This is the first one described by doctors Ancient Greece and Rome of symptoms are signs of inflammatory damage. Pain is what signals us about some kind of trouble that arises inside the body or about the action of some destructive and irritating factor from the outside.
Pain, according to the well-known Russian physiologist P. Anokhin, is designed to mobilize various functional systems the body to protect it from harmful factors. Pain includes such components as: sensation, somatic (bodily), autonomic and behavioral responses, consciousness, memory, emotions and motivation. Thus, pain is a unifying integrative function of a whole living organism. V this case – human body... For living organisms, even without signs of higher nervous activity, can experience pain.
There are facts of changes in electrical potentials in plants, which were recorded when their parts were damaged, as well as the same electrical reactions when researchers injured neighboring plants. Thus, the plants reacted to damage caused to them or to neighboring plants. Only pain has such a peculiar equivalent. Here is such an interesting, one might say, universal property of all biological organisms.
The types of pain are physiological (acute) and pathological (chronic).
Pain happens physiological (acute) and pathological (chronic).Sharp pain
According to the figurative expression of academician I.P. Pavlova, is the most important evolutionary acquisition, and is required to protect against the effects of destructive factors. The meaning of physiological pain is to discard everything that threatens life process, upsets the balance of the body with the internal and external environment.Chronic pain
This phenomenon is somewhat more complex, which is formed as a result of long-term pathological processes in the body. These processes can be both congenital and acquired during life. The acquired pathological processes include the following - the long-term existence of foci of inflammation with various reasons, all kinds of neoplasms (benign and malignant), traumatic injury, surgical interventions, outcomes inflammatory processes(for example, the formation of adhesions between organs, a change in the properties of the tissues that make up their composition). Congenital pathological processes include the following - various anomalies in the location of internal organs (for example, the location of the heart outside chest), congenital developmental anomalies (for example, congenital intestinal diverticulum and others). Thus, a long-term focus of damage leads to permanent and minor damage to the structures of the body, which also constantly creates painful impulses about damage to these structures of the body affected by a chronic pathological process.Since these injuries are minimal, the pain impulses are quite weak, and the pain becomes constant, chronic and accompanies a person everywhere and almost around the clock. The pain becomes habitual, but does not disappear anywhere and remains a source of long-term irritating effects. Pain syndrome that exists in a person for six or more months leads to significant changes in the human body. There is a violation of the leading regulatory mechanisms essential functions the human body, disorganization of behavior and psyche. The social, family and personal adaptation of this particular individual suffers.
How common is chronic pain?
According to research by the World Health Organization (WHO), every fifth inhabitant of the planet suffers from chronic pain caused by all kinds of pathological conditions associated with diseases of various organs and systems of the body. This means that at least 20% of people suffer from chronic pain of varying severity, intensity and duration.
What is pain and how does it arise? The department of the nervous system is responsible for the transmission of pain sensitivity, substances that cause and maintain pain sensations.
Feeling pain is difficult physiological process, including peripheral and central mechanisms, and having an emotional, mental, and often vegetative coloring. The mechanisms of the pain phenomenon have not yet been fully disclosed, despite the numerous Scientific research that continue right up to the present time. However, let us consider the main stages and mechanisms of pain perception.Nerve cells that transmit a pain signal, types of nerve fibers.
The very first stage of pain perception is the effect on pain receptors ( nociceptors). These pain receptors are located in all internal organs, bones, ligaments, in the skin, on the mucous membranes of various organs in contact with the external environment (for example, on the intestinal mucosa, nose, throat, etc.). Today, there are two main types of pain receptors: the first are free nerve endings, when irritated, there is a feeling of dull, diffuse pain, and the second are complex pain receptors, when excited, a feeling of acute and localized pain arises. That is, the nature of pain sensations directly depends on which pain receptors have perceived irritating effect... Regarding specific agents that can irritate pain receptors, we can say that they include various biologically active substances(BAS) formed in pathological foci (the so-called, algogenic substances). These substances include various chemical compounds - these are biogenic amines, and products of inflammation and cell decay, and products of local immune reactions. All these substances, completely different in chemical structure, are able to provide irritating effect on pain receptors of various localization.
Prostaglandins are substances that support the body's inflammatory response.
However, there are a number of chemical compounds involved in biochemical reactions that themselves cannot directly affect pain receptors, but enhance the effects of substances causing inflammation... This class of substances includes, for example, prostaglandins. Prostaglandins are formed from special substances - phospholipids which form the basis of the cell membrane. This process proceeds as follows: a certain pathological agent (for example, enzymes are formed prostaglandins and leukotrienes. Prostaglandins and leukotrienes are generally called eicosanoids and play an important role in the development of the inflammatory response. The role of prostaglandins in the formation of pain in endometriosis, premenstrual syndrome, as well as painful menstruation syndrome (algodismenorrhea) has been proven.So, we examined the first stage in the formation of pain sensation - the effect on special pain receptors. Consider what happens next, how a person feels pain of a certain location and character. To understand this process, you need to familiarize yourself with the pathways.
How does the pain signal go to the brain? Pain receptor, peripheral nerve, spinal cord, thalamus - more about them.
A bioelectric pain signal formed in the pain receptor by several types of nerve conductors ( peripheral nerves), bypassing the intraorgan and intracavitary nerve nodes, goes to spinal nerve ganglia (nodes) located next to the spinal cord. These nerve ganglia accompany each vertebra from the cervical to some lumbar. Thus, a chain of nerve ganglia is formed, going to the right and left along the spinal column. Each nerve ganglion is associated with a corresponding site (segment) spinal cord... The further path of the pain impulse from the spinal nerve ganglia is directed to the spinal cord, which is directly connected to the nerve fibers. 
In fact, the spinal can is a heterogeneous structure - white and gray matter is emitted in it (as in the brain). If the spinal cord is viewed in cross section, then the gray matter will look like the wings of a butterfly, and the white matter will surround it on all sides, forming the rounded outlines of the boundaries of the spinal cord. So, rear part these butterfly wings are called the posterior horns of the spinal cord. Through them, nerve impulses are forwarded to the brain. The front horns, according to the logic, should be located in the front of the wings - and this is how it happens. It is the front horns that conduct the nerve impulse from the brain to the peripheral nerves. Also in the spinal cord in its central part there are structures that directly connect nerve cells front and rear horns spinal cord - thanks to this there is the possibility of the formation of the so-called "gentle reflex arc", when some movements occur unconsciously - that is, without the participation of the brain. An example of how a short reflex arc works is pulling a hand away from a hot object.
Since the spinal cord has a segmental structure, therefore, nerve conductors from their area of responsibility enter each segment of the spinal cord. In the presence of an acute stimulus from the cells of the posterior horns of the spinal cord, excitation can abruptly switch to the cells of the anterior horns of the spinal segment, which causes a lightning-fast motor reaction. They touched a hot object with their hand - they pulled their hand right away. In this case, painful impulses still reach the cerebral cortex, and we realize that we have touched a hot object, although the hand has already been reflexively withdrawn. Similar neuro-reflex arcs for individual segments of the spinal cord and sensitive peripheral regions may differ in the construction of levels of participation of the central nervous system.
How does a nerve impulse reach the brain?
Further, from the posterior horns of the spinal cord, the path of pain sensitivity is directed to the overlying parts of the central nervous system along two paths - along the so-called "old" and "new" spinothalamic (nerve impulse path: spinal cord - thalamus) pathways. The names "old" and "new" are conditional and speak only about the time of the appearance of these paths in the historical segment of the evolution of the nervous system. However, we will not go into the intermediate stages of a rather complicated nervous path, we will restrict ourselves only to the statement of the fact that both of the indicated pathways of pain sensitivity end in areas of the sensitive cerebral cortex. Both the "old" and "new" spinothalamic pathways pass through the thalamus (a special area of the brain), and the "old" spinothalamic pathway also passes through the complex of structures of the limbic system of the brain. The structures of the limbic system of the brain are largely involved in the formation of emotions and the formation of behavioral responses. It is assumed that the first, more evolutionarily young system (the “new” spinothalamic pathway) of pain sensation paints a more definite and localized pain, while the second, evolutionarily more ancient (“old” spinothalamic pathway) serves to conduct impulses that give a viscous, poorly localized pain. In addition, the specified "old" spinothalamic system provides emotional coloring of pain sensation, and also participates in the formation of behavioral and motivational components of emotional experiences associated with pain.
Before reaching the sensitive areas of the cerebral cortex, pain impulses pass, the so-called preprocessing in certain parts of the central nervous system. This is the already mentioned thalamus (optic tubercle), hypothalamus, reticular (reticular) formation, areas of the middle and medulla oblongata... The first, and perhaps one of the most important filters on the path of pain sensitivity is the thalamus. All sensations from the external environment, from the receptors of internal organs - everything passes through the thalamus. An unimaginable amount of sensitive and painful impulses passes every second, day and night, through this part of the brain. We do not feel how the heart valves friction, the movement of the abdominal organs, all kinds of articular surfaces against each other - and all this is due to the thalamus.
In case of a malfunction of the so-called anti-pain system (for example, in the absence of the production of internal, own morphine-like substances, which arose due to the use of drugs), the aforementioned flurry of all kinds of pain and other sensitivity simply overwhelms the brain, leading to terrifying in duration, strength and severity emotional pain. This is the reason, in a somewhat simplified form, of the so-called "withdrawal" when there is a deficit in the supply of morphine-like substances from the outside against the background of prolonged use of narcotic drugs.
How is the pain impulse processed by the brain?
The posterior nuclei of the thalamus provide information on the localization of the source of pain, and its median nuclei - on the duration of exposure to the irritating agent. The hypothalamus, as the most important regulatory center of the autonomic nervous system, participates in the formation of the autonomic component of the pain reaction indirectly, through the involvement of centers that regulate metabolism, the work of the respiratory, cardiovascular and other systems of the body. The reticular formation coordinates already partially processed information. The role of the reticular formation in the formation of the sensation of pain as a kind of special integrated state of the body, with the inclusion of all kinds of biochemical, vegetative, somatic components, is especially emphasized. The limbic system of the brain provides a negative emotional coloration. The very process of comprehending pain as such, determining the localization of the pain source (meaning a specific area own body) in conjunction with the most complex and varied reactions to pain impulses occurs without fail with the participation of the cerebral cortex. Sensory areas of the cerebral cortex are the highest modulators of pain sensitivity and play the role of a so-called cortical analyzer of information about the fact, duration and localization of pain impulses. It is at the level of the cortex that the integration of information from various types of conductors of pain sensitivity occurs, which means a full-fledged design of pain as a multifaceted and diverse sensation. At the end of the last century, it was revealed that each level of construction of the pain system from the receptor apparatus to the central analyzing systems of the brain can have the property of amplification painful impulses. A kind of transformer substation on power lines.
We even have to talk about the so-called generators of pathologically enhanced excitement. So, from the modern point of view, these generators are considered as the pathophysiological basis of pain syndromes. The aforementioned theory of systemic generator mechanisms makes it possible to explain why, with insignificant irritation, the pain response is quite significant in sensations, why after the termination of the action of the stimulus, the sensation of pain continues to persist, and also helps to explain the appearance of pain in response to stimulation of skin projection zones (reflexogenic zones) with pathologies of various internal organs.
Chronic pains of any origin lead to increased irritability, decreased performance, loss of interest in life, sleep disturbances, changes in the emotional-volitional sphere, and often lead to the development of hypochondria and depression. All these consequences already in themselves enhance the pathological pain reaction. The emergence of such a situation is interpreted as the formation of closed vicious circles: painful stimulus - psycho-emotional disorders - behavioral and motivational disorders, manifested in the form of social, family and personal maladjustment - pain.
Anti-pain system (antinociceptive) - a role in the human body. Pain threshold
Along with the existence in the human body of the pain system ( nociceptive), there is also an anti-pain system ( antinociceptive). What does the anti-pain system do? First of all, each organism has its own genetically programmed threshold for the perception of pain sensitivity. This threshold allows us to explain why stimuli of the same strength, duration and character different people react differently. The concept of the threshold of sensitivity is a universal property of all receptor systems of the body, including pain. Just like the pain sensitivity system, the anti-pain system has a complex multi-level structure, from the level of the spinal cord to the cerebral cortex. How is the activity of the anti-pain system regulated?
The complex activity of the anti-pain system is provided by a chain of complex neurochemical and neurophysiological mechanisms. The main role in this system belongs to several classes of chemicals - brain neuropeptides, including morphine-like compounds - endogenous opiates(beta-endorphin, dynorphin, various enkephalins). These substances can be considered so-called endogenous analgesics. These chemicals have a depressing effect on the neurons of the pain system, activate anti-pain neurons, modulate the activity of higher nerve centers pain sensitivity. The content of these anti-pain substances in the central nervous system decreases with the development of pain syndromes. Apparently, this explains the decrease in the pain sensitivity threshold up to the appearance of independent pain sensations against the background of the absence of a pain stimulus.It should also be noted that in the anti-pain system, along with morphine-like opiate endogenous analgesics, well-known brain mediators, such as serotonin, norepinephrine, dopamine, gamma-aminobutyric acid (GABA), as well as hormones and hormone-like substances - vasopressin (antidiuretic hormone), neurotensin. Interestingly, the action of brain mediators is possible both at the level of the spinal cord and the brain. Summarizing the above, we can conclude that the inclusion of the anti-pain system allows you to weaken the flow of pain impulses and reduce pain. In the event of any inaccuracies in the operation of this system, any pain can be perceived as intense.
Thus, all pain sensations are regulated by the joint interaction of the nociceptive and antinociceptive systems. Only their coordinated work and subtle interaction makes it possible to adequately perceive pain and its intensity, depending on the strength and duration of the effect of the irritating factor.
Pain is an opportunity for the body to inform the subject that something bad has happened. Pain draws our attention to burns, fractures, sprains and advises us to be careful. There is not a large number of people who are born without the ability to feel pain, they can tolerate the most severe injuries... They usually die in early period maturity. Their joints wear out from excessive stress, as without feeling discomfort from prolonged stay in the same position; they do not change their position for a long time. Without pain symptoms infectious diseases, unnoticed in time, and various injuries to parts of the body proceed in more acute form... But significantly more people who feel chronic pain (persistent or recurrent back pain, headache, arthritis, cancer).
Nociceptive sensitivity(from Lat. notion - I cut, damage) - a form of sensitivity that allows the body to recognize harmful effects for it. Nociceptive sensitivity can be subjectively presented in the form of pain, as well as in the form of various interoreceptive sensations, such as heartburn, nausea, dizziness, itching, and numbness.
Painful sensations arise as a response of the body to such influences that can lead to a violation of its integrity. They are characterized by a pronounced negative emotional coloring and autonomic shifts (increased heart rate, dilated pupils). In relation to pain sensitivity, sensory adaptation is practically absent.
Pain sensitivity determined by pain thresholds, among which there are:
The lower one, which is represented by the magnitude of irritation at the first appearance of a sensation of pain,
The upper one, which is represented by the amount of irritation at which the pain becomes unbearable.
Pain thresholds differ depending on general condition organism and from cultural stereotypes. Thus, women are more sensitive to pain during periods of ovulation. In addition, they are more sensitive to electrical stimulation than men, but have the same sensitivity to extreme thermal stimulation. Traditional people are more resistant to pain.
Unlike, for example, vision, pain is not localized in any specific nerve fiber that binds the receptor to the corresponding part of the cerebral cortex. There is also no single type of stimulus that causes pain (as, say, light irritates vision), and there are no specific pain receptors (like rods and cones of the retina). Irritants that cause pain, in small doses, can cause other sensations, such as warmth, coldness, smoothness, or roughness.
Pain theories. There were two alternative positions in the interpretation of the specificity of pain perception. One position was formed by R. Descartes, who believed that there are specific pathways coming from specific pain receptors. The more intense the flow of impulses, the stronger the pain. Another position was presented, for example, by Goldsheider (1894), who denied the existence of both specific pain receptors and specific pathways for pain conduction. Pain occurs whenever an excessive flow of stimuli associated with other modalities (skin, auditory, etc.) enters the brain. Currently, it is believed that there are still specific pain receptors. So, in Frey's experiments, it was proved that there are special pain points on the surface of the skin, the stimulation of which does not cause any other sensations except pain. These pain points are more numerous than the pressure or temperature sensitivity points. In addition, morphine can make the skin insensitive to pain without altering other skin sensitivities. Free nerve endings, also located in internal organs, act as nocireceptors.
Pain signals are transmitted through the spinal cord to the nuclei of the thalamus and then to the neocortex and limbic system. Along with the nonspecific mechanisms of the onset of pain, which are turned on when any afferent nerve conductors are damaged, there is a special nervous apparatus of pain sensitivity with special chemoreceptors that are irritated by kinins formed when blood proteins interact with damaged tissues. Kinins can be blocked by pain relievers (aspirin, pyramidon).
I wonder how painful sensations are remembered. Experiments show that after medical procedures people forget about the duration of pain. Instead, the moments of the strongest and final painful sensations are recorded in the memory. D. Kahneman and his colleagues established this when they asked the participants to put one hand in the ice-cold water that was causing pain and hold it in it for 60 seconds, and then the other in the same water for 60 seconds, plus another 30 seconds, but the water in these 30 seconds no longer caused such strong pain. And when the participants in the experiment were asked which procedure they would like to repeat, the majority wished to repeat more long procedure, when the pain sensation, although it lasted longer, subsided at the end of the procedure. When patients recalled the pain experienced during the examination of the rectum a month later, they also remembered better the last (and also the most painful) moments, and not the total duration of the pain. From this it follows that it is better to slowly ease the pain during a painful procedure than to abruptly interrupt the procedure at the most painful moment. In one experiment, the doctor did this during the procedure for examining the rectum - he extended the procedure for one minute and made the patient feel less pain during this time. And although an additional minute of discomfort did not reduce the total duration of pain during the procedure, patients nevertheless later recalled this procedure as less painful than the one that lasted less time, but ended at the most painful moment.
Types of pain. It has long been noticed that deliberate infliction of additional pain on oneself contributes to a decrease in the subjective force of pain. So, for example, Napoleon, who suffered from kidney stones, interrupted this pain by burning his hand in a candle flame. This raises the question of what should probably be said about different types of pain.
It has been found that there are two types of pain:
Pain transmitted by fast-conducting nerve fibers (L-fibers) large diameter, is distinguished by sharpness, clarity, speed and, apparently, comes from specific areas of the body. it warning system body, indicating that an urgent need to remove the source of pain. This kind of pain can be felt if you are pricked with a needle. The warning pain quickly disappears.
The second type of pain is also transmitted by slowly conducting nerve fibers (S-fibers) of small diameter. This is slow, aching, Blunt pain which is widespread and very unpleasant. This pain is exacerbated if the irritation is repeated. It is a pain resembling a system it signals to the brain that the body has suffered damage and that movement restriction is necessary.
Although there is no generally accepted theory of pain control gate theory (or sensory gateway), created by the psychologist R. Melzak and the biologist P. Wall (1965, 1983), is considered as the most justified. In accordance with it, it is believed that the spinal cord has a kind of nerve "gate" that either blocks pain signals, or allows them (relief) to go to the brain. They noticed that one kind of pain sometimes suppresses another. Hence the hypothesis was born that pain signals from different nerve fibers pass through the same nerve "gates" in the spinal cord. If the gate is "closed" by one pain signal, other signals cannot pass through it. But how does the gate close? Signals transmitted by large, fast-acting nerve fibers of the warning system appear to close the spinal pain gate directly. This prevents the slow pain of the "reminiscent system" from reaching the brain.
Thus, if tissue is damaged, small fibers are activated, opening the neural gate, and a feeling of pain arises. The activation of the large fibers causes the pain gate to close, causing it to subside.
R. Melzak and P. Wall believe that the theory of gate control explains the analgesic effects of acupuncture. Clinics use this effect by supplying a weak electrical current to the skin: this stimulation, felt only as a slight tingling sensation, can significantly ease more excruciating pain.
In addition, pain can be blocked at the level of the spinal hilum due to an increase in general arousal, the appearance of emotions, including during stress. These cortical processes activate fast L-fibers and thereby block access for information transmission from S-fibers.
Also, the gate in front of pain can be closed with the help of information that comes from the brain. Signals that travel from the brain to the spinal cord help explain examples psychological impact for pain. If different ways distract attention from pain signals, then the sensation of pain will be much less. Sports injuries may not be noticed until after a shower. While playing basketball in 1989, Ohio State University team player J. Berson broke his neck, but continued the game.
This theory also explains the occurrence of phantom pain. Just like we see a dream with closed eyes or we hear a ringing in complete silence, as 7 out of 10 cripples suffer from amputated limbs (in addition, it may seem to them that they are moving). This phantom sensation of the extremities suggests that (as in the examples with vision and hearing) the brain may misunderstand the spontaneous activity of the central nervous system that occurs in the absence of normal sensory stimulation. This is due to the fact that after amputation there is a partial regeneration of nerve fibers, but primarily of the S-fiber type, but not L-fibers. Because of this, the spinal gate remains always open, which leads to phantom pain.
Pain control... One way to relieve chronic pain is to stimulate (massage, electromassage, or even acupuncture) the large nerve cords to block the pathway for pain signals. Rubbing the skin around the bruise creates additional irritation that blocks some of the pain signals. Ice on the bruised area not only reduces swelling, but also sends cold signals to the brain that close the gate to pain. Some people with arthritis may carry a small, portable pacemaker near the affected area. When it irritates the nerves in the sore spot, the patient feels more vibration than pain.
Depending on the symptoms in a clinical setting, one or more methods of pain relief are chosen: medications, surgery, acupuncture, electrical stimulation, massage, gymnastics, hypnosis, and auto-training. So, the well-known preparation according to the Lamaze method (preparation for childbirth) just includes several of the above techniques. Among them are relaxation (deep breathing and muscle relaxation), counter-stimulation ( light massage), distraction (concentration of attention on some pleasant object). After E. Worthington (1983) and colleagues conducted several such sessions with women, the latter more easily tolerated the discomfort associated with holding hands in ice water. Nurse can distract the attention of patients who are afraid of injections by loving words and asking to look somewhere when inserting a needle into the body. Beautiful view on a park or garden from the window of a hospital ward also has a positive effect on patients, helps them forget unpleasant feelings. When R. Ulrich (1984) got acquainted with medical records of patients at the Pennsylvania Hospital, he concluded that patients who were treated in wards overlooking the park required fewer drugs, they left the hospital faster than those who lived in cramped wards, whose windows overlooked a blank brick wall.
We face pain in life from the moment of birth, because it is not in vain that we are born with crying. And then we cannot avoid it: we fall, scratch, cut, burn ourselves. And although we are always pretty angry with her in childhood, having matured, we begin to understand its importance After all, if there were no painful sensations, we could die from our own rash actions or just accidents: we would be seriously injured with simple kitchen knives, and falling asleep on the beach, or, leaning against a hot radiator, they woke up with terrible burns. Indeed, pain was given to us for salvation, and as long as we feel it, we are alive and relatively healthy.
There are diseases in which there is insensitivity to pain:
- Paralysis due to stroke: the localization of numbness is tied to the part of the brain where the hemorrhage occurred.
- Diseases that cause conduction disorders of the spinal cord: trauma, later stages vertebral dorsopathy, for example intervertebral hernia, infectious diseases spine.
- Leprosy and other diseases
Have you ever asked yourself: why do we feel pain?
This question has always been of great concern to neuropathologists, neurosurgeons and other doctors. After all, knowing why the pain syndrome occurs, you can come up with a mechanism of protection against it. This is how the famous analgesics appeared, and then more powerful substances that allow you to fight pain symptoms.
We feel pain thanks to special receptors - nerve endings that are equipped with all the nerves of our peripheral nervous system. The entire surface of our body is entangled in a web of nerves. By this, nature protected us from harmful external influences, armed with reflexes: we are in pain - we withdraw our hand. This is due to the sending of a signal by the irritated receptor to the brain and the subsequent response lightning order-reflex from it.
The deeper, the less sensitive the nerves. They are already programmed for another task: protecting the spine and internal organs. The spine is protected by the nerve roots that emerge from the spinal cord, and the internal organs are protected by the autonomic nervous system, which is reasonably arranged, with different sensitivity for different organs.
Three thresholds of pain protection
If our nerve endings and roots responded to literally all pain signals, we simply would not be able to live because of constant suffering. Therefore, the Creator, for our salvation and salvation of the brain, so as not to be distracted by trifling scratches, came up with as many as three pain thresholds of protection. The threshold is crossed when the number of pain impulses exceeds the conditional permissible value.
- The first threshold is at the level of the PNS (peripheral nervous system). This is where minor irritations are screened out. Therefore, we do not cry from a small scratch, and we may not even notice it.
- The second threshold is located at the level of the CNS (central nervous system), in the spinal cord. Here, the filtration of pain signals that have passed through the PNS threshold, analysis of radicular signals arising from vertebral pathologies in the back, analysis of pain impulses that are sent by the autonomic nervous system, which connects all internal organs with the central nervous system, takes place.
- The third threshold (most important) is pain threshold located in the brain of the central nervous system. The brain has to decide, through a complex analysis and counting impulses from all pain receptors, whether in sum it represents a danger to us, whether to signal it to us. All these operations are performed by neurons in the brain for a fraction of a millisecond, which is why our response to pain stimulation is almost instantaneous. Unlike the previous thresholds, which send impulses upward thoughtlessly, the brain approaches this analysis selectively. It can block pain signals or reduce pain sensation with endorphins (a natural pain reliever). During stress and critical situations, adrenaline is produced, which also reduces pain sensitivity.
Types of pain and its analysis by the brain
What are the types of pain, and how are they analyzed by our brain? How does the brain manage to choose from huge amount the signals supplied to it are the most important?
According to our perception, pain is of the following types:
Sharp
It looks like a knife blow, its other name is dagger
Acute pain occurs suddenly and lasts intensely, warning our body of a serious danger
- Injuries (cut, puncture wounds, fractures, burns, bruises of the spine, ruptures and tears of organs during a fall, etc.)
- Inflammation and purulent abscesses of internal organs (appendicitis, peritonitis, ulcer perforation, cyst rupture, etc.)
- Displacement of the vertebrae, and other diseases of the spine
If in the first two cases the pain is constant, then in the third it has the character of a lumbago (lumbago or ishis), which is typical, for example, for all acute back pain
Chronic
It is permanent, it can be aching, pulling, spilled over the surface. Areas where the disease is localized are highly sensitive.
Chronic long-term pain is an indicator that some organ inside us is not healthy for a long time
She periodically turns into acute with the next attack of the disease
Examples:
- Cholecystitis, pancreatitis, gastritis
- Rheumatoid arthritis, bone tuberculosis
- , spondylosis, intervertebral hernia
The close relationship between acute and chronic pain manifestations is clearly demonstrated. Backache (lumbago) after a few days turns into a constant aching pain - lumbodynia, indicating that the disease has not gone anywhere - it is constantly with us.
Chronic and acute pain are passed through different nerve fibers. Fibers, A with a protective myelin sheath are intended for acute pain and are prioritized. B fibers are used for chronic and are secondary. When a focus of acute pain occurs, fibers B are turned off, and impulses of fibers A, as the most important, enter the brain. The speed of signal transmission through them is 10 times faster than in the fibers of B. That is why when acute back pain occurs, the chronic pain disappears somewhere, and we always feel acute pain more intensely than chronic pain.
In fact, chronic pain, of course, has not gone anywhere, it just temporarily ceases to be recorded. This rule holds true for several sources of pain as well. For example, apart from herniated discs, you also have osteoarthritis. Acute back pain due to an attack of a hernia will temporarily turn off aching chronic ones, and vice versa: an exacerbation of osteoarthritis will eclipse the chronic process caused by a hernia.
Chronic pathological
It exists all the time, it causes torment, it is "unhelpful", and sometimes it is difficult to explain the reason for it. This is a kind of failure in the transmission of pain impulses at one of the levels. Examples of
- Phantom pain - occurs with amputation of a limb (there is no limb, but the pain remains)
- Syringomyelia (painful sensitivity, also called "dolorosis anesthesia")
A paradoxical disease in which one feels at the same time strong pain, but at the same time, what hurts (for example, an arm, leg or other area) is absolutely insensitive to external stimuli. A sign of such patients is a lot of burns on the hands or feet. The disease is caused by morphological changes in tissue in the area of the spinal cord.
And in conclusion:
Do not try to treat pain without finding out its cause - it can be deadly!
In what cases, for example?
- Attack of appendicitis
- Exacerbation of gallstone disease
- Spine contusion
- Heart attack
- Perforated ulcer and many other diseases
Be healthy! Be more attentive to your feelings.
Pain. What this feeling is - everyone knows. Despite the fact that it is very unpleasant, its function is useful. After all, severe pain is a signal from the body, which is aimed at drawing a person's attention to malfunctions in the body. If the relationship with him is in order, then you can easily distinguish the pain that arose after physical exercise from the one that appeared after a very spicy dish.
Most often it is divided into two types: primary and secondary. Other names are epicritical and protopathic.
Primary pain
The primary pain is pain that is directly caused by some kind of injury. It can be a sharp pain after a needle prick. This type very sharp and strong, but after the impact of the damaging object ceases, the primary pain immediately disappears.
It often happens that the pain after the disappearance of the traumatic effect does not disappear, but acquires the status chronic illness... Sometimes it can persist for so long that even doctors are unable to determine the reason for which it originally arose.
Secondary pain
Secondary pain is already pulling in nature. At the same time, it is very difficult to indicate the place in which it is localized. In such a situation, it is customary to talk about a pain syndrome that requires treatment.
Why does pain syndrome occur?
So, the person has secondary pain. What is this syndrome? What are the reasons for it? After tissue damage occurs, pain receptors send an appropriate signal to the central nervous system, that is, the brain and spinal cord. This process is associated with electrical impulses and the release of special substances that are responsible for the transmission of nerve signals between neurons. Since the human nervous system is quite a complex system, which has many connections, in the management of sensations associated with pain, there are often disruptions in which neurons send pain impulses even when there are no stimuli.
Localization of pain
By localization, the syndrome is divided into two forms: local and projection. If the failure happened somewhere on the periphery of the human nervous system, then the pain syndrome almost exactly coincides with the damaged area. This can include pain after visiting the dentist.
If a failure occurred in the central nervous system, then a projection form appears. This includes phantom, wandering pains.
Depth of pain
According to this characteristic, visceral and somatic are divided.
Visceral pain is the sensation of internal organs.
Somatic pain is perceived as joint, muscle and skin pain.
There are symptoms that require an urgent response.
Very severe, sharp head pain that has not been seen before
In this case, you need to urgently consult a doctor. It can be both pain from a cold or a cerebral hemorrhage, which is much more serious. If there is no certainty about the reason that caused such a feeling, then you need to undergo a medical examination or call ambulance... Treating acute pain before the cause is identified is not the most a good option. The main feature- it is that the sensation passes before the injury heals. Correct diagnosis is very important.
Sore throat, chest, jaw, arm, shoulder, or abdomen
If chest pain appears, this may not be a good sign of pneumonia or heart attack. But you need to know that with heart disease there is usually some discomfort, not pain. What is the discomfort with such diseases? Some complain of squeezing in the chest, as if someone was sitting on top.
The discomfort associated with heart disease can be felt in the upper chest, but also in the jaw or throat, left arm or shoulder, and also in the abdomen. All this can be accompanied by nausea. So, if a person constantly experiences something like this and knows that he is at risk, he urgently needs to be checked. Indeed, very often people lose time, as they misinterpret the symptoms of pain. Doctors say that the discomfort that occurs from time to time must also be taken seriously. It can be associated with physical stress, emotional distress or excitement. If this is experienced after gardening, and then goes away during rest, then it is most likely angina pectoris, the attacks of which most often occur in hot or cold weather. Discomfort and pain in women with cardiovascular diseases are implicit. They can disguise themselves as symptoms of diseases. gastrointestinal tract, which include discomfort in the abdomen, bloating. After menopause, the risk of such diseases increases dramatically. Therefore, you need to be attentive to your health.
Pain in the lower back or between the shoulder blades
Some doctors say this is a sign of arthritis. But there are other options to keep in mind. It can be a gastrointestinal disorder or a heart attack. In a particular case It's a dull pain in these places can be a symptom In people who are at risk for diseases associated with the heart and blood vessels, the integrity of the organs may be impaired. Such people include those with excessively high blood pressure, circulatory problems, as well as smokers and patients with diabetes mellitus.
Severe abdominal pain
This can include inflammation of the appendix, problems with the pancreas and gallbladder, as well as stomach ulcers and other disorders that cause abdominal pain. You need to see a doctor.
Pain in the calf muscles
Thrombosis is a very serious condition. With it, severe pain is felt. What is thrombosis? This is when a blood clot develops in the veins, causing discomfort. Faces this disease big number of people. Its danger lies in the fact that part of such a clot breaks off, which leads to death. Risk factors are elderly age, cancer, low mobility after prolonged bed rest, obesity, pregnancy. Sometimes there is no pain, but only swelling. In any case, it is best to seek help immediately.
Fever in the legs
This problem is familiar to many people with diabetes. It was on her that this dangerous disease was identified. Some people don't know they have diabetes. So the heat in the legs is one of the first signs. Tingling sensations or which may indicate damaged nerves.
Dispersed pain, as well as combined
Diverse physical painful symptoms often occur when depressive conditions... Patients may complain of soreness in the limbs or abdomen, diffuse pain in the head, and sometimes all of them. Due to the fact that discomfort can be chronic and not felt strongly, patients and their families can simply ignore such symptoms. And the stronger depressive disorder, the more difficult it is for a person to describe sensations. Pain after trauma is often difficult to explain. This can be confusing to doctors. That is why it is necessary to identify other symptoms before diagnosing depression. If you lose interest in life, you cannot think and work with high efficiency, and quarrels with people occur, you need to get the help of a doctor. When something hurts, you do not need to endure silently. After all, depression is not just a deterioration in the condition and quality of life. It needs to be treated very actively before it can cause serious changes.
All of the above types of pain are dangerous, as they can be symptoms. serious illnesses... Therefore, at the slightest sign, you should immediately seek help from doctors. After all, the essence of pain lies in the fact that a person understands that something is wrong in the body. except unpleasant sensations and significant changes in the human body, pain can lead to sad consequences, the worst of which is death.
In the entire history of mankind, only 20 cases have been described in which people have absolutely no pain sensitivity. This phenomenon is called analgia. People suffering from this genetic disorder suffer a large number of injuries, in early childhood they have multiple scars on the tongue and mucous membranes of the mouth: when teething, the baby begins to bite the tongue and cheeks. Later, fractures and burns appear. It is very difficult for such people to live and have to regularly examine their bodies for damage. That is, pain is actually a useful phenomenon, it allows a person to understand: harmful processes are going on in the body, you need to find out what is wrong, or, if the pain is sharp, you need to quickly change your behavior (for example, remove your hand from a hot iron).
What causes pain
The nature of pain is not always the same. In the simplest case, if pain sensitivity is normal, pain occurs as a result of infection, metabolic disorders, and trauma. Tissue damage activates pain receptors that transmit signals to the brain. Such pain - it is also called physiological - easily passes after eliminating its cause and treatment with painkillers. It happens that a diseased organ cannot be cured quickly and completely, and then pain treatment becomes an independent task.
Another cause of pain is damage to the nervous system itself. This pain is called neuropathic pain. Damage can affect both individual nerves and parts of the brain or spinal cord. This is both the pain of herpes, and toothache, and known to tennis players and keyboard people, tunnel syndrome... Neuropathic pain is often associated with sensory abnormalities. It happens that the most common stimuli (heat, cold, touch) are perceived as painful. This phenomenon is called allodynia. Hyperalgesia is an increased pain response to a weak pain stimulus.
The perception of pain depends on many factors. For example, on gender (on average, women are more sensitive to pain) and religiosity (believers find it easier to cope with pain than atheists).
Phantom pain
Back in 1552, the French surgeon Ambroise Paré described the complaints of the wounded about pain in amputated limbs. Today such pains are called phantom pains. It has been established that all people who underwent removal of an arm or leg and half of women who underwent breast amputation complain of phantom pain. One year after surgery, only two thirds of patients experience pain.
It cannot be said that the causes of phantom pain are known. It is now believed that in different departments the central nervous system is formed by a system of foci that generate pathological pain impulses.
There are over 40 treatments for phantom pain, but only 15% of patients are completely cured. Since the specific part of the nervous system responsible for the appearance of phantom pain has not been identified, surgical techniques treatments are ineffective. Local administration of pain relievers helps only a few patients. The technique of electrical stimulation of the motor cortex of the brain is considered quite effective. It can be carried out without surgical intervention- on the surface of the head - or by implanting an electrode for constant direct stimulation of areas of the cortex.
Hangover pain
One of the actions of ethyl alcohol is to suppress the production of the pituitary hormone, which is responsible for fluid retention in the body. With a lack of this hormone, excessive excretion of water by the kidneys begins and dehydration of the body occurs. Alcohol also stimulates the production of insulin, which helps tissue uptake glucose. When liqueurs and sweet wines are consumed, insulin synthesis is doubled. As a result, blood sugar levels drop, which can also cause headache... It can also be provoked by impurities, which are especially abundant in dark-colored drinks: red wine, cognac, whiskey.
The World Health Organization recommends treating cancer pain according to the pain ladder. The first rung of the ladder is mild pain, which is treated with non-steroidal anti-inflammatory drugs. When the first-line drugs stop working, the weak opioid analgesic tramadol, which is not a drug, is used in Russia. At the third stage, with severe unbearable pain, narcotic analgesics are used.
When using narcotic drugs, weakness may appear, which usually goes away after a few days. Constipation can occur because opioids suppress bowel motility. Over time, the dose of analgesic prescribed by your doctor stops working. This is because the pain has worsened, or because drug resistance has developed. In this case, the doctor will recommend an increase in the dose of the medication or prescribe another analgesic. The development of resistance does not mean that drug dependence has appeared. Opioid analgesics, when prescribed for pain management and used correctly, do not cause psychological dependence.
An overdose of an opioid can cause breathing problems, so increasing the dose of the drug is possible only under the supervision of a physician. Abruptly stopping opioids is also dangerous, but with the help of a doctor, you can gradually reduce the dose of the drug and avoid unpleasant symptoms.
Pain not caused by injury
The American Journal of Cardiology in 1989 published data from a survey of more than seven thousand patients with pain in the heart area who were admitted to the department emergency care... According to the results of the examination, only 4% of patients suffered from myocardial infarction, in half it was possible to suspect a heart attack, and 40% of the people who applied had a completely healthy heart. Many parents have had to deal with the situation when a child, cheerful and active on weekends, wilts before school on Monday and complains of abdominal pain. And this is not a pretense: the stomach really hurts, but meanwhile, everything is in order with the stomach and with other organs.
Headache, pain in the heart, in the abdomen, in the back, which has arisen without organic damage to tissues and nerves, is called psychogenic. Psychogenic pain is caused by trauma, depression, and intense emotional states: grief, anger, resentment. Anxious and suspicious people, as well as people prone to demonstrative behavior, are most susceptible to psychogenic pain.
In this state, the work of the nervous system, its sensitivity, changes: impulses that are usually not perceived as painful, begin to be interpreted in this way.
Despite the fact that psychogenic pain is not caused by a violation of the functioning of organs, it must be taken seriously. First, it is important to make sure that this is psychogenic pain, and not dangerous disease... Secondly, psychogenic pain, like any other, worsens the quality of life. You need to cope with this condition with the help of psychotherapy.
How to understand that a person is in pain
There are times when a sick person cannot tell their loved ones that they are in pain. But for those who care for him, it is important to determine the appearance and severity of pain. Often, these problems arise when caring for young children, for debilitated patients, or for people who do not speak due to severe depression.
The manifestation of the fact that a person is in pain may be crying, moans, or a grimace of suffering on the face. But these signs are not always reliable. When it comes to long-term chronic pain, there may be no tears or grimaces of suffering. In this case, attention should be paid to changes in behavior: a sick person either freezes in a forced position, in which pain is felt least of all, or, conversely, rushes about to find the most comfortable position... He avoids movements that can hurt. It happens that a person suddenly becomes apathetic, loses interest in the environment. This is also a likely signal that he is in pain. Doctors can use graphic scales to assess pain: compare different behavioral features, physiological manifestations and, in accordance with accepted norms, draw a conclusion about how strong the patient's pain is. For this, for example, it is necessary to perform a test with an analgesic, paying attention to the respiratory rate, pulse, pressure and general behavior of the person.
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