The Pain Unit, a key element in its treatment

Pain is defined as an unpleasant sensory and emotional experience with actual or potential tissue damage. Also, as a dysphoric and unpleasant sensation. The body responds to this warning signal of damage to prevent or alleviate further consequences. An unrelieved or untreated pain in its cause, can have consequences beyond the momentary suffering, it produces a delay in healing, alters the immune system, the response to stress, produces emotional vegetative symptoms such as depression, and a possible alteration of the peripheral nervous system in its interpretation in the brain, with the risk of creating a situation of chronification or chronic pain.

Widely demonstrated in epidemiological studies of the WHO, approximately 40% of acute pain is not properly managed, being this even worse in underdeveloped countries. The lack of understanding, knowledge and training in most primary care physicians or surgical specialists, as well as a caution in the use of inadequate dosages of drugs and analgesic techniques, are identified as the origin of the problem of undiagnosed or undertreated acute or chronic pain syndromes.

The Pain Unit today

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, when faced with a painful syndrome, should avoid its monopolization, recognize 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 the development of a painful syndrome and its subsequent chronification due to the neuroplastic changes of adaptation to a trauma of the nervous system. Pain can itself become a disease. That is why a methodical and multidisciplinary approach in its diagnosis and treatment is so important to avoid the transformation in time of an acute pain together with the sum of other phenomena, in a chronic syndrome with its own identity.

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Although it is not always possible or advisable to completely eradicate pain, as it often serves as a first sign of inner damage and protection against trauma, it should at least be ethical to make it bearable.

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 (Pain Europe, Friker; 2005), present results that identify that one in five citizens is affected by pain. The prevalence increases with age up to 47% in those over 65 years of age, more frequent in women; being predominantly pain in the lower extremities, lumbar and cervical spine, and headaches in younger people.

29% self-medicate without satisfaction with their condition and 39% do not take any measure or drug at all. Of those who were treated in a Pain Unit, 94% were very satisfied with the treatment prescribed.

Pain management has evolved enormously with the creation of the Pain Units, thanks to the establishment of pain medicine, a part of medicine dedicated to the study and treatment of pain in all its aspects.

The Pain Unit in Spain

The first Pain Unit was created in the United States in the mid-1960s, and the first one in Spain was created in Madrid in the 1970s. Since then, Third Level Units have been created in most large hospitals.

In a Pain Unit the following problems and/or pains are diagnosed and treated in a methodical and protocolized way: acute pain, chronic non-operable lumbar and cervical pain syndromes, postoperative lumbar pain or post-laminectomy syndrome. The treatment of radiculopathies, peripheral neuralgia or pain syndromes is also frequent. Neuropathic pain (of metabolic origin, diabetes, etc.), myofascial or post-traumatic syndromes, headaches and cephalgias, as well as the optimization and follow-up of oncological pain, pelvic-perineal pain, dystrophic-sympathetic reflex syndromes and arthrosic-rheumatic pain in general.

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Pain treatment can be conservative pharmacological, which mainly consists of the optimization and dosage of the necessary analgesic drugs in a staggered manner or, if indicated, interventional techniques such as peripheral infiltrations, neural and epidural blocks, neural and facet radiofrequency techniques, epidurolisis or the implantation of neurostimulators or continuous drug infusion pumps.