Prevention
It used to be assumed that over time, temporary pain would not harm the patient. Nowadays, it is more likely that one does not have to endure prolonged pain, since by relieving the pain with an analgesic, one also prevents the development of a pain memory. For prevention, weak painkillers such as paracetamol are suitable, but also strongly potent painkillers such as opioids, which also include the well-known painkiller morphine.
However, prevention can only be carried out if an upcoming pain event is expected. Because usually the patients go only to the physician, if the pain is already chronically present and thus a pain memory already developed. In this case no more prevention can be made.
The pain memory develops by a so-called synaptic long-term potentiation, whereby it comes to a sensitization opposite pain. During the development of pain there is an influx of calcium into pain mediating nerve cells. This influx is mediated by glutamate receptors (subtype NMDA).
This is where various prevention options can be applied. On the one hand, the glutamate release of the pain-mediating fibers, known as nociceptive fibers, can be reduced or even stopped completely. For this purpose, various anaesthesia techniques can be used in the spinal cord, including infiltration, conduction and plexus anaesthesia.On the other hand, the so-called NMDA receptor (=glutamate receptor) can be blocked by medication. Ketamine or Memantine, for example, are suitable for this.
