Pain therapy

Introduction

The term pain therapy covers all procedures that contribute to the relief of acute or chronic pain. Pain therapy makes use of many different possibilities, which can be individually selected and adapted according to the type of pain and the patient.

What is a pain?

Pain refers to an unpleasant sensory and emotional experience that is accompanied by (potential) damage to body tissue. Acute pain has a warning function. For example, if you reach for the hotplate, the rapidly occurring pain causes the hand to retract.

Without pain perception, the body is at increased risk of injury. An example is diabetics whose nerves are already damaged due to illness. They often lose the sensation of pain, especially in their legs, which means that injuries to the feet and lower legs often go unnoticed.

In many cases, the lesions are only noticed when the tissue is already dying off. In contrast, chronic pain is often a problem. One speaks of chronic pain when the pain has been uninterrupted for more than 3-6 months.

In this case the pain has lost its warning function and massively impairs the patient’s quality of life. One example is phantom pain, in which patients feel pain in an amputated limb. An adapted pain therapy relieves these people of much of their suffering.

Pain therapeutic principles

The different methods that can be used for pain therapy work in very different ways. Pain can therefore be modulated and suppressed in different ways. For example, the individual analgesics can act peripherally, i.e.

on pain receptors located directly at the site of origin of the pain, but they can also act centrally, i.e. in the brain and spinal cord, on the development of pain. Weaker painkillers usually suppress the formation of messenger substances that lead to irritation of nerve endings and thus generate pain. A well-known representative of this group is paracetamol, which inhibits a certain enzyme, cyclooxygenase.

This enzyme forms certain substances to which the nerve endings react with pain. Stronger painkillers, such as opioids, act on pain receptors in the spinal cord on the one hand, and on pain receptors in the brain on the other. In the spinal cord, they dampen the transmission of pain by occupying the receptors in the pain-conducting nerve tracts and activating pain-inhibiting pathways. In the brain, they cause a change in the perception of pain in the responsible area of the brain, the thalamus. This is where a high density of pain receptors is located, so that the painkillers can attack there well and lead to a damping of pain processing.