ALWAYS always considered the curse of age, the pain in reality it can be avoided or at least delayed as long as possible as long as we abandon the idea that in order to be cured we have to wait until we are sick and begin as soon as possible to build the foundations of our health today and especially tomorrow. He is deeply convinced of it Paolo Mariconti, anesthetist and specialist in pain medicine, member of the scientific committee of Amia – Italian Association of Anti-Aging Doctors – which has recently published the book ‘Healing pain. Investigative tactics and treatment strategies’ (Edizioni Virgilio).
Let it be for a‘migraine or a backache, we have all encountered pain in the course of life and often the first reaction is to ignore it and try to get used to it unless it comes in acute form and then we go to the doctor to chase it away. In fact, we should pay more attention to this uncomfortable tenant because when he knocks on our door he generally has something to report and in fact it is often the first signal that leads the patient to the doctor. “The acute pain it is the alarm signal launched by the organism in a situation that endangers its safety ”, explains Mariconti who in the book deals with the theme, addressing it as an investigation where the enemy to be found, imprisoned and annihilated is chronic pain. “The body collects the painful message thanks to a dense network of nerve receptors, called nociceptors. Acute pain is accompanied by a series of reactions also mediated by the nervous system not controlled by the will, such as increased pressure, tachycardia, lacrimation, sweating “.
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Chronic pain, a disease
If acute pain is an alarm signal, chronic pain should be considered a disease that affects every aspect of the life of those who suffer from it, also causing social isolation and depression and modifying the rhythm of sleep, organ function, hormonal structure and metabolic. In short, favoring the aging processes. “The causes are often due to a disease that cannot be cured, as happens in the case of osteoarthritis. Other times it is due to a lesion of the nervous system. The most common causes are uncontrolled diabetes, herpetic neuralgia or shingles, and nerve injuries, ”explains the doctor. It may also happen that ableeding, a stroke, trauma or an area of inflammation in an area of the brain involved in the perception of pain, modify the balance of incoming messages with the consequent appearance of important pain syndromes.
If pain can be considered ‘guilty’ of our discomfort, the investigator who can find the mechanisms that generate it is the pain doctor or algologist. “As an investigator collects the clues to arrive at the arrest of the culprit, in the same way the algologist searches for the signs of disease present on the patient and then chooses the therapy, which largely consists in the use of drugs, infiltrative techniques, approaches interventional and psychological type “, explains Mariconti. The expert also proposes the most correct diet, prescribes an appropriate nutritional supplement and recommends suitable motor activity.
The specialist
To understand the origin of pain, the algologist first listens and collects clues through clinical and instrumental investigation. It is important to understand if the pain is limited or widespread, felt on the surface or in depth, if it occurs suddenly or is constant, if it is of medium intensity or presents with violent crises. The specialist also performs some tests to check for sensitivity using a cotton ball, a safety pin and a heat source. And then there are the diagnostic tests: “In some cases it is sufficient to resort to ultrasound, CT scan or Nuclear Magnetic Resonance”, explains the algologist (ed. Pain therapy expert). “The painful areas can be subjected to a tele-thermographic examination through which it is possible to obtain images corresponding to the thermal mapping of the different districts. To investigate the presence of nerve injuries, tests such as electromyography, which collects the signals by means of electrodes, are useful needle, or evoked potentials, which consist in recording the brain response to stimuli of a different nature “, adds Mariconti.
Pain relief
The goal of therapy is to reduce the intensity of the pain so that it interferes with the pain as little as possible life quality, in case it is not possible to completely eliminate it. For this, the pain doctor identifies the therapy that best suits the life of the patients who must follow it regularly and at fixed times. Various categories of medications, from anti-inflammatories, to antidepressants, opiates and cannabis derivatives that work mainly on the central nervous system by restoring the activity of endogenous analgesic systems. Neuromodulators that regulate nerve activity and the excitability of nerve fibers are also used. “You can exploit the action of unusual findings, such as some preparations for local use based on capsaicin, a substance contained in chilli that is an excellent analgesic for pain from nerve damage,” says Mariconti. “Other abnormal drugs are clonidine-soaked patches, generally prescribed to control hypertension. They are able to reduce the sensitivity of nerve endings to noradrenaline, and are able to block some mechanisms responsible for neuralgic pain in the area of application “.
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The new routes of administration
Over the years, the pain medicine has developed new routes of administration to reduce the drug burden. “Opiates can now be taken in solutions, in tablets, orally or transmucosally, that is, by placing the tablets under the tongue or between the gum and cheek, or as nasal sprays, thus exploiting their rapid absorption”, explains the algologist. The transdermal administration takes place instead through the application of patches on the intact skin that allow a constant absorption of the drug. A curious way of delivering drugs is district intradermal therapy, better known as mesotherapy, used in certain situations of osteoarticular and muscular pain. Through very short and thin needles the patient is subjected to multiple injections of local anesthetics, anti-inflammatory and muscle relaxants. In this way, small reservoirs of medicine are created only where it is needed and the body’s exposure to high drug doses is reduced.
The poison of the hermit crab
When it is preferable to inject drugs into contact with the nervous system, interventional techniques using very thin catheters are used. Small reservoirs that deliver micro-dosages are implanted under the skin and refilled at regular intervals to promote continuous analgesia. “The substances that can be administered in this way are few. Among them is ziconotide, a molecule extracted from the venom of the hermit crab, a mollusk of the Caribbean Sea that uses the paralyzing properties of the toxin to capture its prey, which is used as a powerful analgesic. It is prescribed in particularly selected cases and with careful monitoring of side effects ”, explains the doctor. And then there are the new high-tech treatments including thebone marrow electrostimulation, the techniques of neurolesion by means of radio frequency, the intervertebral disc procedures and kyphoplasty. “They are scarcely invasive interventions. Hospitalization times – concludes the expert – are short and in most cases the benefits are almost immediate “.
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