Brief overview
- Treatment: pain medication, physical therapy, exercise therapy, psychotherapy, relaxation techniques, complementary procedures (e.g. acupuncture, osteopathy), multimodal pain therapy, outpatient pain clinic
- Causes: physical disorder alone or combined with concomitant mental disorders, primarily mental disorders, most common chronic pain disorders (e.g., headaches, back pain, muscle and joint pain)
- When to see a doctor? If the pain does not improve or worsens despite therapy, in the case of severe restrictions in everyday life, numbness and increasing psychological stress.
- Diagnostics: medical history, description of pain, physical examination, further examinations (e.g., neurological, orthopedic, or internal medicine).
What is chronic pain?
Chronic pain is pain that has been present almost always for at least three to six months or recurs frequently and affects the patient physically (loss of mobility, functional impairment), physically-cognitively (state of mind, mood, thinking) and socially. Pain is the predominant symptom (leading symptom) of the complaints.
In contrast to acute pain, chronic pain (actually medically correct: chronic pain syndrome) is no longer a meaningful alarm signal that indicates damage to the body (for example, injury, illness). Instead, it represents an independent pain disorder that often no longer has a clearly identifiable cause.
Chronic pain is often accompanied by other complaints, for example sleep disorders, lack of appetite, increased irritability and depressive moods. In addition, they often mean severe restrictions in everyday life, work and leisure.
Chronification
A chronic pain syndrome often arises from acute complaints: Persistent pain stimuli cause the nerve cells to react more and more sensitively to the stimuli over time, i.e. the pain threshold decreases. The repeated pain stimuli leave pain traces and a pain memory develops. Patients perceive even the slightest pain stimuli or even touch as pain.
The nerve cells sometimes even send pain signals to the central nervous system on their own, even though the original cause of the pain (an injury, for example) has long since healed. So it hurts even though there is no longer an organic cause for it.
Risk factors of chronicity of pain
Chronic pain syndrome is often fueled by numerous factors. These include:
- Persistent psychovegetative tension (someone is constantly under power)
- Anxiety and depression history
- Prolonged stressful or painful experiences in past life history.
- Relatives in pain in the family
- Disaster thinking tendency – someone always imagines the worst consequences
- Constant ignoring of stress limits, constant perseverance
- Fear-avoidance beliefs (movement and physical activity are avoided for fear of increased pain).
- Inadequate pain management when the pain started
- No talking about the pain
- Family conflicts
- Social problems in the environment (such as at work) or financial difficulties
- Pension request
Severe disability and degrees of care
Under certain circumstances, it is possible to apply for severe disability in the case of chronic pain. The pension office or social services office determines the degree of disability (GdB) after the patient has submitted an application. To be classified as severely disabled, a GdB of 50 is required.
Whether you are entitled to a care degree (formerly: care level) with chronic pain is decided by an expert and depends on many factors.
You can find more information about this in the article: Care degrees (formerly: care levels).
Therapy: How is chronic pain treated?
Chronic pain is treated in a variety of ways, depending on the type and intensity of the pain. For example, pain medications, antidepressants, physical therapies (such as massage, water applications, cold and heat treatments), exercise therapy (such as physiotherapy, sports), acupuncture and nerve stimulation (TENS), and psychological therapies are used to relieve chronic pain.
Find out which painkillers are most commonly used and what the possible side effects are here: Which painkiller is the right one?.
Today, it is considered proven that, in addition to physical (biological) factors, psychological and social factors also play a major role in the development of chronic pain. For example, persistent pain is often accompanied by symptoms such as sleep disturbances, resulting in fatigue, reduced performance, poor mood, and even fear of failure and depression.
Thus, the current treatment approach when pain medication-only therapy is not effective is to mitigate the limitations of physical, psychological, and social functioning.
The treatment of a patient with chronic pain is therefore preferably carried out not only by one physician, but by experts from different disciplines (= interdisciplinary). Ideally, these therapists are specialized in the treatment of pain patients. This holistic treatment approach is called interdisciplinary multimodal pain therapy (IMST). The multimodal approach is particularly useful when the pain causes severe stress in everyday life.
IMST is often available as partial or full inpatient treatment in special clinics, but is also sometimes offered on an outpatient basis.
In addition, some large hospitals (university hospitals) have so-called pain outpatient clinics. Here, patients with acute and chronic pain can find help. They are a link between inpatient facilities and physicians in private practice. In pain outpatient clinics, physicians initiate further diagnostic and therapeutic steps if necessary or carry out therapy monitoring. This often saves long journeys for patients suffering from pain.
Psychological pain therapy includes, for example, cognitive behavioral therapy, depth psychological treatment, relaxation therapy, biofeedback, hypnosis, and pain acceptance.
Relaxation techniques
Chronic pain usually means permanent stress for those affected, coupled with anxiety, frustration, despair and depressive mood. Such negative emotions intensify the pain. However, you have the opportunity to become active yourself:
Relaxation techniques help to break this vicious circle. Suitable techniques include autogenic training, biofeedback, meditation, yoga, progressive muscle relaxation and mindfulness training. They influence pain perception, support pain management and stimulate the body’s self-healing powers.
Complementary Medicine
Complementary medicine refers to treatment methods that are used to complement conventional medicine. Ask an experienced therapist about the following procedures:
- Acupuncture: The therapist applies fine needles, which is supposed to influence pain positively
- Acupressure: Certain points are stimulated by pressure with the fingertips, which is supposed to reduce pain
- Osteopathy: Holistic therapy performed with the hands; functional disorders are to be corrected
- Magnetic field therapy: magnetic fields are used to relieve pain
- Reflex therapy: stimulation of certain zones on the surface of the skin that are associated with the internal organs; e.g. reflexology massage
Schuessler salts: Schüßler salts are also among the complementary methods and can be taken for ailments. For example, for chronic pain in the back, the Schüßler salts No. 9 Natrium phosphoricum, No. 11 Silicea, No.1 Calcium fluoratum and No. 2 Calcium phosphoricum are recommended.
The tablets are taken in ascending order, i.e. first for about a week No. 9, then additionally No. 11 and so on. Let the tablets melt in your mouth each time. For minor pain, take the tablets once a day; for more severe chronic pain, take them up to ten times a day.
Get advice on taking the Schüßler salts from a therapist!
If the complaints persist over a long period of time, do not get better or even worse, you should always consult a doctor. The concept of Schüßler salts and their specific effectiveness are controversial in science and not clearly proven by studies.
Causes and possible diseases
Simplistically, chronic pain can be divided into three categories:
1. chronic pain as an accompanying symptom of a physical disorder: this includes, on the one hand, normal pain that accompanies a physical disorder such as rheumatism, osteoarthritis, osteoporosis or nerve damage. On the other hand, this category includes unusual pain, such as phantom pain after an amputation.
Complaints in the context of complex regional pain syndrome (CRPS) are also included. This is a persistent, regional pain that is disproportionately long and intense. It is unrelated to the triggering trauma (such as nerve damage) and cannot be explained by other causes.
2. partially explainable physical pain with accompanying psychological illness (comorbidity): This includes chronic pain associated with tissue damage that is exacerbated by psychological factors. One example is back pain radiating into the leg caused by a herniated disc in the lumbar spine (lumboischialgia). They are aggravated, for example, by inadequate coping with the disease, an anxiety disorder or depressive disorders.
3. chronic pain as an expression of a primarily mental illness: chronic pain occurs primarily in connection with depressive disorders, but also with anxiety disorders, post-traumatic stress disorder or other mental illnesses.
Chronic forms of pain
The most common forms of pain, which sometimes take a chronic course, include:
- Headaches such as chronic migraine, chronic tension headache
- Back pain like chronic low back pain
- Muscle pain as in fibromyalgia (chronic pain disorder that affects not only the muscles but also the tendons and joints)
- Joint pain as in osteoarthritis, rheumatoid arthritis
- Tumor pain
- Nerve pain (e.g., due to a herniated disc pressing on a nerve root).
- Gastrointestinal pain (e.g. irritable bowel syndrome, irritable stomach)
- Soul pain (= somatoform pain disorder): Pain in various regions of the body for which no physical cause has been found.
- Lower abdominal pain in women (e.g., due to endometriosis, a buildup of tissue outside the uterus).
- Phantom pain (during amputations, after tooth removal)
- Complex regional pain syndrome (CRPS): sometimes occurs after severe injuries to the arms or legs; complex symptoms include pain, inflammation, reduced range of motion and strength
- Restless Legs Syndrome (RLS): neurological disorder with insensations and pain of the legs/arms
When to see the doctor?
Be sure to see a doctor if:
- you have persistent or recurrent pain of unclear cause
- The pain is getting worse
- The pain is accompanied by other symptoms, for example, chronic back pain with numbness in the legs or chronic headaches with impaired consciousness
- Your daily life and quality of life are affected by chronic pain (psychological stress)
What does the doctor do?
First, the doctor will have a detailed conversation with you about your medical history (anamnesis). The following questions will be the focus:
- How long have you had chronic pain?
- Where do these occur?
- How does the chronic pain feel (pain character)?
- How severe is the pain?
- Are they triggered, intensified or alleviated by factors such as exercise, cold, heat, stress, etc.?
The doctor also needs information about pain-related impairments in everyday life, any other complaints (such as sleep disorders, digestive problems), previous and current illnesses, operations and previous therapies.
Psychosocial information is also important for the physician, for example, information on education and occupation, job situation, satisfaction, family status, and any current conflicts and stresses.
This is followed by a thorough physical examination. Depending on the type of chronic pain (for example, headache, back pain) and information from the interview, the doctor initiates further examinations. These include, for example, neurological, orthopedic or internal medicine examinations.
If necessary, imaging procedures are also used, such as ultrasound, X-ray, computer tomography (CT) or magnetic resonance imaging (MRI). Blood tests and electrophysiological examinations (such as measuring the conduction velocity of the nerves) are sometimes also helpful.
