[건강이 최고] If pain persists for more than 6 months despite treatment, it is diagnosed as ‘chronic pain’
Kim (51), who has been suffering from chronic pain for more than six months, is suffering from insomnia. Since she had no clear disease name or cause, she was not properly diagnosed and treated, so she was misunderstood as malingering or mental illness.
Chronic pain generally refers to persistent pain that causes discomfort in daily life for more than 6 months despite continuing conservative treatment. When the chronic pain becomes centralized and the neurotransmitter system is damaged, the cause of the pain is resolved and the pain becomes excessive even without stimulation.
The area of pain is various, such as back, waist, neck, chest, headache, etc. Various diseases such as spinal disease, rheumatoid arthritis, migraine or trigeminal neuralgia can worsen chronic pain, and sometimes pain caused by trauma caused by accidents or falls can become chronic.
The prevalence of depression or depression in chronic pain patients is about 30-70%, and those who complain of sleep disorders or loss of motivation are as high as 60-80%. Im Yoon-hee, a professor of anesthesiology and pain medicine at Sanggye Paik Hospital, said, “It is presumed that neurotransmitters such as serotonin and norepinephrine are involved in the transmission of emotions and pain in the brain.”
The most representative type of chronic pain is ‘complex regional pain syndrome’ (CRPS). It is a sensory neurological disease in which the pain that started in a specific part of the body gets worse and further, the color of the skin changes or the hair falls out, the bone density weakens due to poor blood circulation, and the joints cannot be used.
In addition, there are chronic headaches, myofascial pain syndrome, post-spine surgery pain syndrome, peripheral polyneuropathy, and phantom limb pain (feeling pain as if an amputated limb is still present).
The main symptom of chronic pain is pain that occurs even in the absence of a stimulus that causes pain. Characteristically, the more there is no stimulation, the more pronounced the pain is, so there are many cases of complaining of pain in the middle of the night.
In addition, arthritis and neuropathy patients often have a characteristic that the pain becomes more severe depending on the weather or environmental change. Various physical, sensory, and psychiatric symptoms such as digestive system disorders, lethargy, and emotional changes may be accompanied.
The cause of chronic pain is still not clear. It is believed to be caused by a combination of environmental and genetic factors.
The main principle of occurrence is that somatosensory nerves, which detect pain and transmit it to the spinal cord and brain, become sensitive to pain and generate pain signals even though there is no stimulus that can cause pain.
Chronic pain is diagnosed through ‘diagnosis of exclusion’, in which possible diagnoses are eliminated one by one. Through various tests, the primary cause of pain, such as fractures or inflammation, is found. As a result of the examination, if there is no abnormal structure or physiological abnormality, but persistent pain is diagnosed as chronic pain.
The primary treatment for chronic pain is medication. Tricyclic antidepressants, which regulate the activity of pain transmission pathways in the brain stem, are used first.
In addition, there are times when a nervous system drug or an anticonvulsant drug is used, and physical therapy can increase the treatment effect.
If drug treatment does not improve, nerve block can be performed. Nerve block is a procedure that anesthetizes the nerves in the pain transmission pathway. There are many different methods of nerve block, and it is performed in an appropriate way depending on the type of pain.
For chronic pain that persists despite drug treatment and nerve block, surgical treatment is considered. There are methods of finding and cutting somatosensory nerve transmission pathways and electrical stimulation methods.
If you have phantom limb pain or peripheral neuropathy, it is effective to use a method that cuts the spinal cord somatosensory neurotransmission pathway. If the centralization of chronic pain changes the neurotransmitter system in the brain, it is helpful to cut off the anterior target that feels pain in the brain.
Electrical stimulation methods can also be performed on the spinal cord and brain. The most popular pain surgery is spinal nerve stimulation, which involves inserting a low-frequency electrical stimulation machine into the patient’s body.
Patients with spinal nerve stimulator implantation can control pain through their preferred electrical stimulation. When abnormal pain occurs in the brain, deep brain stimulation or brain cortex stimulation is used.
A healthy lifestyle is the most important to prevent chronic pain. You can eat a balanced diet regularly, get adequate sleep, and do regular exercise that suits you. Relieving tension and reducing stress through hobbies can also help.
Jeong Mun-young, a professor of neurosurgery at Soonchunhyang University Bucheon Hospital, said, “Chronic pain is difficult to treat, but it is not an incurable disease. If treated in close cooperation with a specialist, the quality of life can definitely be improved,” he said. “In addition, chronic pain can be misunderstood as malingering because there is no visible way to express the abnormality.
Professor Jeong said, “Rather than thinking, ‘I need to completely get rid of the pain,’ I recommend continuing your daily life while receiving appropriate treatment with a comfortable mind.” “In particular, it is good to improve blood circulation and increase muscle mass through steady exercise. Unlike the initial treatment effect, narcotic analgesics eventually increase the intensity of pain and cause drug addiction, so it is better not to use them.”
Daeik Kwon Medical Reporter [email protected]
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2023-07-21 22:40:00
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