Česky
Why does every patient tolerate the same pain differently?
Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Pain is always subjective. Humans have struggled with pain since the earliest times. Animals have also resisted pain. The history of pain management is as old as humanity, although the perception of pain was and is also dependent on societal perspectives. Pain is accompanied by stress. Four components of pain are defined: sensory-discriminative, emotional, autonomic and motor. So when we feel pain, it goes something like this: The body receives an unpleasant stimulus, processes and evaluates it, and a range of different reactions are triggered, including the desire to get rid of the pain, for example by twitching.
Is there such a thing as a universal "pain meter"?
In order to treat pain, we need to assess it. That's why pain assessment exists. Different pain scales are used for this- verbal and non-verbal. For example, the classic visual analogue scale VAS, also used in our hospital. The patient rates how much pain they feel on a scale of 1-10, 10 being the most excruciating pain, 0 no pain. For children or people who cannot speak, we use picture scales. The reactivity of the patient is also assessed, when stimuli are used, and the pain threshold is distinguished. For example, pressure algometry is such a method. Nowadays, of course, there is an increasing effort to objectify pain and, above all, the results of treatment. In some cases, functional magnetic resonance imaging can help experimentally. However, the assessment of the person giving the pain remains the basis. And if someone says it hurts, we ask where it hurts, how it hurts, how much it hurts, but we don't say it can't hurt.
It's said that women tolerate pain better than men. What's the truth in that?
We all know the jokes about the worst male disease, the heartburn. And it's also known that labor pains are among the worst pains. However, women have a lower pain threshold, according to research, and testosterone, the male hormone, raises the pain threshold. So men should be more resistant to pain. Which doesn't rule out individual differences. And also, to make it less simple, the body defends itself against pain by, among other things, secreting so-called endorphins, which are a kind of internal opiates. So they dampen the pain. And at different stages of a woman's hormonal cycle, different amounts of endorphins are released. They're also released before childbirth. They also wash out in a state of pleasure, and adequate aerobic exercise - like brisk walking - helps to wash them out. In recent years, the genetics of pain have also begun to be explored. Apparently, like other things, we inherit pain perception from our ancestors, or at least partly. From this we can conclude, somewhat simplistically, that it depends on ourselves and the situation whether and how much pain we feel.
Seventy percent of non-cancer pain is related to back pain, especially spinal pain. Why are these areas of the human body more prone to pain? How to cope with them?
At our Rehabilitation Center, we treat many people with back pain, among other things. Back pain has been much talked and written about in recent years. Almost everyone has experienced back pain. We often tend to think of musculoskeletal pain as a disease of civilisation. Certainly there are many factors in modern times that overload the spine. The spine holds the human body upright and a great deal of strain is placed on all the structures of the musculoskeletal system. Man was not designed to sit permanently in a chair, at a computer, in a car. But everyone is also not meant for top sports. One of the problems is certainly that we see children who do not move at all or, on the contrary, children who are brought from one ring to another. What is often missing is the natural movement that a child and subsequently an adult does naturally and with joy. Such is the normal gait and such are the normal outdoor games of children. Man was also not designed to live under constant stress. Stress increases muscle tension. And if we do not respond with action, with movement, there is no muscular relaxation.
What do we know about the existence of pain and its treatment in the past?
People suffered from pain in past centuries. The question is how much we know about pain in ordinary people in the past. In archaeological findings, there are signs of arthritis and arthrosis on the bones, and we find the same degenerative and post-traumatic changes on the spine as in modern humans. Charles IV weaved baskets, perhaps part of occupational therapy, yet it is known that he suffered a spinal injury in a tournament after the age of thirty. And the famous prehistoric glacier hunter Otzi had some kind of tattoo on his acupuncture points, perhaps part of pain management. The implication is that musculoskeletal pain is nothing new under the sun. There's no miracle cure. But there are many ways to work with our musculoskeletal system to make the most of what we have been given. An experienced doctor and physiotherapist can advise. Sometimes medication may also need to be prescribed. And quite simply, to move appropriately and enjoy life.
How do you distinguish acute from chronic pain?
Pain is divided by duration into acute -up to 3 months duration. If it lasts or returns for more than 3-6 months, it is chronic pain. Acute pain is treated differently than chronic pain. Acute pain is an important warning factor. For example, a myocardial infarction without pain or with vague pain will not lead a person to a doctor in time. Chronic pain loses its meaning as a warning signal. On the contrary, it is often accompanied by feelings of hopelessness and depression. Very old people statistically perceive less acute pain-which is bad, for example, when abdominal pain risks overlooking an acute abdominal episode. Conversely, they perceive more chronic pain, without a clear stimulus.
How far has pharmacy progressed in treating chronic pain?
Pharmacy has advanced a lot, perhaps too much. Pain medication is becoming a normal part of life. It is important to know that pain medication does not treat the cause. If we take something temporarily for a toothache or headache, that's fine. Chronic use of medications is difficult and without proper recommendations can lead to addiction and further pain. It is up to the doctor to choose the appropriate medication for a particular pain and the appropriate dosage. All medications have so-called side effects, but that does not mean they are automatically bad. The important thing is that the positive effect of the medicine outweighs the negative effect. The biggest risk of uncontrolled use of medicines is inappropriate combinations that can cause health problems. Pain management includes not only common analgesics, but also drugs originally used for depression, epilepsy, sedation and so on.
What do you do if an increasingly higher dosage of analgesics does not work and, on the contrary, causes other problems, such as stomach...
Then you need to reconsider the treatment. And most importantly, nowhere, not even in specialized pain centers, is it only medication. Pain treatment always includes rehabilitation, counselling, possibly psychological support, various kinds of sprays, some complementary methods like acupuncture and so on.
How "trendy" is the administration of opioid substances in pain management in contemporary medicine?
Opioid treatment is viewed in different ways. It can be said that algesiologists are not too afraid of opiates. Of course, with all the strict regulations. And also according to the recommended procedures. In general, the risk of gastrointestinal damage with common antirheumatic drugs such as Brufen is somewhat underestimated and the risk of opiate treatment is overestimated. But beware, opioids for patients who have non-cancer pain must be prescribed by one specialist doctor, the patient must follow all the rules and controls and be aware of their limitations. The assessment of adverse effects varies, perhaps according to the prevalence of treatment. In the United States, where opioid treatment for musculoskeletal pain has been more common, there is also ample evidence of patient harm or death due to higher uncontrolled doses of opioids in undisciplined patients
What alternative pain management methods do you use at RN Beroun and how effective are they?
At the Rehabilitation Hospital Beroun we use acupuncture as a complementary method. We have good results in indicated patients. I do not like to use the term alternative methods. Perhaps only in the sense of another option. In the age of guessing what everything can cure and how alternative methods are practiced somewhere, it is not a good classification. Acupuncture is an old healing method and we use it when we believe it will help to improve treatment.
