Pain - definition and types, classification and types of pain. Pain, pain syndrome: causes, types, diagnosis, treatment Their manifestations are acute pain with

Pain syndrome is an uncomfortable sensation that every person has felt at least once in a lifetime. Such an unpleasant process is accompanied by almost all diseases, so this syndrome has many varieties, each of which is characterized by its own causes, symptoms, their intensity, duration and methods of treatment.

Very often, people try to get rid of it themselves and seek help from doctors too late, while requiring immediate treatment. It is also important to understand that the manifestation of pain is not always bad, but, on the contrary, makes it clear to a person with which internal organ he has problems.

Varieties

Pain syndrome has a wide range of diversity, since the human body is a favorable field for its manifestation. There are many pain syndromes:

• myofascial pain syndrome- muscle tension, due to which there is an unexpected sharp pain. It does not have a pronounced localization, since in humans the muscles are located throughout the body;
• abdominal pain syndrome- is the most common expression of problems with the gastrointestinal tract and is accompanied by different intensity of pain. Often there is an abdominal pain syndrome in children - absolutely any pathological process in the child's body can become the causes of expression - from a viral cold to the malfunctioning of internal organs;
• vertebrogenic pain syndrome- in this case, the appearance of pain in the spinal column and the back as a whole is noted. Appears against the background of compression of the roots of the nerves of the spinal cord. In the medical field, it has a second name - radicular pain syndrome. Occurs more often with osteochondrosis. Pain can disturb a person not only in the back, but also in the legs and chest;
• anococcygeal pain syndrome- based on the name, it is localized in the coccyx and posterior perineum. To diagnose this type of pain, it is necessary to conduct a comprehensive examination of the patient;
• patellofemoral- characterized by pain in the knee joint. If treatment is not started in time, it can lead to disability of the patient, as cartilage is erased;
• neuropathic- is expressed only with damage to the central nervous system and indicates a violation of the structure or functioning of tissues. Occurs from various injuries or infectious diseases.

In addition to this classification, each of the syndromes can exist in the form of:

• acute - with a single manifestation of symptoms;
• chronic pain syndrome - which is expressed by a periodic exacerbation of symptoms.

Common syndromes have their own designation in the international classification system of diseases (ICD 10):

• myofascial - M 79.1;
• vertebrogenic, M 54.5;
• patellofemoral - M 22.2.

Etiology

The causes of each of the syndromes depend on the location. So, myofascial pain syndrome appears on the background of:

• prolonged use of medications;
• various heart diseases and chest injuries;
• incorrect posture (very often expressed due to stoop);
• wearing tight and uncomfortable clothes, strong squeezing with belts;
• performing hard physical exercises. Often professional athletes suffer from such an ailment;
• increase in body weight of a person;
• sedentary working conditions.

The reason for the appearance of the abdominal type of syndrome, in addition to diseases of the digestive tract, are:

• withdrawal from drug use;
• shattered nervous system;

Radicular pain syndrome manifests itself when:

• hypothermia of the body;
• congenital pathology of the structure of the spine;
• sedentary lifestyle;
• oncology of the spinal cord;
• strong impact of physical stress on the spine;
• hormonal changes that may occur due to pregnancy or the removal of all or one half of the thyroid gland;
• various injuries of the back and spine.

The appearance of chronic pain syndrome is due to:

• diseases or injuries of the musculoskeletal system;
• various joint lesions;
• tuberculosis;
• osteochondrosis;
• oncological neoplasms in the spine.

Causes of anokopchikovy pain syndrome:

• injuries of the coccyx or pelvis, strong one-time or minor, but regular. For example, driving a car on bad roads;
• complications after medical intervention in the anus;
• prolonged diarrhea;
• chronic .

The grounds for the formation of patellofemoral pain can be:

• standing work;
• long walks or hikes;
• loads in the form of running and jumping, very often performed by athletes;
• age group, quite often this disease affects older people;
• knee injuries, even minor ones, lead to the formation of this type of pain, but not immediately, but after a certain period of time.

Provocateurs of neuropathic syndrome:

• infections that affect the functioning of the brain;
• pathological processes occurring in this organ, for example, hemorrhages or the formation of cancerous tumors;
• lack of vitamin B12 in the body;

The cause of vertebrogenic syndrome is often osteochondrosis.

Symptoms

Depending on the type of manifestation of pain, the symptoms may be intense or absent altogether. Signs of myofascial pain syndrome are:

• constant pain without pronounced localization;
• clicks when opening the mouth;
• the oral cavity does not open more than two centimeters (in the normal state - about five);
• problematic chewing and swallowing;
• pain moving to the ears, teeth and throat;
• uncontrollable twitching of facial muscles;
• frequent urge to urinate;
• discomfort while walking;
• discomfort in the chest area.

Symptoms of the abdominal syndrome:

• increased fatigue of the body;
• severe dizziness;
• frequent vomiting;
• the heart rate is increased, chest pains are possible;
• loss of consciousness;
• bloating;
• pain can spread to the back and lower limbs;
• feces and urine become darker in color.

Manifestation of anokopchikovy pain syndrome:

• during defecation, the anus and rectum hurt, and in the normal state, such a feeling is localized only in the coccyx;
• exacerbation of discomfort at night, and has nothing to do with going to the toilet room;
• duration of pain from a few seconds to an hour;
• a dull ache may radiate to the buttocks, perineum, and thighs.

Symptoms of radicular pain syndrome are:

• the appearance of pain depending on which nerve was damaged. Thus, it can be felt in the neck, chest, back, heart and legs;
• at night it can be manifested by increased sweating;
• swelling and change in skin tone;
• complete lack of sensitivity at the site of nerve damage;
• muscle weakness.

Symptoms of this syndrome may resemble signs of osteochondrosis.

Patellofemoral pain is expressed in one specific place - the knee, and the main symptom is considered to be a fairly audible crunch or crack during movements. This is due to the fact that the bones of the joint are in contact due to the thinning of the cartilage. In some cases, symptoms of osteochondrosis appear.

Diagnostics

Due to the fact that for some pain syndromes it is difficult to determine the place of localization of pain, hardware studies become the main means of diagnosis.

In the diagnosis of myofascial pain syndrome, ECG, echocardiography, coronography and myocardial biopsy are used. To confirm the abdominal type, analyzes are carried out and, and, FEGDS. Women are tested for pregnancy.

In the definition of anokopchikovy pain syndrome, an important place is occupied by differential diagnosis. The disease should be distinguished from other diseases of the anus, which have similar symptoms. Radiography and additional consultations of a gynecologist, urologist and traumatologist are carried out.

Recognition of radicular syndrome takes place on the basis of examination and palpation, as well as MRI not only of the back, but also of the chest. During the diagnosis, it is important to exclude osteochondrosis. Due to the clear location of the localization, patellofemoral syndrome is diagnosed quite simply, using CT, MRI and ultrasound. In the early stages of the disease, radiography is not performed, since no abnormalities in the structure of the knee will be found.

Treatment

For each individual type of pain syndrome, personal methods of therapy are characteristic.

For the treatment of myofascial pain syndrome, not one method is used, but a whole range of therapeutic measures:

• correcting posture and strengthening the muscles of the back and chest is carried out by wearing special corsets;
• medication injections of vitamins and painkillers;
• physiotherapeutic methods, treatment with leeches, a course of massages and acupuncture.

Abdominal pain syndrome is rather difficult to treat, especially if it was not possible to determine its cause, so doctors have to look for ways to get rid of pain on their own. For this, antidepressants, various antispasmodics and drugs aimed at relaxing muscles can be prescribed.

Treatment of anokopchikovy pain syndrome mainly consists of physiotherapy, which includes UHF, the influence of currents, the use of therapeutic mud compresses, massage of spasmodic muscles. Of the drugs prescribed anti-inflammatory and sedative substances.

Therapy of radicular syndrome consists of a whole range of measures - ensuring complete rest for the patient, the use of medications that relieve pain and inflammation, and the passage of several courses of therapeutic massages. Therapy has common features with the treatment of osteochondrosis.

To cure patellofemoral syndrome in the early stages, it will be enough to ensure peace and complete immobilization of the affected limb for one month, using compresses that the specialist will prescribe. In later stages, surgery may be needed, during which either cartilage is transplanted or the bones of the joint are brought back to normal.

The sooner the treatment of neuropathic syndrome begins, the better the prognosis will be. Therapy consists of the administration of drugs such as anesthetics. Therapy with antidepressants and anticonvulsants is also carried out. Non-drug methods include acupuncture and electrical nerve stimulation.

Prevention

To prevent the onset of pain syndrome, it is necessary:

• always follow the correct posture and do not overload the back muscles (it will help to avoid the radicular type);
• perform moderate physical activity and lead an active lifestyle. But the main thing is not to exaggerate, so that patellofemoral syndrome does not arise;
• maintain normal body weight and prevent obesity;
• wear only comfortable clothes and in no case narrow;
• avoid injuries, especially back, legs, chest and skull.
• at the slightest health disorder, immediately consult a doctor;
• several times a year to undergo preventive examinations in the clinic.

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Pain is an important adaptive reaction of the body, which has the value of an alarm signal.

However, when pain becomes chronic, it loses its physiological significance and can be considered pathological.

Pain is an integrative function of the body, mobilizing various functional systems to protect against the impact of a damaging factor. It is manifested by vegetosomatic reactions and is characterized by certain psycho-emotional changes.

The term "pain" has several definitions:

- this is a kind of psycho-physiological state that occurs as a result of exposure to super-strong or destructive stimuli that cause organic or functional disorders in the body;
- in a narrower sense, pain (dolor) is a subjective painful sensation that occurs as a result of exposure to these superstrong stimuli;
Pain is a physiological phenomenon that informs us about harmful effects that damage or represent a potential danger to the body.
Thus, pain is both a warning and a protective reaction.

The International Association for the Study of Pain defines pain as follows (Merskey and Bogduk, 1994):

Pain is an unpleasant sensation and emotional experience associated with actual and potential tissue damage or a condition described in terms of such damage.

The phenomenon of pain is not limited solely to organic or functional disorders in the place of its localization, pain also affects the activity of the organism as an individual. Over the years, researchers have described innumerable adverse physiological and psychological consequences of unrelieved pain.

The physiological consequences of untreated pain of any location can include everything from deterioration of the function of the gastrointestinal tract and respiratory system, to increased metabolic processes, increased growth of tumors and metastases, decreased immunity and prolonged healing time, insomnia, increased blood clotting, loss of appetite and decrease in work capacity.

The psychological consequences of pain can manifest as anger, irritability, feelings of fear and anxiety, resentment, discouragement, despondency, depression, solitude, loss of interest in life, reduced ability to perform family responsibilities, reduced sexual activity, which leads to family conflicts and even to request euthanasia.

Psychological and emotional effects often influence the subjective reaction of the patient, exaggeration or underestimation of the significance of pain.

In addition, the degree of self-control of pain and disease by the patient, the degree of psychosocial isolation, the quality of social support and, finally, the patient's knowledge of the causes of pain and its consequences can play a certain role in the severity of the psychological consequences of pain.

The doctor almost always has to deal with the developed manifestations of pain-emotions and pain behavior. This means that the effectiveness of diagnosis and treatment is determined not only by the ability to identify the etiopathogenetic mechanisms of a somatic condition that manifests itself or is accompanied by pain, but also by the ability to see behind these manifestations the problems of limiting the patient's usual life.

A significant number of works, including monographs, are devoted to the study of the causes and pathogenesis of pain and pain syndromes.

As a scientific phenomenon, pain has been studied for more than a hundred years.

Distinguish between physiological and pathological pain.

Physiological pain occurs at the moment of perception of sensations by pain receptors, it is characterized by a short duration and is directly dependent on the strength and duration of the damaging factor. Behavioral reaction at the same time interrupts the connection with the source of damage.

Pathological pain can occur both in receptors and in nerve fibers; it is associated with prolonged healing and is more destructive due to the potential threat of disrupting the normal psychological and social existence of the individual; the behavioral reaction in this case is the appearance of anxiety, depression, depression, which aggravates the somatic pathology. Examples of pathological pain: pain in the focus of inflammation, neuropathic pain, deafferentation pain, central pain.

Each type of pathological pain has clinical features that make it possible to recognize its causes, mechanisms and localization.

Types of pain

First type- Sharp pain caused by tissue damage, which decreases as it heals. Acute pain has a sudden onset, short duration, clear localization, appears when exposed to an intense mechanical, thermal or chemical factor. It can be caused by an infection, injury, or surgery, lasts for hours or days, and is often accompanied by symptoms such as palpitations, sweating, paleness, and insomnia.

Acute pain (or nociceptive) is pain that is associated with the activation of nociceptors after tissue damage, corresponds to the degree of tissue damage and the duration of the damaging factors, and then completely regresses after healing.

Second type- chronic pain develops as a result of damage or inflammation of the tissue or nerve fiber, it persists or recurs for months or even years after healing, does not have a protective function and causes suffering to the patient, it is not accompanied by signs characteristic of acute pain.

Unbearable chronic pain has a negative impact on the psychological, social and spiritual life of a person.

With continuous stimulation of pain receptors, their sensitivity threshold decreases over time, and non-painful impulses also begin to cause pain. Researchers associate the development of chronic pain with untreated acute pain, emphasizing the need for adequate treatment.

Untreated pain subsequently leads not only to a material burden on the patient and his family, but also entails huge costs for society and the health care system, including longer hospital stays, reduced ability to work, multiple visits to outpatient clinics (polyclinics) and emergency rooms. Chronic pain is the most common common cause of long-term partial or complete disability.

There are several classifications of pain, see one of them in Table. one.

Table 1. Pathophysiological classification of chronic pain

Pain classification

Somatic pain occurs when the skin of the body is damaged or stimulated, as well as when deeper structures are damaged - muscles, joints and bones. Bone metastases and surgery are common causes of somatic pain in patients with tumors. Somatic pain is usually constant and fairly well-defined; it is described as pain throbbing, gnawing, etc.

Visceral pain

It is described as deep, constrictive, generalized and may radiate into the skin. Visceral pain, as a rule, is constant, it is difficult for the patient to establish its localization. Neuropathic (or deafferentation) pain occurs when nerves are damaged or irritated.

It can be constant or intermittent, sometimes shooting, and is usually described as sharp, stabbing, cutting, burning, or an unpleasant sensation. In general, neuropathic pain is more severe than other types of pain and is more difficult to treat.

Clinically pain

This classification may be useful for initial therapy, however, in the future, such a division is not possible due to the close combination of these pains.

nocigenic pain

Pain in visceral injury results from rapid contraction, spasm, or stretching of smooth muscles, since smooth muscles themselves are insensitive to heat, cold, or cut.

Pain from internal organs with sympathetic innervation can be felt in certain areas on the surface of the body (Zakharyin-Ged zones) - this is referred pain. The most famous examples of such pain are pain in the right shoulder and right side of the neck with gallbladder disease, pain in the lower back with bladder disease, and finally pain in the left arm and left side of the chest with heart disease. The neuroanatomical basis of this phenomenon is not well understood.

A possible explanation is that the segmental innervation of the internal organs is the same as that of the distant areas of the body surface, but this does not explain the reasons for the reflection of pain from the organ to the body surface.

The nocigenic type of pain is therapeutically sensitive to morphine and other narcotic analgesics.

neurogenic pain

Neurogenic pain has many clinical forms.

These include some lesions of the peripheral nervous system, such as postherpetic neuralgia, diabetic neuropathy, incomplete damage to the peripheral nerve, especially the median and ulnar (reflex sympathetic dystrophy), detachment of the branches of the brachial plexus.

Neurogenic pain due to damage to the central nervous system is usually due to a cerebrovascular accident - this is known by the classical name of the "thalamic syndrome", although studies (Bowsher et al., 1984) show that in most cases the lesions are located in other areas than the thalamus.

Many pains are mixed and are clinically manifested by nocigenic and neurogenic elements. For example, tumors cause both tissue damage and nerve compression; in diabetes, nocigenic pain occurs due to damage to peripheral vessels, and neurogenic pain due to neuropathy; with herniated discs that compress the nerve root, the pain syndrome includes a burning and shooting neurogenic element.

Psychogenic pain

It is enhanced in hysterical personalities, and more accurately reflects reality in non-hysteroid patients. It is known that people of different ethnic groups differ in their perception of postoperative pain.

Patients of European descent report less intense pain than American blacks or Hispanics. They also have low pain intensity compared to Asians, although these differences are not very significant (Fauucett et al., 1994). Some people are more resistant to developing neurogenic pain. Since this trend has the aforementioned ethnic and cultural characteristics, it seems to be innate. Therefore, the prospects for research aimed at finding the localization and isolation of the "pain gene" are so tempting (Rappaport, 1996).

Any chronic disease or ailment accompanied by pain affects the emotions and behavior of the individual.

Pain often leads to anxiety and tension, which themselves increase the perception of pain. This explains the importance of psychotherapy in pain control. Biofeedback, relaxation training, behavioral therapy, and hypnosis used as a psychological intervention are found to be useful in some stubborn, treatment-refractory cases (Bonica, 1990; Wall and Melzack, 1994; Hart and Alden, 1994).

Treatment is effective if it takes into account the psychological and other systems (environment, psychophysiology, behavioral response) that potentially influence pain perception (Cameron, 1982).

The discussion of the psychological factor of chronic pain is based on the theory of psychoanalysis, from behavioral, cognitive and psychophysiological positions (Gamsa, 1994).

G.I. Lysenko, V.I. Tkachenko

Neuropathic pain, unlike ordinary pain, which is a signal function of the body, is not associated with disorders in the functioning of any organ. This pathology has recently become an increasingly common ailment: according to statistics, 7 out of 100 people suffer from neuropathic pain of various degrees of severity. This kind of pain can make even the simplest of tasks excruciating.

Kinds

Neuropathic pain, like “normal” pain, can be acute or chronic.

There are also other forms of pain:

• Moderate neuropathic pain in the form of burning and tingling. Most often felt in the limbs. It does not cause particular concern, but it creates psychological discomfort in a person.
• Pressing neuropathic pain in the legs. It is felt mainly in the feet and legs, can be quite pronounced. Such pain makes it difficult to walk and brings serious inconvenience to a person's life.
• Short term pain. It may last only a couple of seconds, and then disappear or move to another part of the body. Most likely caused by spasmodic phenomena in the nerves.
• Oversensitivity when exposed to the skin of temperature and mechanical factors. The patient experiences discomfort from any contact. Patients with such a disorder wear the same habitual things and try not to change positions during sleep, as a change in position interrupts their sleep.

Causes of neuropathic pain

Pain of a neuropathic nature can occur due to damage to any parts of the nervous system (central, peripheral and sympathetic).

We list the main factors of influence for this pathology:

• Diabetes. This metabolic disease can lead to nerve damage. This pathology is called diabetic polyneuropathy. It can lead to neuropathic pain of various nature, mainly localized in the feet. Pain syndromes are aggravated at night or when wearing shoes.
• Herpes. The consequence of this virus may be postherpetic neuralgia. Most often, this reaction occurs in older people. Neuropathic post-herpes pain can last for about 3 months and is accompanied by severe burning in the area where the rash was present. There may also be pain from touching the skin of clothing and bedding. The disease disrupts sleep and causes increased nervous excitability.
• Spinal injury. Its effects cause long-term pain symptoms. This is due to damage to the nerve fibers located in the spinal cord. It can be strong stabbing, burning and spasmodic pain in all parts of the body.
• This severe brain damage causes great damage to the entire human nervous system. A patient who has undergone this disease for a long time (from a month to a year and a half) can feel pain symptoms of a stabbing and burning nature in the affected side of the body. Such sensations are especially pronounced when in contact with cool or warm objects. Sometimes there is a feeling of freezing of the extremities.
• Surgical operations. After surgical interventions caused by the treatment of diseases of internal organs, some patients are disturbed by discomfort in the suture area. This is due to damage to the peripheral nerve endings in the surgical area. Often such pain occurs due to the removal of the mammary gland in women.
• This nerve is responsible for facial sensation. When it is compressed as a result of injury and due to the expansion of a nearby blood vessel, intense pain can occur. It can occur when talking, chewing, or touching the skin in any way. More common in older people.
• Osteochondrosis and other diseases of the spine. Compression and displacement of the vertebrae can lead to pinched nerves and neuropathic pain. Compression of the spinal nerves leads to the occurrence of radicular syndrome, in which pain can manifest itself in completely different parts of the body - in the neck, in the limbs, in the lumbar region, and also in the internal organs - in the region of the heart and stomach.
• Multiple sclerosis. This lesion of the nervous system can also cause neuropathic pain in different parts of the body.
• Radiation and chemical exposure. Radiation and chemicals have a negative effect on the neurons of the central and peripheral nervous system, which can also be expressed in the occurrence of pain sensations of a different nature and intensity.

Clinical picture and diagnosis in neuropathic pain

Neuropathic pain is characterized by a combination of specific sensory disturbances. The most characteristic clinical manifestation of neuropathy is a phenomenon referred to in medical practice as "allodynia".

Allodynia is a manifestation of a pain reaction in response to a stimulus that does not cause pain in a healthy person.

A neuropathic patient may experience severe pain from the slightest touch and literally from a breath of air.

Allodynia can be:

• mechanical, when pain occurs with pressure on certain areas of the skin or irritation with their fingertips;
• thermal, when pain manifests itself in response to a thermal stimulus.

Certain methods for diagnosing pain (which is a subjective phenomenon) do not exist. However, there are standard diagnostic tests that can be used to evaluate symptoms and develop a therapeutic strategy based on them.

Serious help in diagnosing this pathology will be provided by the use of questionnaires for pain verification and its quantitative assessment. Accurate diagnosis of the cause of neuropathic pain and identification of the disease that led to it will be very useful.

For the diagnosis of neuropathic pain in medical practice, the so-called method of three "C" is used - look, listen, correlate.

• look - i.e. identify and evaluate local disorders of pain sensitivity;
• listen carefully to what the patient says and note the characteristic signs in the description of pain symptoms;
• correlate the patient's complaints with the results of an objective examination;

It is these methods that make it possible to identify the symptoms of neuropathic pain in adults.

Neuropathic pain - treatment

The treatment of neuropathic pain is often a lengthy process and requires a comprehensive approach. In therapy, psychotherapeutic methods of influence, physiotherapy and medication are used.

Medical

This is the main technique in the treatment of neuropathic pain. Often this pain is not relieved by conventional painkillers.

This is due to the specific nature of neuropathic pain.

Opiate treatment, although quite effective, leads to tolerance to the drugs and can contribute to the formation of drug dependence in the patient.

Most commonly used in modern medicine lidocaine(in the form of an ointment or patch). The drug is also used gabapentin and pregabalin- effective drugs of foreign production. Together with these drugs, sedative drugs for the nervous system are used, which reduce its hypersensitivity.

In addition, the patient may be prescribed drugs that eliminate the effects of diseases that led to neuropathy.

Non-drug

plays an important role in the treatment of neuropathic pain physiotherapy. In the acute phase of the disease, physical methods are used to relieve or reduce pain syndromes. Such methods improve blood circulation and reduce spasmodic phenomena in the muscles.

At the first stage of treatment, diadynamic currents, magnetotherapy, and acupuncture are used. In the future, physiotherapy is used that improves cellular and tissue nutrition - exposure to a laser, massage, light and kinesitherapy (therapeutic movement).

During the recovery period physiotherapy exercises is given great importance. Various relaxation techniques are also used to help relieve pain.

Treatment of neuropathic pain folk remedies not particularly popular. Patients are strictly forbidden to use folk methods of self-treatment (especially warming procedures), since neuropathic pain is most often caused by inflammation of the nerve, and its heating is fraught with serious damage up to complete death.

Permissible phytotherapy(treatment with herbal decoctions), however, before using any herbal remedy, you should consult your doctor.

Neuropathic pain, like any other, requires careful attention. Timely treatment will help to avoid severe attacks of the disease and prevent its unpleasant consequences.

The video will help you understand the problem of neuropathic pain in more detail:

Pain I

In the description of patients, pain sensations by their nature can be sharp, dull, cutting, stabbing, burning, pressing (squeezing), aching, pulsating. By duration and frequency, they can be constant, paroxysmal, associated with the time of day, seasons of the year, physical activity. , posture of the body, with certain movements (for example, with breathing, walking), eating, defecation or urination, etc., which makes it possible to suspect the localization and pathology that causes pain. The features of emotional reactions accompanying pain, for example, the feeling of fear of death that accompanies retrosternal B. with angina pectoris, myocardial infarction, and pulmonary embolism, are also of diagnostic value.

A certain diagnostic orientation is given by the differentiation of somatalgia, i.e. pain caused by irritation of the fibers of the somatic nerves, and vegetalgia (sympathology) that occurs when the sensory fibers of the autonomic innervation are involved. Somatalgia (permanent or paroxysmal) are localized in the zone of innervation of peripheral nerves or roots and are usually not accompanied by autonomic disorders, or the latter (with very intense pain) have a character (general, increased blood pressure, increased heart rate, etc.).

With vegetalgia, disorders of vegetative functions are observed as a rule and are often local in nature, expressed as local spasms of peripheral vessels, changes in skin temperature, goosebumps, impaired sweating, trophic disorders, etc. Sometimes vegetalgia reaches the degree of causalgia (Causalgia) , often with reflected pain of the type of repercussion (Repercussion) with the appearance of pain in the Zakharyin-Ged zones. Perhaps the appearance of pain in one half of the body (), which is observed, in particular, with damage to the thalamus. The high frequency of repercussion with the appearance of pain in areas distant from the affected organ should be borne in mind in the differential diagnosis of diseases of internal organs, blood vessels, bones, and joints. for example, with myocardial infarction (myocardial infarction), B. is possible not only in the sternum with irradiation to the left hand, but also B. in the thoracic spine, B. in the lower, in the forehead, in the right hand, in the abdomen (abdominal form), etc. With all the variety of manifestations of pain repercussion, the total characteristic of B. helps to highlight features that are typical or atypical for any process in the region of internal organs. for example, dissecting aneurysm of the aorta is similar in many characteristics to myocardial infarction, but B.'s spread along the spine with irradiation to the legs, which is characteristic of a dissecting aneurysm, is not typical of myocardial infarction.

The behavior of the patient during painful paroxysms also has diagnostic value. for example, with myocardial infarction, the patient tries to lie still, the patient with an attack of renal colic rushes about, takes various poses, which is not observed with a similar localization of B. in a patient with lumbar sciatica.

In diseases of the internal organs, B. occurs as a result of blood flow disorders (, thrombosis of the mesenteric or renal artery, atherosclerotic stenosis of the abdominal aorta, etc.); spasm of smooth muscles of internal organs (stomach,); stretching of the walls of hollow organs (gall bladder, renal pelvis, ureter); the spread of the inflammatory process to areas supplied with sensitive innervation (on the parietal pleura, peritoneum, etc.). substance of the brain is not accompanied by B., it occurs when the membranes, venous sinuses, and intracranial vessels are irritated. Pathological processes in the lung are accompanied by B. only when they spread to the parietal pleura. Strong B. arise at a spasm of vessels of heart. B. in the esophagus, stomach, and intestines often occurs when they are spastic or stretched. Pathological processes in the parenchyma of the liver, spleen, kidneys do not cause pain if they are not accompanied by acute stretching of the capsule of these organs. Pain in the muscles occurs with bruises, myositis, convulsions, arterial circulation disorders (in the latter cases, B. proceeds according to the type of sympathalgia). At defeat of a periosteum and bone processes B. have extremely painful character.

It must be borne in mind that pain in diseases of the internal organs may not occur for a long time and grow like an avalanche only at an incurable stage of the process (for example, with malignant neoplasms). After curing a somatic disease, persistent pain is possible associated with the consequences of damage to the nerve trunks, their ischemic changes, adhesions, changes in the functional state of the nodes of preganglionic autonomic innervation, as well as with psychogenic fixation of pain.

The elimination of pain as one of the most painful manifestations of the disease for the patient is one of the priorities solved by the doctor in the process of determining treatment tactics. The best option is to eliminate the cause of pain, for example, removal of a foreign body or squeezing, reduction of dislocation, etc. If this is not possible, preference is given to influences on those links of pathogenesis with which pain is associated, for example, taking alkalis to relieve pain in duodenal ulcers, nitroglycerin for angina pectoris, antispasmodics (see Antispasmodics) and anticholinergics (see Anticholinergics) - with hepatic and renal colic, etc. With the ineffectiveness or impossibility of causal and pathogenetic therapy, they resort to symptomatic treatment of pain with the help of analgesics (Analgesics) , the effect of which may be enhanced by the simultaneous use of neuroleptics (Neuroleptics) or tranquilizers (Tranquilizers) . However, with an unspecified nature of the somatic disease, especially with unclear abdominal pain, the use of analgesics is contraindicated due to the possible modification of the clinical picture, making it difficult to diagnose the disease, in which urgent surgical intervention may be indicated (see Acute abdomen) . With local pain, incl. with some neuralgia, local anesthesia is sometimes appropriate . With persistent debilitating pain in patients with chronic diseases and the low effectiveness of analgesics, symptomatic surgical B. is used - radicotomy, cordotomy, tractotomy, and other methods.

Bibliography: Valdman A.V. and Ignatov Yu.D. Central mechanisms of pain, L., 1976, bibliogr.; Grinshtein A.M. and Popova N.A. Vegetative syndromes, M., 1971; Erokhin L.G. Facial pains, M., 1973; Kalyuzhny L.V. Physiological mechanisms of regulation of pain sensitivity, M., 1984, bibliogr.; Karpov V.D. nervous diseases, M., 1987; Kassil G.N. Science of pain, M., 1975; Kryzhanovsky G.N. Determinant structures in the pathology of the nervous system, M., 1980; Nordemar R. Back pain, . from Swedish., M., 1988; Shtok V.N. , M., 1987, bibliogr.

Rice. 1. Scheme of the occurrence of projected pain. Nerve impulses caused by direct stimulation (indicated by the arrow) travel along afferent fibers in the spinothalamic tract to the corresponding zone of the cerebral cortex, causing a sensation of pain in that part of the body (hand) that is usually caused by irritation of nerve endings: 1 - part of the body with pain receptors; 2 - sensation of pain at the location of the corresponding pain receptors; 3 - brain; 4 - lateral spinothalamic tract; 5 - spinal cord; 6 - afferent nerve fiber.

Rice. 2. Scheme of the occurrence of referred pain. Pain sensations from the internal come to the spinal cord, individual structures of which synaptically contact the nerve cells of the spinothalamic tract, on which nerve fibers terminate, innervating a certain segment of the skin: 1 - skin; 2 - the trunk of the sympathetic nervous system; 3 - back spine; 4 - lateral spinothalamic tract; 5 - spinal cord; 6 - front spine; 7 - internal organ; 8 - visceral nerve.