Созылмалы ауру: себептері, түрлері және емдеу жолдары

Pain that lasts longer than three months
and can last from three months to several years; Various diagnostic manuals such as DSM 5 and ICD 11 have proposed several definitions of chronic pain, but the accepted definition is that it is "pain that lasts longer than the expected period of recovery." Creating a pain mechanism prevents possible damage to the body, but chronic pain is a pain without biological value (doesn't have a positive effect). This pain has different divisions; cancer, post traumatic or surgery, musculoskeletal and visceral are the most important of these divisions. Various factors cause the formation of chronic pain, which can be neurogenic (gene dependent), nociceptive, neuropathic, psychological or unknown. Some diseases such as diabetes (high blood sugar), shingles (some viral diseases), phantom limb pain, hypertension and stroke also play a role in the formation of chronic pain. The most common types of chronic pain are back pain, severe headache, migraine, and facial pain. Chronic pain can cause very severe psychological and physical effects that sometimes continue until the end of life. Analysis of the grey matter (damage to brain neurons), insomnia and sleep deprivation, metabolic problems, chronic stress, obesity and heart attack are examples of physical disorder; And depression, cognitive disorders, perceived injustice (PI) and neurosis are examples of mental disorder. A wide range of treatments are performed for this disease; Drug therapy (types of opioid and non opioid drugs), cognitive behavioral therapy and physical therapy are the most significant of them. Medicines are usually associated with side effects and are prescribed when the effects of pain become severe. Medicines such as aspirin and ibuprofen are used for milder pain and morphine and codeine for severe pain. Other treatment methods, such as behavioral therapy and physiotherapy, are often used as a supplement along with drugs due to their low effectiveness. There is currently no definitive cure for any of these methods, and research continues into a wide variety of new management and therapeutic interventions, such as nerve block and radiation therapy. Chronic pain is considered a kind of disease, this type of pain has affected the people of the world more than diabetes, cancer and heart diseases. During several epidemiological studies conducted in different countries, wide differences in the prevalence rate of chronic pain have been reported from 8% to 55.2% in countries; For example, studies evaluate the incidence in Iran and Canada between 10% and 20% and in the United States between 30% and 40%. The results show that an average of 8% to 11.2% of people in different countries have severe chronic pain, and its epidemic is higher in industrialized countries than in other countries. According to the estimates of the American Medical Association, the costs related to this disease in this country are about 560 to 635 billion dollars.

The mechanism of continuous activation and transmission of pain messages, leads the body to an activity to relieve pain (a mechanism to prevent damage in the body), this action causes the release of prostaglandin and increase the sensitivity of that part to stimulation; Prostaglandin secretion causes unbearable and chronic pain. Under persistent activation, the transmission of pain signals to the dorsal horn may produce a pain wind up phenomenon. This triggers changes that lower the threshold for pain signals to be transmitted. In addition, it may cause non nociceptive nerve fibers to respond to, generate, and transmit pain signals. Researchers believe that the nerve fibers that cause this type of pain are group C nerve fibers; These fibers are not myelinated (have low transmission speed) and cause long term pain. These changes in neural structure can be explained by neuroplasticity. In chronic pain, this process is difficult to reverse or stop once established. EEG of people with chronic pain showed that brain activity and synaptic plasticity change as a result of pain, and specifically, the relative activity of beta wave increases and alpha and theta waves decrease. Inefficient management of dopamine secretion in the brain can act as a common mechanism between chronic pain, insomnia and major depressive disorder and cause its unpleasant side effects. Astrocytes, microglia and satellite glial cells also lose their effective function in chronic pain. Increasing the activity of microglia, changing microglia networks, and increasing the production of chemokines and cytokines by microglia may exacerbate chronic pain. It has also been observed that astrocytes lose their ability to regulate the excitability of neurons and increase the spontaneous activity of neurons in pain circuits. The typical pain management team includes medical practitioners (particularly anesthesiologists), rehabilitation psychologists, physiotherapists, occupational therapists, physician assistants, and nurse practitioners. Acute pain usually resolves with the efforts of one practitioner; however, the management of chronic pain frequently requires the coordinated efforts of a treatment team. Complete, longterm remission of many types of chronic pain is rare. Chronic pain may originate in the body, or in the brain or spinal cord. It is often difficult to treat. Epidemiological studies have found that 8–11.2% of people in various countries have chronic widespread pain. Various non opioid medicines are initially recommended to treat chronic pain, depending on whether the pain is due to tissue damage or is neuropathic. Psychological treatments including cognitive behavioral therapy and acceptance and commitment therapy may be effective for improving quality of life in those with chronic pain. Some people with chronic pain may benefit from opioid treatment while others can be harmed by it. People with non cancer pain who have not been helped by non opioid medicines might be recommended to try opioids if there is no history of substance use disorder and no current mental illness. Non opioid treatment of chronic pain with pharmaceutical medicines might include acetaminophen (paracetamol) or NSAIDs. Various other nonopioid medicines can be used, depending on whether the pain is a result of tissue damage or is neuropathic (pain caused by a damaged or dysfunctional nervous system). There is limited evidence that cancer pain or chronic pain from tissue damage as a result of a conditions (e. g. rheumatoid arthritis) is best treated with opioids. For neuropathic pain other drugs may be more effective than opioids, such as tricyclic antidepressants, serotonin norepinephrine reuptake inhibitors, and anticonvulsants. In women with chronic pain, hormonal medications such as oral contraceptive pills ("the pill") might be helpful. When there is no evidence of a single best fit, doctors may need to look for a treatment that works for the individual person. Interventional pain management may be appropriate, including techniques such as trigger point injections, neurolytic blocks, and radiotherapy. While there is no high quality evidence to support ultrasound, it has been found to have a small effect on improving function in non specific chronic low back pain. Psychological treatments, including cognitive behavioral therapy and acceptance and commitment therapy can be helpful for improving quality of life and reducing pain interference. Brief mindfulness based treatment approaches have been used, but they are not yet recommended as a first line treatment. The effectiveness of mindfulness based pain management (MBPM) has been supported by a range of studies. Among older adults psychological interventions can help reduce pain and improve self efficacy for pain management. Psychological treatments have also been shown to be effective in children and teens with chronic headache or mixed chronic pain conditions. While exercise has been offered as a method to lessen chronic pain and there is some evidence of benefit, this evidence is tentative. For people living with chronic pain, exercise results in few side effects. Some people with chronic pain benefit from opioid treatment and others do not; some are harmed by the treatment.

Alternative medicine refers to health practices or products that are used to treat pain or illness that are not necessarily considered a part of conventional medicine. When dealing with chronic pain, these practices generally fall into the following four categories: biological, mind body, manipulative body, and energy medicine. Vitamin E is perhaps the most studied out of the three, with strong evidence that it helps lower neurotoxicity in those with cancer, multiple sclerosis, and cardiovascular diseases. Hypnosis, specifically, can offer pain relief for most people and may be a safe alternative to pharmaceutical medication. Evidence does not support hypnosis for chronic pain due to a spinal cord injury. Preliminary studies have found medical marijuana to be beneficial in treating neuropathic pain, but not other kinds of long term pain. as of 2018, the evidence for its efficacy in treating neuropathic pain or pain associated with rheumatic diseases is not strong for any benefit and further research is needed. For chronic non cancer pain, a recent study concluded that it is unlikely that cannabinoids are highly effective. However, more rigorous research into cannabis or cannabis based medicines is needed. Acupuncture has also been found to be an effective and safe treatment in reducing pain and improving quality of life in chronic pain including chronic pelvic pain syndrome. Transcranial magnetic stimulation for reduction of chronic pain is not supported by high quality evidence, and the demonstrated effects are small and short term. Spa therapy could potentially improve pain in patients with chronic lower back pain, but more studies are needed to provide stronger evidence of this. While some studies have investigated the efficacy of St John's Wort or nutmeg for treating neuropathic (nerve) pain, their findings have raised serious concerns about the accuracy of their results. Kinesio tape has not been shown to be effective in managing chronic non specific low back pain. Myofascial release has been used in some cases of fibromyalgia, chronic low back pain, and tennis elbow but there is not enough evidence to support this as method of treatment.

Chronic pain varies in different countries affecting anywhere from 8% to 55% of the population. It affects women at a higher rate than men, and chronic pain uses a large amount of healthcare resources around the globe. In the United States, chronic pain has been estimated to occur in approximately 35% of the population, with approximately 50 million Americans experiencing partial or total disability as a consequence. According to the Institute of Medicine, there are about 116 million Americans living with chronic pain, which suggests that approximately half of American adults have some chronic pain condition. The Mayday Fund estimate of 70 million Americans with chronic pain is slightly more conservative. In an internet study, the prevalence of chronic pain in the United States was calculated to be 30.7% of the population: 34.3% for women and 26.7% for men. In Canada it is estimated that approximately 1 in 5 Canadians live with chronic pain and half of those people have lived with chronic pain for 10 years or longer. Chronic pain in Canada also occurs more and is more severe in women and Canada's Indigenous communities. These conditions can be difficult to treat due to the high potential of medication interactions, especially when the conditions are treated by different doctors. Severe chronic pain is associated with increased risk of death over a ten year period, particularly from heart disease and respiratory disease. Several mechanisms have been proposed for this increase, such as an abnormal stress response in the body's endocrine system. Additionally, chronic stress seems to affect risks to heart and lung (cardiovascular) health by increasing how quickly plaque can build up on artery walls (arteriosclerosis). However, further research is needed to clarify the relationship between severe chronic pain, stress and cardiovascular health. and although the exact connection between the comorbidities is unclear, a 2017 study on neuroplasticity found that "injury sensory pathways of body pains have been shown to share the same brain regions involved in mood management." Chronic pain can contribute to decreased physical activity due to fear of making the pain worse. Pain intensity, pain control, and resilience to pain can be influenced by different levels and types of social support that a person with chronic pain receives, and are also influenced by the person's socioeconomic status. Chronic pain of different causes has been characterized as a disease that affects brain structure and function. MRI studies have shown abnormal anatomical and functional connectivity, even during rest involving areas related to the processing of pain. Also, persistent pain has been shown to cause grey matter loss, which is reversible once the pain has resolved. One approach to predicting a person's experience of chronic pain is the biopsychosocial model, according to which an individual's experience of chronic pain may be affected by a complex mixture of their biology, psychology, and their social environment. Some investigators have argued that it is this neuroticism that causes acute pain to turn chronic, but clinical evidence points the other way, to chronic pain causing neuroticism. When long term pain is relieved by therapeutic intervention, scores on the neurotic triad and anxiety fall, often to normal levels. Self esteem, often low in people with chronic pain, also shows improvement once pain has resolved. People who score highly on measures of catastrophization are likely to rate a pain experience as more intense than those who score low on such measures. It is often reasoned that the tendency to catastrophize causes the person to experience the pain as more intense. One suggestion is that catastrophizing influences pain perception through altering attention and anticipation, and heightening emotional responses to pain. However, at least some aspects of catastrophization may be the product of an intense pain experience, rather than its cause. That is, the more intense the pain feels to the person, the more likely they are to have thoughts about it that fit the definition of catastrophization.

Individuals with post traumatic stress disorder (PTSD) have a high comorbidity with chronic pain. Patients with both PTSD and chronic pain report higher severity of pain than those who do not have a PTSD comorbidity.

People with chronic pain may also have symptoms of depression. In 2017, the British Medical Association found that 49% of people with chronic pain had depression.

Chronic pain's impact on cognition is an under researched area, but several tentative conclusions have been published. Most people with chronic pain complain of cognitive impairment, such as forgetfulness, difficulty with attention, and difficulty completing tasks. Objective testing has found that people in chronic pain tend to experience impairment in attention, memory, mental flexibility, verbal ability, speed of response in a cognitive task, and speed in executing structured tasks. A review of studies in 2018 reports a relationship between people in chronic pain and abnormal results in test of memory, attention, and processing speed.

Chronic pain leads to a significant decrease in quality of life, decreased productivity, decreased wages, worsening of other chronic diseases, and mental disorders such as depression, anxiety, and substance use disorder. Acetaminophen, a standard drug treatment for chronic pain, can cause hepatotoxicity when taken in excess of four grams per day. In addition, therapeutic doses for patients with chronic liver diseases may also cause hepatotoxicity. Long term risks and side effects of opioids include constipation, drug tolerance or dependence, nausea, indigestion, arrhythmia (QT prolongation of electrocardiography in methadone treatment), and endocrine gland that can lead to amenorrhea, impotence, gynecomastia, and decreased become energy. Also there is a risk of opioid overdose depending on the dose taken by the patient. Current treatments for chronic pain can reduce pain by 30%. This reduction in pain can significantly improve patients' performance and quality of life. However, the general and long term prognosis of chronic pain shows decreased function and quality of life. Also, this disease causes many complications and increases the possibility of death of patients and suffering from other chronic diseases and obesity. In addition, comorbid psychiatric disorders, such as major depressive disorder, can significantly delay the diagnosis of pain disorders. Major depressive disorder and generalized anxiety disorder are the most common comorbidities associated with chronic pain. Patients with underlying pain and comorbid mental disorders receive twice as much medication from doctors annually as compared to patients who do not have such co morbidities. Studies have shown that when coexisting diseases exist along with chronic pain, the treatment and improvement of one of these disorders can be effective in the improvement of the other. Patients with chronic pain are at higher risk for suicide and suicidal thoughts. Research has shown approximately 20% of people with suicidal thoughts and between 5 and 14% of patients with chronic pain who commit suicide.

Evidence exists for unconscious biases and negative stereotyping against racial minorities requesting pain treatment, although clinical decision making was not affected, according to one 2017 review. Minorities may be denied diagnoses for pain and pain medications, and are more likely to go through substance abuse assessment, and are less likely to transfer for pain specialist referral. A 2010 University of Michigan Health study found that black patients in pain clinics received 50% of the amount of drugs that patients who were white received. Preliminary research showed that health providers might have less empathy for black patients and underestimated their pain levels, resulting in treatment delays. Pain related injustice perception has been conceptualized as a cognitive appraisal reflecting the severity and irreparability of pain or injury related loss (e. g., "I just want my life back"), and externalizing blame and unfairness ("I am suffering because of someone else's negligence."). It has been suggested that understanding problems with top down processing/cognitive appraisals can be used to better understand and treat this problem.

COVID 19 has disrupted the lives of many, leading to major physical, psychological and socioeconomic impacts in the general population. Social distancing practices defining the response to the pandemic alter familiar patterns of social interaction, creating the conditions for what some psychologists are describing as a period of collective grief. Individuals with chronic pain tend to embody an ambiguous status, at times expressing that their type of suffering places them between and outside of conventional medicine. With a large proportion of the global population enduring prolonged periods of social isolation and distress, one study found that people with chronic pain from COVID 19 experienced more empathy towards their suffering during the pandemic. In light of this, it may be helpful for organizations to consider the social environment of their workplace, and how it may be working to ease or worsen chronic pain issues for employees.