Τρίτη 19 Μαΐου 2020

WHAT WE CAN LEARN FROM NOCEBO HYPERALGESIA THAT COULD REINFORCE SOOTHING OF PAIN

Pain,especially chronic pain,is a disease and not a symptom ,though it usually  begins as a symptom.20,5% of the people in the world suffer from chronic pain. According to an estimate posted on January 18 ,2020 on  Med alert Help ,patients experience persistent pain after routine surgery up to 50% of the time,18% of women suffer from migraine attacks,9,8% of patients in pain clinics suffer from neuropathic pain and back  pain is the leading cause for sick  lave and early retirement in Europe.
The complex interaction between the initial stimulus of tissue injury and the subjective experience of nociception of acute and chronic pain can be described by 4 general processes known as transduction transmission modulation and perception and there are a list of important psychologic(affective and cognitive ) factors that impact the  multidimensional experience of pain .Depression, anxiety, anger, low levels of  activity, pain beliefs(pain related fears and self efficacy) and passive coping are important components of the nociceptive sensation. Furthermore, pain operant conditioning processes a person incurs when living with pain,  avoidance behaviors, responded learning and kinesophobia lead to a low quality of life .
That means, in simple words, that in order to  delete pain and its detrimental consequences from a patient's  living reality we must heal the tissue injury the best possible way and eliminate all  other cognitive and psychologic factors that every human being is subjected to because of his nature and last but not least,we must inhibit all neurologic mechanisms that tranmute acute to chronic pain and allow it to install in patient's perception.
but the subject of this post is not exactly that, since I think that it has become common knowledge that a complete rehabilitation program    in combination ,if necessary ,with a surgery is the best way to face chronic pain.
It has been  observed that in  nocebo hyperalgesia ,although it works in the same way as placebo analgesia, operant CNS conditioning and neurotransmitters modulation, is more resistant to extinction than the later ,often persisting indefinitely.
Another difference is that nocebo hyperalgesia is accompanied by anticipatory elevated autonomic arousal like palpitation or hyperventilation ,symptoms of stress that follows hyperalgesia. The survey concluded that heightened anticipatory anxiety in the form of elevated autonomic arousal may
explain why nocebo hyperalgesia persists relative to placebo analgesia.
People  who read my posts must know that I believe in combination of means of healing.
Hopefully, combining the  existing  therapeutic plan, physical therapy, water therapy ,occupational  therapy, psychotherapy and  analgesics.We could also try to combine all that  , not with anxiety of course but with harmless autonomic arousal-  like symptoms such as   pulse increase with an easy aerobic exercise, like  upper or lower  limbs    cycling quite fast ,for 1 minute with heart monitoring if there are cardiovascular problems , while reciting positive and thankful affirmations in order  to vanish  chronic pain.
    

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