Chronic Pain – Pain that persists or recurs for more than three months, persists for more than one month after resolution of an acute tissue injury, or accompanies non-healing lesions. The causes of its occurrence are various diseases, in particular, the transferred herpes.
Find out on estet-portal.com about the possibilities of using botulinum toxin in the treatment of chronic pain from deputy for scientific work of the Institute of Neurosurgery named after Academician A.P. Romodanova, MD Vadim Beloshitsky.
The main links in the pathogenesis of chronic pain syndrome
V.B.: I have to say that it's really important to separate acute and chronic pain. Acute pain is the body's response to injury or threat of injury, acute pain indicates that the body requires protection in order to avoid serious injury.
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In some cases, if the pain exists for more than 3 months, it begins to take on a life of its own. You could say it becomes chronic pain.
Chronic pain exists in the nervous system. By this time, any damage is already healing. By this time, there is no longer a threat to the body, but the pain still remains, and it is precisely such a concept as sensitization that matters in the pathogenesis of chronic pain syndrome.
Sensitization – this is an increased excitability of cell structures, structures of the nervous system. Cells become excited, they produce a signal that is perceived by the brain as pain.
Mechanism of Chronic Pain
VB: There is peripheral sensitization and central. Peripheral − these are neuron receptors of nerve cells, they can produce an excessive signal, they can be more sensitive, but certainly in chronic pain, changes occur in the central nervous system.
There are structures responsible for the perception of pain, that is, their activation contributes to the fact that the pain continues and there are antinoceceptive structures, that is, parts of the brain that should suppress the sensation of pain, their function also suffers in chronic pain, they do not can fully perform their function.
An indication for the diagnosis of chronic pain syndrome is the existence of pain for more than 12 weeks.
Approaches to the classification of chronic pain
VB: There are also nociceptive and neuropathic pain. Nociceptive pain − it is an irritation of the receptors. For example, changes in the spine, which, when moving, provoke irritation of the nervous system. They provoke pain.
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But there is neuropathic pain associated with the fact that there is damage to the sensitive or sensory nervous system. It has its own characteristics and is accompanied by sensitive disturbances. For example, the occurrence of hypoesthesia on the gums, allodynia, which can be caused by a simple touch of a brush, which can occur after herpes. We distinguish chronic pain as mechanical and nociceptive.
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The most common mistakes in making this diagnosis
It is necessary to pay attention to the nature of the pain: headache, dorsal, respectively, and errors in making a diagnosis are different. If we are talking about chronic pain, then this is insufficient and not timely treatment of acute pain, incorrect determination of the nature of pain, incorrect diagnosis of the source of pain.
Effectiveness of botulinum toxin in chronic post-herpetic pain
The average effect of botulinum toxin is believed to last 3 months. The procedure is usually repeated every 3 months according to the instructions. Therapy with botulinum toxin affects some aspects of pathogenesis. But after the effect of the procedure, the pain may return.
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There is evidence that there is a vaccine against herpes. Most often, after childhood chickenpox, the virus continues to live in sensory neurons. There is no active infection, as immunity is preserved. With age, the immune system weakens and the virus becomes active, which can lead to the activation of the virus.
This varicella-zoster antigen vaccine allows vaccination after age 50 to prevent future complications.
Comparison of the action of botulinum toxin with other neurosurgical techniques
V.B.: Each technique is selected individually, for each disease, for each condition accompanied by chronic pain, different approaches can be effective.
Morphine pumps are more commonly used for patients with cancer who cannot tolerate opioid therapy.
They are shown a pump, because the administration of drugs is intrathecal – allows you to enter the minimum dose and with the least number of side effects. Each of the methods for chronic pain syndrome has its own niche.
Beloshitsky Vadim Vasilyevich
Consultation by phone: +380 98 119 76 77
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