The management of chronic pain is a developing field in medicine. Its goal is the relief from pain, the rehabilitation of bodily functions, and the improvement in the individual's quality of life. It covers the need for patient care, using the best scientific information currently available.
Algology is a new medical specialization that deals with the treatment of painful conditions. It acknowledges the complex nature of pain and approaches it from the perspective of the expert. The doctor who offers his/her services in the pain clinic already possesses a medical specialization (usually anesthesiology) and following that, specializes in the field of pain management.
The International Association for the Study of Pain (IASP) defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”.
Pain is an individual's protection mechanism. In chronic conditions, however, it results in pathophysiological processes that have damaging effects on the body and do not offer any benefit for survival.
Pain mechanism: tissue injury leads to the release of nociceptive mediators and triggers a series of reactions. A process of inflammation is initiated locally, while neurological endings transfer signals, through chemical or mechanical irritation, from the periphery to the central nervous system. There they are interpreted as a sensation of pain. The experience of pain does not depend, however, just on the irritation itself, but also on the way the brain perceives it, through mechanisms of reinforcement and repression, and translates the sensation as unpleasant. The purpose of the above process is to indicate danger, in order to avoid similar situations and to trigger endogenous (internal) correction mechanisms to repair the damage; an orchestrated process in which the nervous, paracrine, endocrine and immune systems all take part.
The treatment of a patient who has painful conditions begins with a medical interview and medical history and continues with the physical examination and appropriate laboratory and diagnostic tests. It is important to avoid incorrect terms and descriptions that will result in involving physician and patient in inappropriate tests and may lead to false expectations.
Treatment is guided by the history of the pain in question, its onset, intensity, duration, the conditions that relieve it or intensify it and the anatomical structures involved in the pain.
Treatment for the pain relief of patients at the pain clinic can require a range of methods and techniques such as:
- Appropriate drug prescription
- Interventional procedures (nerve blocks, neurolysis, neurostimulation)
- Techniques such as: Transcutaneous Electric Nerve Stimulation (TENS), injections into painful points (trigger points), articular infiltrations.
- Physiotherapy, Chiropractic
- Acupuncture, electro-acupuncture
- Relaxation techniques, hypnosis, biofeedback
- Counselling and psychological support
- Cooperation with other medical specialities
In most cases, combinations of different methods are adopted (the multidimensional approach) and a personalized treatment plan is created according to the patient's needs.