Causes of Pain
Pain from excess nociception
These are the pains that occur when the intensity of the information transmitted by the pain fibers is large enough to reach the brain. These pains are the most common: they correspond to trauma (shocks, cuts, burns, sprains, fractures, etc.) or are associated with inflammatory phenomena (dental abscess, appendicitis, conjunctivitis, etc.).
The pain then fulfills its alarm function fully and the doctor searches in priority for the lesion or the disease which is the cause, implements an adequate treatment (for example, prescribes an anti-inflammatory) and, at the same time, strives alleviate or eliminate the associated pain (with an analgesic).
Nociceptive pain is also a major cause of chronic pain. For example, chronic inflammation of the joints affected by osteoarthritis is the cause of the chronic pain associated with this disease.
Neurogenic pain (or neuropathic pain) is pain related to a malfunction of the nervous system. They can occur following a lesion of the peripheral nervous system (the nerves) or the central nervous system (spinal cord, brain) These neurogenic pains are quite specific and most often result in tingling, burning sensations, swelling, crushing, tingling or electric shocks. They can be brutal, dazzling, episodic or continuous. They can occur in the absence of any stimulation or, more often, during usually painless stimulations: touch, draft, contact with tissue, etc. They are made worse by cold or emotions. They are often difficult to bear and quickly have a negative impact on the psyche.
The origin of nerve damage is very varied. It may be trauma (injury, amputation), insufficient oxygen supply (stroke, prolonged nerve compression), infection (by shingles virus), metabolic disease (diabetes), intoxication (alcoholism) or even the effect of certain drugs (especially those used in the treatment of AIDS).
These pains are often difficult to relieve. They evolve and persist despite the healing of the nerve damage. This is the case with shingles: the virus is only present at the start of the infection, but the nerves that have been affected are the site of neurogenic pain that can last several months, even years.
When the two previous causes are ruled out, one can evoke the existence of psychogenic pain. They are linked to mental disorders which cause a painful sensation in the absence of any organ damage. They are difficult to identify and require the advice of a psychiatrist. They can be associated with anxiety and depression and, more rarely, with certain serious mental illnesses. It is essential to distinguish them from cases where it is the existence of chronic pain (for which there is a physical cause) which leads to the development of a depressive state. In some cases of so-called “masked” depression, there is a form of anxiety that is accompanied by real pain, with a feeling of suffocation, muscle tension, palpitations or the impression of having a lump in the throat. In other cases, the pains linked to the depressive state appear without anxious state, or are associated with minimal physical lesions which do not make it possible to explain the intensity of the pains and the handicap evoked by the patient. Most commonly it is back pain, diffuse muscle pain or headache.
Pain associated with medical care
These are pains associated with surgical procedures, medical examinations, treatments or care. They have a marked psychological dimension, because they are linked to a particular apprehension. The medical and paramedical professions have long neglected this aspect of their practice, believing that they can cause “little harm” for “great good”. This is no longer the case today and a special effort is being made to make interventions, care and treatment as painless as possible.
The range of medical examinations has evolved considerably towards so-called “non-invasive” techniques, which avoid any painful trauma. This is true of radiographs, but also of ultrasound and all modern means of medical imaging. New procedures are also being developed to improve common gestures (injections, blood samples, biopsies, etc.): these small gestures can now be made painless, especially in children. Advances in anesthesia have made it easier to endure painful and painful exams (colonoscopies, for example). Surgery has also made huge strides in relieving post-operative pain: morphine and its derivatives are no longer reserved for palliative care and help provide analgesia and optimal comfort for patients.
There remains the psychological dimension of pain, linked to this apprehension of being in pain… Some health professionals still neglect it, while in most cases it is enough to have a clear explanation of the actions planned, while reassuring the patient about the fact that he will benefit from effective management of any painful phenomena that may arise.
Pain is a warning sign and a very common component of cancer. It is most often a combination of nociceptive and neurogenic pain, with a strong psychological component. Everything seems painful when it comes to cancer: the disease itself, but also the medical exams and the treatments. The management of pain, acute and chronic, is therefore an integral part of the therapeutic approach of oncologists. This management has evolved in recent years towards more effective protocols and major analgesics (for example morphine and its derivatives) are no longer reserved for the terminally ill. The treatments have also progressed a lot and we take better account of their adverse effects. However, according to oncologists, many cancer patients still remain imperfectly relieved of their suffering, either because caregivers are insufficiently attentive to it, or because patients hesitate to complain, for fear of having to face new examinations or treatments. .
There are still cases in which the origin of the pain, or associated disease, remains unexplained. Back pain (when no lesion is present), functional colopathies (chronic intestinal diseases of unknown origin) and certain neuralgia remain mysterious. Migraine is also a good example of unexplained pain: we know the mechanism that causes pain (an inflammation of certain blood vessels in the brain) but we still ignore the initial cause, except that there is an inherited predisposition and a number of triggers identified.
These unexplained pains are particularly painful to bear, because medicine does not have a curative treatment and must be content to treat the pain with, sometimes, very effective specific drugs (treatments for migraine attacks, facial neuralgia, etc.) . The affected person remains uncertain despite numerous consultations and may, in the long run, develop an anxious and depressed state which, in turn, aggravates their suffering.
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