Modern opportunities for the treatment of chronic pain in the outpatient setting

Pain is one of the most common complaints that patients come to the doctor with. From the position of physiology, pain is one of the most important reactions of the body, aimed at the survival of both an individual and a biological species. This symptom contributes to the adaptation of living organisms to changing environmental conditions through the formation of conditioned reflexes associated with behavior that ensures the avoidance of pain.

However, pain not only informs the nervous system about damage to the nervous structures of the body, but also causes reflex and behavioral reactions that make it possible to minimize the damaging effect.

Pain, which lasts a long time, absorbs all the attention of a person, displacing his desires and needs, changes the social essence. The severity of this influence can be so strong that mental disorders are possible, in some cases leading to suicide attempts. And although the causes of pain can be very different disorders in the body, but often patients are brought to the doctor only by pain, and they first of all want to get rid of it. And after that, it becomes possible to carry out diagnostic and therapeutic procedures.

Unfortunately, today more and more patients suffer from chronic pain. Every now and then at every step you can hear: a toothache or a headache, pain in the joints, lower back pulls, pain in the abdomen… Often they are all chronic. This is due to an increase in the number of oncological diseases, untimely treatment of patients with a doctor, which provokes the transition of diseases to chronic and severe stages, an unhealthy lifestyle, as well as the high cost of surgical treatment of many diseases. How to help such people? How to save them from the painful feeling - pain at least for a while?

The main task of the doctor is to determine the intensity of pain on subjective grounds, as well as to establish how much this pain affects the patient, his quality of life and mental state. To do this, it is necessary to collect a detailed anamnesis of the disease and life. Learn from the patient how he himself assesses the severity of pain on a 10-point scale. This is necessary to determine the effectiveness of the prescribed therapy. After all, subjective sensations tend to change under the influence of various factors.

Only by evaluating these parameters, the doctor can decide on the choice of therapy. In most cases, getting rid of the pathological process and curing the underlying disease, the doctor manages to solve all the problems of the patient. But there are diseases that cannot be cured, therefore, antinociceptive treatment is required from a specialist.

The intensity of the analgesic effect of the drugs should correspond to the severity of the person's condition and the characteristics of the pathological process.

When choosing a treatment, the doctor should keep in mind the basic requirements for outpatient treatment:

• efficiency;
• rapidity of onset of anesthesia;
• no side effects;
• good portability;
• no addiction to the drug.

Also, treatment should not include the use of complex techniques or additional devices. The use of drugs can be both in oral and injectable forms.

Medications that meet the requirements to some extent are referred to as other antipyretics and analgesics. The drugs of this group have a central action (paracetamol) or with a combined central and peripheral action. Means belonging to this group are called non-steroidal anti-inflammatory drugs (NSAIDs).

Their analgesic effect is due to the launch of several mechanisms of action. It is known that a number of mediators that take part in the inflammatory process (kalikrein-kinin system, histamine, serotonin, catecholamines, components of the complement system) are able to initiate pain, thereby supporting the pain process. Their mechanisms are implemented due to tissue damage, increasing the sensitivity of peripheral receptors, and also causing edema. Therefore, by suppressing the release of mediators, pain can be reduced.

If we take into account NSAIDs, they act by suppressing the activity of the COX enzyme. This enzyme converts inactive arachidonic acid into active prostaglandin molecules, which are the main triggers for pain and fever. They also act on blood vessels, expanding them, causing swelling of tissues, exudation of blood plasma.

There are 2 types of cyclooxygenase (COX-1 and COX-2). COX-2 takes part in the development of inflammation, while COX-1 plays a protective role in the gastric mucosa from exposure to hydrochloric acid. Against this background, drugs have appeared that inhibit the activity of COX-2 selectively. But, as for the pain effect, it is just COX-1 and COX-2 that take part in it. Therefore, it is advisable to use COX-1,2 blockers for the treatment of pain.

By reducing COX, NSAIDs reduce neutrophil migration, prevent degranulation, limiting the formation of inflammatory mediators. These drugs block the stabilization of lysosome membranes, lipid peroxidation, preventing damage to structures, and reduce the formation of ATP.

The use of the drug acetaminophen, which acts on the central mechanisms, has also been effective. That is, NSAIDs act not only peripherally. This ability of drugs of this group made it possible to use them to combat postoperative pain, pain after other traumatic manipulations.

It means that NSAIDs act on the central and peripheral mechanisms of pain perception, and also have an anti-inflammatory effect. Recently, dexketoprofen (the dextrorotatory isomer of ketoprofen) has become a commonly used drug in this group.

Studies have shown a pronounced analgesic effect of ketoprofen. It has also been found to be a racemic mixture of two stereoisomers. In this case, only the right-rotating isomer has activity. But the second does not give any positive effect, but only causes side reactions. Thanks to the ability to synthesize a highly purified right-sided isomer, a new drug has appeared that allows a 2-fold reduction in the dose of the drug, while reducing the risk of side effects. It's dexketoprofen.

In practice, the trometamol salt of the drug is used, which has good absorption. On average, plasma concentrations peak after 20 minutes.

Short half-life and rapid elimination reduces the possibility of side effects. There is also evidence of the absence of cumulative effects of the drug.

As mentioned above, in the treatment of pain, the speed of the onset of the effect is very important. Therefore, the use of injectable forms of the drug will make it possible to create the maximum concentration in a few minutes, bypassing the digestive tract.

Dexketoprofen eliminates muscle, joint, fascial, traumatic pain. It is effective in renal colic and in dentistry after extraction of teeth and other minor surgical interventions in the maxillofacial region.
These abilities make it possible for dexketoprofen to successfully compete with other drugs, and even opiates. Of particular interest is the possibility of using it for local anesthesia.

Thus, in the presence of patients with chronic pain who need relief from pain and improved quality of life, a specialist can alleviate the condition with the help of NSAIDs, namely dexketoprofen, as one of the most effective drugs.

And patients should remember that pain is a serious signal of problems in the body that require treatment not only of the pain itself, but of the whole organism as a whole.