“One is born in pain and dies in pain, and between life and death there is more pain than one would like.” This pessimistic concept of existence, in spite of being very real, is in contrast with the thought of the Epicureans and hedonists, for whom one should seek the maximum enjoyment and the greatest corporal or spiritual enjoyment in the face of the hardships that at some point in life will arise. Pain, for man, is an enemy that must be banished and for this he has sought many ways to make it disappear, from invocations and sacrifice to incantations against the forces of evil. However, other natural and empirical remedies have also been used, supported by their own or common experience, using hypnosis and suggestion techniques, preparing themselves with philosophical and moral attitudes and other attitudes. The objective is always the attempt to combat and eliminate it, although pain, ontogenetically, is a reason for alarm and preservation of the individual. However, persistent pain makes it an uncomfortable guest, the so-called chronic pain.
That is why, in all civilizations, in all countries and in all historical moments, it has been tried to explain what and why is pain and how to combat it, so that it has been more important and peremptory emotive for the development of the art of healing.
Pain is a sensation inherent to the human being that fulfills a very important biological function, but, in addition, it is one of the clinical manifestations of multiple diseases. It is estimated that about 20% of the population suffers from chronic pain, a fact that has great individual, social, occupational, welfare and economic repercussions.
Pain is the most frequent cause of medical consultation in Primary Care, being pain of musculoskeletal origin the cause of more than 60% of them. The definition of pain is complicated, since pain encompasses a diversity of aspects and multiple variants. The most widely accepted definition today is that of Merskey, as modified by the taxonomy subcommittee of the International Association for the Study of Pain (IASP). The IASP defines pain as the “unpleasant sensory and emotional experience associated with actual or potential tissue injury”. Pain perception consists of a sensitive neural system (nociceptors) and afferent nerve pathways that respond to tissue stimuli; but nociception is a complex process that can be influenced by other factors such as mood, physical activity and previous experiences.
How is pain classified?
Pain can be classified in many ways, but basically we will refer to the chronology and the existence of an underlying process, and we will not deal with its pathophysiological aspects.
Chronology: acute or chronic pain. As a general rule, the pathophysiology and symptomatology of diseases with acute pain are well known, the diagnosis is not difficult and, with exceptions, there is effective medical or surgical treatment. Therefore, pain and associated responses usually disappear within a few days and weeks. However, an inappropriate approach can result in acute pain becoming chronic.
Chronic pain is the type of pain that lasts beyond tissue repair (3-6 months), may be secondary to pathophysiological changes occurring in the nociceptive system, and is itself a disease.
Underlying disease: oncologic or non-oncologic pain.
Rheumatic diseases are the most common cause of chronic non-oncologic pain. The binomial pain-rheumatic process involves significant comorbidity, loss of functional capacity, incapacity for work and reduced quality of life, hence the importance of pain management.
In the approach to a patient with pain, especially if it is chronic pain, a correct clinical history and physical examination are necessary to define the type of pain and to be able to manage it in the most appropriate way, and it is always necessary to quantify the intensity of the pain to be able to assess the response to treatment.
There are many drugs available for the treatment of pain since Peripheral analgesics are compounds widely used in the clinic for the symptomatic management of musculoskeletal pain with mild or moderate pain. If the intensity is greater and we are talking about moderate-severe intensity, we can resort to opioids, which in recent years have undergone significant pharmacological development with a significant reduction in their adverse effects.
Some antidepressants and antiepileptics are used as co-analgesics, especially in the management of neuropathic pain.
Interventional techniques are intended to try to reduce the nociceptive afferents that reach the brain, where the sensation of pain becomes conscious. They are mainly used for pain that is difficult to control.
It is perhaps the emergence of a new discipline known as “Pain Medicine” that has helped to improve knowledge and approach with the creation of multidisciplinary units with the aim of improving health care for human pain, assisting training and education in this complex field and promoting and disseminating knowledge of it.
Let us be optimistic and positivist and as Marañon said “Without accepted and understood pain, the most profoundly human virtue, which is serenity, would not exist”.