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A certain diagnostic orientation is provided by the differentiation of somatalgias, i.e. pain caused by irritation of the fibers of the somatic nerves, and vegetalgia (sympathetic) arising from the involvement of the sensitive fibers of the autonomic innervation in the pathological process. Somatalgias (permanent or paroxysmal) are localized in the zone of innervation of peripheral nerves or roots and are usually not accompanied by autonomic disorders or the latter (with very intense pain) are generalized (generalized sweating, increased blood pressure, increased heart rate, etc.).
- The appearance of pain in one half of the body (hemialgia) is possible, which is observed, in particular, with damage to the thalamus.
- The high frequency of repercussion with the appearance of pain in areas distant from the affected organ should be borne in mind in the differential diagnosis of diseases of internal organs, blood vessels, bones, joints.
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- For example, with a myocardial infarction (myocardial infarction) B. are possible not only in the sternum with irradiation to the left hand, but also B. in the thoracic spine, B. in the lower jaw, in the forehead, in the right hand, in the abdomen ( abdominal form), etc.
- With all the variety of manifestations of pain repercussion, the summary characteristic of B. helps to highlight features that are typical or atypical for any process in the field of internal organs
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- For example, dissecting aortic aneurysm in many characteristics of B. is similar to myocardial infarction, but B.'s spread along the spine with irradiation to the legs, characteristic of a dissecting aneurysm, is not typical of myocardial infarction.
- The patient's behavior during painful paroxysms also has diagnostic value.
- For example, with myocardial infarction, the patient tries to lie motionless, the patient with an attack of renal colic rushes about, takes various poses, which is not observed with a similar B. localization in a patient with sciatica.
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- In diseases of internal organs B. arises as a consequence of blood flow disturbances (angina pectoris, thrombosis of the mesenteric or renal artery, atherosclerotic stenosis of the abdominal aorta.
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In the description of patients, pain sensations by their nature can be sharp, dull, cutting, stabbing, burning, pressing (squeezing), aching, pulsating, In terms of duration and frequency, they can be constant, paroxysmal, associated with the time of day, seasons, physical exertion , body posture, with certain movements (for example, breathing, walking), eating, defecating or urinating, etc., which makes it possible to suspect the localization and nature of the pathology causing pain. The features of the accompanying pain of emotional reactions, for example, the feeling of fear of death, accompanying retrosternal B. with angina pectoris, myocardial infarction, and thromboembolism of the pulmonary arteries, are also of diagnostic value.
In vegetalgia, disorders of autonomic functions are observed as a rule and are often local in nature, expressed by local spasms of peripheral vessels, changes in skin temperature, "goose bumps", sweating disorders, trophic disorders, etc. Sometimes vegetalgias reach the degree of causalgia (Causalgia), often with reflected pains of the repercussion type (Repercussion) with the appearance of pain in the Zakharyin-Ged zones.
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Allows with a high degree of certainty to assume a certain disease, for example angina pectoris (angina pectoris), duodenal ulcer (see Peptic ulcer), pleurisy , urolithiasis (with renal colic), Migraine, etc. On the other hand, in many cases it is very difficult to justify the diagnosis by the peculiarities of pain, because pain is a subjective symptom with pronounced individual differences in its perception.
An objective assessment of B. in a person is difficult. The intensity of pain depends on the patient's personal characteristics, his psychological mood, emotional background, the environment in which the patient is.
Strong motivation, efforts of the patient's will, switching attention, for example, to intellectual activity, can reduce or even completely suppress sensation B. With mental disorders (some forms of schizophrenia, extensive damage to the frontal lobes of the brain, alcohol intoxication), pain sensitivity may be impaired, painless the course of severe pathological conditions (myocardial infarction, perforated stomach ulcer, bone fracture, etc.). The congenital absence of B.'s feeling (analgia) is also known.
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In addition to the nociceptive system in the body, there is an antinociceptive system formed by the structures of the central gray periaqued substance, hypothalamus, suture nucleus, reticular formation of the midbrain, thalamus, pretectal nucleus, substantia nigra, some areas of the somatosensory cortex, etc.
Electrostimulation of these structures causes a state of analgesia, in which painful nerve impulses are pre- or postsynaptically blocked neurochemically - as a result of the release of serotonin, catecholamines, endogenous opioid (endorphins, enkephalins, dynorphins) or non-opioid (neurotensin, cholecystokinin, calcitonin, angiotensin, etc.) peptides. At the same time, these substances inhibit the release of neurotransmitters of pain impulses.
The interaction of the nociceptive and antinociceptive systems forms the evolved, genetically specified, biologically expedient and functionally mobile pain threshold, which in a healthy organism is adequate to the action of only directly harmful stimuli. Artificial stimulation of the antinociceptive system (by acupuncture, drug administration, etc.) or a decrease in the activity of the nociceptive system (by novocainization, destruction of nociceptive pathways, etc.) causes the disappearance of pain while maintaining the pathological process or focus (see Pain relief, Reflexotherapy, Functional neurosurgery).
The diagnostic value of pain as a symptom of a disease or pathological process is ambiguous. In some cases, the analysis of the peculiarities of pain according to its various characteristics (localization, intensity, irradiation, frequency, duration, etc.)