Mechanisms of Chronic Pain

Mechanisms of Chronic Pain An electronic version and the latest edition of this book is available here

Mechanisms of Chronic Pain:  Clinical Aspects: 2rd pub., reh. and comp. / Y.F. Kamenev, V.V. Kamenev. –  Ekaterinburg : Urals University Press, 2009. – 200 p.p. – (Pain Medicine)

This book presents theoretical and practical bases for the new clinical discipline that is being formed for the solution of important clinical tasks – correct diagnostics and effective treatment of all forms and types of chronic pain. The issue at hand is bringing into practice the «Clinical Alphabet of Pain» by means of which a medical professional of any specialty can correctly identify the nature of any pain syndrome and to consider an optimal course of treatment in accordance with it. The book describes in detail the mechanisms of various types of chronic pain, namely the muscular, osseous, articulate, visceral, vascular, and neurogenic pains. To identify the origin of pain syndromes, the authors provide a specially developed algorithm for examination of patients with chronic pain. Also described are the principles of diagnosing the psychogenic pain, the antipode of the pain syndromes originating in tissues. At the end of the book, one can find an extended dictionary of algomedical terms and a schematic plan of examining chronic pain patients’ organs and systems. The book is intended for practicing physicians of all specialties, with a special recommendation to family doctors.

TABLE OF CONTENTS

Preface

Preface to first edition

CHAPTER 1. Dual Nature of Mechanisms of Chronic Pain

CHAPTER 2. Classification of Chronic Pain

CHAPTER 3. Tissue Mechanisms of Primary Chronic Pain

      3.1 Triggering Mechanisms of Tissue (Myofascial) Pain

      3.2 Triggering Mechanisms of Intraosseous Pain

      3.3 Triggering Mechanisms of Joint (Sinovial) Pain

      3.4 Triggering Mechanisms of Visceral Pain

      3.5 Triggering Mechanisms of Vascular (Ischemic) Pain

      3.6 Triggering Mechanisms of Neurogenic Pain

CHAPTER 4. Clinical Essence of Pain Dysfunction of Nervous System

      4.1 Vegetative Pain

      4.2 Somatic Pain

CHAPTER 5. Diagnostic Algorithm of Clinical Research of Chronic Pain

      5.1 Basis for Establishing the Nature of Pain Syndrome

      5.2 Study and Recording of Pain

      5.3 Clinical Examination

      5.4. Selection of Additional Research Methods

      5.5. Study of the Characteristics of Vegetative Regulation

CHAPTER 6. Psychogenesis Pain in Clouse Depression

CHAPTER 7. Tentative Nomenclature of Disorders and Syndromes Based on Pain Type

      7.1. Disorders Associated With Tissue (Myofascial) Pain

      7.2. Disorders Associated With Joint (Sinovial) Pain

      7.3. Disorders Associated With Intraosseous Pain

      7.4. Disorders Associated With Vascular (Ischemic) Pain

      7.5. Disorders Associated With Neurogenic Pain

DICTIONARY OF SCIENTIFIC TERMS IN PAIN MEDICINE

APPENDIX

SCHEMATIC PLAN OF CLINICAL EXAMINATION OF PATIENTS SUFFERING FROM CHRONIC PAIN BY ORGANS AND SYSTEMS OF HUMAN BODY

REFERENCES

Let us sum up. In the form presented, the science of chronic pain acquires the features of completeness and self-sufficiency. This now makes it possible to analyze a problem, which is old as the world on a new (previously unknown) level.

What is noteworthy here?

The modern stage of chronic pain study is based upon ideas concerning the association between changes on the periphery (tissue structures) and in the nervous system, their functional links, and interaction as a primary regulatory mechanism of pain sensitivity in the damaged area. When this interaction is ignored, even a correct diagnosis cannot always guarantee success in pain therapy.

The experience of several generations of physicians was necessary to realize an obvious fact: the establishment of base mechanisms and patterns in the formation of chronic pain should not be fully identified with the pathogenesis of the disorder responsible for the appearance of pain events. As a result of the order of the pathological process, the change in pathogenic mechanisms at its various stages of development is accompanied by the appearance of new sources of pain sensations that may arise from the most widely varied body organs and tissues. Practice has shown that, in many disorders, the algesic print is capable of undergoing substantial changes in conjunction with the complication of the pain syndrome structure. In addition, the newly appearing pain determinants become, in their manifestations, independent of the original disorder that caused them. The pain pathology acquires chronic nature, with the appearance at its various structural and functional levels of self-sustaining pathological cycles.

The «Clinical Alphabet of Pain» helps to understand the principles of pain formation in each type of pathology and to use the most effective means of pain therapy for its abatement. In providing medical attention for the patients with pain, it is necessary to consider the fact that disorders are characterized by constant change in pathological pain determinants due to the progression of tissue and organ changes.

At first, the change in pain determinants occurs within a single tissue structure (a phase of the pathological process), after which the tissues and organs adjacent to the pathological center become sources of pain. If the disorder is accompanied by the appearance of biomechanical (structural) disparities, then the number of pathological pain determinants increases to a multitude. The professionalism of the physician in such cases lies in understanding the patterns of the formation of pain in each type of pathology and in using the most effective means of pain therapy for its elimination.

Without understanding how pain can transform itself from one type into another, and, correspondingly, how the approaches to its elimination are modified within the domain of the same disorder, it is impossible to provide real help to patients in chronic pain. Here we refer to the discovery of hidden pain determinants that cannot be discerned otherwise, except by means of in-depth clinical investigation into the dialectical nature of this phenomenon.

Diseases that are characterized by alteration of the biomechanics of the locomotor apparatus or by a shift of the pathological process from one tissue structure to another are always accompanied by mutation of pain mechanisms in connection with complication of the structure of the pain syndrome. The picture of pain is, as it were, interwoven of a multiplicity of independent forms of pain, fundamentally distinct from one another with respect to the conditions of their development, the mechanisms of their formation, their clinical manifestations, and finally, the methods of treating them.

The new theory of chronic pain can be used to determine the resources of pain-control therapy of patients with pathology of the most diverse organs and systems of the body. This refers to re-examination of, and making the necessary adjustments to, the schema of pain treatment for diseases relating essentially to all branches of medicine (internal medicine, surgery, gynecology, neurology, and other disciplines).

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