We tell a super short story of pain, patience and deliverance.
Often in films and TV shows on a medical theme, we see that pain is evaluated on a 10-point system. Usually it is used for emergency surgeries and injuries, but the stereotype is universal: it seems that “5 out of 10” is bearable, clenched your teeth and don’t complain, but “9 out of 10” – something needs to be done. Until it hurts on “9 out of 10”, whether it’s the head, stomach or teeth, we usually don’t think regarding pills and other means, we just endure.
Maybe in vain? Let’s find out!
What is pain?
From a biological point of view, pain is a signaling system in our brain. It occurs when cells and tissues are damaged somewhere in the body. These damaged cells release certain chemicals, sending an SOS signal to the Control Center, the brain. Strictly speaking, all pain occurs in the brain, but the source of the signal allows you to more or less accurately determine the area of damage.
True, if the car alarm can be turned off by pressing a button, our Control Center continues and continues to sound the alarm – even when we have long understood: “Yes, yes, there is damage here, the location is clearly established.” And prolonged pain becomes uncomfortable in itself, interfering with our usual activities.
What is the pain like?
There are many classifications of pain: by localization, by strength, by character. The most commonly used and informative when communicating with doctors is the classification by severity:
1. Short-term, or transient. It usually appears for a short time and goes away on its own. For example, pain with a small skin injury is almost always transient.
2. Sharp. Associated with tissue damage and is most often measured using a 10-point scale. Pain relief is usually an additional method of treatment, and not the main one: during an attack of toothache, you can relieve this unpleasant sensation, but in order for it to go away completely, you will need a dentist. Very often this category of pain is headache, lasting, say, the whole evening.
3. Subacute. Most often, this is background pain, lasting from 2 to 6 months, and sometimes associated with psychological factors. It can and should be removed, but in parallel it is necessary to establish its cause and treat the disease associated with it.
4. Chronic. Occurs in response to a serious injury and lasts longer than 6 months. Over time, it ceases to perform a “localizing” function: a person just has a headache almost every day, and why it hurts, where the damage is, is already quite difficult to establish. In extreme cases, the pain syndrome turns into a separate disease, which is treated purposefully.
When to relieve pain, and when not?
According to most doctors and researchers, there is no point in enduring acute, subacute, or chronic pain. As soon as it was possible to determine the area where the tissues were damaged (whether it be teeth, skin, joints or internal organs), it is necessary to deal with both the treatment of the underlying disease, that is, the elimination of damage and its consequences, and auxiliary measures, that is, anesthesia.
In other words: if you have a toothache, your task is to quickly understand which one, take painkillers and make an appointment with a doctor. If you were able to identify the problem tooth, then the signaling system of your body has fulfilled its function at 100%. Continued pain is simply the imperfection of the human body (yes, evolution has not yet learned how to “turn off the alarm”).
When did painkillers appear?
The first mentions of painkillers that have come down to us date back to the middle of the 2nd millennium BC. Instead of tablets, plant substances were used: poppy, dope, mandrake root, hemlock, belladonna, as well as a number of narcotic substances. Since almost all of these drugs were extremely dangerous, the pain was removed only in exceptional cases, when it became unbearable, “10 out of 10” – for example, during surgical operations (and even then not always).
A revolution in anesthesiology occurred at the beginning of the 19th century, when the rapid development of surgery and a better understanding of the human body led to the discovery of more and more new substances that have an analgesic effect. Ether vapors, chloroform – inventions of that era, used for anesthesia. They were quite toxic and are hardly used today, but in those days they were a breakthrough.
The date of birth of modern non-narcotic emergency pain relief is October 16, 1846: it was on this day that physician John Wharton at the Boston Hospital performed the first operation under anesthesia.
But “household” anesthesia, that is, one that is not used for dental treatment or surgical operations, appeared in 1920: the German scientist Ludwig Knorr synthesized metamizole sodium, and this non-opioid analgesic has become one of the most popular around the world – right up to the present day. It was thanks to him that it became possible to relieve headaches, toothaches and other types of pain without the risk of addiction and any serious consequences – and therefore outside of doctors’ offices and hospitals.
What does science say regarding modern pain relief?
To date, non-opioid analgesics, in particular, metamizole sodiumhave been thoroughly studied. The largest study devoted to them – a meta-analysis in 2015, which collected data from 696 different studies, showed that the side effects of using this drug are extremely rare, and no deaths were recorded at all. [1].
In 2021, another meta-analysis compared the efficacy of metamizole with drugs such as triptan in the treatment of migraine. There was no statistically significant difference in efficacy, as well as in safety: metamizole remains an effective drug for this purpose even 100 years following the invention [2].
What is known regarding pain today?
Each person feels pain in their own way, and there is no universal pain scale. It is from here that disputes arise regarding how painful childbirth is: indeed, in some women they are relatively easy, others experience real “10 out of 10”.
What is the most common pain? Among the acute ones, the most common is headache: 75% of people experience it at least 1 time during the year. [3]. In addition, 26.5% of people experience pain in the lower back at least once within 3 months. [4]. And one or another type of chronic pain has become a constant companion of life for, according to various estimates, from 11 to 40% of the population [5].
Источники: 1) Goadsby, P.J., Lantéri-Minet, M., Michel, M.C. et al. 21st century headache: mapping new territory. J Headache Pain 22, 19 (2021) 2) Institute of Medicine (US) Committee on Advancing Pain Research, Care, and Education. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington (DC): National Academies Press (US); 2011. PMID: 22553896
But the dependence on gender in the perception of pain was not noticed: both men and women, apparently, perceive it more or less the same – in the sense that everything is individual, and not gender conditioned. And it is equally useless for both sexes to endure pain – here science is quite unanimous.
The material is informational and educational in nature.
Illustrations: Diana Ohman
1. Kötter T, da Costa BR, Fässler M, Blozik E, Linde K, Jüni P, Reichenbach S, Scherer M. Metamizole-associated adverse events: a systematic review and meta-analysis. PLoS One. 2015 Apr 13;10(4):e0122918. doi: 10.1371/journal.pone.0122918. PMID: 25875821; PMCID: PMC4405027.
2. Peres MFP, Scala WAR, Salazar R. Comparison between metamizole and triptans for migraine treatment: a systematic review and network meta-analysis. Headache Med [Internet]. 2022 Jan. 13 [cited 2023 Mar. 27];12(3):182-230. Available from: https://headachemedicine.com.br/index.php/hm/article/view/566
3. Goadsby, P.J., Lantéri-Minet, M., Michel, M.C. et al. 21st century headache: mapping new territory. J Headache Pain 22, 19 (2021). https://doi.org/10.1186/s10194-021-в01233-7
4. Institute of Medicine (US) Committee on Advancing Pain Research, Care, and Education. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington (DC): National Academies Press (US); 2011. PMID: 22553896. https://nap.nationalacademies.org/read/13172/chapter/3#28
5. James Dahlhamer, PhD1; Jacqueline Lucas, MPH1; Carla Zelaya, PhD; Richard Nahin, PhD; Sean Mackey, MD, PhD; Lynn DeBar, PhD; Robert Kerns, PhD; Michael Von Korff, ScD; Linda Porter, PhD; Charles Helmick, MD. Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults — United States, 2016. CDC Weekly / September 14, 2018 / 67(36);1001–1006. https://www.cdc.gov/mmwr/volumes/67/wr/mm6736a2.htm
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