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Orthopedics/Neurology

Pain Management/Analgesia

Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage (International Association for the Study of Pain).

El dolor es considerado un síntoma. Su mecanismo se considera vital, ya que es una defensa que tiene el cuerpo para detectar y localizar algún proceso que este causando daño. El dolor esta asociado a la percepción de cada sujeto, por lo que la intensidad puede o no estar vinculada con la gravedad del fenómeno que lo esta produciendo.

Pain is considered a sympton. Its mechanism is considered vital, since it is a defense that the body has to detect and locate some process that is causing damage. Pain is associated with the perception of each subject, so the intensity may or may not be linked to the severity of the phenomenom that is producing it. Pain is no longer considered a sympton and is taken into account as a disease when it becomes chronic, affecting the quality of life of the patient who suffers from it, producing alterations in daily activities, insomnia, mood changes, anxiety and depression.

It is estimated that chronic pain affects 25-29% of the world´s population. Aproximately 30 million people in Mexico have chronic pain, with a reported prevalence in men over 60 years of 41.5%, and in women over 60 years is 48%. In 2014, the prevalence of chronic pain in Mexico varied from 16-70%, being more frequent in women than in men, and was associated with degenerative disease and in those over 65 years of age.

According to its duration, pain can be classified as acute of chronic. Acute pain has a short and limited duration, is generally associated with an injury or disease, and disappears with the healing of the latter. Chronic pain lasts beyond the healing of the injury or disease that caused it or is associated with a chronic condition. Sometimes it is not posible to clearly identify the cause of chronic pain.

Pain can be classified according to its origin:

  • Nociceptive pain: it is caused by the activation of pain receptors in response to a stimulus. It is divided into somatic, which has its origin in structures such as muscles, tendons, joints, ligaments and bones; visceral whose origin is hollow and solid viscera.
  • Neuropathic pain: originates in structures of the central and peripheral nervous system.
  • Psychogenic pain: it is pain in which, after exhausting all diagnostic possibilities, no real or functional tissue lession is found, and represents 1% of patients suffering from pain.

Before starting treatment, the physician evaluates the temporality, causality, location, distribution, characteristics, type of pain, severity or intensity, duration, periodicity, coincident circumstances and previous treatment. It is recommended that patients with chronic pain should also undergo a psychological evaluation.

The general guidelines for the treatment of acute and postoperative pain in Mexico generally recommend the following for its treatment:

  • Mild pain: use anti-inflammatory analgesics.
  • Moderate pain: weak opioids are added to the previous treatment.
  • Severe pain: use strong opioids which can be combined with anti-inflammatory analgesics.

There are also guidelines for the treatment of oncologic pain and neuropathic pain. In the case of cancer patients, pain can can be sever and require the use of strong opioids. For neuropathic pain, other types of drugs known as adjuvants are used; in this group are anticonvulsants and antidepressants, in addition, strong opioids can be used.

Diabetes melitus is the second leading cause of death in Mexico, causing the death of approximately 100,000 people annualy. This condition produces neuropathic pain, which manifests as burning, cutting, stabbing, cramping and cold sensation, which increases during the night. If the disease is not diagnosed and treated in a timely manner, it generates chronic pain of moderate to severe intensity, which affects the performance of daily activities and affects the patient´s quality of life.

Pain can be a symptom or a disease, having an important impact on the patient´s life quality, being a priority that diagnosis and treartment are implemented in a timely manner by health professionals.

At Liomont we have a wide pipeline of medications for the management of all types of pain.   

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