Humanity and Science in Pain Managements

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Pain is known to be the first medical consultation pattern and a global health concern. Therapeutic medicine was for a long time interested in treatment of disease more than relieving patients. Although medically correct, this approach remains insufficiently human. Unfortunately, such conducts still practiced actually. For example, in emergency, when a patient with acute appendicitis arrives, he’s accusing an abdominal pain. So, pending diagnosis using all necessary examinations, the patient still suffering, because the medical team is concentrated on diagnosis establishment more than relieving pain. Such approaches were based for a long time on the convenience that if pain is relieved, the diagnosis became more difficult. It’s actually known that this idea is absolutely false. This is the proof that, despite of all efforts, pain management still insufficient. Whatever the type of pain or its origin, suffer pain is causing significant health and social problems with evidence that patients are receiving inadequate care. Several reflections are raised.

Progress in understanding mechanisms involved in the onset of pain improved the management. In fact, distinguishing acute pain and chronic pain is fundamental basis. Defining pain is the first step to manage it. If acute pain (like acute inflammation, postoperative pain, or trauma) therapies are overall excellent, they still not satisfying in chronic pain such as neuropathic pain, complex regional pain syndrome or fibromyalgia. The first reason is that acute pain mechanisms are clearer than chronicles. The second reason, also related to the first, is pharmacotherapies availability. The necessity of improve basic understanding of the mechanisms underlying pain is likely to suggest new avenues for the development of novel pharmacotherapies. Epigenetic abnormality in the spinal cord during neuropathic pain is confirmed since few years. Epigenetic modifications in the spinal cord are caused by long-term increases in chemokine expression. Nerve injury activates primary afferent nociceptors, which transmit information to the dorsal horn of the spinal cord. Activation of secondary neurons in spinal pathways by long-term chemokine expression is capable of inducing epigenetic modifications. The final result is central sensitization leading to a neuropathic pain-like state. The complexity of pain mechanisms explains the multitude of analgesics and numerous used protocols.