Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue trauma. The pain can be divided in several ways according to the length of duration, the presence or absence of cancer, according to the localization, as well as whether it affects more internal organs or is manifested more on the skin. explains about portal "H1" prof. Dr. Nebojsa Ladjevic. It is considered that back pain, after the common cold, is the second most common reason for absence from work, and the results of studies show that chronic back pain is the first on the list of diseases that cause functional disability in modern society.

According to Prof. Ladjevic, one of the significant divisions is whether or not it has a neuropathic component.

"When we talk about duration, we divide it into acute pain that occurs immediately after trauma (trauma can be part of an injury or caused by surgery) and chronic pain. "Chronic pain is the one that lasts even after the healing of the damaged tissue and lasts more than three months," explains the interlocutor of the "H1" portal.

He adds that the characteristic of acute pain is that it has a clear onset associated with tissue damage, intensity and duration with the dynamics of the pathological process, which is why acute pain has a warning character.

"This is precisely where the importance of pain lies, because although it is unpleasant, it warns us that something harmful is happening. Acute pain is usually well treated, i.e. suppressed by the use of analgesics. These are cases such as injuries, renal or biliary colic, fractures, but also pains that exist in the postoperative period," explains Ladjevic.

Treatment of acute pain

"In suppressing acute pain, we usually use non-steroidal anti-inflammatory drugs such as ibuprofen, diclofenac, paracetamol or aspirin, but also strong analgesics from the opioid group such as tramadol, morphine and fentanyl. The dose and method of administration of these drugs is prescribed by the doctor and he monitors the effects of the therapy mostly in hospital conditions or day hospitals and observations", says Dr. Ladjevic.

He points out that chronic pain is much more complex to treat because it can have a variety of causes and can also contain a neuropathic pain component, which is difficult to treat.

"Chronic pain does not have a warning character, it is characterized by a difference between the degree of anatomical damage and pain intensity, clinical symptoms and signs, the degree of physical limitation and the impact on the quality of life. Over time, it can become a disease in itself," Ladjevic points out.

The most common chronic non-malignant pain is lower back pain.

"Back pain is considered the second most common reason for absenteeism after the common cold, and the results of studies show that chronic back pain is the first on the list of diseases that cause functional disability in modern society. This pain represents a significant socio-economic burden for developed countries such as Germany, Switzerland, the Netherlands and America," explains the professor for the "H1" portal.

He adds that billions of dollars are allocated annually to treat patients with chronic back pain. Therefore, protocols have been designed to treat this pain in order to reduce the total material and non-material losses, on an individual, family and social level.

"Chronic back pain is a symptom of a heterogeneous group of diseases and disorders, with a high frequency, with a significant impact on the psychophysical functioning of the individual, which in most cases has a good prognosis and lasts longer than three months. . Chronic specific back pain can be caused by a disease of the visceral organs with presented pain in the region of the spinal column, a traumatic, inflammatory or tumor process located in the structures of the spinal column. "Chronic non-specific back pain is caused by a degenerative process in the structures of the spinal column (intervertebral discs, intervertebral joints, soft tissue structures) and it is responsible for 90-95 percent of all causes of back pain," says Ladjevic.

According to the professor, there are several risk factors such as heavy physical work, the presence of anxiety and depression, job dissatisfaction, young age, smoking, obesity and a sedentary lifestyle.

"It is believed that the initial event in the development of the degenerative process is insufficient supply of intervertebral disc cells with glucose and oxygen, which leads to metabolic changes and changes in its elastic properties. Changes in the elastic properties of the discs under conditions of increased exposure lead to subsequent mechanical damage to the discs, disturbance of the statics of the spinal column, increased load on the joints with subsequent osteoarthritic changes. "All these structural changes lead to compromise of the spinal canal and spinal nerve root with subsequent inflammatory changes," says the doctor.

Diagnosis of chronic pain

"The diagnosis of chronic back pain is based on clinical and radiographic findings, i.e. it is first necessary to exclude the possibility of a certain cause of pain. The history of pain includes data on the onset of pain, intensity, duration, provoking factors, quality, localization, spread, response to previous therapy," says Ladjevic, director of the Center for Anesthesiology and Resuscitation of the University Clinical Center of Serbia.

He adds that the therapeutic approach is individual (adapted to each patient) and multimodal (pharmacotherapy, physical treatment, behavioral therapy). The pharmacotherapeutic approach should be as little as possible, and physical therapy and cognitive-behavioral therapy procedures should be intensively applied.

Professor Ladjevic points out that the goal of treatment should be to reduce pain (not eliminate pain), improve the quality of life by improving the patient's functionality, by identifying the mechanisms that cause pain and affect psychosocial factors (biopsychosocial approach).

"It is necessary to carry out patient education, modification of the patient's activities while avoiding provocative positions, but preserving daily adapted physical activity. Complementary therapeutic methods are also recommended: acupuncture, yoga, relaxation techniques, as well as physical techniques of transcutaneous electrical nerve stimulation (TENS). "There are mostly recommendations for the application of cognitive behavioral therapy, which changes the unrealistic model of thinking, understanding, feelings and behavior for the current painful condition (catastrophizing)," says the professor.

Depending on the severity of the pain and the findings during the physical examination, NSAIDs, antispasmodics, corticosteroids and opioids of limited duration (up to 14 days), antidepressants can be used in pharmacotherapy. Interventional procedures for this type of pain are not recommended, as they may encourage further chronic pain. All modalities of therapeutic treatment are carried out in specialized centers taking into account the multifactorial and complex basis of chronic non-specific back pain, according to Prof. Dr. Nebojsa Ladjevic.