Ischemic pain is considered to be the most difficult to control because common painkillers are not effective. It appears when blood flow through the blood vessels is obstructed for some reason. What are the causes of ischemic pain and what is its treatment?
Contents:
- Ischemic leg pain
- Intestinal ischemic pain
- Ischemic headache
Ischemic painaccompanies almost all diseases of blood vessels. It occurs in ischemic heart disease, in Raynaud's disease, obliterating arteritis, in diabetes and intermittent claudication. In 98% of cases, ischemia is the result of developed atherosclerosis. Ischemia is a condition in which less blood reaches certain tissues, and with it less oxygen, than is currently needed to maintain normal cellular metabolism.
Ischemia and the associated pain can appear in many areas of our body. It can affect the lower and upper limbs, head, brain and intestines.
Ischemic leg pain
A classic example of ischemic pain is pain that occurs in intermittent claudication. It appears while walking. During exercise (e.g. walking), blood supply is poor and the process of anaerobic glycolysis (resulting from tissue hypoxia) in the muscles is increased. The overproduction of lactate by anaerobic glycolysis causes acidosis, which is manifested by exercise pain (called claudication). The pain is so strong and sharp that it forces the person to stop and rest.
The disease is progressive. If it is not treated, it will lead to a situation where pain will also appear at rest. This is a condition called critical ischemia. The consequence may be tissue necrosis in the leg. With extensive necrosis, the procedure of choice to save the patient's life is to amputate part or all of the limb.
In the initial stage of the disease, its development may inhibit internal medicine, later it is necessary to intervene with a vascular surgeon who will open the narrowed vessel or, if possible, perform a bypass.
In the advanced stage of the disease, however, often surgical treatment is noteffective and it is a situation in which relief can be provided by a procedure performed by a specialist in interventional pain management.
This procedure consists in blocking the activity of the sympathetic nervous system at the height corresponding to the innervation of a given limb. The most precise method in limb pain is thermolesion, which allows for the selective destruction of the relevant nerve fibers. It not only provides pain relief, but also improves the blood supply to the limb by increasing and activating collateral circulation. It comes to the so-called redistribution of blood and, consequently, improvement of tissue oxygenation.
This treatment is therefore not only an analgesic, but also a healing procedure, supporting the causal treatment of the underlying disease. It should be taken into account that the redistribution in the initial phase after the procedure can be very painful, because the tissues that have been handicapped so far react with a shock to an increase in their blood supply.
Ischemic leg pain occurs in every fifth person aged 55 and over. The risk of developing chronic ischemic pain increases with age. After the age of 70, more than half of people feel it.
Ischemic leg pain occurs when the narrowing of the inner diameter of an arterial vessel is greater than 50%.
Intestinal ischemic pain
Intestinal ischemia can be classified as chronic, resulting from narrowing of the arteries that supply blood to the intestines, and acute, resulting from a sudden and complete blockage of blood flow to the intestines. Chronic intestinal ischemia results from narrowing of the visceral arteries, which are the arteries that supply blood to the intestines. Insufficient blood supply, rich in oxygen and nutrients, causes a number of characteristic symptoms, often called abdominal angina. Ischemia most often affects the small intestine, but ischemia of the large intestine can also occur.
The most common cause of chronic intestinal ischemia is atherosclerosis. The deposition of atherosclerotic plaques in the arteries of the intestine and the symptoms caused by it are analogous to coronary atherosclerosis.
The symptom of chronic intestinal ischemia is the so-called triad of symptoms.
- Abdominal pain that occurs most often 15-60 minutes after eating a meal. Digesting and moving food are the work of the intestines, requiring a greater supply of oxygen and nutrients. While the blood flow through the narrowed vessels may be sufficient at rest (i.e. without food in the intestines), during work, when more blood is needed, the necessary nutrients begin to be lacking. It is just pain that manifests itself. The more hearty and fatty the meal, the morework they have to put the intestines into digestion. It makes the pain worse. The symptoms last for about 1-3 hours.
- Destruction. Pain following meals causes most patients to refrain from eating. In addition, insufficiently supplied intestines work worse, and therefore they do not absorb nutrients from food. Moreover, patients with intestinal ischemia experience a feeling of rapid satiety. In 80% of cases, chronic intestinal ischemia results in weight loss.
- Persistent diarrhea.
Other symptoms of chronic intestinal ischemia include nausea, vomiting, constipation, gas, and general weakness.
In patients with chronic intestinal ischemia, the goal of treatment is to restore normal blood flow through the abdominal arteries. This can be done in two ways.
- A surgical procedure during which the atherosclerotic plaque that obstructs the flow through the artery is removed (endarterectomy). Another option for surgical treatment is to create a bypass to bypass the stenosis site. A fragment of a patient's vein taken elsewhere or an artificial vascular prosthesis is implanted in front of and behind the stenosis site, so that the blood can bypass the obstacle and flow freely.
- Intravascular treatment, or angioplasty, involves inserting a catheter into the narrowed artery with a balloon at the end. Inflating the balloon at the stenosis allows the vessel to expand. Additionally, you can use stents, i.e. small "springs" that keep the vessel wall widening.
Currently, treatment often begins with a lower-risk endovascular procedure, and if it is unsuccessful or when anatomical conditions make it impossible, surgery is performed in the form of endarterectomy or bypassing stenosis. In most patients, surgical treatment restores normal blood flow to the intestines. It should be emphasized, however, that without changing eating habits, weight reduction, quitting smoking and implementing regular physical activity, the problem will continue to increase. In about 25% of patients, the disease recurs within a few years after surgery. Taking preventive measures and following medical recommendations can stop or at least slow down the deposition of atherosclerosis in the vessels.
Ischemic headache
Headaches of vascular origin are migraine and vasomotor headaches related to arterial hypertension and occurring in the course of atherosclerosis. Ischemic headache may be related to atherosclerosiscervical. For many people, the first symptom of carotid atherosclerosis is a stroke.
There is also a group of patients who only experience dizziness and headaches, tinnitus, strange tingling in the limbs, and disturbed sensation and balance. If such symptoms occur in people with heart disease, high cholesterol or smokers, it is better not to ignore them.
The carotid arteries are the most important vessels that supply blood to the brain. We can feel their work by putting our fingers to the side of the neck. The vertebral arteries hidden in the spine are equally important for the smooth functioning of the brain. The narrowing of the lumen of these arteries leads to very dangerous ischemia of the brain.
It can be said without exaggeration that efficient and patent carotid arteries are a guarantee of our he alth. It is important not only that the blood flows efficiently through all four arteries, but also that the embolic material, i.e. atherosclerotic plaques detached from the inner wall of the artery, does not enter the vessels of the brain with the blood.
If a fragment of the atherosclerotic plaque reaches the brain, very serious neurological disorders will occur. In the worst case scenario, the patient dies. The carotid arteries are more sensitive to atherosclerotic lesions than the vertebral arteries.
Carotid atherosclerosis occurs in about 30% of people over 65.
Atherosclerotic lesions of the carotid arteries vary in severity, which determines the patency and the method of their treatment. In Poland, 10 thousand. Carotid restoration surgery to protect patients from a stroke or even loss of life.
It should be remembered that strokes are the third cause of death in the country, 80% of which are ischemic strokes, i.e. caused by the stoppage of blood supply to the brain. This shows the scale of the problem not only from a medical point of view, but also from an economic and social point of view.
About the author
Anna Jarosz A journalist who has been involved in popularizing he alth education for over 40 years. Winner of many competitions for journalists dealing with medicine and he alth. She received, among others The "Golden OTIS" Trust Award in the "Media and He alth" category, St. Kamil awarded on the occasion of the World Day of the Sick, twice the "Crystal Pen" in the national competition for journalists promoting he alth, and many awards and distinctions in competitions for the "Medical Journalist of the Year" organized by the Polish Association of Journalists for He alth.
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