Pain represents by far the most widespread health disorder in everyday life. It not only reduces quality of life, but also overall satisfaction with life. This is evident from data from the Federal Health Survey, a representative study by the Robert Koch Institute on the health status of the population in Germany.
Pain is subjective
Pain is always a subjective sensory sensation, which is also described very differently by those affected: It may express more of a feeling (“excruciating,” “debilitating”) or refer to a sensory quality (“burning,” “stabbing,” “pressing”). In the consultation, this can already serve the pharmacist as an initial indication of the type and cause of the pain. Pain perception and processing depend on various internal and external factors. These factors influencing pain include, for example:
- Age
- Gender
- General condition
- Previous pain experiences
- Respective time of day
Pain types show age-dependent frequency distribution
In each stage of life, typical situations occur that are associated with certain physical and mental stresses that can cause acute pain. For example, training and studies are often accompanied by stress, tension, and lack of sleep. If the recovery phases are insufficient, tension headaches can be the result. In the Federal Health Survey, 48.5 of the women and 27.5 percent of the men under 30 surveyed said they had suffered from headaches in the past seven days. The frequency decreases with aging, and is only about half in each of the age groups 60-69. Lack of exercise and monotonous, sedentary activities, on the other hand, characterize the modern working world – a high risk for tension and acute back pain. The incidence of back pain increases steadily over a person’s working life, and by the age of fifty it is significantly higher than in people under 30. Leg and hip pain also increase with age and are most common at advanced ages. This is because strenuous and unfamiliar activities in particular can overtax older people and cause acute pain in the musculoskeletal system.
Chronobiology of pain experience
Of particular interest in the context of pain sensitivity are findings from chronobiology, a science that studies rhythmic changes in bodily functions. Body processes are subject to physiological sequences that recur at specific temporal periods. Genetically determined internal clocks are responsible for this, as are external clocks such as the day-night rhythm. Under natural conditions, the “internal clocks” are synchronized by the periodic signals of the environment with the environmental cycle to which they are adapted. In humans, more than 100 different rhythms of varying duration are now known.
The circadian rhythm
The best-known biorhythm is the circadian rhythm, which is followed by every cell in the body and which, at about 24 hours, includes a day and a night. Pain sensations and reactions to pain stimuli also depend on diurnal rhythmic processes, knows Professor Dr. Hartmut Göbel, director of the Kiel Pain Clinic: “This is confirmed by evidence of circadian rhythms in the concentrations of endorphins and enkephalins in the corresponding pain-processing centers in the brain.” Pain perception is only one-third as intense in the afternoon as in the morning, one reason why this time of day is particularly favorable for visiting the dentist. Biorhythms can also modulate the effects of pharmaceuticals at different levels. The effectiveness of painkillers is significantly stronger in the evening than in the morning. “However, the day-night rhythm for pain sensitivity is more pronounced in women than in men,” Göbel explains.
Gender-specific pain perception
As the data from the Federal Health Survey show, women are affected by acute pain almost twice as often as men over the course of a year. Women also complain of more intense and longer-lasting pain, and their pain tolerance is at a lower level. The causes lie on the one hand in biological differences at the hormonal level, and on the other hand the body’s own control system for pain acts differently in the sexes: women react to pain more emotionally.Men, on the other hand, use more instrumental and analytical strategies. They research the causes and try to solve the problem themselves. Pain can therefore have different consequences for the sexes – for women, these are often anxiety, depression and sleep disorders. Men ignore pain more often. This carries the risk that it will become chronic more quickly and cause long-term damage due to overuse.
Avoid chronification
Pain states are learnable by the body. Repetitive pain can lead to more intense and prolonged pain sensations, as the pain threshold is lowered in the process. Therefore, early and adequate pain relief is important, with medications used responsibly and supplemented by non-drug measures. Here, analgesics with only one active substance are recommended. “Combination analgesics should be avoided in any case, as they are burdened with an increased risk of pain chronification,” says Göbel. Preparations containing acetylsalicylic acid (ASA) are particularly suitable and recommended by the DMKG as the drug of first choice. The active ingredient provides reliable relief for headaches and acute back, muscle and joint pain. ASA inhibits the synthesis of prostaglandins (hormone-like substances), which are pain mediators that increase the activability of pain receptors.