Pain therapy

Pain therapy as a branch of anaesthesiology can be divided into three areas: A wide range of drugs is available for the treatment of these pains, which differ in their effectiveness and in the form in which they are administered to the body. Oral painkillers (drugs to be swallowed) are available in the form of drops and tablets and are used for both mild pain (e.g. paracetamol) and severe pain (e.g. opioids).

Painkillers can also be introduced directly into the bloodstream via a venous catheter (so-called intravenous application). The onset of action here is significantly faster than with oral administration; however, the drugs available are very similar to oral medication; here too, opioids are frequently used for severe pain. However, since direct administration of the drug into the bloodstream carries the risk of overdose, this form of pain therapy is rarely used in the home environment.

If freedom from pain is to be achieved in a certain region of the body, the use of regional anaesthesia is recommended. Here, a thin plastic tube is placed near a nerve. Flushing the nerve with an analgesic (here: local anaesthetic) leads to the elimination of pain sensation in all body regions that are connected to the brain via these nerves.

This is used, for example, for nerves in the armpit area to perform operations on the arm or in the groin to be able to operate on the leg. In addition, the local anaesthetic can be injected near the spinal cord. The freedom from pain then extends to the entire body region below the injection site.

Regional anaesthesia methods are often used during an operation, as lower doses of circulatory painkillers and anaesthetics are required. The plastic tube can also be connected to a pump (so-called pain pump) in order to continuously administer local anaesthetics over a longer period of time. In this way it is even possible to achieve freedom from pain for up to several weeks – in practice the pain pump is usually used for no more than a few days as part of acute pain therapy.

This is partly due to the risk of infection at the injection site. Another possibility for pain relief is the administration of medication through the skin (so-called TTS = Transdermal Therapeutic System). A patch stuck to the skin continuously releases painkillers (opioids) through the skin to the body.

Preventive administration of painkillers which prevent a previously foreseeable pain (e.g. during operations) from occurring in the first place
Short-term treatment of acute pain, such as that which may occur in the wound area in the days following an operation
Therapy of long-term pain conditions, such as chronic pain, e.g. tumour diseases, chronic back or headaches. This procedure can also be used in long-term pain therapy.

All forms of pain therapy presented here can also be combined with each other. Although emergency medicine is a field of anaesthesiology, an interdisciplinary approach involving specialists from different medical fields is often necessary. Frequently, internists or surgeons complete the further training course “emergency medicine“.

Emergency medicine covers both the area outside medical facilities (rescue medicine) and emergency care within a hospital. The task of emergency medicine is the restoration and maintenance of acutely threatened vital functions. Vital functions include all organ systems that are important for survival: heart, blood circulation, lungs, brain.

To restore sufficient heart function and an intact blood circulation, emergency medication is available to strengthen the strength of the heart and keep it beating rhythmically. The application of electrical impulses (so-called defibrillation) also aims at making the heart beat rhythmically. To replace the heartbeat in the event of cardiac arrest, cardiac pressure massage can be performed, often combined with artificial respiration of the patient, since the cardiovascular system and lung function are closely related.

In emergency medicine, blood losses are often responsible for functional restrictions in the blood circulation. The aim of therapy is to quickly stop the source of bleeding and, if necessary, to compensate for the blood loss by means of fluid or blood donation. Impending functional limitations of the brain, e.g. due to increased water accumulation in the head after accidents, can also be treated by administering medication.