Pain management and analgesic therapy: what is it? | Emergency Live

Pain therapy, also known as analgesic therapy or algology, includes medication, surgical treatment, rehabilitation measures and psychotherapeutic support, depending on the type of pain to be treated and its causes.

The desire to control pain has always shaped all human cultures.

In this sense, the therapy of pain (or rather the attempt to modify the algic symptomatology) actually has very ancient origins

Thus, even in primitive societies, shamans and sorcerers adopted religious practices of magic (in any case linked to the unconscious) aimed at repelling the “evil spirit” held responsible for the suffering of the individual.

This exogenous, purely “obtrusive” concept of pain can already be found in the Assyro-Babylonian and Egyptian high cultures.

The latter dates the location of the center of sensitivity in the heart, a concept that will remain unchanged for centuries.

Numerous instruments are used in pain therapy: analgesics, physical therapies, techniques that are very similar to surgical interventions, so-called blockades, and today, in rare cases, even real neurosurgical procedures.

analgesic drugs

The treatment of pain with pharmacological therapy essentially uses NSAIDs (nonsteroidal anti-inflammatory drugs, always with good or excellent analgesic activity), weak and strong opioids, anticonvulsants and antidepressants (widely used in neuropathic pain) and local anesthetics.

NSAIDs are usually the first step in pain management

These drugs are particularly effective for “nociceptive” pain; However, when given alone, they can usually only be used for a limited time due to side effects, especially in the first digestive tract (burning, bleeding, ulcers).

In addition, the analgesia of NSAIDs is characterized by a “ceiling effect”: an unlimited increase in doses beyond a certain maximum dose, established in clinical trials before the analgesic was placed on the market, only leads to an increase in side effects, but not in Analgesia.

Antidepressants and anticonvulsants are used mainly in chronic pain of the neuropathic type.

Local anesthetics, which are mainly effective in nociceptive forms of pain, act on both peripheral nerves and neurons of the central nervous system.

opioid drugs

The second step in the management of nociceptive pain is represented by weak opioids such as codeine, followed by strong opioids such as morphine.

All opioids, weak and strong, act through a more or less intense filter or gate effect on the transmission of the pain impulse to the spinal cord and other parts of the central nervous system.

In practice, opioids allow only a fraction of the pain impulses to be transmitted to the cerebral cortex; With adequate dosage, the gate closes completely, and opioids completely suppress the transmission of pain impulses.

Weak opioids cannot control very severe pain, but they also expose the user to a reduced risk of addiction and are therefore used for mild to moderate pain.

However, weak opioids are often unable to control chronic pain for more than four weeks on average, after which a switch to a strong opioid is usually required.

Strong opioids do not have the ceiling effect characteristic of NSAIDs: they control well particularly severe acute pain such as that of a heart attack, but above all precisely because of the lack of a “ceiling effect” and the possibility of increasing the dose, they are useful, often indispensable, to deal with severe chronic pain to control, which are caused by malignant diseases.

Like analgesia, the undesirable effects of weak and strong opioids also develop in the central nervous system: sedation, drowsiness, vomiting, dizziness, the risk of physical and psychological dependence

Physical therapy: X-ray therapy

Of the analgesic radiotherapy techniques, X-ray therapy (the targeted administration of X-rays) is the most effective.

The electrons released in the irradiated tissue have a strong anti-inflammatory and pain-relieving effect.

The electrical stimulation of nerve structures involved in the generation and transmission of pain can also be very useful.

TENS is based on this principle and is carried out using portable devices capable of stimulating skin and nerve structures.

pain blocks

Blocks are pain control techniques that, by their nature, closely resemble surgical procedures, although they are mostly performed on an outpatient basis.

Blockages can be pharmacological or “neurolytic” in nature.

In the first case, local anesthetics are used, which are injected into well-defined nerve structures or into adjacent areas: for example, a ganglion attached to the trigeminal nerve to control the most severe forms of trigeminal neuralgia, or near the spinal cord to create a so-called to achieve “peridural” analgesia that eliminates painful sensitivity without requiring the patient to be completely asleep.

The purpose of all blocks is to reversibly suppress the transmission of nerve impulses on their way from the nociceptors to the cerebral cortex.

The question of the reversibility of the block achieved with local anesthetics is important since neurolithic-type blocks use substances that damage nerve structures and are injected into these structures with the aim of inducing a definitive loss of function.

In very severe pain, and usually in end-stage patients, the same goal can be achieved by appropriate surgical techniques, removing or severing certain anatomical structures: for example, the bundles of nerve fibers that run from the spinal cord to the thalamus.

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