Pain is defined as an unpleasant sensory and emotional experience with actual or potential tissue damage and a dysphoric, discomforting sensation. The body responds to this warning signal of damage to prevent or alleviate further consequences. Unrelieved or poorly treated pain can have consequences beyond the momentary suffering, producing a delay in healing, altering the immune system, the response to stress, producing emotional vegetative symptoms such as depression and a possible alteration of the peripheral nervous system in its interpretation in the brain. All this leads to the risk of creating a situation of chronic pain.
Why does chronic pain appear?
Widely demonstrated in epidemiological studies of the W.H.O., approximately 40% of pain is not treated appropriately, being this even worse in underdeveloped countries. Lack of understanding, knowledge and training in most primary care or surgical specialists, as well as a cautiousness in the use of inadequate dosages of analgesic drugs and techniques, are the origin of the problem in acute or chronic pain syndromes that have not been diagnosed or treated properly.
Today it is inconceivable that there are persistent untreated painful conditions, causing anguish to the patient and suffering to their relatives. Specialists and general practitioners should avoid its monopolization, recognize it early and refer patients for early diagnosis, treatment and subsequent follow-up to specific multidisciplinary Pain Units. Early treatment of a painful condition can prevent and simplify its development into a painful syndrome and its subsequent chronification due to adaptive neuroplastic changes in the face of nervous system trauma.
How can chronic pain pathology be addressed?
Pain can become a disease in itself. That is why a methodical and multidisciplinary approach in its diagnosis and treatment is so important to avoid its transformation into a chronic syndrome. However, it is not always possible or advisable to completely eradicate pain, as it often serves as a first sign of internal damage and protection against trauma. The magnitude of the problem is presented in the personal cost of suffering, feelings of incapacity and emotional depression, often the cost of family suffering, absenteeism and loss of work, as well as the indirect socio-economic costs it produces.
Recent studies carried out in the European Community show that one out of every five citizens is affected by some kind of pain. Moreover, the prevalence increases with age up to 47% in those over 65 years of age, more frequent in women; pain in the lower extremities, lumbar and cervical spine, and headaches are predominant in younger people. 29% self-medicate without satisfaction of their ailment and 39% do not take any measure or drug. Twenty-seven percent suffer from interference in their daily activities and of those who were treated in a pain unit, 94% were very satisfied with the prescribed treatment.
How has pain management evolved?
Pain management has evolved enormously with the creation of Pain Units. The first Pain Unit was created in the USA. In Spain it appeared in the 70’s. Since then, Third Level Units have been created in most of the large hospitals. In this unit, acute pain, chronic non-operable lumbar and cervical pain syndromes, postoperative lumbar pain or post-laminectomy syndrome, radiculopathy, peripheral neuralgia, post-herpetic pain syndromes, neuropathic pain (metabolic origin, diabetes, etc.), myofascial syndromes, post-traumatic pain, post-traumatic pain, etc., are diagnosed and treated in a methodical and protocolized manner. ), myofascial syndromes, post-traumatologic, headaches and cephalgias, optimization and follow-up of oncological pain, pelvic-perineal pain, sympathetic dystrophic reflex syndromes, arthroscopic-rheumatic in general.
Treatment can be conservative pharmacological, which consists of the optimization and dosage of appropriate analgesic drugs in a staggered manner or, if indicated, interventional techniques such as peripheral infiltrations, neural blocks, epidurals, neural and facet radiofrequency techniques, epidurolisis or implantation of neurostimulators or continuous drug infusion pumps.