Pain Therapy: Stepchild of Medicine

Many people fear getting sick. And almost everyone is afraid of pain. Pain is initially a protective mechanism: it signals to us that something is wrong in our body. If the cause passes, but the pain remains, it becomes an illness itself – and often a long path of suffering for those affected.

Pain therapy: 10 million sufferers in Germany

In Germany alone, around eight to ten million people suffer from chronic pain, according to the German Pain League. But only a small proportion of them are receiving appropriate treatment. This is because there is a lack of facilities and specialists in this fairly young field of medicine. Until a few years ago, pain therapy was not even an examination subject in medical school. Some doctors therefore do not take their patients’ complaints seriously enough. Pain – often without an identifiable organic cause – is not infrequently dismissed as imagination or “psychological stuff” or as something the patient has to deal with on his or her own. Often, however, it is the sufferers themselves who do not seek treatment, or no longer do so – for fear of being considered a failure, malingerer or “psycho”, or even because of bad experiences with therapists.

Pain therapy: causes of pain diverse

Acute pain is a protective mechanism and therefore usually disappears after hours or a few days – along with its trigger. Chronic pain, on the other hand, outlasts its cause by months or even years and thus becomes a disease itself. In recent years, pain has been differentiated not only according to the triggering diseases, but also according to the mechanisms of pain development. For example, there is pain caused by inflammation, nerve pain or tumor pain. This is – in addition to the pain intensity – also important for an adequate therapy.

Types of chronic pain

Pain that can become chronic includes:

Neurons learn

The transmitters of the protective stimulus pain are the nerve pathways. In the past, scientists assumed that nerves – much like a power cable – were simple signaling pathways whose only job was to transmit the stimuli. Today, we know that nerves also have what is known as pain memory: The longer and more frequently they transmit a pain stimulus, the greater the risk that the pain will take on a life of its own, becoming chronic and thus a disease in its own right. Early sufficient relief of acute pain is therefore very important to avoid the formation of a pain memory and to prevent consequences of a chronic pain disease such as depression and social isolation.

Pain is not destiny

If you have been suffering from pain for a long time, you should first confide in your family doctor. He or she may also refer you to a specialist in pain management or to a pain hospital. Under no circumstances should you simply accept the fact that you are suffering from pain. Pain is not a fate – it is a disease that can be cured. It is helpful if you already keep a pain diary and bring it with you to the first consultation. In it, record the exact type and frequency of the pain according to time of day and activity (Is it worse in the morning or evening? Does movement make it better or worse? Etc.)

It is important to discuss the causes of the pain with the patient. Often a vicious circle has already developed between cause and effect: for example, pain due to muscle tension and, in turn, muscle tension due to pain. To intervene here and to break this circle together with you is the task of the pain therapist.

Pain therapy: cause determines form of therapy

Chronic pain is a complex clinical picture with various triggers that usually requires an individually adapted and multi-pronged therapy. Thus, the goal is not only to combat the pain, but also to positively influence the quality of life and prevent further attacks of pain. Migraine patients, for example, need in-depth counseling to reduce the risk factors that trigger an attack.This also includes a conscious diet, giving up smoking and alcohol consumption, and a regulated sleep rhythm. Drug therapy (often as a combination of several substances) is helpful in most cases. It not only serves to reduce the pain, but above all helps the person affected by chronic pain to become active again and thus also to be fit enough for further measures. Painkillers and anti-inflammatory drugs for mild to moderate pain and opiates for severe pain are used, as well as herbal medicines (willow bark, devil’s claw, nettle leaves), antidepressants and anticonvulsants for nerve pain. In addition to effective medications, other types of therapy are available to relieve or eliminate pain. Physical therapy, massage, medicinal baths, or stimulation current (especially TENS = transcutaneous electrical nerve stimulation) are some of them.

Acupuncture in pain management

Acupuncture has also been shown to be effective. In many cases, it is covered in whole or in part by health insurers; for knee joint arthrosis and back pain, it is included in the catalog of services provided by statutory health insurers. Other alternative healing methods available to the pain therapist to complement the therapy concept include chiropractic, osteopathy and Dorn therapy. These methods deal with the mechanics of the body and can help relieve tension and pain through certain influences on muscles, joints and nerve nodes. One method that helps in many cases of chronic pain is the bio-feedback method. Here, sufferers learn to become aware of what is going on in their body and how to control it so that the pain is less. In addition, there are some so-called invasive procedures, in which either drugs are injected for local anesthesia, painkiller pumps are used or “nerve pacemakers” (spinal cord stimulation, SCS) are implanted.

Pain therapy: don’t forget the psyche

Chronic pain not only affects the body, but it also limits the quality of life, can wear down the mind, and can lead to depression and even suicidal thoughts. The psychological component of pain therapy must therefore never be ignored. Often it is possible to cope better with everyday life with pain and to break the vicious circle of pain development by dealing with the pain disease. Many medical practices offer special programs for the psychological care of pain patients. In self-help groups and Internet forums, those affected can exchange information with each other, pass on advice and help, and experience the feeling of not being alone with their illness. Relaxation methods such as autogenic training or progressive muscle relaxation, which have a positive effect on the psyche and body at the same time, are also an important component.

Strict standards for pain centers

Pain therapy facilities in Germany have only been around for a few years. They deal with the prevention, diagnosis and treatment of chronic pain disorders and must meet certain requirements and standards. Only then are they granted permission to call themselves a “specialist facility for pain patients”. In pain hospitals, pain outpatient clinics or pain practices, therapists from at least three medical specialties as well as psychologists and physiotherapists qualified in pain therapy work together on an interdisciplinary basis. You can find out where pain centers and specialists are located in your area from your family doctor, the medical association or on the Internet. Don’t wait – no one has to live with pain!