ترجمة: د. زهير الخويلدي
"Acute pain is the easiest in general to control it. The drug and comfort are effective treatments."
"Pain, a complex experience consisting of a physiological and psychological response to a harmful stimulant. Pain is a warning mechanism that protects the organism by influencing it to withdraw from harmful stimuli; mainly associated with injury or threat to infection. Pain is self -causing it, because it contains an emotional and sensory component.Although the neurological anatomical basis for pain receiving before birth, individual pain responses are learned in early childhood and are affected by social, cultural, psychological, cognitive and genetic factors, among other things.
These factors are responsible for the differences in the tolerance of pain between humans. Mathematics, for example, may be able to withstand or ignore pain during exercise, and some religious practices may require participants to bear the pain that seems unbearable for most people, and the important functions of pain are to alert the body to possible damage. This is achieved through nervous therapy of harmful stimuli. However, the feeling of pain is only one part of a painful response, which may include an increase in blood pressure, an increase in heart rate and reflexive withdrawal from the harmful alarm. Acute pain can arise from bone fracture or touch a hot surface. During acute pain, there is an immediate strong feeling for a short period, sometimes it is described as a sharp tingling feeling, followed by a slight palpal feeling. It is difficult to identify and treat chronic pain, which is often associated with diseases such as cancer or arthritis. If the pain cannot be relieved, psychological factors such as depression and anxiety can increase the severity of the condition.
Early concepts of pain
Pain is a physiological and psychological component of human existence, and therefore it is known to humanity since the first ages, but the ways that people respond and imagine the pain is greatly different. In some ancient cultures, for example, the pain was deliberately attached to individuals as a way to calm angry deities. Pain was also seen as a form of punishment that was attached to human beings by deities or demons. In ancient China, the pain was believed to arise from a imbalance between the two supplementary life powers, Yin and Yang. The ancient Greek doctor, Hippocrates, believes that the pain is associated with a lot or a very little of the four mixtures (blood, phlegm, bile or black bile). The Muslim doctor, Ibn Sina, believes that the pain is a feeling that arose with a change in the physical condition of the body.
Theories of pain
The medical understanding of the physiological basis for pain is a relatively recent development, and it has appeared seriously in the nineteenth century. At that time, many British, German and French doctors realized the problem of "chronic pain without a lesion" and attributed it to a functional disorder or constant irritation in the nervous system. The concept of the world of physical functions and the German comparative anatomy world, Johannes Peter Muller, was on common feelings, which is the ability of the individual to properly realize internal sensations, one of the creative causes proposed to pain. American doctor and author S -Mitchell noticed civil war soldiers with burning pain (persistent burning pain; later known as complex regional pain syndrome), painful pain, and other painful cases after a long period of healing their original wounds. Despite the strange and hostile behavior of his patients often, Mitchell was convinced of their physical suffering.
By the late nineteenth century, specific diagnostic tests began to develop specific signs of pain in redefining neuroscience, leaving a small space for chronic pain that cannot be explained in the absence of other physiological symptoms. At the same time, practitioners of psychiatry and the field of psychoanalysis found that "hysterical" pain provides possible visions about mental and emotional diseases. The contributions of individuals such as the English physiological world, Sir Charles Scott Sherington, supported the concept of privacy, which, according to him, was the "real" pain an individual direct response to a specific harmful stimulus. Sherington presented the term pain to describe pain response to such stimuli.
Privacy theory suggested that individuals who reported pain in the absence of a clear cause were delusional, nervous obsessive, or a speculation (often the result of military surgeons or those who treat workers' compensation cases). Another theory, which was common among psychologists at the time but was abandoned shortly after, was the theory of intense pain, as the pain was considered an emotional condition, incitement to very unusually severe stimuli. In the nineties of the nineteenth century, German neurologist Alfred Goldsider supported Sherington's insistence that the central nervous system is incorporating inputs from the ends. Goldsider suggested that the pain is the result of the brain's awareness of the spatial and temporal patterns of sensation. French surgeon René Learish, who worked with injured soldiers during the First World War, suggested that the nerves that destroy the sheath of myelin surrounding the synthetic nerves (nerves in response to fighting or escape) may lead to pain when responding. For natural stimuli and internal physiological activity.
The American neurologist William K. Levingstone, who worked with patients with artificial injuries in the thirties of the last century, was drawn by drawing a rebound diagram inside the nervous system, which he described as the "vicious circle". Levingstone assumed that permanent severe pain causes functional and organic changes in the nervous system, resulting in a state of chronic pain. However, various theories about pain were greatly ignored until World War II, when organized teams of doctors began to monitor and treat large numbers of individuals with similar injuries. In the fifties of the last century, American anesthesiologist Henry K. found. Betcher, using his experience in treating civilian and wartime patients, is that soldiers who suffer from serious injuries often suffer from much lower pain than civil surgery patients.
Betcher concluded that the pain is caused by the merging of the physical sensation with the "cognitive reaction component". Thus, the mental context of pain is important. The pain for the surgical patient means disrupting normal life and fears of a serious disease, while the pain that the wounded soldier suffers from the battlefield and increased the opportunity to survive. Therefore, the assumptions of privacy theory, which was based on laboratory experiments in which the element of reaction was relatively neutral, cannot be applied to understanding clinical pain. Betcher's conclusions were supported by the work of the American anesthesiologist John Bunika, who was considered in his book Pain Management (1953) that clinical pain includes both physiological and psychological components. The Dutch nerve surgeon Wilim Nordbos has expanded the pain theory as a merger of multiple inputs in the nervous system in his short but classic pain (1959).
The ideas of Nurdinbus, Canadian psychologist Ronald Milzak and British neurologist Patrick David Wall. Melzac and Walls Goldsider's ideas, Levingstone, and Nardenbus gathered with the available research evidence and in 1965 they suggested what is called the theory of control of the pain gate. According to the portal control theory, pain perception depends on a nervous mechanism in the gelatinous layer of the dorsal century of the spinal cord. The mechanism acts as a tangled gate that regulates the sensation of pain from the milliarified and non -lined neuroma and the activity of inhibitory neurons. Thus, stimulating nearby nerve endings can inhibit the nerve fibers that transmit pain signals, explaining the comfort that can occur when the affected area is stimulated by pressure or rubbing. Although the theory itself has proven incorrect, the hint that laboratory and clinical observations together can prove the physiological basis for a complex nervous integration mechanism to perceive pain inspired a small generation of researchers and challenge them.
In 1973, relying on increased interest in the pain resulting from Wall and Melzac, Bonika organized a meeting between researchers and multiple -disciplinary doctors.Under the leadership of Bonika, the conference, which was held in the United States, resulted in the birth of a multidisciplinary organization known as the International Association for the Study of Pain and a new magazine entitled pain, was initially edited by Wall.The formation of the International Association for the Study of Pain and the Journal was a sign of the appearance of pain as a professional field, and in the following decades, research on the problem of pain has expanded significantly.
From this work, two main results appeared. First, it was found that the severe pain caused by another injury or incentive, if it continues over a period, changes the nervous chemistry of the central nervous system, thus sensing it and leading to neurological changes that continue after removing the initial alarm. This process is seen as chronic pain by the affected individual. The involvement of nervous changes in the central nervous system has been proven in the development of chronic pain through multiple studies. In 1989, for example, American anesthesiologist Gary Je Jari Bennett and Chinese scientist Ze Yekwan, the neural mechanism behind the phenomenon in mice with narrow ligaments loosely placed around the sciatic nerve.
In 2002, the Chinese neuroscientist Men Chu and his colleagues reported the identification of two enzymes, the two types 1 and 8 of the Indonesian Cequalaz enzyme, in the arms of the front mice that play an important role in educating the central nervous system of pain stimulants. The second result that appeared is that the realization of pain and response varies according to sex, race, learning and experience. Women seem to suffer from pain often with more emotional pressure than humans, but some evidence shows that women may deal with severe pain more effectively than men. African American Americans show a greater ability to be affected by chronic pain and a higher level of disability compared to white patients. These notes have been confirmed through nervous chemical research. For example, in 1996, a team of researchers led by American neuroscientist John Dr. Levin that different types of opioid drugs produce different levels of pain relief in women and men. Other research conducted on animals suggested that early life experiences can cause nervous changes at the molecular level that affect the individual's response to pain as an adult. The important conclusion of these studies is that there are no two people who suffer from pain in the same way.
Pain physiology
Despite its own nature, most of the pain is associated with tissue damage and has a physiological basis.However, not all tissues are sensitive to the same type of injury.For example, although the skin is sensitive to burning and cutting, it is possible to cut visceral organs without causing pain.However, excessive expansion or chemical irritation of the visceral surface causes pain.Some tissues do not cause pain, whatever the way to stimulate it.The liver and air veshes in the lungs are not sensitive to almost all stimulants.Consequently, the tissues only respond to the specific stimuli that they are likely to face and generally do not respond to all kinds of damage.
Pain receptors, found in the skin and other tissues, are neurons with ends that three types of mechanical, thermal and chemical stimulants; Some ends mainly respond to one type of alert, while other ends can discover all species. The chemicals produced by the body that arouse pain receptors include pionicinine, serotonin and histamine. Prostaglandin is fatty acids that are released when inflammation occurs and can increase the feeling of pain by sensitizing nerve endings; This increase in allergies is called hyperactivity, and the experience of the double stage of acute pain mediates two types of primary nerve fibers that transmit electrical impulses from tissues to the spinal cord via ascending nerve tract.
Delta fibers are the largest and fastest connected between the two types, due to the thin myelin cover, and therefore they are linked to the sharp, local pain that occurs first. Delta fibers are activated by mechanical and thermal stimuli. The smaller c microfa fibers respond to the chemical, mechanical and thermal stimuli and are associated with a weak and long -term feeling that follows the first rapid feeling of pain. Pain pulses enter the spinal cord, as they are mainly intertwined on the neurons of the pods of the back area and gelatinous gelatinous substance of the gray material of the spinal cord. This region is responsible for organizing and modifying the incoming implications. There are two different paths, spinal and spinal spilles, transporting the pulses to the brain and tunnel. It is believed that the inputs of the spine affects the conscious feeling of pain, and it is believed that the kinetic path affects the aspects of arbitrary and emotional pain.
In the dorsal century. The analgesic response (analgesics) is controlled by neurological chemicals called endorphins, which are phonopogenic peptides such as analvaline produced by the body. These substances prevent the reception of pain stimulants by linking the nerve receptors that stimulate the inhibitory nervous path. This system can be activated by stress or shock and may be responsible for the lack of pain associated with a serious injury. It may also explain the difference in capabilities between individuals to perceive pain. The origin of pain signals can be unclear for the patient. The pain that arises from the deep tissue but is called "tangible" in the surface tissues with the pain indicated. Although the precise mechanism is unclear, this phenomenon may be caused by the rapprochement of nerve fibers from different tissues with the same part of the spinal cord, which may allow nerve impulses from one path to pass to other paths. The pain of the imaginary end suffers from an amputated limb and suffers from pain on the missing end. This phenomenon occurs because the nerve trunks that connect the absent side to the brain are still present and capable of excitement. The brain continues to explain the incentives from these fibers as coming from what it previously learned to be the party.
Pain psychology
Pain perception of the brain processing of new sensory inputs is produced with existing memories and emotions, in the same way that other perceptions are produced. Childhood experiences, cultural situations, heredity and sex are factors that contribute to developing the awareness of each individual to different types of pain and response to them. Although some people may be physiically able to better withstand pain than others, cultural factors instead of genetics are usually responsible for this ability. The point at which the alarm begins to become painful is the threshold of pain perception; Most studies have found that this point is relatively similar among different groups of people. However, the threshold of pain, which is the point where the pain becomes unbearable, is a great difference between these groups. The heavy and non -emotional response to infection may be a sign of courage in certain cultural or social groups, but this behavior can also hide the severity of the injury of the examiner. Depression and anxiety can reduce both types of pain thresholds. However, anger or excitement can temporarily obscure pain. Emotional relief can also reduce the feeling of pain. The context of the pain and meaning it carries for the patient also determines how the pain perception.
Pain
Attempts to relieve pain usually address the physiological and psychological aspects of pain. Reducing anxiety, for example, may reduce the amount of medications needed to relieve pain. Acute pain is the easiest in general to control it. The drug and comfort are often effective treatments. However, some pain may challenge treatment and last for years. Such chronic pain can be exacerbated by despair and anxiety. Doctors are effective pain relief medications and are used to treat severe pain. Opion, a dry extract obtained from the inpatible poppy seeds, is one of the oldest analgesics. Movin, powerful opium material, very effective analgesic. These narcotic alkaloids simulate the endorphins that the body naturally produces by linking its receptors and preventing or reducing the stimulation of neurons of pain. However, the use of opioid pain relievers should be monitored not only because they are substances that cause addiction but also because the patient can tolerate them and may require gradually larger doses to achieve the required level of pain relief. An overdose can cause a deadly respiratory inhibition. Other important side effects, such as nausea and psychological depression when withdrawing, also reduce the benefit of opioid materials, where excerpts from willow bark (the sex of saliks) contain effective salicylic substance, and have been used since ancient times to relieve pain.
Salisilat modern anti -inflammatory analgesics, such as aspirin (acetylcellic acid), and other anti -inflammatory analgesics, such as acetaminophen, non -steroidal anti -inflammatory drugs (non -steroidal anti -inflammatory; for example, ibuprofen), and cycop oxidants (Cox) (Cox) (as a way Example, silicoxip), less effective than opioids but not addiction. Aspirin, non -steroidal anti -inflammatory and Cox inhibitors are either selectively or selectively preventing the activity of Cox enzymes. Cox enzymes are responsible for converting aradeonic acid (fatty acid) to prostaglandins, which increases the sensitivity to pain. Acetaminophen also prevents the formation of prostaglandins, but its activity appears to be mainly limited to the central nervous system and is practiced through multiple mechanisms. Medicines known as N-methala-D-asbartat (namsarins), which include examples of dextromethurfan and Citamin, can be used in the treatment of certain forms of nerve pain, such as diabetic neuropathy. Medicines work by preventing Namsres, whose activation is involved in a cause of pain.
Psychiatric drugs, including antidepressants and sedatives, can be used to treat patients with chronic pain and who also suffer from psychological conditions. These medications help reduce anxiety and sometimes change the feeling of pain. The pain appears to be reduced in a similar way by hypnosis, fake medications, and psychotherapy. Although the reasons that make the individual have been reported to relieve pain after taking an imaginary medicine or after psychotherapy are still unclear, researchers suspect that the expectation of rest is stimulated by release dopamine in the brain area known as the ventral scheme. The activity in the abdominal scheme is associated with an increase in dopamine activity and is associated with the effect of the imaginary medicine, where the relief of pain is reported after treatment with an imaginary drug.
Certain nerves can be banned in cases where the pain is limited to a little sensory nerves. Phenol and alcohol are a solvent of nerves destroying nerves. Yedocaine can be used to temporarily relieve pain. The nerves are rarely performed surgically, because it can result in serious side effects such as engine loss or recovery, and some pain can be treated by electrical stimulation of the skin through the skin (TNS), where electrical poles are placed on the skin over the painful area. The stimulation of additional peripheral neurological ends has an inhibiting effect on the nerve fibers that generate pain. Acupuncture, compresses and heat treatment may work with the same mechanism, and chronic pain, which is generally defined as the ongoing pain for at least six months, represents the biggest challenge in managing pain. Chronic uncomfortable discomfort can cause psychological complications such as broth, depression, sleep disorders, loss of appetite and a feeling of impotence.
Many pain clinics offer a multidisciplinary approach to the treatment of chronic pain. Patients with chronic pain may need unique strategies to manage pain. For example, some patients may benefit from the use of surgical implants. Examples of implants include delivery of medications inside the offer, where a pump planted under the skin communicates pain relievers directly to the spinal cord, implanting the spinal cord stimulation, where an electrical device is sent in the body electrical pulses to the spinal cord to inhibit the transfer of pain signals. Other strategies for chronic pain management include alternative therapy, exercise, physical therapy, cognitive behavioral therapy, and electrical stimulation of the nerve through the skin. Treatment can be useful for identifying feelings associated with chronic pain patients with unknown chronic pain. "