Chronic Pain

Pain (synonyms: Pain; Chronic Facial Pain; Chronic Pain Patient; Chronic Pain a.n.k. ; Chronic Pain Syndrome; Chronic Uninfluenceable Pain; Diffuse Pain a.n.k. ; Generalized Pain; Intermittent Pain; Panalgesia; Pain; Pain in Carcinoma; Thalamic Pain Syndrome; Therapy-Resistant Pain; Tumor Pain; Unclear Pain Condition; Unclear Pain; ICD-10-GM R52-: Pain, not elsewhere classified) represent a complex subjective sensory perception that, as an acute event, has the character of a warning and guidance signal. However, in contrast to acute pain, chronic pain is no longer a meaningful alarm signal that indicates damage to the body. One speaks of chronic pain if it lasts longer than three months and is not tumor-related or recurs frequently. Pain is divided into the following forms according to the ICD-10-GM:

  • Acute pain (ICD-10-GM R52.0) – the acute pain has a warning function (tissue damage).
  • Chronic unmanageable pain (ICD-10-GM R52.1) – pain that occurs for more than six months or recurrently
  • Other chronic pain (ICD-10-GM R52.2)
  • Pain, unspecified (ICD-10-GM R52.9)

Pain is classified into three forms according to its etiology (cause):

  • Nociceptor pain (caused by tissue irritation or damage):
    • Originating from excitation of nociceptors (pain receptors) by an impending or incurred injury (traumatic, inflammatory, or tumor).
    • No damage to nerves
    • The pain can be movement-dependent or colic-like; nocturnal pain is also one of them
    • Typical clinical pictures are: Osteoarthritis (degenerative joint disease), musculoskeletal pain, fractures (bone fractures), ischemic pain (blood flow-related pain).
  • Neuropathic pain (NPS) (caused by nerve damage):
  • Pain resulting from functional disorders:
    • Often occurring multilocularly (“in multiple locations”).
    • Z. E.g. back pain as a result of poor posture of the body.

The most common cause of chronic pain is musculoskeletal disorders (16%). Chronic pain can be a symptom of many diseases (see under “Differential diagnoses”). Frequency peak: Chronic pain occurs predominantly in middle age (approx. 45-64 years). The prevalence (disease frequency) is 10-20% (in Germany). Approximately every fifth patient in primary care practices suffers from chronic pain. It is estimated that 8-16 million people in Germany suffer from chronic pain. As a rule, several regions of the body are affected. The most common complaint is back and joint pain.The 3-month prevalence for pain in children is 71%.The prevalence for chronic, functional abdominal pain is up to 25%. In Germany, there are estimated to be approximately 3.5 million people with neuropathic pain (NPS). Course and prognosis: Nearly 50% of patients with chronic pain wait more than a year for a diagnosis. The later a sufferer seeks treatment, the less favorable the prognosis. In many cases, it takes a very long time to find an adequate therapy, which is usually interdisciplinary (involving multiple disciplines). Chronic pain is very distressing and often the quality of life of those affected suffers. Comorbidities (concomitant diseases): Chronic pain is increasingly associated with anxiety disorders, depression, somatoform disorders and post-traumatic stress disorders.