PAIN Treatment
PAIN Treatment
Maria Dalamagka
Chapter 1
Protocol of Pain
Novel Research in Sciences
Maria Dalamagka
Protocol of Pain. Nov Res Sci. 6(1). NRS. 000627. 2021.
DOI: 10.31031/NRS.2021.06.000627
https://crimsonpublishers.com/nrs/pdf/NRS.000627.pdf
https://painmanagement.conferenceseries.com/ocm/2017/dalamagka-maria-edessa-general-hospital-greece
5th International Conference and Exhibition on
Pain Research and Management. Exploring and acquiring the advances in Pain Research. October 05-07, 2017
https://www.researchgate.net/publication/382428764_ebookpdf
Mini Review
When acute pain progresses to chronic, then it is not a symptom of a condition, but is in itself a condition. It lasts longer than the expected course of the disease or injury. Usual period of 3-6 months. In the past the answer to chronic pain was: “everything is in your mind”. A useful definition by Margo McCaffrey is: “pain is what describes the person who experiences it and exists when he says he exists [1].” The International Union for the Study of Pain says it is “an unpleasant aesthetic and emotional experience, combined with actual or potential tissue damage, or described in terms of such damage”. Pain is transmitted through the body through the nervous system when nerve endings detect damage to a part of the body. Today, pain specialists can understand how pain is created: the way the nervous system, including the spinal cord, interacts with the brain to create the sensation of pain [2]. Knowledge of the neurotransmitter system, the chemical messengers that transmit nerve signals, has paved the way for important new methods of treating pain. In recent years, scientists have learned how to manage these chemical messengers to change the way they interact with brain signals. This has led to the use of antidepressants and other drugs, which work with certain chemicals in the brain, such as which affect emotions and help in perceiving pain. There are now drugs that are very effective. And with advances in MRI, researchers can prove that the changes are very real in the brain. We can see exactly where the sensation of pain in the brain is created, when it is activated by a stimulus. We can see the effects of pain on a person’s emotional state. There is also a new concept, a process called central awareness. If the initial pain from an injury is not treated properly, then these pain signals are sent repeatedly, resulting in changes in the central nervous system, which make it increasingly vulnerable. So over time, even normal stimuli can be perceived as painful. With this knowledge, pain specialists are now prescribing medications that attack moderate to severe chronic pain from different perspectives: innovative drugs, nerve-targeting techniques, and drug delivery pumps that offer strong nerve analgesia [3].
Doctors also approve of the use of psychotherapy, relaxation techniques, hypnosis and alternative therapies, such as acupuncture, which rely on the growing evidence of a brain body connection to relieve chronic pain. There is still much to learn, but research has shown evidence of the development of even newer treatment options. Pain specialists now prescribe medications that attack moderate to severe chronic pain from different angles: innovative drugs, nerve-targeting techniques, and drug pumps, which offer strong nerve root analgesia. Doctors also approve of the use of psychotherapy, relaxation techniques, hypnosis and alternative therapies, such as acupuncture, which rely on the growing evidence of a brain body connection to relieve chronic pain. There is still much to learn, but research has shown evidence of the development of even newer treatment options. Pain specialists now prescribe medications that attack moderate to severe chronic pain from different angles: innovative drugs, nerve-targeting techniques, and drug pumps, which offer strong nerve root analgesia.
Doctors also approve of the use of psychotherapy, relaxation techniques, hypnosis and alternative therapies, such as acupuncture, which rely on the growing evidence of a brain body connection to relieve chronic pain. There is still much to learn, but research has shown evidence of the development of even newer treatment options. and drug delivery pumps, which offer a strong analgesia to the nerve roots. Doctors also approve of the use of psychotherapy, relaxation techniques, hypnosis and alternative therapies, such as acupuncture, which rely on the growing evidence of a brain-body connection to relieve chronic pain. There is still much to learn, but research has shown evidence of the development of even newer treatment options. and drug delivery pumps, which offer a strong analgesia to the nerve roots. Doctors also approve of the use of psychotherapy, relaxation techniques, hypnosis and alternative therapies, such as acupuncture, which rely on the growing evidence of a brain-body connection to relieve chronic pain. There is still much to learn, but research has shown evidence of the development of even newer treatment options [4,5]. Many patients come for treatment in the final stages of chronic pain, when it is more difficult to treat. The sooner treatment is started, the better the chances of successfully treating the pain. When the pain is severe then doctors turn to stronger drugs to treat it: a.Antiepileptics: Medications used to treat seizures are effective in treating chronic pain. It is unclear how they control pain, but it is thought to lead to milder effects of neuropathic pain, such as post-herpes zoster neuralgia. These include Pregabalin (Lyrica), gabapentin (Neurontin) and Carbamazepine (Tegretol). A new generation of antiepileptic drugs seems to be promising, with fewer side effects [6]. b.Antidepressants: Low doses of common antidepressants are prescribed for many chronic pain problems. These drugs regulate the levels of chemicals in the brain, and this is thought to be their mechanism in controlling pain. Antidepressants often help when other treatments do not lead to complete pain control. They lead to pain relief, whether the person suffers from depression or not. The doses used to treat pain are usually lower than those used to treat depression. Amitriptyline (Elavil), Nortriptyline (Pamelor) and Norpramin are tricyclic antidepressants, prescribed for chronic pain, especially cancer pain, neuropathic pain from diabetic neuropathy and postherpetic neuralgia from shingles. They affect the levels of chemicals in the brain, such as norepinephrine and serotonin. Duloxetine (Cymbalta) is a serotonin and norepinephrine reuptake inhibitor, which increases the availability of brain chemicals serotonin and norepinephrine. Duloxetine has been approved for the treatment of diabetic neuropathy, fibromyalgia and musculoskeletal pain, such as osteoporosis and chronic back pain [7]. c.Pain relief creams: Topical analgesics, such as capsaicin containing Zostrix, are often helpful. Capsaicin works by reducing the transmission of a pain chemical called substance P to the brain.
Products with these ingredients also have a similar effect: salicylate (found in products such as Aspercreme and Bengay), a substance that reduces inflammation and provides pain relief, and anti irritants such as camphor, eucalyptus oil and the menthol, which lead to pain relief by causing cold or heat at the site of the pain [8]. d.Skin patches: A transdermal patch containing lidocaine can provide relief from chronic pain. Patches have been approved for neuropathic pain from shingles, a condition known as post herpes neuralgia. Lidoderm and Lidopain are two skin patches of lidocaine. Capsaicin is also available in a patch and is placed by the doctor himself and is called Qutenza. It can be used every three months [9]. e.Opioids: When the pain is severe then the next stage is opioids. Opioids such as codeine, fentanyl, morphine, oxycodone act on pain receptors at the level of nerve cells and are very effective in controlling severe chronic pain. But opioid use has always been controversial. There is a perception among doctors that they will get into legal trouble if they undergo treatment or show excessive zeal in treating opioid pain. It is a factor associated with inadequate training on these drugs. They are very effective for the right patients. They should be used carefully, but they can be used in the long run. There is a small risk of addiction. But studies show that the risk is small when used properly. When prescribed because, pain specialists often use combinations of medications, such as new prolonged-release antidepressants. The combination of drugs allows us to reduce the amount of opioids and leads to better pain control, because the mechanism of action of opioids is different from other drugs, such as antidepressants and antiepileptics. This approach is critical to treating neuropathic pain, such as diabetic neuropathy. Tramadol (Ultram ER) is a non-opioid drug that acts on opioid receptors. It is indicated in moderate to moderate pain, when continuous pain management is required. Synthetic opioids do not appear to be addictive. They are effective in treating many different pain syndromes. Many doctors prefer them before moving on to opioids [10]. f.Among the newest opioids for pain control are: The Duragesic transdermal patch for the treatment of moderate to severe pain. Provides continuous supply of opioid fentanyl for 72 hours. More options for pain flares: There are two fast-acting drugs that contain fentanyl. They were developed for cancer patients who have sudden pain and are already taking opioids for cancer pain. Fentanyl citrate (Actiq) comes in the form of a lollipop and Fentora is a soluble tray in the mouth. The following procedures can also help control pain: i.Nerve blockages: When a group of nerves causes pain in a specific organ or area of the body, the pain can be ruled out by injecting a local anesthetic. This is a nervous breakdown. Injections and nerve blocks are more effective in treating acute pain. But also, in patients with a depressed nerve, nerve blockages can alleviate the pain so that the patient can function and start physical therapy. And if treatment is started early, the development of chronic pain will be prevented. Radiofrequency ablation: A small area of nerve tissue is heated to reduce pain signals from that area. The procedure is performed under the guidance of CT imaging. A needle is inserted into the affected nerve area and an electric current is used to thermally destroy the target. A new technique, the application of high frequency pulses, offers only neuro transformation, without leading to nerve damage, as the temperature does not exceed 45 oC. The control of chronic pain lasts from three to six months. This is a great advantage, because it is a very localized and very specific treatment for pain. It’s not a panacea, but it can really make a difference in some cases. TENS .: Percutaneous electrical nerve stimulation. The treatment is useful for short-term pain relief. It includes a small device, which distributes low level electricity and helps to exclude pain. It is very useful in the treatment of various types of muscle pain and is often used with infusions at T trigger point (myoperitoneal trigger points, which are alginate in pressure, parts of the body). ii.Trigger point injection: These are sore spots on muscle or connective tissue. They can sensitize the nerves around them and cause pain in other parts of the body. Particular sensitivity can also develop in nearby muscles or areas of the body. An injection of a local anesthetic (sometimes with a steroid) is given into the trigger point to relieve the pain. It usually requires only a few treatments to resolve the trigger point and the pain that arises from it. It is a relatively simple and safe process. iii. Pain pacemakers: The technique is called electrical spinal cord stimulation and involves a pacemaker (neurostimulator) implanted in the body. The neurostimulator provides low-level electrical signals to the spinal cord or to specific nerves and prevents the transmission of pain to the brain (electrodes are placed in the epidural space and connected to the neurostimulator). The patient can adjust the on/off switch and adjust the intensity of the electrical signals. Electrical stimulation of the spinal cord is applied when other techniques have failed, as well as when a cancerous pain has infiltrated a nerve root. Implantable drug delivery pumps. These are also called intrathecal pumps because they send analgesic drugs to the spinal cord. Local anesthetics, Opioids and other analgesics can be given through these implantable pumps. At the touch of a button, it is injected analgesic and nerve block, so as not to transmit pain to the spinal cord. These pumps are often used in cancer patients, but also in patients who have tried drugs but developed side effects. The dosage is much lower than that of the oral one, so the side effects are less. There is also a psychological benefit to pumps, as controlling pain can help in the prevention of post-traumatic stress. iv.Surgery: Surgery can help in some cases. Removing a tumor can offer pain relief, as can shrinking a tumor with radiotherapy. In neurosurgery, a cross-section of the nerves is made to control the pain.
Advice for better
Dealing with chronic pain: It is very difficult to live with a chronic pain, which leads to depression, anxiety, anger and can make the pain worse. Negative emotions reduce the body’s endogenous opioids and increase its sensitivity to pain. When chronic pain settles, the person’s life shrinks to give way to pain. Activities are limited and this perpetuates the vicious cycle of pain as the perception of pain becomes worse. Health, work and interpersonal relationships “bleed”. Sleep and mood disorders perpetuate the sensation of pain. With counseling, patients gain skills in managing chronic pain. They can also find solutions to everyday problems that cause them stress and depression [11].
Alternative approaches to Chronic pain: Stress aggravates the pain, so a relaxation technique is great useful in all types of pain. When the patient is upset with something, his pain will rise several points on the pain scale. Biofeedback, for example, helps people train their minds to control bodily functions such as muscle tension, respiration and heart rate, leading to a reduction in stress and stress responses. Relaxation techniques are an important part of treating pain. Deep breathing, meditation, guided mental imagery, and hypnosis allow
the mind to help the body. Regular exercise helps reduce stress and promote relaxation, which helps relieve chronic pain. Acupuncture, a traditional Chinese technique, has earned the respect of Western medicine. The National Institutes of Health recognizes acupuncture as an effective way to treat pain, especially in headaches and back pain, and suggests that the technique can help with other chronic pain conditions, such as arthritis, fibromyalgia and muscle aches. Acupuncture is extremely useful with pain and more and more insurance companies abroad are covering acupuncture treatments.
References
1. Margo McCaffery, Chris Pasero (1999) Pain: Clinical manual. 2nd (edn.), Mosby publishers, US, pp. 1-795.
2. French JA, Gazzola DM (2011) New generation antiepileptic drugs: What do they offer in terms of improved tolerability and safety? Ther Adv Drug Saf 2(4): 141-158.
3. Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D (2006) Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain 10(4): 287-333.
4. Morley S, Eccleston C, Williams AC (1999) Systematic review and meta analysis of randomized controlled trials of cognitive behavioral therapy for chronic pain in adults, excluding headache. Pain 80(1-2): 1-13.
5. (2003) Pain management services: Good practice. RCoA and BPS, UK.
6. (2006) Desirable criteria for pain treatment facilities. IASP Seattle, USA.
7. (2004) A practical guide to the provision of chronic pain services for adults in primary care. BPS, UK, pp. 1-90.
8. Maniadakis N, Gray A (2000) The economic burden of back pain in the UK. Pain 84(1): 95-103.
9. Jensen MP, Chodroff MJ, Dworkin RH (2007) The impact of neuropathic pain on health-related quality of life: review and implications. Neurology 68(15): 1178-1782.
10.(2003) Acupuncture: Review and analysis of reports on controlled clinical trials. WHO Health Systems Library, pp. 1-87.
11. Dimitris Vasilakos, Pain & its treatment.
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Chapter 2
Dalamagka Maria. (2018). Neuropathic Pain. Archives of Anesthesiology, 1, 28–30. https://doi.org/10.22259/2638-4736.0102004
Archives of Anesthesiology. 2018; 1(2): 28-30
https://sryahwapublications.com/article/abstract/2638-4736.0102004
Neuropathic Pain
Maria Dalamagka
Abstract
Background and purpose: Neuropathic pain (NP) is often refractory to pharmacologic and non-interventional treatment. Neuropathic pain can be distinguished from non-neuropathic pain by two factors. In neuropathic pain there is no transduction (conversion of a nociceptive stimulus into an electrical impulse). Finally, injury to major nerves is more likely than injury to non-nervous tissue to result in chronic pain. This review focuses on the clinical treatment of neuropathic pain as well aims to improve the care of adults with neuropathic pain.
Methods: Clinical treatment of neuropathic pain depends on clinical evaluation, as treatment can be pharmacological or not; invasive treatment or other therapies.
Results: Neuropathic pain because of its heterogeneity, there is often uncertainty regarding the nature and exact location of a lesion or health condition associated with neuropathic pain.
Conclusions: Both peripheral and central nervous system mechanisms contribute to the persistence of most types of neuropathic pain. Patients with conditions as diverse as diabetic polyneuropathy, human immunodeficiency virus (HIV) sensory neuropathy, poststroke syndromes, and multiple sclerosis frequently experience daily pain that greatly impairs their quality of life.
Implications: Progress in basic science will lead to a greater understanding of the pathophysiologic mechanisms of neuropathic pain.
Introduction
Neuropathic pain (NP) has been defined by the International Association for the Study of Pain as pain arising as a direct consequence of a lesion or disease affecting the somatosensory nervous system [1]. According to an Institute of Medicine report, one in three Americans experiences chronic pain more than the total number affected by heart disease, cancer, and diabetes combined [2]. The prevalence of NP is 6-8% in the general population, but associated factors are advancing age, female gender and lower socioeconomic groups [3] Around 15-25% of people with chronic pain are currently thought to have neuropathic pain [3,4].
Physiology and Mechanism
The generation of pain in response to tissue injury involves four basic elements. Transduction, a function of nociceptors that converts noxious stimulation to nociceptive signals; Transmission, a process that sends nociceptive signals along nerve fibers from the site of injury to the central nervous system (CNS); Transformation or plasticity, a mechanism that modulates nociceptive signals at synaptic sites and at the level of the CNS through ascending, descending, or regional facilitation and inhibition; Perception, a key component of the clinical pain experience that integrates cognitive and affective (emotional) responses. Neuropathic pain can be classified according to the underlying disease (diabetic neuropathy, multiple sclerosis), the location of the lesion (peripheral nerve damage, spinal cord) and the underlying mechanism. Characteristics of neuropathic pain are automatic start, independent stimulus, continuous burning, breakthrough pain, electric shock-like pain, dysaesthesia (abnormal and unpleasant sensation), paraesthesia, hyperalgesia (increased response to normally painful stimuli), allodynia (pain from non painful stimuli). In neuropathic pain, tissue damage directly affects the nervous system, resulting in the generation of ectopic discharges that bypass transduction [5]. The pain is initiated or caused by a primary lesion or dysfunction in the nervous system, and yet its cause is heterogeneous and commonly may be inflammatory (for example, post herpetic neuralgia), metabolic, or ischaemic [6]. The main approach is to divide peripheral neuropathic pain into stimulus evoked pain or stimulus independent pain (spontaneous pain) [7].
Evaluation and Treatment of Neuropathic Pain
Clinical evaluation of pain includes: historical and onset of symptoms; localization, quality, intensity and duration of pain; evaluation of the impact of pain on ordinary activities and any sleep disorders; effect of pain in the psychological realm of patient; answer or not previous treatments. Non pharmacological treatments for neuropathic pain includes: maintain activity and labor employment; mobilisation, exercise, TENS, Acupuncture. Pharmacological treatments includes: analgesics such as Paracetamol, mild opioid (tramadol, codeine); non-steroidal anti-inflammatory drugs; opioids, antidepressants, anti epileptics, local factors such as Lidocaine 5%. Invasive techniques such as Neuro modulation in which a series of treatments aimed at changing the perception of pain after stimulation or inhibition of neural pathways. Another treatment is induction of bone marrow; in resistant neuropathic pain are inserted one or two epidural electrodes, which are then connected to an electrical source, such as that of the pacemaker. Finally another option is pulsed radio frequency in which a single needle is inserted in the area of neural damage. The resulting heat creates a temporary impairment of the nervous tissue [8].
Conclusions
Injury to the peripheral or central nervous system results in maladaptive changes in neurons along the nociceptive pathway that can cause neuropathic pain. Neuropathic pain is very challenging to manage because of its heterogeneity. There is often uncertainty regarding the nature and exact location of a lesion or health condition associated with neuropathic pain. Chronic neuropathic pain is common in clinical practice. Patients with conditions as diverse as diabetic polyneuropathy, human immunodeficiency virus (HIV) sensory neuropathy, post stroke syndromes, and multiple sclerosis frequently experience daily pain that greatly impairs their quality of life. Both peripheral and central nervous system mechanisms contribute to the persistence of most types of neuropathic pain. Interest in the mechanisms and treatment of chronic neuropathic pain has increased during the past several years, and this is likely to result in significant treatment advances in the future. Progress in basic science will lead to a greater understanding of the pathophysiologic mechanisms of neuropathic pain.
References
[1] Treede RD, Jensen TS, Campbell JN et al. Neurology 2008; 70: 1630-5
[2]Research, Care, and Education. Relieving pain in America. A blueprint for transforming prevention, care, education and research. National Academies Press, 2011. http://books.nap.edu/openbook.php?record_id=13172&page=1.
[3] Torrance N, Smith BH, Bennett MI et al.. The epidemiology of chronic pain of predominantly neuropathic origin. Results from a general population survey. J Pain 2006;7:281-9.
[4] Bouhassira D, Lantéri-Minet M, Attal N et al.. Prevalence of chronic pain with neuropathic characteristics in the general population. Pain 2008;136:380-7.
[5] Devor M. Neuropathic pain and injured nerve: peripheral mechanisms, Br Med Bull1991;47:619-30.
[6] Merskey H, Bogduk N. Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain
7] Woolf CJ, Mannion RJ. Pain: neuropathic pain: aetiology, symptoms, mechanisms and management. Lancet 1999; 353: 1959–1964
[8] Neuropathic pain – pharmacological management: NICE clinical guideline 173 (November 2013)
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Chapter 3
Acupuncture for Depression and PsychologicalDisorders
Zendy. Research Library
https://zendy.io/title/10.22259/2638-4736.0102002
Maria Dalamagka
Archives of Anesthesiology. 2018; 1(2): 06-09.
Advances in Complementary & Alternative medicine. ISSN2637-7802. Crimson publishers.
Feasibility and Outcome; Euro Surgery 2020: August 10, 2020; London, UK.
International Conference on Surgery and Anesthesia. J Med Imp Surg, 5(1), 4. Journal of Medical Implants & Surgery.
Abstract
Acupuncture therapy has been known as a practice related to oriental medicine, and recently has been detected as a potential therapeutic tool for which there is good scientific evidence. Depression and anxiety are usually classified as mental illnesses and it is more useful to think of them as disturbances in brain health, which is directly related to the physical makeup and brain mechanisms and emotional and relational issues. The ancient Chinese practice of acupuncture could be used for the treatment of depression and anxiety, instead of drugs. The purpose of this review was to summarize the existing evidence on acupuncture as a treatment for anxiety and depression. Search of the literature on acupuncture treatment was limited to specific mental health conditions: depression and anxiety disorder. The literature review focused on systematic reviews. Search focused on the latest versions. The available resources provide some evidence that acupuncture is an effective treatment for these conditions. The findings of the studies show that acupuncture can play an important Role in the treatment of depression and anxiety
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Chapter 4
Annals of Clinical Anesthesia Research
Ann Clin Anesth Res. 2021; 5(1): 1035
Review Article
Pain Management
https://www.remedypublications.com/open-access/pain-management-6683.pdf
Webinar on Neurosurgery 2021. London, UK. https://www.longdom.com/webinars/neurosurgery/scientific-program
Pain Management. https://www.alliedacademies.org/journal-cancer-immunology-therapy/
Maria Dalamagka
Abstract
When acute pain turns into chronic, then it is not a symptom of a disease, but it is a disease in itself. It lasts longer than the expected course of the disease or injury. Usual period of 3 to 6 months. In the past the answer to chronic pain was: "everything is in your mind". A useful definition by Margo McCaffrey is: "pain is what describes the person who experiences it and exists when he says he exists."The International Association for the Study of Pain says it is "an unpleasant aesthetic and emotional experience, combined with actual or potential tissue damage, or described in terms of such damage". Pain is transmitted through the body through the nervous system when nerve endings detect damage to a part of the body.
Keywords: Pain; Antiepileptics; Antidepressants; Pain relief creams; Opioids
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Chapter 5
https://austinpublishinggroup.com/anesthesia-analgesia/fulltext/ajaa-v8-id1088.php
Ann Physiother Occup Ther 2020, 3(1): 000146
Annals of Physiotherapy & Occupational Therapy ISSN: 2640-2734
Pain
Maria Dalamagka
Abstract
Pain acts as a protective mechanism of the body, by forcing the person to react so that it is removed from the stimulus. It is important not only for cases where there is marked tissue damage, but also for everyday simple activities. Thus, when a person sits on the hips for a long time, it is possible to damage the tissues due to the inhibition of the skin’s blood supply to the places where the skin is compressed by body weight. When the skin starts to ache because of ischemia, the person completely unconsciously changes position. However, when the sensation of pain is lost, as is the case with spinal cord injury, the person cannot feel the pain and thus does not change position. This condition leads to ulcers in the area where the pressure is applied very quickly. The feeling of pain is caused by the irritation of the nerve receptors in the skin and deep tissues. There are two different types of pain: rapid pain and slow pain (rapid and slow pain). Rapid pain occurs within 0.1 second after the application of alogen stimuli, while slow pain begins to be felt after a second or more. Subsequently, the intensity increases slowly for many seconds, and in many cases even for several minutes. Rapid pain is also described as acute pain, cramping pain, electrical pain, etc. This type of pain can be felt by inserting a needle into the skin, either by knife-fitting the skin and by the effect of electrical discharge on the skin. Rapid pain is not felt by most of the body’s deeper tissues. Slow pain is characterized as caustic pain, shallow pain, pulse pain, chronic pain, etc. This type of pain is usually associated with tissue damage. It can become excruciating and can lead to long unbearable hopeless anxiety. It can come from both the skin and any deep tissue or organ. The ways to treat these two types of pain are different. The centripetal fibers that lead to rapid pain are thin, type Aδ-fibers, while the fibers for slow pain are type C and starches. The feeling of pain they transmit is characterized as “slow”, prolonged, blunt and diffuse pain. All pain receptors are free nerve endings. They abound in the superficial layers of the skin, as well as in some internal tissues, such as the periosteum, arterial walls, articular surfaces, as well as the sickle and skull dome. Most other deep tissues are not richly equipped with nerve endings of pain.
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Chapter 6
Neuropathic pain occurs as a result of damage or disease in the somatosensory system, it affects 1.5% of the population and its diagnosis and treatment is quite difficult.
Neuropathic pain can be classified according to:
• The underlying disease (diabetic neuropathy, multiple sclerosis)
• The location of the damage (peripheral nerve damage, spinal cord)
• And the underlying mechanism
Neuropathic pain can be associated with:
Diabetic neuropathy
Chronic postoperative pain
Spinal cord injury
Trigeminal neuralgia
Multiple sclerosis
Polyneuropathy
Amputation
Postherpetic neuralgia
Ghost member
Alcoholism
Cancer chemotherapy
Stroke
Sciatica
Significant and persistent chronic pain requires further monitoring. Social and psychological factors should be assessed from the earliest stages. The diagnosis of neuropathic pain is based on an accurate history and examination. Diagnostic scoring tools such as DN4 or LANSS may be helpful.
Characteristics of neuropathic pain:
• Automatic start, independent of stimulus
• Constant burning sensation
• Piercing pain
• Dysesthesia (pathological and unpleasant sensation)
• Paraesthesia
• Hyperalgesia (increased response to normal painful stimuli)
• Allodynia (pain from non-painful stimuli)
Clinical assessment of pain:
• History and onset of symptoms
• Location, quality, intensity and duration of pain
• Evaluation of the effect of pain on usual activities as well as any sleep disturbances
• Effect of pain on the psychological sphere of the patient
• Response or non-response to previous treatments
Initial treatment options for neuropathic pain:
Non-pharmacological treatments:
• Maintenance of activity and employment
• Mobilization, exercise, TENS, Acupuncture
Pharmacological treatments
• Opioids, Antidepressants, antiepileptics
Various treatments
• Topical agents such as Lidocaine 5%
• Opioids when other treatments fail
Pain relievers such as:
• Paracetamol, mild opioids (tramadol, codeine) and non-steroidal anti-inflammatory drugs.
Interventional techniques – Neuromodulation: A series of treatments that aim to change the perception of pain after stimulation or inhibition of nerve pathways.
Spinal cord stimulation: in persistent neuropathic pain, one or two epidural electrodes are inserted, which are then connected to an electrical source, such as a pacemaker.
Pulsed radiofrequency: A single needle is inserted into the area of nerve damage. The heat produced creates a temporary damage to the nerve tissue.
Pain Assessment in Geriatric Patients
www.iator.gr
https://archive.org/
https://archive.org/details/httpswww.acquirepublications.orgjournalanesthesiaarticlesjaad2200101
www.iator.gr
What is pain?
We attribute different characters to pain. If a child is injured, he will cry and say "I have a wound". The mother will ask: where does it hurt my love? Consider that these are two different approaches to pain: 1. The emotional element of pain, which is phylogenetically primitive and deals with pain as something unpleasant, to be avoided and the last most recent one: 2. The discrete element of pain, which it is the ability to perceive exactly where the pain is and respond appropriately.
Pain in bark
It used to be said that cortical structures were only superficially involved in the perception of pain, if at all. This is wrong, as a multitude of connections connect higher cortical structures to pain centers in the thalamus and brainstem. Important structures of the cortex are:
The primary sensory cortex
The secondary sensory cortex
The anterior part of the central lobe of the cerebral hemispheres (insula)
The adductor helix
The primary sensory cortex is responsible for detecting pain. The afferent gyrus is associated with the emotional component of pain.
The chamber
The thalamus is the central station of pain transmission. Several of its cores deal with pain. The lateral nuclei deal with the sensory/tactile component of pain and the medial nuclei with the emotional component of pain.
Midbrain
There are a number of pain-related structures in the midbrain. Most of this circuitry is related to the emotional component of pain, with extensive connections to the reticular formation of the brainstem. Important elements are the following:
Perihydral gray matter
The red nucleus
The core of Darkschewitsch
The median nucleus of Cajal
The sphenoid nucleus and Edinger–Westphal nucleus
The brain stem
The most important center of pain in the pons is the locus coeruleus (locus coeruleus). This contains noradrenaline and neurons that regulate pain via pathways that descend to the spinal cord.
The medulla oblongata
It also participates in the emotional component of pain. The giant cell nucleus and the lateral reticular nucleus are important.
The spinal cord
It has traditionally been thought that most pain fibers (A and C) enter the gray matter of the posterior horns of the spinal cord. They then synapse via the ascending tract with the dorsothalamic tract. In fact, anything over 40% of the sensory fibers enter the ventral root. There was great excitement when the gate control theory was first described. Although the mechanism is now documented and in clinical use, it is known to be a simplification. The basic idea is that the incoming pain stimulus can be interrupted by other stimuli because many nerve cells communicate with each other in the posterior horn. The most important fibers that enter from the periphery to the dorsal horn are: Amyloid C fibers that are important transmitters of long-lasting pain, which causes the surgical trauma. Thin medullary Adh fibers associated with a more localized pain.
Aβ fibers that carry information about position perception from the periphery to the spinal cord
Unpleasant stimuli entering through C fibers can be suppressed by simultaneous stimulation of A-δ fibers (stimulus of high intensity and low frequency, as for example with acupuncture) or by stimuli passing through A-β fibers. For example TENS: transcutaneous electrical nerve stimulation and the simple friction of the skin, which is very well known by mothers, to reduce the perception of pain.
Ascending street
Spinal-reticular-dynecerebral tract: has few or no opioid receptors. It has little to do with the perception of pain, as a painful stimulus.
Katiusha street
Equally important are the fibers, which descend from the brainstem to the spinal cord to modify incoming stimuli. Neurotransmitters are noradrenaline especially in the locus coeruleus and serotonin in the raphe nuclei. Opioid receptors are particularly prominent here.
Pain in the periphery
Most tissues contain special pain receptors, which are called nociceptors. In the past, it was believed that the painful stimulus was perceived through overstimulation of the receptors. This is wrong. The quality of pain appears to depend on the area of stimulation and the nature of the fibers transmitting the pain sensation. Even in the periphery, there is a distinction between acute immediate pain ("the first pain") transmitted by Aβ fibers and prolonged unpleasant burning pain, transmitted by smaller myelinated C fibers.
Nociceptors have many different receptors on their surface, which modulate their sensitivity to stimulation. These include GABA, bradykinin, histamine, serotonin, capsaicin, opiate receptors, but the diverse roles of these receptors are little mentioned.
The most striking thing, regarding the perception of pain in the periphery, is that most nociceptors remain inactive. Inflammation sensitizes the greater majority of nociceptors and leads them to a greater sensitivity to stimulation (hyperalgesia). Hyperalgesia can be primary (felt in the area of stimulation, related to the sensitization of the neurons of this dermatome) or secondary (felt in a remote area from the primary trauma and possibly related to the mediation of NMDA "wind up".
Neurotransmitters
A multitude of neurotransmitters mediate the transmission of the sensation of pain, both in the brain and in the spinal cord. The number of neurotransmitters is increasing every day. We can classify them into the following categories:
Stimulants: glutamate and tachykinins
Inhibitory: There are many inhibitory neurotransmitters, but in the CNS, GABA (γ-aminobutyric acid) seems to predominate.
Neurotransmitters involved in the centripetal regulation of pain. The alpha-2 stimulatory effects of noradrenaline and the actions of serotonin are evident. Opioids relieve pain by activating μ- and δ-receptors.
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Chapter 9
Dalamagka Maria. (2015). In the Past the Answer to Chronic Pain was “All in your Mind.” Journal of Pain Management & Medicine, 01. https://doi.org/10.35248/2684-1320.15.1.101
Journal of Pain Management & Medicine
Pain Manage Med 2015, 1:1
In the Past the Answer to Chronic Pain was "All in your Mind"
Maria Dalamagka
Chronic Pain
A useful definition from Margo McCaffrey is the following: “pain is the description of the individual who is experiencing it and exist when he says so”.
The International Association for the Study of Pain defines it as "an unpleasant sensory and emotional experience, combined with actual or potential tissue damage, or described in terms of such damage.
The pain is transmitted through the body to the nervous system,
where the nerve endings detect damage in a body part. The nerves transmit the warning through specific neural pathways in the brain, where the signals are interpreted as pain.
Today specific pain can understand how the sensation of pain is
generated: the way in which the nervous system, including the spinal cord, interacts with the brain, so as to create the sensation of pain. Knowledge of the neurotransmitter system, i.e. chemical messengers that transmit nerve signals, has opened the door to important new methods of treating pain. In recent years, scientists have learned how to manage these chemical messengers, to change the way we interact with brain signals.
This led to the use of antidepressants and other drugs, which work with specific chemicals in the brain that affect emotions and help in pain perception. Most drugs are very effective.
And with advances in magnetic resonance imaging, researchers can demonstrate that changes are very real to the brain. We can see exactly what creates the sensation of pain in the brain, when activated by a stimulus. We can see the impact of pain on the person's emotional state.
There is also a new concept, a process called central sensitization. If the original pain from an injury is not properly treated, then these pain signals are sent repeatedly, thus leads to changes in the central nervous system, which make it more and more vulnerable. So, over time even physiological stimuli, can perceive as painful. With this knowledge, the specialists of pain prescribe now drug treatments that attack moderate to severe chronic pain from different angles: innovative medicines, techniques designed to nerves and medical drug pumps, they offer a strong analgesia in the nerve roots. Doctors also approve the use of psychotherapy, relaxation techniques, and hypnosis and alternative therapies such as acupuncture, based on more and stronger evidence mind-body connection in relieving chronic pain. There is still much to
learn, but research has provided evidence for the development of even newer treatment options.
Treatment Options
Many patients come for treatment in the final stages of chronic pain when it is more difficult to treat. The sooner it starts treatment, the more chance there is for successful pain management.
When the pain is severe then doctors turn to stronger drugs:
1. Antiepileptic
2. Antidepressants
3. Creams for Pain Relief
4. Skin patches
5. Opioids
6. Nervous blocks: When a group of nerves causing pain to a specific organ or body area, the pain can be blocked by the injection of local anesthetic. This is a nerve block.
7. Cautery ablation (radiofrequency ablation): A small area of neural tissue is heated to reduce the pain signals from that area. The procedure is conducted under the guidance of imaging CT.
8. TENS: Transcutaneous Electrical Nerve Stimulation
9. Injection in the trigger point: Painful points in a muscle or connection tissue. They can sensitize the nerves around them and cause pain in other parts of the body.
10. Pain-Pacemakers: The technique called spinal cord electrical stimulation and includes a pacemaker type device, implanted in the body.
11. Implantable medical drug pumps: These are also called intrathecal pumps, because they send pain medication to the spinal cord.
12. Surgery: Surgery can help in some cases Advisory for bettermanagement of chronic ponoukai relaxation techniques.
13. Acupuncture: The National Institutes of Health recognizes acupuncture as an effective measure of pain management, particularly headaches and low back pain
Glob J Nutri Food Sci. 1(1), 1-2: 2018. GJNFS.MS.ID.000502. DOI: 10.33552/GJNFS.2018.01.000502I
SSN: 2644-2981
Global Journal of Nutrition & Food Science
https://irispublishers.com/gjnfs/abstract/acupuncture.ID.000502.php
www.iator.gr
Acupuncture
Maria Dalamagka
Acupuncture involves the activation of specific points of the skin, usually by inserting needles. Acupuncture was based on the principles of Chinese traditional medicine. Traditional acupuncturists perceived health in terms of a violent force or energy, called Qi, which circulates between organs along channels that are called meridians. The flow of energy “Qi” must have the right strength and quality in each of these meridians and organs, so as to maintain health. Acupuncture points are located along the meridians and can alter the flow of energy and appear to correspond to the terminal nerve endings. There is a distinct difference between traditional and western acupuncture, but the two approaches overlap significantly. Also, traditional acupuncture is not a treatment recorded sometime in history, but there are significant deviations between different acupuncture schools. Two acupuncturists may choose different points, depth of needle penetration and different needle residence times. As far as Western theories are concerned, acupuncture induces signals in central nerves that alter the transmission through the spinal cord, as well as the perception of pain in the brain. In 1987 Pomeranz suggested the theory that acupuncture stimulation stimulates muscle fibers A-δ and C, which leads to the transmission of signals to the spinal cord and this in turn leads to local release of dynorphin and enkephalin. These local processes are transmitted via centrifugal pathways to the midbrain, where they activate a series of stimulatory and inhibitory spinal cord transporters. The final release of neurotransmitters, such as serotonin, dopamine and norepinephrine in the spinal cord, leads to pre- and postsynaptic inhibition and inhibition of pain transmission. When these signals reach the hypothalamus and the pituitary, they induce the release of the coronary artery and endorphins. Pomeranz’s theory was confirmed by numerous experiments in his research laboratory, but also by other researchers. This fundamental principle for acupuncture-induced analgesia has been explored over the last three decades and with a series of neurophysiological and imaging studies.
________________________________________
https://www.scholarscentral.com/abstract/systematic-review-acupuncture-in-chronic-pain-low-back-pain-and-migraine-101213.html
J Pain Relief 2015, 4(5), 1-4. DOI: 10.4172/2167-0846.1000195
J Pain Relief ISSN: 2167-0846
Systematic Review: Acupuncture in Chronic Pain, Low Back Pain and Migraine
Maria Dalamagka
Acupuncture is widely used for chronic pain. The aim of the study was to assess the effectiveness of acupuncture as a treatment of chronic pain, within the context of the methodological quality of the studies. Complementary medicine databases, bibliographies and articles were searched
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Chapter 12
Annals of Clinical Cases ISSN: 2692-7993, Medtext Publications
Multifactorial Experience of Pain. Ann Clin Cases. 2020;1(1), 7-8::1004.
https://www.medtextpublications.com/open-access/multifactorial-experience-of-pain-436.pdf
Maria Dalamagka
Editorial
Pain is defined in many ways: "An unpleasant aesthetic and emotional experience associated with actual or potential tissue damage or described in terms of such damage. Pain is a category of complex experiences, as it is not a single sensation produced by a single stimulus".
"Pain is what a person experiences and takes place when he says it is happening". Paroxysmal pain is pain of moderate or severe intensity and occurs in the background of chronic controlled pain. Paroxysmal pain can be described as automatic, unexpected, or predictable and predictable. Psychological discomfort has been defined as a multifactorial unpleasant emotional experience in terms of the psychological sphere (cognitive, behavioral, emotional), social and spiritual and can affect the effective treatment of cancer, such as physical symptoms and treatment. Discomfort can range from vulnerability, sadness and phobia to depression, anxiety, and an existential and spiritual crisis.
Good communication between doctor and patient, planning and trust are essential to controlling the pain associated with cancer. The multidimensional nature of pain must be taken into account in the evaluation and management of patients. Psychological factors can have a significant effect on the perception of pain and how the sufferer responds behaviorally and emotionally. As a chronic stressful condition, chronic pain can lead to disability and anxiety, but it can also be caused by psychological factors. The prevalence of depressive disorders is significantly higher in those patients with high levels of cancer pain. This suggests that pain and psychiatric morbidity are related and also that cancer pain plays an important role in the onset and worsening of depression.
Pain is more than just a physical phenomenon, although the psychological, social and spiritual aspects of pain are not always evaluated. Research shows that a multidimensional approach to pain is the answer. A universal assessment of pain should consider the manifestations of pain and its functional effects; psychosocial factors stress level, mood, cultural influences, phobias, and effects on interpersonal relationships, and factors that affect pain tolerance.
Medication for Cancer Pain Includes
• Paracetamol and Non-Steroidal Anti-Inflammatory Drugs(NSAIDs). They are universally accepted as part of treatment.Relieving pain by combining an opiate with an NSAID or vice versa increases pain relief.
• Patients with neuropathic pain should be given a tricyclic antidepressant (e.g., amitriptyline or imipramine) or antiepileptics (gabapentin, carbamazepine, phenytoin) with careful monitoring of side effects.
• Ketamine is used only in selected patients, who have persistent pain that remains uncontrolled by other means (e.g., neuropathic pain, ischemic limb pain).
• Capsaicin is the active component of hot peppers and contact with the skin leads to a reduced susceptibility of this region. Itis used in postherpetic neuralgia and diabetic neuropathy.
• For mild to moderate pain, a weak opioid, such as codeine may be given in combination with a non-opioid analgesic.
• Strong opioids used in palliative care include morphine,alfentanil, buprenorphine, diamorphine, fentanyl, hydro morphine, methadone, and oxycodone.
Methadone has a long and unpredictable half-life with significant variation among patients and requires careful monitoring. The firstline treatment for patients with severe cancer pain is morphine. Due to the fact that patients use these drugs year after year, the oral route is the preferred one. In patients who prefer a patchwork compound orin people with difficulty swallowing or unresolved nausea, trans dental phenytoin patches may be appropriate if the pain is constant.
Paroxysmal pain is defined as the transient exacerbation of moderate or severe pain. It has the following characteristics: rapid onset, duration with an average value of 30 minutes and is associated with a difficult psychological and functional outcome. It is also associated with an inadequate response to regular opioids. The sudden and unpredictable onset of paroxysmal pain can affect breathing, circulation, or even urination.
The distinction between paroxysmal pain and a deficient dose of regular 24- hour analgesia (usually occurs shortly before the next dose of regular analgesia) is significant. An increase in the dose of analgesic will solve the problem in the second case.
In addition, it should be noted that patients starting an opioid for moderate or severe pain should have access to antiemetic treatment. Complementary therapies used to treat cancer, although increasing in popularity, the evidence to support their use remains weak. The main ones, such as radiotherapy for bone pain, showed a systematic review, complete pain relief in a month. Transdermal cemento plasty involves injecting acrylic bone cement into malignant cavities to relieve pain or stabilize the bone. Transdermal vertebroplasty involves the insertion of acrylic bone cement into the vertebral body in order to relieve pain or stabilize the vertebral fracture and in some cases to restore spinal height.
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Chapter 13
Acta Scientific Nutritional Health ASNH
ISSN: 2582-1423
DOI: 10.31080/ASNH.2020.02.0002
Editorial
Stress
Maria Dalamagka
https://www.researchgate.net/publication/382428764_ebookpdf
www.iator.gr
There are many different definitions of stress. Some define stress as a disturbance of a person's normal psychological or physiological state. Sometimes they use the word "stress" as a term equivalent to "arousal" and "activation". It is also used as a term for "bad effects". The many different definitions of stress have caused much ambiguity and confusion on the subject. When reading an article, listening to a lecture, or participating in a discussion about stress, make sure the definition used is clear. One of the most useful definitions of stress is this: Stress is an internal process that occurs when an individual faces a demand that is perceived to exceed the available resources to respond effectively to it, and where failure to effectively cope with the demand has significant unwanted consequences. In other words, anxiety is experienced when there is an awareness of a substantial imbalance between demand and capacity, under conditions where failure to meet demand is perceived to have undesirable consequences. Related Concepts The perception and awareness of the imbalance between demand and ability and the negative consequences of not meeting the demand is necessary for the individual to experience stress. However, the perception should not be exact. A false belief can cause significant anxiety. Stress is the events and thoughts that lead the person to perceive that there is a threatening demand. Strain is the negative effects of stress. Strain can manifest as fatigue, irritability, difficulty concentrating, medical and physical problems, insomnia, depression, anxiety, overeating, drug and alcohol abuse, risk-taking, or reduced functioning, to name a few possibilities. Stress can be positive and negative. On the positive side it warns us of a threat and increases our level of arousal and activation so we can be more effective in dealing with the threat. It is mismanagement or excessive stress that causes stress and can be destructive to the individual or the system. When a potential stressor is perceived as threatening, the person's arousal level increases and anxiety is experienced. The individual selects from available resources a coping response that is expected to be effective in reducing or eliminating stress. If stress is successfully reduced, the individual experiences a relaxation of arousal and increased confidence in being able to handle future stress. If the coping response is not successful, anxiety and heightened arousal continue. If new strategies are not tried or are not successful, prolonged stress and increased arousal lead to stress.
There is no absolute right way to manage stress. The best approach is to assess the specific situation, adapt the method to the particulars of the situation, and then monitor its effectiveness. Stress management is directed at one or more of the five interacting components involved in the stress process: 1) demand, 2) awareness, 3) arousal, 4) competence, and 5) negative consequences. Here are some examples: Identify and reduce requirements or increase capacity by setting limits, ie saying "no" and do not take on additional responsibilities before fulfilling or controlling existing ones. Get more time or get extra help or increase your efficiency by using better tools or getting extra training. Awareness, the perception or cognitive component, is probably the most important aspect. We need to be aware of all the relevant issues regarding our requirements, our capabilities, our resources and the possible consequences. We need to see these things with precision and clarity and plan accordingly. Our beliefs will determine how we handle issues and how we feel. We could also put ourselves in danger by holding false beliefs, using denial and avoidance, and not knowing or perceiving a real threat. Do something to reduce arousal and tension and lower your activation level. Take a break and stop thinking about the demands and consequences, relax and focus again on pleasant events. Work off the extra intensity by exercising or participating in recreation. The use of narcotic drugs should be avoided or only used as a temporary last resort because something needs to change.
Accept what cannot be changed and refocus your thinking and energy on what can be done to overcome the negatives and make things better. Professional therapy can help minimize or eliminate any physical or psychological problems that have developed due to stress. Everyone experiences stress and is vulnerable to it. We can manage it, reduce it and control it, and we can minimize or prevent negative consequences. There are some similarities between mechanical systems and human systems that are useful in assessing the potent effects of stress. Every system, human or mechanical, has limits and requirements for efficient operation. Every system operates within tolerances for the demands, pressures and stresses imposed on it. The electrical circuits in your home are capable of handling a limited amount of power. If the water pressure in your plumbing is higher than it is designed to handle, a component will eventually leak or break. If you use your new car hard all the time and neglect proper maintenance, it will start to give you trouble and deteriorate faster. Continue to ignore it and it will crash and force you to watch it. Pushing a system beyond its limits and neglecting proper maintenance causes wear and tear. Like machines, human systems have limits and breaking points and require maintenance. If you are under increased pressure, push yourself hard and neglect proper self-maintenance, you will deteriorate and eventually break down. Your body will force you to stop. Don't risk losing your personal relationships or losing your health. Stress can be harmful to your health. Improper handling of stress can be devastating. It lowers our resistance and makes us more vulnerable to illness and disease. Increased internal pressure can cause our health to deteriorate resulting in a variety of serious physical problems. Victims of stress can become emotionally disabled. Stress can cause the loss of not only health, but also jobs, families, and even life.
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Chapter 14
Dalamagka Maria. (2018). Pain and Acupuncture. Open Access Journal of Gerontology & Geriatric Medicine, 4. https://doi.org/10.19080/oajggm.
Gerontology & Geriatric Medicine ISSN: 2575-8543
OAJ Gerontol & Geriatric Med 4(3), 001: OAJGGM.MS.ID.555637 (2018)
Corpus ID: 260123905
J Complement Med Alt Healthcare J 6(3), 001: JCMAH.MS.ID.555688 (2018)
Pain and Acupuncture
Maria Dalamagka
The word pain derives its origin from the Indo-European root meaning aleg suffer. The word pain is later and is derived from the Latin word «poena» means punishment. Since ancient times there was disagreement about the perception of pain and its assessment. Unlike vision, hearing and smell, pain does not seem to be a primary sense, but rather an emotional experience. Most researchers pain, felt the pain as a complex concept, which is induced by noxious stimuli. Although the pain is the most common symptom in medical and despite huge advances that have occurred in the field of analgesia and anesthesia, the pathophysiological mechanisms involved in the genesis and maintenance of not fully understood. The definition of pain given in 1979 by the Classification Committee of the International Study of Pain (IASP) «as an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.” In other words, although the Physiology and Anatomy define a precise point of reference for the detection and transmission of messages interpreted as painful, what differentiates the experience of pain, it is the fact that there is always an emotional rating of pain experience.
The scientific term acupuncture is incomplete performance of Chinese therapeutic method Zhen - Jiu, which means drilling and burning. Acupuncture has a complete theory with great therapeutic potential. To measure it, used selected energy points of the skin and underlying tissues.
According to the zones of Head (1893), are changing relationships between internal organs and skin. The Heine (1988) demonstrated the morphological structure of the acupuncture points, as each acupuncture point corresponds to the position of a angeionefrikou bundle. Acupuncture except regional case action appears to present a distant effect. Thus, in Pomeranz (1976) the synthesis of endorphin seems to be influenced favorably by needling. The revival of acupuncture began in the late 1950s, when a group of surgeons in China thought that if acupuncture can improve existing pain, why not used to prevent the inevitable pain that accompanies surgery. For this method used the term analgesia with acupuncture (acupuncture analgesia). The subsequent visit of US President Richard Nixon to China in 1972 catapulted the popularity of acupuncture in the US and worldwide. The methods for stimulating acupuncture points, besides the classical acupuncture include the application of electric current to the needles, which are inserted into the acupoints (electroacupuncture), or by skin electrodes positioned over the acupuncture points (transcutaneous electrical stimulation), the injecting chemicals into acupuncture points and the pressing massage on selected acupuncture points (acupressure). To 1833 o Guillaume Duchenne de Boulogne, founder of modern electrotherapy starts using electroacupuncture. In 1844 the Hermel uses electro-puncture (electro-puncture) for the treatment of sciatica and lumbosacral neuritis with acupuncture to the affected area. In 1955 Reinhold Voll establishes the low frequency electroacupuncture (1-10 Hz). In late 1971 the Dr. Nguyen Van Ngi and his team used the method of acupuncture analgesia (acupuncture analgesia) in 50 major surgeries with good results.
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Chapter 15
Dalamagka Maria*. (2022). Complex Regional Pain Syndrome - CRPS. Zenodo.
https://explore.openaire.eu/search/other?orpId=od______2659::32643a5283b4d889e167bec65c7c6825
Maria Dalamagka
Summary - Abstract
CRPS was first studied in the early 1800s by Claude Bernard. During the American Civil War, it was observed that soldiers after injury were often led to neuropathic pain, which was called causalgia by Silas Weir - Mitchell. The terms algodystrophy, Sudeck 's syndrome, persistent burning pain have been used from time to time. For this reason, the IASP (International Association for the study of pain) proposed to call the syndrome Complex Regional Pain Syndrome and to separate it into 2 groups: Type I: no obvious nerve damage. It was formerly characterized as reflex sympathetic dystrophy, reflex neurovascular dystrophy, algodystrophy, or Sudeck -type atrophy. Type II: there is clearly a nerve injury. It used to be called heartburn. There is complete disagreement regarding the pathophysiology of the syndrome. Numerous pathophysiological components of the disease have been identified, including neurogenic inflammation, peripheral and central sensitization, and disturbed sympathetic function. In cases of injury, local inflammation causes the production of inflammatory cytokines and neuropeptides. Cytokines stimulate osteoclasts of adjacent bones, bone remodelling increases, and osteoporosis is induced. Pain is attributed to stimulation of nociceptors by acidic enzymes released by osteoclasts to dissolve bone tissue. Its features include pain, sensory disturbances, edema, autonomic dysfunction, motility disorders, and trophic changes. Usually, automatic pain or allodynia is not limited to the territory of a single peripheral nerve and shows a disproportion with respect to stimulation. Stage I: sympathetic stimulation, burning sensation, muscle spasm, vasoconstriction, joint stiffness, reduced hair growth. Stage II: muscle atrophies, osteoporosis. Stage III: irreversible damage, limb deformities.
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Chapter 16
Self-Hypnosis and Pain
Research & Investigations in Sports
DOI: 10.31031/RISM.2018.04.000577
Abstract
The possibilities of self-suction can be particularly useful in the management of pain. It is possible to modify the experience of pain. The only obstacle is the limits of imagination, but as you surely know the imagination knows little boundaries. Sometimes deep relaxation can help, before giving to yourself the suggestions you need. Other times just let yourself travel and become one with these submissions and so you can be led into a trance state without deep relaxation. What is trance? Trance is not a mystical experience that only trained hypnotists can induce. It’s part of our everyday life. If you ever drive a car, you suddenly discovered that you were driving for miles without realizing it, you will understand what is going on (as can happen and reading a good book). It is often described as «the loss of sense of time.» The secret is to gain some experience, so you have control over knowing what to do when you get into a trance state. It is an opportunity to gain control of physics and emotional experience of pain. Efficacy using self-hypnosis is a matter of exercise. It would help experiment with different approaches and find one that suits you best and which one is most useful. Before you begin, make a review of the pain experience. Is there any good reason why you want to stay in this situation? Does it offer you something like attention or relaxation? in this way you will decide that you want to make the difference. When you first start, it would be good to do it at a time when the pain is not so bad. When you become more familiar with self-esteeming approaches, it will be easier to use it when the pain is more intense. It has been reported that the duration of analgesia is increasing day by day. It is helpful to think about the possibility of decrease, rather than disappearance of pain. So, if you imagine a ladder from 1-10, and if you start by classifying your pain at level 7, then your purpose will be to decrease it to 5 or 4. By reaching this level you will feel more comfortable. With time you will find yourself reducing pain levels to 2 or 3. You may still see your pain touching 0. This will be great. And even if you reduce your pain to some level, see the difference between the two levels of pain and reward yourself for the control you have achieved.
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