The ability of a person to overcome pain is considered the most important protective mechanism that ensures the survival and adaptation of living organisms to changing environmental conditions. The International Association
For the Study of Chronic Pain defines pain as follows: “Pain is an unpleasant sensory and emotional experience associated with, or described in terms of, existing or potential tissue damage.”
Acute pain is pain that is associated with the activation of pain receptors after tissue damage, and which completely resolves after healing.
However, unpleasant sensory sensations may persist or appear after healing, while, no longer being a protective function of the body, they have a negative effect on the body, causing it suffering. The appearance of such pain is usually associated with damage to the peripheral or central nervous system, and they are chronic. The International Association for the Study of Pain defines chronic pain as “pain that continues beyond the normal healing period” and should be considered when it has lasted at least 3 months.
However, it is important to note that the main difference between chronic pain and acute pain is not the time factor, but qualitatively different neurophysiological, psychophysiological and clinical relationships.
The causes of chronic pain are varied. Among them:
- Diseases of the musculoskeletal system.
- Oncological processes.
- Surgical interventions.
- Sedentary lifestyle.
- Phantom pain (after amputation of a limb).
Prolonged pain worsens the quality of life of the patient, causes the formation of anxiety, irritability, and a tendency to depressive states.
Timely identification of the cause of chronic pain, the appointment of the necessary treatment improves the prognosis and quality of life of patients.
Depression in pain
Patients with chronic pain often suffer from psychopathological disorders. The most common type of pathological conditions of this kind in chronic pain syndromes (CPS) are depressive disorders. Some scientists believe that any CPS is accompanied by depression of varying severity.
Many researchers are of the opinion that the incidence of depression in chronic pain depends on the nosological form of CHD and its localization. Depression is much more common in patients with conditions such as fibromyalgia and chronic tension-type headaches. Also, it is important to note that depression in most cases is a consequence of chronic pain and a natural response to patients’ disability, and not the actual cause of CPS.
The appearance of depression against the background of pain syndrome is an explainable fact, because CPS leads to the appearance of negative emotions, leads to sleep disturbances, appetite, limits the patient’s capabilities, and reduces his quality of life. Depression associated with pain is more likely to develop in patients who are predisposed to the development of disorders of this kind or have a history of depressive episodes. When a depressive syndrome is attached to pain, its tolerance worsens, its intensity increases, and it transforms into a chronic form.
In addition, drug therapy may play a role in the development of depression in CHD. For example, long-term use of drugs with analgesic effect, in particular non-steroidal anti-inflammatory drugs, can lead to the formation of a depressive disorder.
Pain and depression, among other things, may have different origins and may not be related to each other.
In any of these cases, coexisting pain and depression always exacerbate each other, forming a typical vicious circle of pain-depression-pain-depression.
Most often, with CPS, a latent, somatized depression develops.
To determine it, you can be guided by the following clinical symptoms:
* Increased irritability.
* Difficulties in making decisions.
* Constant fatigue, increased fatigue.
* reduced performance.
* Decreased appetite and body weight.
* sleep disturbances (early morning awakenings).
* Deterioration of well-being in the morning with a slight improvement in the evening.
It is also important to note that against the background of CPS, depressive disorders are often combined with anxiety syndromes.
To date, special scales have been developed for the diagnosis of depression. To reduce the amount of time for assessing the presence of this pathological condition, a method of two questions was developed: “In the last month, have you experienced feelings of emptiness, depression, hopelessness?” and “In the last month, have you experienced a decrease in interest and pleasure in your usual events and activities?” These questions help to suspect depression, but in the future a more in-depth examination of the disease is needed to clarify the diagnosis and establish the immediate cause. A pathological condition of this kind, especially in the presence of pain, requires immediate medical attention.