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Pain is defined as the painful and unpleasant sensation felt in a part of the body. The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with present or potential tissue damage, or described in terms of such damage”. This definition is more complete and more precise, because it is not limited to the sensation of pain or tissue damage. We found two important concepts of pain.

When the damage is tissue, pain is felt by the organ in question. Thus, when the hand is placed on a hot plate, the pain signal causes the person to remove the hand from the place, to avoid further damage. The pain threshold can be different from one person to another, so we must consider what a person feels.

It is still important to distinguish between acute pain and chronic pain. Acute pain occurs suddenly due to illness or injury (such as a fracture , operation, etc.). It can be short-lived (for a moment or hours) or persistent (weeks or months), but it never lasts beyond the illness or wound-healing process that caused it. It is usually easy to treat.

Chronic pain comes on gradually and is persistent. In this case, chronic pain lasts longer than 6 weeks. It can be continuous or periodic. Chronic pain persists beyond wound healing and is difficult to treat.

The 3 levels of pain

For the treatment of different types of pain, the WHO has defined three levels of pain, depending on their intensity. Depending on the level, medications will be different for treatment.

– Level I corresponds to mild to moderate pain. At this point, the doctor will prescribe acetaminophen , acetylsalicylic acid (aspirin) or non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or diclofenac .

 – Level II corresponds to moderate to severe pain or when treatments given for level I have failed. At this point, the doctor will prescribe weak opioids. This class of drugs includes codeine and tramadol.

– Level III corresponds to severe pain or when treatments given for level II pain have failed. At this point, the doctor will give you strong opioids like morphine and its derivatives.

For levels II and III, the doctor may also prescribe adjuvants. These are drugs that do not have a direct effect on pain, but can increase the effectiveness of the selected pain reliever.

In Level I, when pain is not accompanied by inflammation, the doctor will prescribe paracetamol first, because its risk/benefit profile is good. It has a good analgesic effect and low risk (little interaction and side effects). Its use is highly recommended if the patient is suffering from gastric disorders, asthma and heart failure . NSAIDs can cause gastric ulcers, asthma, heart failure (by increasing salt and water retention). However, paracetamol is known for its hepatotoxicity, which is why the maximum dose of 4 grams per day should not be exceeded. In people suffering from liver failure, it will be necessary to reduce the dose of this medicine, or consider an alternative.

Ibuprofen remains the first choice when inflammation appears along with pain, because its risk/benefit ratio is better than other NSAIDs. Indeed, ibuprofen has a good analgesic and anti-inflammatory effect. Its side effects on the gastric system ( heartburn , ulcers) and on the cardiovascular system are lower than for other drugs used to treat pain. When the person has gastric disorders, a medicine for the protection of the stomach can be associated with the medicine.

 For cases of pain levels II and III, weak (level II) and strong (level III) opioids will be used. These can lead to addiction. The weak opioid of choice is codeine, while the strong opioid of choice is morphine, as it is the most well-known molecule, being the reference and most cost-effective molecule. According to WHO, priority should be given to oral forms of administration, and use the lowest possible effective dose. The doctor will prescribe the drug only if necessary.

These medications can cause side effects such as vomiting, respiratory depression and addiction. With regard to tramadol (for level II pain), the risk of dependence is greater, as diffusion to the central nervous system is faster, even when the person has no history of chemical substance abuse.

 Fentanyl, another commonly prescribed opioid, can also induce dependence, as this molecule easily passes into the central nervous system.

To summarize, it can be said that the choice of analgesic will depend on the degree of pain, its effectiveness (risk/benefit ratio), and its economic effectiveness.

Read more articles related to pain: stomachache , headache , toothache , sore throat , muscle pain , backache , migraine , fever .

Additional tips for fighting pain

– Try to exercise regularly. This is an excellent way to produce endorphins, a molecule produced in the brain that resembles morphine, a powerful painkiller. As noted by the Mayo Clinic (reference medical institution in the United States), trying to perform exercises such as walking or running for 30 to 45 minutes often 5 to 6 days a week, with 3 days a week is already possible to have a beneficial effect.

– In case of rheumatic or local pain, you can apply cold or hot compresses to relieve the pain.

– Lose weight. For some conditions, such as arthritis, osteoarthritis or back pain, losing weight helps to relieve the joint and thus reduce pain. Losing a few pounds can already reduce the feeling of pain.

– Get enough sleep. A good night’s sleep improves stress resistance and reduces fatigue, factors that make dealing with pain more difficult.

– Try to limit stress. If it is not possible to reduce it, use methods to better manage it, such as relaxation. Professionals such as doctors or psychologists can help.

– Get massages. This commonly used method slightly improves pain such as back pain or fibromyalgia .

Article written by Van Nguyen (pharmacist). Translated by Matheus Malta (pharmacist).

Questions and answers

“Every time I have a bowel movement I feel pain in the groin and for a while. Then in the scrotum. Could this be an iguinal hernia? What risks do I run if it is not treated?

Pharmacist’s response (by Adriana Sumi)

Inguinal hernia is the exit of the intestine from the abdominal cavity by some rupture that formed in the abdominal wall. This rupture occurs more often in men who do heavier physical exercises, but other factors can also influence the appearance of inguinal hernia.

The most common symptoms are the appearance of a lump in the groin area, especially when sitting, accompanied by pain when the person lifts or performs physical activity, but there may also be discomfort when defecating.

In some cases, usually when the hernia grows a lot, it can go down to the scrotum, and it can increase a lot in size. Generally, very small or very large inguinal hernias do not cause problems other than aesthetics, as the intestinal flow is not compromised, whereas medium-sized hernias can cause strangulation, which can lead to complications such as a serious infection.

Therefore, we recommend that you see a coloproctologist or a gastroenterologist to evaluate your case.

Jeanne Kenney
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I’m a stylist trainer, a content creator, and an entrepreneur passion. Virgo sign and Pisces ascendant, I move easily between my dreams, the crazy world I want, and my feet on the ground to carry out my projects.

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