. Similar neuro-reflex arcs for individual segments of the spinal cord and sensitive peripheral areas may differ in the construction of levels of participation of the central nervous system.

How does a nerve impulse reach the brain?

Next, from the posterior horns of the spinal cord, the path of pain sensitivity is sent to the overlying parts of the central nervous system along two pathways - along the so-called “old” and “new” spinothalamic (nerve impulse path: spinal cord - thalamus) pathways. The names “old” and “new” are conditional and speak only about the time of appearance of these paths in the historical period of the evolution of the nervous system. We will not, however, go into the intermediate stages of a rather complex neural pathway; we will limit ourselves to just stating the fact that both of these paths of pain sensitivity end in areas of the sensitive cerebral cortex. Both the “old” and “new” spinothalamic tracts pass through the thalamus (a special part of the brain), and the “old” spinothalamic tract– also through a complex of structures of the limbic system of the brain. The structures of the limbic system of the brain are largely involved in the formation of emotions and the formation of behavioral reactions.

It is assumed that the first, evolutionarily younger system (the “new” spinothalamic pathway) for conducting pain sensitivity creates a more specific and localized pain, while the second, evolutionarily more ancient (the “old” spinothalamic pathway) serves to conduct impulses that give the sensation of viscous, poorly localized pain. pain. In addition to this, this “old” spinothalamic system provides emotional coloring of the pain sensation, and also participates in the formation of behavioral and motivational components of emotional experiences associated with pain.

Before reaching sensitive areas of the cerebral cortex, pain impulses undergo so-called pre-processing in certain parts of the central nervous system. This is the already mentioned thalamus (visual thalamus), hypothalamus, reticular (reticular) formation, areas of the midbrain and medulla oblongata. The first, and perhaps one of the most important filters on the path of pain sensitivity is the thalamus. All the sensations from external environment, from the receptors of internal organs - everything passes through the thalamus. An unimaginable amount of sensitive and painful impulses passes through this part of the brain every second, day and night. We do not feel the friction of the heart valves or the movement of organs abdominal cavity, all kinds of articular surfaces against each other - and all this thanks to the thalamus.

In case of disruption of the so-called anti-pain system (for example, in the absence of the production of internal, own morphine-like substances, which arose due to the use of narcotic drugs) the above-mentioned barrage of all kinds of pain and other sensitivity simply overwhelms the brain, leading to emotional pain sensations that are terrifying in duration, strength and severity. This is the reason, in a somewhat simplified form, for the so-called “withdrawal” when there is a deficiency in the supply of morphine-like substances from the outside against the background of long-term use of narcotic drugs.

How is the pain impulse processed by the brain?

The posterior nuclei of the thalamus provide information about the localization of the source of pain, and its median nuclei provide information about the duration of exposure to the irritating agent. The hypothalamus, as the most important regulatory center of the autonomic nervous system, participates in the formation of the autonomic component of the pain reaction indirectly, through the involvement of centers regulating metabolism, the functioning of the respiratory, cardiovascular and other body systems. The reticular formation coordinates already partially processed information. The role of the reticular formation in the formation of the sensation of pain as a kind of special integrated state of the body, with the inclusion of all kinds of biochemical, vegetative, and somatic components, is especially emphasized. The limbic system of the brain provides a negative emotional coloring. The very process of awareness of pain as such, determining the localization of the pain source (meaning a specific area of ​​one’s own body) in conjunction with the most complex and varied reactions to pain impulses certainly occurs with the participation of the cerebral cortex.

The sensory areas of the cerebral cortex are the highest modulators of pain sensitivity and play the role of the so-called cortical analyzer of information about the fact, duration and localization of the pain impulse. It is at the level of the cortex that the integration of information from various types of conductors of pain sensitivity occurs, which means the full development of pain as a multifaceted and diverse sensation. At the end of the last century, it was revealed that each level of the pain system from the receptor apparatus to the central analyzing systems of the brain can have the property of amplification pain impulses. Like a kind of transformer substations on power lines.

We even have to talk about the so-called generators of pathologically enhanced excitation. Thus, from a modern point of view, these generators are considered as the pathophysiological basis of pain syndromes. The mentioned theory of systemic generator mechanisms allows us to explain why, with minor irritation, the pain response can be quite significant in sensation, why, after the cessation of the stimulus, the sensation of pain continues to persist, and also helps to explain the appearance of pain in response to stimulation of skin projection zones (reflexogenic zones) in pathologies of various internal organs.

Chronic pain of any origin leads to increased irritability, decreased performance, loss of interest in life, sleep disturbances, changes in the emotional-volitional sphere, and often leads to the development of hypochondria and depression. All of these consequences themselves intensify the pathological pain reaction. The occurrence of such a situation is interpreted as the formation of closed vicious circles: painful stimulus – psycho-emotional disorders – behavioral and motivational disorders, manifested in the form of social, family and personal maladjustment – ​​pain.

Anti-pain system (antinociceptive) - role in the human body. Pain threshold

Along with the existence of a pain system in the human body ( nociceptive), there is also an anti-pain system ( antinociceptive). What does the anti-pain system do? First of all, each organism has its own genetically programmed threshold for the perception of pain sensitivity. This threshold allows us to explain why stimuli of the same strength, duration and nature different people react differently. The concept of sensitivity threshold is a universal property of all receptor systems of the body, including pain. Just like the pain sensitivity system, the anti-pain system has a complex multi-level structure, starting from the level of the spinal cord and ending with the cerebral cortex.

How is the activity of the anti-pain system regulated?

The complex activity of the anti-pain system is ensured by a chain of complex neurochemical and neurophysiological mechanisms. The main role in this system belongs to several classes of chemical substances - brain neuropeptides. These include morphine-like compounds - endogenous opiates(beta-endorphin, dynorphin, various enkephalins). These substances can be considered so-called endogenous analgesics. Specified chemical substances have an inhibitory effect on neurons of the pain system, activate anti-pain neurons, modulate the activity of higher nerve centers of pain sensitivity. The content of these anti-pain substances in the central nervous system decreases with the development of pain syndromes. Apparently, this explains the decrease in the threshold of pain sensitivity up to the appearance of independent pain sensations in the absence of a painful stimulus.

It should also be noted that in the anti-pain system, along with morphine-like opiate endogenous analgesics, well-known brain mediators play an important role, such as serotonin, norepinephrine, dopamine, gamma-aminobutyric acid (GABA), as well as hormones and hormone-like substances - vasopressin (antidiuretic hormone), neurotensin. Interestingly, the action of brain mediators is possible both at the level of the spinal cord and the brain. Summarizing the above, we can conclude that turning on the anti-pain system allows us to weaken the flow of pain impulses and reduce pain. If any inaccuracies occur in the operation of this system, any pain can be perceived as intense.

Thus, all pain sensations are regulated by the joint interaction of the nociceptive and antinociceptive systems. Only their coordinated work and subtle interaction allows us to adequately perceive pain and its intensity, depending on the strength and duration of exposure to the irritating factor.

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

The feeling of pain occurs when sensitive nerve endings are irritated, a huge number of which are found in the skin and other parts of the body. These pain receptors sense many different stimuli, such as heat, pressure, or stretch; The reaction they cause may also be different. Each person experiences pain differently, and psychological factors sharpen this perception. In general, pain is an alarm signal that the body is in danger, is under excessive stress, or is sick.

If you have pain

• Pain is an alarm signal from our body. Take this signal seriously and try to eliminate the cause of the pain.
• Painkillers may help reduce the external manifestations of pain, but will not eliminate its cause.
• Since pain that is not treated can become chronic, it must be treated.
• If the pain does not go away, go to the doctor. You should also see a doctor if you cannot determine the exact location of severe pain, or if you have other complaints besides pain.
• Painkiller medications can have various side effects, especially if used for a long time. Consult your doctor or physical therapist about the safe use of these medications.
• Pregnant and breastfeeding women should not take painkillers. Many of them can cause severe problems in children. In small doses, they can be taken by infants and young children (for more than detailed information consult your doctor or pharmacist).

Definition, transmission and perception of pain

To better understand what pain is, let's consider how our body perceives the pain signal and how this information is transmitted further and processed.

Nerve cells receive and transmit signals. Each nerve cell has a part with which it perceives the signal and transmits it further. The short branches of a nerve cell are called dendrites, and they receive stimuli. When the free end of a nerve is irritated, an electrical signal is generated, which is transmitted further through the nerve cell to the axon. An axon is a long extension of a nerve, often covered in a myelin sheath. The myelin sheath speeds up the transmission of electrical signals. The axon operates on the principle of a one-way street, and along it the signal goes only in one direction - to the ending that transmits the signal. At the end of the nerve there are synapses that provide signal transmission to other nerve and muscle cells.

At the synapse, an electrical signal stimulates the release and release of substances called neurotransmitters into the synaptic cleft. Neurotransmitters enter 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, enter the cell through these channels. They have an electrical charge, which causes the formation of the corresponding electric potential and electrical signal transmission.

When the signal reaches the spinal cord, it is transmitted further to the brain. The signal first travels to a region of the brain known as the thalamus, and from there to the sensitive areas of the cerebral cortex. Here the signal is converted 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 at all. A signal in the spinal cord can trigger the reflex. In this case, the signal is transmitted further to nerve cells called motor neurons, which cause the muscles to contract. Thanks to this, we can react to pain even before we have determined through analysis what kind of sensation it is.

For example, when we touch a hot surface with our hand, we pull it away before we even realize that the surface is hot.

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

If you wear shoes for a certain amount of time and don’t concentrate on the sensations, you gradually stop noticing them. But if the shoes are uncomfortable and cause pain, it becomes difficult to pay attention to anything else.

Types of pain

The pain can vary in intensity and cause different sensations - from tingling to burning and throbbing. If the patient is able to identify the source of pain and describe its type, it is much easier to determine its cause.

Types of pain depending on location:

Somatic pain comes 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 pain occurs when nerve cells are overstimulated or damaged.

Acute and chronic pain

Acute pain lasts for a limited period of time and can pass quickly, so it is easier to bear, even if it is more intense
Chronic pain can be either long-lasting (back pain, pain caused by a tumor) or recurring frequently (migraine, angina). Chronic pain is difficult to bear

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 is caused by a real pain signal.

Pain memory

Without adequate treatment, the pain signal continues to flow and can cause irreversible changes in the nerve fibers. The nerves become too sensitive, and even a slight touch or change in temperature gives rise to a feeling of pain. Thus, easily treatable acute pain can become difficult to tolerate chronic pain.

Pain is closely related to an individual's pain threshold. Each person reacts to pain differently. The pain threshold is also influenced by the specific situation, for example, fear exacerbates the perception of pain, and concentration on some other object softens it.

Pain intensity

The intensity of pain cannot be measured because each of us has a different threshold for pain perception. Therefore, to assess the intensity of pain, various questionnaires are used.

The simplest way to measure pain is with a visual analogue scale. The patient is asked to describe the intensity of the pain by selecting the appropriate number of items 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 pain level or pictogram. For young children, along with this scale, use a diagram with various expressions on the child's face that convey shades of pain

Describing the intensity of pain using words

0 No pain 2 Mild pain 4 Moderate pain 6 Moderate pain 8 Severe pain 10 Unbearable pain

Wong-Baker Face Scale

Pain tolerance scale

0 No pain 2 Pain can be ignored 4 Interferes with activities 6 Interferes with concentration 8 Interferes with basic needs 10 Requires bed rest

Other questionnaires include questions about the location of pain and an accurate description of the sensations. An accurate description of pain helps in making a diagnosis. IN individual situations and in cases of illness, more detailed analysis. Several types of standardized questionnaires are available to help determine the severity of the disease and its impact on quality of life. Patients are asked whether they are able to cope with daily activities, such as dressing, bathing, etc.

By using modern methods It is possible to monitor 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 determine how bad a patient feels due to the pain they experience.

Pain and inflammation

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

To understand how pain and inflammation are related to each other, consider the following example. Touching a sharp object, such as a needle or knife, causes an instinctive reaction in the body: the hand withdraws from the object even before we have subjected the situation to conscious analysis. Immediately after this we feel a sharp pain. The body's response depends on the severity of the injury. The heartbeat quickens and the body mobilizes for action. dangerous situation. The initial pain subsides over a few minutes or hours. The next day, changes are visible at the wound site: it is red and sometimes hot. The feeling of pain also changed: acute pain was replaced by diffuse pain. In addition, even lightly touching intact, reddened skin next to the wound can be painful.

The reason for 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 expansion of small blood vessels. More blood flows to the tissues, which explains their redness and feeling of heat. Inflammatory mediators also increase the sensitivity of nerve cells, so even a soft touch, which normal conditions would not cause discomfort, but it is painful at the wound site.

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

Pain treatment

Pain can be the result of various factors and manifests itself with different intensities, so there is no one optimal way to treat all cases of pain, and each patient's response to treatment is individual. Because of this, treatment must be specific. The main goal is to eliminate the cause of pain.

Remedies for pain:

Weak and medium action

Paracetamol
NSAIDs (Diclofenac, Ibuprofen, Naproxen)
Metamiazole

Potent

Tramadol
Mild opioids
Strong opioids
Up

Drug therapy for pain

Depending on the intensity of the pain or its location, various medications or groups of medications are used. To relieve acute pain, people often resort primarily to drugs containing paracetamol. Paracetamol does not have a pronounced anti-inflammatory effect; it is gentle on the stomach, but can cause serious disturbances in the liver. Patients with liver problems should consult their doctor before taking these medications.

Drinking alcohol at the same time as paracetamol can be very dangerous and even fatal.

The group of non-steroidal anti-inflammatory drugs (NSAIDs) includes many different drugs. The most commonly used medications 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 stomach ulcers should consult their doctor before using these medications.

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

Metamiazole is a strong NSAID given to patients with severe pain. But it can cause blood problems, such as a decrease in the number of white blood cells and red blood cells. Because of this additional risk, the doctor must evaluate the balance between the benefits of therapy and the risks of using this medication. Metamiazole can only be used when it has been prescribed to the patient.

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

All mild and strong opioids have similar side effects, they cause dependence and tolerance. Opioids weaken the function of nerve signal transmission from one nerve cell to another, but at the same time disrupt the transmission of other signals between nerve cells. Opioids have life-threatening side effects, such as depression respiratory function and decreased gastrointestinal activity. Opioids are substances whose circulation is strictly controlled and which are used only in special cases, for example, to relieve post-operative or tumor-related pain. Antiepileptic drugs and vitamin B2 are more effective in treating neuropathic pain than classical painkillers.

Attention!

The medicine that works wonders for your neighbor will not necessarily help you. It may even be dangerous because you have other risk factors. Talk to your doctor or pharmacist if you decide to change how you manage your pain.

Using more than one medicine at the same time may increase the risk of side effects. Do not change your therapy yourself or take medications that you have at home or that you have purchased without first consulting your doctor or pharmacist.

Non-drug treatment of pain

Non-drug treatment techniques can be used alone or in conjunction with medications. Just as with drug therapy, each patient responds differently to different methods. Your doctor can advise different kinds therapy, but their effect can only be assessed by the patient himself. To understand which method is most effective, it is worth trying several techniques.

Physical therapy helps treat the cause of the pain by training the muscles and improving range of motion. Physiotherapy (massage, warming, cooling) helps to relax, so it is recommended to reduce painful symptoms.

Electrotherapy is based on the peculiarity of the transmission of a nerve signal as an electrical one. Targeted electrical stimulation helps balance the pain signaling system.

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

The effectiveness of any treatment method, with or without medication, can best be assessed by the patient himself. Everyone has individual needs and desires that should be discussed with your healthcare provider. It may be advisable to try another type of treatment if the current one does not provide the desired relief. The list of therapies listed here is far from complete. Your doctor may suggest other alternatives.

How can you avoid unwanted side effects?

Every medication that has any effect can also cause side effects. The doctor carefully evaluates the benefits and possible risks of therapy in order to minimize unwanted side effects.

When choosing a particular medicine to treat a patient, the doctor thinks not only about maximum effectiveness, but also about possible side effects. The doctor should always evaluate the ratio of the desired effect and risks. The risk of adverse events is not equally great in all patients, but depends on the disease, age, gender, other medications taken and other risk factors.

Various forms of medication are available: injections, tablets, suppositories or topical preparations such as gels, patches or sticks. This allows therapy to be tailored to individual needs.

To reduce individual side effects, you can take additional medications at the same time. With long-term use of NSAIDs, therapy is supplemented with gastroprotectors - so-called proton pump inhibitors. These medications reduce the risk of gastrointestinal bleeding that may result from long-term use of NSAIDs.

You can help your doctor choose the most appropriate medicine by telling him or her about other medicines you are taking that were not prescribed for you. The doctor must be informed about all risk factors and your wishes in order to prescribe the optimal treatment for you.

Pain. Everyone knows what this feeling is. Despite the fact that it is very unpleasant, its function is useful. After all, severe pain is a signal from the body, which is aimed at drawing a person’s attention to problems in the body. If the relationship with him is in order, then you can easily distinguish the pain that arose after physical exercise from the one that appeared after a very spicy dish.

Most often it is divided into two types: primary and secondary. Other names are epicritic and protopathic.

Primary pain

Primary is pain that is caused directly by any damage. This may be a sharp pain after a needle prick. This type is very sharp and strong, but after the impact of the damaging object stops, the primary pain immediately disappears.

It often happens that pain after the disappearance of the traumatic effect does not disappear, but acquires the status of a chronic disease. Sometimes it can persist for so long that even doctors are unable to determine the reason why it originally occurred.

Secondary pain

Secondary pain is already nagging in nature. At the same time, it is very difficult to indicate the place in which it is localized. In such a situation, it is customary to talk about a pain syndrome that requires treatment.

Why does pain occur?

So, a person has secondary pain. What is this syndrome? What are its reasons? After tissue damage occurs, pain receptors send a corresponding signal to the central nervous system, that is, the brain and spinal cord. This process is associated with electrical impulses and the release of special substances that are responsible for the transmission of nerve signals between neurons. Since the human nervous system is a rather complex system with many connections, in the management of sensations associated with pain, there are often failures in which neurons send pain impulses even when there are no stimuli.

Localization of pain

Based on localization, the syndrome is divided into two forms: local and projection. If the failure occurred somewhere on the periphery of the human nervous system, then the pain syndrome almost exactly coincides with the damaged area. This may include pain after visiting the dentist.

If a malfunction occurs in the central nervous system, then a projection form appears. This includes phantom, wandering pain.

Depth of pain

According to this characteristic, visceral and somatic are divided.

Visceral pain refers to sensations from the internal organs.

Somatic pain sensations are perceived as joint, muscle and skin pain.

There are symptoms that require urgent attention.

Very strong, sharp pain in the head that has never been experienced before

In this case, you must immediately consult a doctor. This can be either pain from a cold or a cerebral hemorrhage, which is much more serious. If you are not sure of the reason that caused such a feeling, then you need to undergo a medical check or call an ambulance. Treating acute pain before its cause is identified is not a good option. The main sign is that the sensation goes away before the damage heals. Correct diagnosis is very important.

Pain in the throat, chest, jaw, arm, shoulder, or stomach

If you experience chest pain, this may not be a good sign of pneumonia or a heart attack. But you need to know that with heart disease there is usually some discomfort, not pain. What is discomfort in such diseases? Some people complain of tightness in the chest, as if someone is sitting on top of them.

The discomfort associated with heart disease can be felt in the upper chest, as well as in the jaw or throat, left arm or shoulder, and in the abdominal cavity. All this may be accompanied by nausea. So, if a person constantly experiences something like this and knows that he belongs to a risk group, he needs to be checked urgently. After all, very often people waste time because they misinterpret the symptoms of pain. Doctors say that discomfort that occurs from time to time should also be taken seriously. It may be associated with physical tension, emotional distress, or anxiety. If this is experienced after working in the garden, and then goes away during rest, then this is most likely angina pectoris, attacks of which most often occur in hot or cold weather. Discomfort and pain in women with cardiovascular diseases are subtle. They can masquerade as symptoms of gastrointestinal diseases, which include abdominal discomfort and bloating. After menopause, the risk of such diseases increases sharply. Therefore, you need to be attentive to your health.

Pain in the lower back or between the shoulder blades

Some doctors say this is a sign of arthritis. But there are other options to keep in mind. This could be a gastrointestinal disease or a heart attack. In a particular case, aching pain in these places may be a symptom. In people who are at risk for diseases associated with the heart and blood vessels, the integrity of the organs may be compromised. These people include those with excessively high arterial pressure, circulatory problems, as well as smokers and diabetics.

Severe abdominal pain

This may include inflammation of the appendix, problems with the pancreas and gall bladder, as well as stomach ulcers and other disorders that cause abdominal pain. You need to see a doctor.

Pain in the calf muscles

Thrombosis is a very serious disease. It feels strong pain. What is thrombosis? This is when a blood clot forms in the veins, causing discomfort. A large number of people face this disease. Its danger lies in the fact that part of such a clot breaks off, which leads to death. Risk factors are old age, cancer, low mobility after prolonged bed rest, obesity, and pregnancy. Sometimes there is no pain, but only swelling. In any case, it is better to seek help immediately.

Heat in the legs

This problem is familiar to many people with diabetes. It was from this that this dangerous disease. Some people don't know they have diabetes. So heat in the legs is one of the first signs. There is a tingling sensation or sensation that may indicate damaged nerves.

Scattered pain, as well as combined

Various physical painful symptoms often occur during depression. Patients may complain of soreness in the limbs or abdomen, diffuse pain in the head, and sometimes all three. Due to the fact that unpleasant sensations can be chronic and not felt strongly, patients and their families can simply ignore such symptoms. And the stronger depressive disorder, the more difficult it is for a person to describe sensations. Pain after psychological trauma is often difficult to explain. This may confuse doctors. This is why it is important to identify other symptoms before making a diagnosis of depression. If you have lost interest in life, you cannot think and work with high efficiency, and you have quarrels with people, you need to get help from a doctor. When something hurts, you don’t have to endure it in silence. After all, depression is not just a deterioration in the condition and quality of life. It must be treated very actively before it has time to cause serious changes.

All of the above types of pain are dangerous, as they can be symptoms of serious diseases. Therefore, at the slightest sign you should immediately seek help from a doctor. After all, the essence of pain is for a person to understand that something is wrong in the body. In addition to unpleasant sensations and significant changes in the human body, pain can lead to sad consequences, the worst of which is death.

Pain is the most common symptom of most diseases. The occurrence of pain in different parts body indicates that something is wrong with the body, the problem should be identified and treated as soon as possible.

Often sharp pains become chronic along with the course of the disease that caused the discomfort. Therefore, it is important to pay attention to them in time and identify the problem that has arisen before the disease reaches an advanced stage.

Common pains - types

The most common things that bother people are: painful sensations:

• headache;
• joint pain;
• sore throat and many others.

The nature of such experiences also varies depending on the disease. The pain can be sharp, throbbing, aching, and so on. In some cases, its character can directly indicate the probable disease and the stage of its development.

Important! Do not forget that in some cases pain can “radiate” to healthy organs; you should always keep this factor in mind for a correct diagnosis.

Every person experiences a headache at least once in their life. In most cases, this condition is not considered serious, but quite common. However, frequent, unusual, or too intense sensations may indicate serious illness.

Headaches vary in intensity and frequency, usually this helps determine the disease itself. However, the diagnosis is usually confirmed after examination and other symptoms are identified.

Causes

There are many causes of painful sensations in the head. The most common type of chronic pain, migraine, develops due to stress, constant extreme fatigue, and abuse of coffee and other invigorating foods.

The following can also serve as a trigger for headaches:

• high or low blood pressure;
• mental illness;
• excessive physical activity;
• ear diseases;
• diseases of the spine and others.

Painful sensations in the head can also be accompanied by much more serious conditions, such as cerebral hemorrhage, brain tumor or meningitis.

Symptoms

If any symptoms appear, should you be concerned and consult a specialist? After all, not in all cases headaches really need to be treated. You should pay more attention in the following cases:

1. The painful sensations become literally unbearable, too intense.
2. There is tension, a feeling of pressure in the neck, shoulders, and back.
3. Pain sensations are concentrated in one part of the head.
4. The appearance of nausea, photophobia.
5. Increased pain with physical activity or even normal walking.

If attacks appear constantly, they are preceded by “flashes” of light, bright spots, “stars” before the eyes, you should definitely consult a specialist.

Also, the appearance of a headache after a head injury often indicates a concussion.

Important! Normally, the head should not hurt without apparent reason longer than three days in a row. Otherwise, it is recommended to consult a doctor.

Many people are also bothered by painful sensations in the joints. The joints of the legs are especially often affected; pain in the knees is a fairly common reason for visiting a doctor. According to statistics, half of the world's population has experienced them at least once in their lives.

If your knees hurt, you should first determine the cause, the disease that caused the discomfort. After all wrong therapy can greatly harm an already weakened joint.

Causes

Unpleasant sensations in the knees can occur due to ordinary physical strain or injury, but most often this is a consequence developing disease joints. The most common diseases that occur are:

1. Arthrosis. An inflammatory process in which joint tissues are destroyed and the joint itself becomes deformed over time.
2. Arthritis. An inflammatory disease, sometimes a consequence of other problems.
3. Meniscus damage. As a rule, it occurs after an injury, sometimes minor. May provoke arthrosis with deformation. A distinctive feature of pain experienced when the meniscus is damaged is its severity and intensity.
4. Inflammation of the tendons - periarthritis. Most often, pain appears on the inside of the knee and occurs when going up or down stairs in older people.
5. Various vascular pathologies. They do not affect the joint, but the nature of the pain is reminiscent of joint diseases.

Knee pain can also occur due to arthrosis. hip joint. In this case, it will “give” to the knee.

Important! Most knee diseases require careful diagnosis.

Symptoms

There are symptoms, the appearance of which in the presence of pain in the knee will accurately indicate whether there is a problem or discomfort - a consequence of excessive physical activity. You should seriously worry about your health if you have the following signs:

• swelling, fever;
• crunch in the knee;
• aching nature of pain at night.

These symptoms may indicate serious pathologies, so if they are detected, you should immediately consult a doctor and begin treatment.

Unpleasant sensations in the tailbone area when sitting or walking are a common symptom of some diseases of the musculoskeletal system. It often appears after injury, usually a fall. However, pain in the tailbone area may indicate pinched intervertebral discs or calcium deficiency.

It can also appear during pregnancy. In this case, you should urgently consult your doctor; such pain may indicate the presence of various pathologies of fetal development.

A sore throat

Sore throats are also common. Contrary to popular belief, it can occur not only with a cold. Unpleasant sensations in the throat can indicate various problems. respiratory tract and not only.

Causes

The main reason is colds and various respiratory tract infections. Also, a sore throat can appear due to allergies or irritation, for example from cigarette smoke or carbon monoxide.

A feeling of a lump in the throat is often present when cervical osteochondrosis. It may even be accompanied by a cough. This happens due to pinched nerve endings in the cervical spine.

Symptoms

Unpleasant sensations in the throat are usually accompanied by the following symptoms:

• dry cough, hoarseness;
• inflammation of the cervical lymph nodes;
• temperature increase.

If these symptoms are present, you should consult a doctor. Many respiratory diseases have unpleasant complications requiring long-term treatment.

Pain is the most obvious symptom of most diseases and should never be ignored.

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