Post-traumatic pain. Causes and therapeutic concepts.

Area of Science:

• Pain Medicine
• Neurology
• Pharmacology

Background:

• Patient-centered pain therapy is essential.
• Efficient pain management necessitates identifying the pain's origin.
• Posttraumatic pain often involves peripheral nociceptors, while neuropathic pain stems from nervous system lesions.

Purpose of the Study:

• To differentiate between nociceptive and neuropathic pain mechanisms.
• To outline therapeutic algorithms for various pain types.
• To clarify the role of different treatment modalities, including pharmacotherapy and nerve blocks.

Main Methods:

• Review of current pain therapy standards.
• Discussion of treatment algorithms for nociceptive and neuropathic pain.
• Evaluation of pharmacologic agents (analgesics, co-analgesics, opioids) and interventional techniques (nerve blocks, trigger point infiltrations).

Main Results:

• Neuropathic pain can involve central sensitization and sympathetic nervous system activation, potentially leading to chronification.
• Non-opioid analgesics, co-analgesics, and opioids are key in chronic pain management, requiring adherence to strict standards.
• Local anesthetic monotherapy for chronic pain is outdated; adjuvant blocks and trigger point infiltrations may benefit posttraumatic pain.

Conclusions:

• Distinguishing pain etiology is crucial for effective therapy.
• Sympathetic blockades are primarily indicated for diagnosing and treating sympathetic maintained pain (SMP).
• Treatment strategies must be tailored to pain type, incorporating pharmacotherapy and judicious use of interventional procedures.