Is it good to endure the pain?

We must not heed the recommendation to endure the pain if they have ever told us. It must be fought from the first moment. Pain delays the evolution of diseases, including wound healing, and can promote their chronicity.

It is not necessary to consult a doctor to take a non-steroidal anti-inflammatory analgesic that does not need a prescription when something hurts and the medication has been prescribed for a similar condition of a self-limited nature.

Multicellular living things have a large number of specialized nerve endings to detect very different stimuli. There are some, for example, dedicated to the perception of low-intensity mechanical stimuli, such as a caress.

But our body also has nerve endings dedicated solely and exclusively to the perception of pain, which are called nociceptive.

Many of the most frequent pains, such as those caused by trauma or surgical interventions, are called nociceptive pains because they are related to an injury to a tissue or organ, and their duration follows a course parallel to that of recovery from it.

These pains have 2 important characteristics. The first is that we can combat them by using non-steroidal anti-inflammatory painkillers, namely the drugstore classics, ibuprofen, paracetamol, and aspirin.

For these pain of moderate-intensity, they are a quick and easy solution, since in most cases it is not necessary to go to the family doctor. And fortunately, we use them, because all three are among the top five drugs sold in the pharmacy without a prescription.

When should I take a pain reliever?

But the question that we will surely ask ourselves next is And when and how do I take it?

As soon as the annoyance begins. Pain does not exist to test us or to allow us to make displays of stoicism and toughness.

Pain exists to alert us to bodily harm and consequently so that we can act to prevent further harm.

And in order to fulfill this objective, the appropriate thing is to combat it. The sooner the better. In addition, pain generates fear and negative emotions. Thus it is understood that for both patients and doctors, the battle against pain is of great importance.

However, in the last 20 years, there have been hardly any new pain medications that have reached wide clinical use. Except for tramadol and tapentadol, and some strong fentanyl analogs opioids.

But this has not discouraged biomedical science, which has many means to identify new molecules and cell types involved in the genesis, transmission, and chronification of pain.

Currently, research is focused on better understanding the pathophysiological processes that underlie different forms of pain, such as fibromyalgia, and on identifying how the nervous system is altered, giving rise to forms of pain that evolve autonomously regarding stimuli.

Pain may be subjective, but it is always real!

There are many differences between human beings, and among them, we could also include the way each person feels pain.

Some people are more sensitive to pain than others. They are not necessarily more whiny or mushy. But how do you measure the intensity of pain?

Well, until recently, researchers did it almost exclusively in a perhaps too subjective way. It consisted of asking the patient what value he gave to the pain he was suffering on a scale of 1 to 10.

They completed this assessment by collecting a series of more objective data. For example, in the case of an individual who complained of severe low back pain, they looked at whether or not he could stand up, walk, lift his legs …

Today it is possible to observe the reactions that pain causes in our brain, thanks to brain imaging techniques.

Researchers have well-identified brain structures and some of the modifications they undergo when a subject feels pain.

The magnitude of the modifications allows specialists to somehow measure the intensity of the pain.

To find out more: is chronic pain a disease? ยป

Opioids for severe pain

We have already seen that pain of moderate-intensity is relieved with commonly used anti-inflammatory pain relievers, but when it comes to severe pain, opioid drugs become the best option.

This type of medication has significant side effects (nausea, vomiting, constipation, depression of the respiratory system, tolerance, dependence …) that in some cases can lead to death. And that is why it is essential to adapt the opioid doses to the intensity of pain and the characteristics of the patient.

In any case, opioid medications are tremendously effective and essential for certain pain conditions.

In our country, professionals in the health system stand out for their ability to control and manage this type of drug.

To more effectively serve and improve the quality of life of these individuals, Pain Units were created. They are multidisciplinary teams, frequently led by an anesthetist, who focus their efforts on fighting chronic pain conditions resistant to conventional analgesics. To do this, they resort to drugs with a narrow therapeutic range (the difference between the therapeutic and toxic dose is small), to special forms and routes of administration such as infiltration of peripheral nerve trunks or the placement of devices that allow the self-administration of drugs by the patient…

This form of administration, used mainly with opioid drugs, has the advantage of using more moderate doses of opioids to achieve more rapid effects and appropriate to the intensity of pain at the time it occurs.

In other situations, when the pain has a foreseeable time course, it is preferable to administer the medication with a fixed schedule and with anticipation. Not all pain treatments are pharmacological in nature, using other types such as electrostimulation and even surgery.

Placebo, the invisible ingredient

The subjectivity of pain has led scientists to study to what extent pain is amplified or generated by the subject independently of the noxious stimulus, and consequently, to determine to what extent the analgesic effect of drugs is due to the action on that process. This is what is called the placebo effect. It is not, however, a specific effect of analgesic drugs, but is observed with any therapeutic intervention and manifests itself in multiple ways. Determining the magnitude of the placebo effect is essential in the study of pain and therapeutic solutions.

On the one hand, knowing it is an advantage for those patients who are more sensitive to this phenomenon and who could benefit more from actions that favor it, but on the other hand, it is necessary to separate the grain (the pharmacological effect itself) from the straw (the Placebo effect).


Hot pepper against pain

In the year 1493, Christopher Columbus returned from his second trip to the “New World” with a crop used in Mexico for 6,000 years, the pepper.

No one could imagine that this vegetable, the sowing of which spread rapidly throughout Europe, would become one of the weapons used against pain.

The capsicum pepper has capsaicin among its compounds, which is what gives the pepper, chili, or chili, that spice so common in Mexican food and other areas of Latin America.
Capsaicin is the main component of some patches that, applied locally, reduce pain at that point.

In addition, this compound has an advantage over other pain relievers, and that is that its side effects are minor.

The toxin from the pufferfish, one of the ten most poisonous animals in the world, investigated as an anesthetic

The pufferfish is considered a delicacy in certain cultures such as the Japanese, despite being loaded with a lethal toxin, tetrodotoxin. This exotic gastronomic hobby has caused more than one corpse on the table.

In fact, tetrodotoxin is 1,200 times more poisonous than cyanide, there is no known antidote, and the toxin from a single specimen could kill 30 adult humans. Well, as dangerous as it may seem, that does not prevent it from being widely used in scientific research, since it acts in a similar way to local anesthetics.

But how is it used with these extremely high toxic levels? It is about administering it added with polymers that facilitate its slow release in the body, and with other drugs that help transfer this toxin to nociceptive neurons.

The story of the challenge of fighting pain

Until relatively recently, society understood that pain was innate to life and therefore there were practically no alternatives to alleviate it. Already among Neolithic men, attacked by terrible toothaches, as has been demonstrated, there was a conviction that the pain was caused by demons or spirits of the dead.

One of the first and most used resources throughout history to combat pain has been cold. With it, the areas affected by a wound were desensitized, even being used as an anesthetic in the amputation operations that were carried out on the battlefield to the soldiers of the Napoleonic army during the invasion of Russia.

The human being has also taken advantage of the nature that surrounds him in his battle against pain, resorting to natural narcotics such as the poppy, and even taking advantage of the electric shocks that eels produce to numb.

A perfect example of this use is that, in 300 BC, the Greek Hippocrates, considered the father of medicine, created the so-called ‘soporific sponge’, composed of opium, henbane, blackberry juice, lettuce, mandrake, and ivy.

It will take several centuries, specifically until 1846, for Dr. William Morton to apply the first general anesthesia in the removal of a tumor in the neck at the Massachusetts General Hospital, Boston.

From that moment on, the surgery experienced a great boost thanks to the entire anesthetic arsenal that began to develop.

But what about the pain other than the use of the scalpel and chronic?

The conclusion of the Second World War marked the beginning of the investigation of pain due to the important consequences that the conflict left in a large number of soldiers on all fronts.

There are many issues that surround pain, its intensity, the ways to relieve it, or, not least, the way to cope with it.