There are many concepts of pain.. The first was proposed at the end of the 19th century by M. Frey M. , 1894) and implied the existence of specific pain receptors and afferent pain pathways that transmit excitation to the brain.

The concept of specific nociceptors as free unmyelinated nerve endings was further developed and experimentally confirmed (Zimmermann M. , 1978; Torebjork H. , 1985).

Simultaneously A. Golsheider (GoldscheiderA. , 1894) formulated an alternative concept - the " With an increase in the level of intensity of the total nonspecific flow above the critical one, special signals are sent to the brain that trigger the central apparatus of nociception..

Pain development theories.

Revenko SB. et al. (1992) formulated a concept combining the theories of specificity and intensity. According to it, the body has specialized nociceptive neurons with C-axons.. Their skin endings are excited at low frequencies (less than 2 Hz) by various non-painful stimuli, and painful stimuli lead to high-frequency excitation (over 2 Hz).

The most complex theory is the theory of " The essence of this theory is that in the sensory input system in the spinal cord, there is a special control mechanism that regulates the flow of impulses from the periphery to the overlying parts of the nociceptive system.. The main point of the theory is that impulses passing through thin ("

Two circumstances can close the gate: impulses passing through thick (" The mechanism of action of the thick peripheral fibers that close the gate is that the pain that occurs in deep tissues, such as muscles and joints, is reduced by counter-irritation - mechanical rubbing of the skin surface or the use of irritating ointments (Barr, Kiernan, 1988).

These properties have therapeutic applications, for example, the use of high-frequency, low-intensity electrical stimulation of thick skin fibers (Wall, Sweet, 1967), known as transcutaneous electroneurostimulation, or the use of vibration stimulation (Lunderberg, 1983). The second mechanism (closing the gate from the inside) comes into action when descending inhibitory fibers from the brainstem are activated, either by direct stimulation or by heterosegmental acupuncture (low-frequency high-intensity peripheral stimulation).

In this case, the descending fibers activate interneurons located in the superficial layers of the posterior horns, which post-synaptically inhibit gelatinous cells, thereby preventing the transmission of information above (Swerdlow, Charlton, 1989). A holistic response to pain is determined in this case by physiological systems: the nociceptive homeostatic system of the segmental level, which ensures the activation of protective reactions, and the antinociceptive suprasegmental system, which controls the afferent input..

The most capacious of the existing modern concepts (Loeser J. , 1982) considers pain as a single process - as a kind of hierarchically subordinate structure that includes four main complementary levels: nociception, pain, suffering, pain behavior.

The rate of development and specificity of such a clinical picture of pain is determined by the duration of the influence of the traumatic agent on the mental and somatic spheres, the level and volume of involvement of various somatic (or / and visceral) structures in the processes of pain transmission, constitutional features, differences in the corresponding motor behavior (styles of relief of emotional and.

Different patients experience pain caused by the same injury differently. These differences are partly the result of genetic differences between people, but may also be explained by psychophysiological modulating factors.. Given this, the diagnosis and choice of an adequate therapeutic approach to pain management remain outside the field of global standardization and become indicators of the individual abilities of a doctor as a clinician..

medbe. ru.