La Revue du praticien
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La Revue du praticien · Jun 2013
Review[Pathophysiology of chronic pain. Classification of three subtypes of pain].
Pain is a physiological sensation which aim is to alert for an upcoming danger that may threaten the individual. This system includes peripheral nociceptors that initiate the nociceptive message. Then, the information is conveyed to the brain through the spinothalamic tract that projects to the thalamus, insula, SII and other areas. ⋯ This is the neuropathic pain. Case 3: between the two former cases, there is no evidence for a lesion in the nociceptive system, and there are no evidences for lesion at the peripheral level, but there are evidences of dysregulation(s). These are the cases of dysfunctional pain.
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In 2007, the Plan for the improvement of the quality of life of people with chronic diseases stressed that support for pain was the first expectations of patient associations. And pain support is primarily the field of competence of the treating physician. It is in this context, that (HAS) recommendations were developed to promote the implementation of care tailored for people expressing a chronic pain. They advocate the support procedure: the identification and evaluation of the chronic pain in ambulatory (history, etiologic assessment, tests), the establishment of treatment or application with a specialized structure, diagnostic or therapeutic advice.
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The major development of experimental and clinical pain research over the last two decades should result in the development of new treatment strategies. In the future, the management of chronic pain should rely both on new molecules targetting specific pathophysiological mechanisms and new non pharmacological approaches, such as non invasive transcranial magnetic stimulation, acting on endogenous pain modulatory systems. The variety of new treatment options should allow a more efficacious management of chronic pain, taylored to each patient's profile.
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The pharmacological treatment of chronic pains induced by an excess of nociception is mainly based on analgesics which are classified according to their pharmacological nature (not opioid/opioid) and to their power according to the three World Health Organization steps. Their use is founded on a strategy which differs from the nature of pain (cancer pain vs no cancer pain), in particular with regard to the use of the strong opioids.