Prevention and Treatment of Pain

Patients are referred to the pain clinic by their orthopedic surgeon, rheumatologist, oncologist, or another specialist. This usually happens when the pain has already set in and, moreover, in many cases when it is already chronic (more than 3 or 6 months).

One of the objectives of Pain Clinics is to act before the pain appears. We live in a society of prevention: prevention of accidents at work, road safety courses, and fire drills ….. Why not also prevent the pain? In most cases, pain affects the locomotor system and there we can act and prevent it. There are general measures such as postural hygiene or a balanced diet to achieve this, and other more specific ones such as a targeted analysis to determine vitamin D levels, bone densitometry, or a lumbar or cervical spine test.

An exhaustive and detailed physical examination of apparatus and joints is performed. A question is made about history, toxic habits, behavior, and physical activity….. All these measures aimed at pain prevention are included in the so-called “Pain check-up”. Just as health check-ups are carried out to detect or prevent diseases, we also look for predisposing factors or alterations in blood tests, MRI, or other tests, regardless of whether the patient reports pain, which may favor the onset of pain.

Pain is defined as an unpleasant sensory and emotional experience (IASP Chapman, 1986), and is therefore a personal experience. Everyone experiences it differently. Likewise, the “pain check-up” is carried out in a personalized way, a la carte. It varies according to gender, decade of life, or history of diseases, interventions, and habits of each patient.

Pain Treatment

If the pain has already appeared, we must act both to cure it and to treat its cause. There are different types of pain: somatic or visceral and neuropathic. Somatic pain is produced by an injury to a bone (fracture) or organ (wound). Neuropathic pain appears when it is the nerve that hurts. It is a pain that is difficult to manage. For example, in the case of vertebral crushing due to osteoporosis, in addition to administering painkillers to alleviate the pain, we must treat the osteoporosis, provide calcium to the bone and administer outperforming drugs.

In the case of a vertebral fracture with crushing, we can also perform percutaneous vertebroplasty in the acute phase, which consists of injecting cement into the vertebral body or pedicle, reinforcing the vertebral structure and eliminating the pain.

Neuromodulation consists of altering or “modulating” the neuronal information created by pain and transmitted mainly by the posterior medullary horn. It is a phenomenon of depolarization of the nervous system produced by the passage of an electric current so that the effect can be stimulation or inhibition, either local or at a distance. It is a non-invasive approach to treating severe chronic pain. Chronic stimulation is useful in neuropathic pain.

In addition to these therapies, neuromodulation techniques can also be used to treat chronic pain. Neuromodulation includes techniques such as spinal cord stimulation (SCS) and peripheral nerve stimulation (PNS), which involve the use of electrical impulses to modulate the pain signals that reach the brain. These techniques have been shown to be effective in managing chronic neuropathic pain and can improve the patient’s quality of life.

In conclusion, pain clinics play a crucial role in the comprehensive management of oncologic pain. A personalized approach to pain prevention and treatment, including both pharmacological and non-pharmacological therapies, can help alleviate pain and improve the patient’s quality of life. Neuromodulation techniques, such as SCS and PNS, can also be used to manage chronic pain and should be considered in the treatment plan when appropriate according to Psychreg.

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