The pain (la douleur)
There is not a living being who has not tried by an experiment called: Pain (la douleur), this subjective experience, sensory, emotional and unpleasant is linked to tissue damage or potential. It is important to diagnose specifying after examination and clinical examination the seat of pain, its radiation, extent, type, rhythm, acute or chronic nature, circumstances of onset and the triggers and the impact and intensity.
Pain (la douleur) can be divided into two types acute and chronic. In the first type it is a warning symptom leading to diagnosis, it occurs during myocardial infarction, sciatica, and renal colic for example. In the second type, the diagnostic procedure is the same with a treatment of the cause if it is possible. The mechanism is also distinguished two types:
a/ Pain due to excessive nociception caused by stimulation of peripheral receptors related to visceral or tissue lesions, it is either a mechanical pain triggered by exercise or inflammatory exacerbated the night with a regional topography, sensitivity to sensitivity to analgesic is caused by an excess of nociception.
b/ Neuropathic pain also called deafferentation pain caused by an injury to the nervous system, is the decreased activity of primary afferents causing dysfunction of nerve transmission, in this case the pain does not respond to analgesic but it is sensitive to antidepressants.
The evaluation of pain intensity was made by the use of certain scales: the visual scale and analgesic verbal scale of intensity. The impact of chronic pain is also assessed on sleep, appetite, general condition, its emotional impact of work and family.
The treatment prescribed in cases of neuropathic pain is based antidepressants and if nociceptive processing the treatment is based on analgesics taking into account the patient's history, side effects and intensity of pain in the choice of drugs.
We must respect the principles of prescription painkillers, we act on the case by a specific treatment or etiology of the patient with information on the cause of pain and analgesics, the prescription must meet the levels of WHO. We should never prescribe a preventive treatment on demand and it seeks increased tolerance and increases gradually with the spacing of doses taken within the caution especially in elderly patients. The reassessment of the pain and the effectiveness of treatment and the prevention of side effects and the association of adjuvant therapy.
To treat chronic pain WHO proposes a scheme of progressive use of analgesics formed by three stages, when treatment becomes insufficient prior change of level is planned, the three levels are:
1/Level non-opioid: anti-inflammatory drugs, the paracetamol, noramidopyrine, salicylates.
2/Low morphine level: dextropropoxyphene, tramadol, buprenorphine, codeine.
3/High morphine level.
It operates primarily in the first tier analgesics and analgesics in the second tier, and then the third tier.
For better control of pain are prescribed adjuvant co-analgesics such as:
The anti-inflammatory drugs may be prescribed in cases of bone pain caused by arthritis, bone metastases of various cancers and effusions. They can be taken alone or associated with opioids.
-Corticosteroids are prescribed for pain by inflammation or compression as peritumoral edema, intracranial hypertension and liver and bone metastases.
-Antispasmodics particularly during digestive disorders.
-In pain from nerve compression are used psychotropic ie tricyclic antidepressants and LAROXYL ANAFRANIL type, dosage antidepressant and stronger than the analgesic dose. On some neuropathic pain blazing action of anticonvulsants is obvious, then: TEGRETOL, RIVOTRIL particularly when combined with a muscle spasm, anxiety or insomnia.
-In case of secondary sites, bone and brain metastases and nerve compression can be carried out radiotherapy analgesics which profit can appear after one week.
By Dr H. Sami
Pain (la douleur) can be divided into two types acute and chronic. In the first type it is a warning symptom leading to diagnosis, it occurs during myocardial infarction, sciatica, and renal colic for example. In the second type, the diagnostic procedure is the same with a treatment of the cause if it is possible. The mechanism is also distinguished two types:
a/ Pain due to excessive nociception caused by stimulation of peripheral receptors related to visceral or tissue lesions, it is either a mechanical pain triggered by exercise or inflammatory exacerbated the night with a regional topography, sensitivity to sensitivity to analgesic is caused by an excess of nociception.
b/ Neuropathic pain also called deafferentation pain caused by an injury to the nervous system, is the decreased activity of primary afferents causing dysfunction of nerve transmission, in this case the pain does not respond to analgesic but it is sensitive to antidepressants.
The evaluation of pain intensity was made by the use of certain scales: the visual scale and analgesic verbal scale of intensity. The impact of chronic pain is also assessed on sleep, appetite, general condition, its emotional impact of work and family.
The treatment prescribed in cases of neuropathic pain is based antidepressants and if nociceptive processing the treatment is based on analgesics taking into account the patient's history, side effects and intensity of pain in the choice of drugs.
We must respect the principles of prescription painkillers, we act on the case by a specific treatment or etiology of the patient with information on the cause of pain and analgesics, the prescription must meet the levels of WHO. We should never prescribe a preventive treatment on demand and it seeks increased tolerance and increases gradually with the spacing of doses taken within the caution especially in elderly patients. The reassessment of the pain and the effectiveness of treatment and the prevention of side effects and the association of adjuvant therapy.
To treat chronic pain WHO proposes a scheme of progressive use of analgesics formed by three stages, when treatment becomes insufficient prior change of level is planned, the three levels are:
1/Level non-opioid: anti-inflammatory drugs, the paracetamol, noramidopyrine, salicylates.
2/Low morphine level: dextropropoxyphene, tramadol, buprenorphine, codeine.
3/High morphine level.
It operates primarily in the first tier analgesics and analgesics in the second tier, and then the third tier.
For better control of pain are prescribed adjuvant co-analgesics such as:
The anti-inflammatory drugs may be prescribed in cases of bone pain caused by arthritis, bone metastases of various cancers and effusions. They can be taken alone or associated with opioids.
-Corticosteroids are prescribed for pain by inflammation or compression as peritumoral edema, intracranial hypertension and liver and bone metastases.
-Antispasmodics particularly during digestive disorders.
-In pain from nerve compression are used psychotropic ie tricyclic antidepressants and LAROXYL ANAFRANIL type, dosage antidepressant and stronger than the analgesic dose. On some neuropathic pain blazing action of anticonvulsants is obvious, then: TEGRETOL, RIVOTRIL particularly when combined with a muscle spasm, anxiety or insomnia.
-In case of secondary sites, bone and brain metastases and nerve compression can be carried out radiotherapy analgesics which profit can appear after one week.
By Dr H. Sami
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