Symptoms
Pain is an unpleasant and subjective sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage. Acute pain may be accompanied by activation of the sympathetic nervous system, resulting in rapid heartbeat, deep breathing, hypertension, sweating, and nausea, among other symptoms. Pain has several components:
- Sensory/discriminative: information about the type, duration, intensity, and localization.
- Vegetative: activation of the sympathetic nervous system
- Motor: motor reflexes, automatic pulling away.
- Affective/emotional: emotional evaluation, e.g. fear, helplessness.
- Cognitive: linkage with thinking.
As a complication, chronic pain can develop in the longer term, which is independent of the underlying cause and represents a separate clinical picture. See under chronic pain.
Causes
The cause of acute pain is usually actual or potential tissue damage. The body should be informed of dangerous influences and protected from harm, for example, injury or disease. Acute pain is therefore primarily positive, forcing a bodily response that promotes healing, such as immobilization, pulling the hand away when touching a hot plate, or removing a blood-sucking insect. Fear of pain also keeps us from doing dangerous stupid things. The deeper cause represents the activation of nociceptors by mechanical, thermal, chemical or electrical stimuli. Examples of acute pain:
Pain receptors are free nerve endings located, for example, in the skin, muscles, connective tissue and viscera. The signals are transmitted to the brain via the posterior horn of the spinal cord, linked to emotions and processed. Nerves can also be damaged directly, causing what is known as neuropathic pain (nerve pain). Postherpetic neuralgia represents one example.
Diagnosis
Diagnosis is made by medical treatment. Pain is a symptom and expression of a physical disorder that should be adequately evaluated. Since pain is a subjective sensation, it usually cannot be measured but is evaluated by the patient, for example, with a so-called visual analog scale (VAS) and with a pain questionnaire.
Nonpharmacologic treatment
- Heat, e.g. heat pads, baths.
- Cold, e.g. cold pads
- Rest, e.g. bed rest
- Physiotherapy, massage
- Occupational therapy, ergonomics
- Chiropractic
- Bandages, splints
- Physical therapy, e.g. TENS
- Acupuncture, acupressure
- Wraps, poultices
- Distraction
Drug treatment
Treatment is based on the cause and the specific clinical picture (causal therapy)! Painkillers (analgesics):
- Nonsteroidal anti-inflammatory drugs such as ibuprofen, diclofenac, naproxen, and the COX-2 inhibitors have analgesic, anti-inflammatory, and antipyretic properties. The effects are based on the inhibition of the enzyme cyclooxygenase and the inhibition of the biosynthesis of prostaglandins.
- Paracetamol has antipyretic and analgesic properties. It is used to treat fever and/or pain of various causes. The usual dose in adults is 500 to 1000 mg 3 to 4 times a day (maximum 4000 mg per day), in children the dosage is based on body weight.
- Opioids have exclusively central analgesic and no antipyretic or anti-inflammatory properties. The effects are due to binding to opioid receptors, including the μ-receptor. They are used when non-opioid analgesics such as NSAIDs and acetaminophen are not sufficiently effective.
Topical agents for pain and inflammation, such as pain gels, are locally effective and therefore are expected to have fewer adverse effects:
- Topical NSAIDs such as a diclofenac gel.
- Local anesthetics, such as a lidocaine patch
Herbal medications for inflammation and pain:
- Comfrey ointments
- Arnica ointments
- Devil’s claw
- Willow bark
- Capsaicin, heat patches (eg Isola), warming ointments with essential oils (eg Perskindol).
Co-analgesics:
- Antiepileptic drugs
- Antidepressants
- Glucocorticoids
- Muscle relaxants
Complementary medicine:
- Anthroposophics
- Spagyric, e.g. Cannabis sativa
- Homeopathics
- Schuessler salts, No. 3
- Food supplements
