Nociceptive pain is a syndrome with which any person has met at least once in his life. This term refers to pain caused by a damaging factor. It is formed when there is an effect on some tissue. The sensations are acute, in medicine they are called epicritical. Accompanied by the excitation of peripheral receptors responsible for the perception of pain. Signals are sent to the central nervous system. Such an impulse transmission explains the localization of the onset of soreness.
Physiology
Nociceptive pain appears if a person is injured, if an inflammatory focus develops, or ischemic processes occur in the body. Such a syndrome accompanies degenerative tissue changes. The area of localization of the pain syndrome is precisely defined, obvious. When the damaging factor is removed, soreness (usually) disappears. To weaken it, you can use classic anesthetics. The short-term effect of the drugs is enough to stop the nociceptive phenomenon.
Nociceptive pain is physiologically necessary so that the body receives a warning in time about the dysfunctional state of a certain area. This phenomenon is considered protective. If soreness is observed for a long time, if an aggressive factor is excluded, but the pain still bothers the person, you can not regard it as a signal. This phenomenon is no longer a symptom. It must be assessed as a disease.
From statistics it is known that most often pain of the specified type in the form of a chronicle is formed when a person is sick with arthritis. Muscular and skeletal pains of this nature are frequent.
What happens?
There are two main types of pain: nociceptive and neuropathic. The division into these categories is due to the pathogenesis of the phenomenon, specific mechanisms by which syndromes are formed. To assess the nociceptive phenomenon, it is necessary to analyze the nature of the pain and to evaluate the scale, to determine which tissues, where and how badly damaged. No less important for the analysis of the condition of patients is the time factor.
Nociceptive pain is associated with stimulation of nociceptors. These can be activated if the skin is deeply damaged, the integrity of the bones, deeply located tissues, internal organs is violated. Studies of intact organisms showed the formation of the type of pain in question immediately upon the appearance of a local stimulus. If the stimulus is quickly removed, the syndrome disappears immediately. If we consider nociceptive pain in relation to surgical practices, we have to recognize the relatively long-lasting effect on receptors, accompanied in most cases by a large-scale working area. These aspects explain why there is an increased risk of persistence of pain, the formation of an inflammatory focus. The appearance of an area of chronic pain syndrome with the consolidation of this phenomenon is possible.
About categories
There is pain: nociceptive somatic, visceral. The first is detected if a skin inflammatory site is formed, the skin or muscle are damaged, if the integrity of fascial tissues, soft, is impaired. Somatic cases include a situation of damage and inflammation in the articular and bone areas, tendons. The second type of phenomenon is formed when damage is caused to the internal cavity membranes and hollow, parenchymal organic structures. The hollow elements of the body can stretch excessively, a spasmodic phenomenon can form. Such processes can affect the vascular system. Visceral pain appears with an ischemic process, an inflammatory focus and swelling of some organ.
The second category of pain is neuropathic. In order to better understand the essence of nociceptive pain, this class must also be described in order to know the differences. Neuropathic appears if peripheral or central blocks of NS suffer.
Soreness has an additional psychological aspect. Man is inherently wary of the approach of pain. This is a source of stress and a factor that can trigger depression. There is a possibility of a psychological phenomenon of unresolved pain. Pain syndrome provokes sleep disturbances.
The nuances of the phenomena
As can be seen from the above, the types of nociceptive pain (somatic, visceral) have different neurological mechanisms. This fact is explained scientifically and is important for researchers. Of particular importance are the differences in the mechanisms of the formation of pain for clinical practice. The somatic phenomenon caused by irritation of the nociceptors of the afferent somatic type is clearly localized in the area of tissues that is damaged due to some factor. The use of a classic pain medication allows you to quickly alleviate the condition of the patient. The intensity of the syndrome dictates the need to choose an opioid pain medication or not.
Visceral nociceptive pain is due to specific structural features of the internal organs, and a particularly important aspect is the innervation of such systems. It is known that ensuring operability due to nerve fibers for different internal structures is different. Many internal organs have receptors whose activation due to damage does not lead to awareness of the stimulus. Sensory perception is not formed. The patient does not identify pain. The organization of the mechanisms of such pain (against the background of somatic) has fewer separator mechanisms of sensory transmission.
Receptors and their features
Studying what is characteristic of nociceptive pain of the visceral type, it was found that receptors, whose activity is necessary for sensory perception, are interconnected. There is a phenomenon of autonomous adjustment. The innervation of the afferent type, which is present in the internal organic structures of the body, is partially provided by indifferent structures. Such are able to go into an active state if the integrity of the organ is violated. Their activation is observed in the inflammatory process. Receptors of this class are one of the elements of the body responsible for chronic visceral pain syndrome. Due to it, spinal reflexes are active for a long time. At the same time, autonomous adjustment is lost. The functionality of the organs is impaired.
Violation of the integrity of the body, the inflammatory process - the reasons that cause the classic secretory and motor patterns of activity to go astray. The environment in which receptors exist is unpredictable and dramatically changing. These changes activate silent elements. Sensitivity of the zone develops, visceral soreness appears.
Pain and its sources
An important characteristic of nociceptive pain is its belonging to the somatic type or visceral. It is possible to transmit a signal from one internal structure that has received damage to another. There is a possibility of projection of somatic tissues. Hyperalgesia in the area where the damage is localized is considered primary pain, other types are classified as secondary, since those types are not localized in the area where the damage is present.
Visceral nociceptive pain occurs when mediators, substances provoking pain syndrome appear in the area where the damage is localized. Perhaps inadequate stretching of muscle tissue or excessive contraction of this part of the hollow organ. The parenchymal structure may stretch the capsule into which the organ is enclosed. Smooth muscle tissue is susceptible to anoxia, vascular and ligamentous apparatus - traction, compression. Nociceptive type visceral pain is formed during necrotic processes and the appearance of a focus of inflammation.
These factors are often found when operating an intracavitary type. Operations of this class are especially traumatic and are more likely to lead to dysfunctions and complications. Nociceptive pain studied in neurology is an important aspect, the study of which should give new ways to improve methods and approaches to surgical intervention, anesthesia.
Categories: Visceral Type
Visceral hyperalgesia is observed directly in the affected organ. This is possible in the case of an inflammatory focus or stimulation of nociceptors. The viscerosomatic form is fixed in the area of somatic tissues, to which the projection of soreness extends. Viscero-visceral is a format in which pain spreads from one organ to another. The phenomenon is due to the specific innervation of tissues. If this overlaps in some areas, pain spreads to new parts of the body.
About drugs
The treatment of nociceptive pain involves the use of specialized medicines designed for this purpose. If the syndrome is unforeseen, it appears suddenly, the sensations are acute, due to surgical measures or the disease, due to which the operation is prescribed, you need to choose an analgesic, taking into account the root cause of the condition. The doctor should immediately consider a system of measures to eliminate the cause of the pathology.
If a person is expected to be operated on, the situation is planned, it is important to predict pain in advance and develop measures to prevent it. Take into account where the operation will be carried out, how large-scale the intervention is, how many tissues will be damaged, which elements of the nervous system will have to be touched. Preventive pain protection is required through slowing the start of nociceptors. Anesthesia measures are carried out before the intervention of the surgeon.
Science and practice
Nociceptive somatic pain is known to result from activation of nociceptors. Such elements of the body were first identified in 1969. Information about them appeared in scientific papers published by scientists Iggo and Pearl. Studies have shown that such elements are unencapsulated endings. There are three types of elements. Excitation of a specific is explained by a stimulus that affects the body. There are: mechano-, thermo-, multimodal nociceptors. The first block of the chain of such structures is located in the ganglion of the spinal cord. Affiliates predominantly appear in the spinal structures through the posterior roots.
Scientists, revealing what characteristics nociceptive somatic pain has, discovered the fact of transmission of nociceptive data. The main task of such information is the recognition of damaging effects with the exact definition of the site. This information activates an attempt to avoid exposure. The transfer of information about pain from the face and head is realized through the trigeminal nerve.
Syndromes: what are they?
To characterize nociceptive somatic pain, it is necessary to determine which pain syndrome has formed in a particular case. It can be psychogenic, somatogenic, neurogenic. Nociceptive syndrome is clinically divided into the following after surgery or trauma, due to oncology. Also, a syndrome associated with muscle, joint inflammation, stones in the gall bladder is isolated.
Perhaps a psychogenic phenomenon. Such pain is not caused by somatic damage, is associated with social influence and psychological impact. In practice, doctors are often forced to deal with cases of a combined phenomenon in which several forms of the syndrome are combined at once. In order to correctly formulate the tactics of treatment, it is necessary to determine all types and fix them in the patient’s personal card.
Pain: acute or not?
One of the key characteristics of nociceptive somatic pain is temporary. Any pain syndrome can form in the form of a chronicle or be acute. Acute is formed as a result of nociceptive effects: trauma, illness, muscle dysfunction. Influence is possible due to impaired functionality of some internal organ. In most cases, this type of pain is accompanied by endocrine, neural stress. Its strength is directly determined by the aggressiveness of the effect on the body. Nociceptive pain of this type is observed during the period of the birth of the child and against the background of an acute illness that encompasses internal structures. Its task is to identify which tissue is damaged, to determine and limit the aggressive influence.
Considering what characteristics nociceptive somatic pain has, it should be recognized that in most cases the ability to resolve independently is characteristic. If this does not happen with a certain variant of the course, the syndrome disappears due to treatment. Duration of storage - a few days, although less often the time frame stretches for weeks.
About the Chronicle
Speaking about what characteristics nociceptive somatic pain has, one of the first should be mentioned temporary. It is formed on the basis of acute. This usually happens if regenerative abilities are impaired or the patient received an incorrectly selected therapeutic program. A characteristic feature of the nociceptive type of chronic pain is the ability to persist if the acute stage of the disease resolves. It is customary to talk about the chronicle, if a lot of time has passed, the person should already have been cured, but the pain syndrome is still worrying. The period of formation of the chronicle is from a month to six months.
Finding out what is characteristic of chronic type nociceptive somatic pain, it was found that the phenomenon is often formed due to the peripheral effect of nociceptors. There is a possibility of dysfunction of the PNS, central nervous system. In humans, the neuroendocrine response to stress factors is weakened, sleep disturbances, an affective state are formed.
Theory of Kryzhanovsky
These scientists released two works on the characteristics of soreness. The first saw the light in 97th, the second - in 2005. Determining what is characteristic of nociceptive somatic pain, he proposed dividing all cases of pain into pathological, physiological. Normally, pain is a physiological defense of the body, an adaptation reaction designed to exclude an aggressive factor. Pathological, however, does not have a protective functional, prevents adaptation. This phenomenon cannot be overcome, it is difficult for the body, leads to a violation of the psychological status and disorders of the emotional sphere. CNS activity is disintegrating. People suffering from such pain are prone to suicide. Internal organs undergo changes, deformations, damage to the structure, functionality is disturbed, vegetative work, secondary immunity suffers.
Myological pain is frequent. This accompanies somatic pathologies and diseases of the nervous system.
About treatment
If the pain syndrome is characterized as nociceptive, the therapeutic program should include three aspects. It is important to limit the flow of information from the area of damage to the nervous system, slow down the production of algogens, their release into the body, and also activate antinociception.
Control of impulses from the area of violation is provided by painkillers with local effect. Currently, most often use lidocaine, novocaine. Studies have shown that such active compounds block the sodium channels present in neural membranes and processes. Activation of the sodium system is a prerequisite for the presence of action potential and momentum.
In order to inhibit afferentation, it is necessary to use blockade approaches that affect the spinal structures and peripheral nervous system. In some cases, superficial analgesia is recommended, sometimes - infiltration. For control can apply a central or regional blockade. The latter involves stopping the activity of peripheral elements of the NS.
About the subtleties
Superficial analgesia is necessary to prevent the activity of nociceptors. It is effective if the factor that provoked pain is located in the skin, that is, superficial. General therapeutic, neurological practice allows for infiltration with novocaine solution in a concentration of 0.25% to twice as much. Local anesthesia with ointments, gel-like substances is allowed.
Infiltration anesthesia allows you to deliver the analgesic to the deep skin layers and muscles supporting the skeleton. More often for this purpose they use Procaine.
The regional format is implemented by highly qualified specialists who have been trained in this area. An improperly conducted event with a high degree of probability initiates apnea, a seizure of the type of epilepsy, inhibition of blood flow. In order to eliminate and eliminate the complication in time, you need to monitor the patient's condition, as defined by the standard of general anesthesia. In medicine, they actively use the blockade of the brachial plexus, nerves between the ribs, cutaneous, radial, median, ensuring the work of the elbow. Sometimes intravenous anesthesia of the hand is indicated. For this event, resorting to technology developed by Beer.