Is pain a symptom or a disease?

From the damaged location, pain signals are transmitted along nerve fibers to the brain where our body can perceive pain in a pain perception area. The pain signal is transformed along the way by different systems and the strength of the pain signal can be increased or decreased.
1. Pain is a symptom
1.1 How does the body perceive pain?
A local injury, such as a burn to the hand, stimulates pain receptors. It begins with the endings of sensory nerve fibers sensitive to pain signals that can be found in all types of tissues: skin, muscles and internal organs. From the local injury site, pain signals will be transmitted through peripheral conduction systems to deliver pain information to the brain. This system consists of nerve fibers of different sizes and is capable of transmitting different types of signals at different speeds:
The larger the nerve fiber, the faster it transmits information, usually information about the presence of local pain.
The thinner the nerve fiber, the slower the transmission speed, usually the type of information related to diffuse pain.
Pain signals will be transmitted from the periphery to the spinal cord (located in the spine). From the spinal cord, information will be transmitted to the brain. Different structures in the brain will participate and coordinate to decode the location and nature of pain. From there, it will launch different reflexes in response to the pain information it receives: for example, shrinking your hand to avoid the source of the burn. Pain is a protective reflex of the body.
Some areas of the brain are specialized in storing sensations and forming comparisons with past experiences (also known as the learning process). For example, feel and compare the pain of being burned by different agents: fire burns, oil burns or burns from hot water. Some other areas are more specialized in the emotional aspect of pain and shape the body\’s behavior when faced with pain.
1.2 The body can protect itself to reduce pain
Endogenous narcotic analgesics: Pain is a warning sign that benefits physical integrity but pain is also an unpleasant sensation for the body. Therefore, the body also finds ways to combat this unpleasant feeling. Since 1975, it has been known that the body can secrete pain-fighting substances. These are endogenous morphines (endophine, endomorphine) that inhibit pain sensation to protect the body against painful damage. This is also the foundation for the birth of exogenous narcotic pain relievers, also known as synthetic narcotic pain relievers.
2. Pain is a disease
Gate control is an important concept in pain assessment and management. Pain signals are transmitted all the way thanks to the coordination system: At the spinal cord, there is a very important filtering system, also known as the “gate”. It was described as the “gated gate hypothesis” by Patrick Wall and Ronald Melzack in 1965.
Pain signals are transmitted through this gate. Depending on whether the port is expanded more or less, the information capacity can be increased or decreased, or even completely interrupted. The wider the gate, the more pain signals are detected and the stronger they are. If the door is completely closed, you will no longer feel any pain.
This hypothesis allows understanding the effects of certain responses on pain sensation. For example, putting cold water on a burned area can effectively relieve pain because it triggers gate closure, reducing pain information reaching the brain, resulting in less pain. The body\’s own secretion of endogenous narcotic analgesics to combat pain also follows the mechanism of action on closing this gate.
The gate hypothesis is important in pain treatment. To reduce pain, we can act on the gate to partially or completely close the door. This hypothesis also allows to explain the pain sensation that occurs when there is an imbalance between the pain stimulation system (the gate is easily opened, or is opened excessively) and the pain inhibition system (weakened). gate closing trigger system).
So it can be said that part of the job of a pain doctor is to find ways to \”close the gate\”, understand the abnormalities when \”opening the gate\” and when \”closing the gate\” to help the patient quickly wave goodbye. with pain.
Chronic pain affects 20% of the world\’s population. Chronic pain causes depression, anxiety, impaired living activities, and increased tolerance; suffering while also increasing the economic burden on families and society. Therefore, in May 2019, the International Classification of Diseases introduced a new version of the classification, ICD-11, in which chronic pain is considered a health problem. a disease. Pain that lasts more than 3 months is called chronic pain.
 
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