A review of the approach to chronic non-cancer pain in adults
Pain is an unpleasant feeling that is caused by a harmful stimulus and its purpose is basically to defend and protect against harm. Pain is a reaction caused by the perception of different nerves at the levels of the body to an internal or external stimulus and an emotional and emotional experience that is accompanied by severe tissue and psychological damage and is evaluated according to such criteria. Chronic pain is defined as limited, intermittent or continuous pain that affects the normal function of tissues and lasts for more than twelve weeks. Unlike acute pain, chronic pain is often felt for no apparent reason. Chronic pain is caused by a combination of biological, psychological, and social factors, and most of the time, a multifactorial approach is needed to manage it.
The origin of chronic pain may be neurogenic (of nerve origin), nociceptive (pain caused by tissue damage), or psychological. Treatment of patients with pain due to structural causes such as intervertebral disc pain, degenerative joint diseases or disorders
Inflammation, such as pain caused by rheumatoid arthritis, systemic lupus erythematosus, Crohn’s disease, or other painful conditions, such as pain caused by tissue infarction, are different from each other.
In this article, an approach to the management of chronic non-cancer pain and an overview of non-pharmacological and pharmaceutical treatment methods will be discussed.
Unlike acute pains that are caused by different physiological mechanisms, chronic pains are more of a general physical and mental problem and are a set of chronic pains that cause countless problems for patients suffering from them. Among the immobility of the patient and the resulting problems in the muscles and joints, weakening the patient’s immune system and predisposing him to other diseases, sleep problems, loss of appetite and improper nutrition of the patient. Dependence on drugs, more than usual dependence of the patient on family members and caregivers, excessive and unreasonable use of medical services, failure to provide appropriate services in the workplace or disability, isolation of a person with chronic pain from society and He mentioned family and introversion, anxiety and fear as the cause of pain, feelings of hopelessness, depression and suicide. In fact, chronic pain is a major clinical challenge.
The overall approach and the appropriate initial treatment strategy for chronic pain depend on the accurate assessment of the cause of the pain and the type of chronic pain syndrome. Treatment of chronic pain is usually difficult and in most cases it is not possible to get rid of pain completely. The initial management of a patient with chronic pain includes targeted pain treatment. For example, if nerve function is impaired by compression (eg, carpal tunnel syndrome, trigeminal neuralgia), reducing or eliminating the underlying cause can be effective in reducing pain.
If there is no improvement with non-pharmacological interventions in the first stage, drug treatment is selected according to the type of pain and clinical conditions and the response to treatment according to Algorithm 1. Finally, nerve block with different methods is considered an alternative for resistant pains that have responded well to previous treatments. Table 2 shows the non-opioid drugs used in the treatment of pain. Picture 1 shows the effect of different pain management solutions.
