Understanding Chronic Pain

According to the German Pain League, millions of Germans suffer from chronic pain. Reaching for the tablet leads to side effects for stomach, liver and kidneys. Then many despair. Modern pain therapies offer a way out of the pain spiral.

Torment without end?

Only someone who has suffered from chronic pain can understand what chronic pain really means. A normal pain, however strong it may be, passes relatively quickly. But if it persists or returns constantly, one can no longer speak of a meaningful warning or protective function of the body – then the acute pain has become a chronic pain.

An independent illness that makes even everyday things like dressing, washing, bending down, sitting or standing an ordeal. As a rule, those affected can no longer practise their profession, suffer from insomnia, loss of appetite and exhaustion. As a result, they often unintentionally neglect their partners and friends and fall into social isolation.

It is also typical for chronic pain patients that they lose all zest for life and become depressed. Every sixth suicide is said to have suffered (also) from chronic pain. Anyone who suffers from this now independent clinical picture no longer has to despair. Today, special pain therapists can not only alleviate chronic pain but actually heal it using modern treatment concepts.

Pain careers or doctor hopping

Once the pain has become chronic, only specialists can help. According to many pain therapists, Germany is a developing country when it comes to treating patients with chronic pain.

We consider 800,000 patients to be resistant to treatment, which means that they cannot be helped with simple painkillers. They have already developed a so-called pain memory in the nervous system.

And this cannot be erased with normal means and methods. One would need well-trained pain therapists, but they are rare. As curious as it may sound, there has been no special, standardized training in pain treatment at German universities up to now.

Only since 2016 has it been compulsory for every medical student to provide proof of performance in the field of pain therapy. Until then, the majority of general practitioners had prescribed pain medication in most cases and tried to treat the physical symptoms first.

However, the phenomenon of pain also affects the psyche, pain perception and pain processing. And if the pain then recurs again and again, the suffering plagues often run from one family doctor to the next. Today, chronic pain patients find real help above all in pain outpatient clinics or special pain clinics.

These facilities offer comprehensive, modern therapy concepts, which include behavioural therapy and relaxation training in addition to special medical treatment. The keyword is: holistic pain therapy. Unfortunately, there are so far around 500 facilities offering this special pain therapy. A good double the number would be necessary.

Causes of chronic pain

Often the path into a “pain career” begins with neglect. Any form of pain should be taken very seriously and treated accordingly. Acute pain lasts only a short time and should warn the body of injuries and dangers.

Pain receptors, distributed throughout the entire body, react to threatening stimuli and first direct them via nerve tracts to the spinal cord. From there they reach the brain. In the brain, the signal is evaluated in connection with other sensory impressions. Pain processing and pain perception take place in several different areas of the brain.

So that we do not constantly feel pain, the body also has a pain suppression system. The body’s own morphine-like substances – so-called endorphins – normally absorb acute pain stimuli very quickly.

However, if a pain stimulus is very strong and lasts longer after accidents or injuries, for example, our endorphin system can also be overloaded and fail. The release of pain-relieving substances is then no longer sufficient to prevent continuous fire at the nerve cells in the spinal cord.

Pain after amputation or surgery

The best example of pain memory is phantom pain. Years after amputations, patients continue to experience pain in a limb that no longer exists. Here the pain emanates from the nervous system itself.

One reason for phantom pain, doctors suspect, is the intensity of the pain before amputation. The worse this pain was, the stronger the phantom pain is, so to speak as a reminder of this pain.

Ways out of chronic pain

Patients with chronic pain are in good hands in pain outpatient clinics or special pain clinics, and not only when it comes to drug treatment. As a rule, holistic therapy concepts are also offered there. These include behavioural therapy and relaxation techniques.

The example of phantom pain illustrates that pain can also be a matter of the head, and part of the nervous system itself can be the cause of pain (neuropathy). There is no sensation of pain without the involvement of the psyche.

Today there is also an opportunity for therapy in the knowledge that the pain memory can also be erased or, better said, overwritten. Through the careful use of painkillers, patients are initially relieved of pain for a few hours or days.

Depending on the type and extent of the symptoms, strong opioids can also be used as painkillers if used properly. However, many patients, but often also family doctors, still fear addiction problems – wrongly.

Pumps and plasters

As a last resort, there are now also modern methods to relieve unbearable pain. These include plaster therapy, in which plasters are applied to the skin in various thicknesses. This releases various morphines. The therapy has relatively few side effects.

Another possibility for chronic pain patients are pain pumps. They are implanted under the abdominal wall and connected to the central nervous system. Pain killers or muscle relaxers are continuously dispensed.

No matter which therapy the patient chooses: Tolerable pain must be the first goal in the treatment of chronic pain.

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