Chronic pain

• Origins and causes
• Symptoms
• Diagnosis
• Treatment
• Prevention

Common chronic forms of pain are

• back pain such as a slipped disc,
• joint pain, for example in the case of arthrosis, arthritis or osteoporosis,
• signs of wear and tear,
• headaches, e.g. migraine or tension headaches and
• Muscle pain, often associated with tendon and joint pain.

Development and causes

How does chronic pain develop?

Chronic pain can develop from acute symptoms, often with a physical cause. The pain threshold is lowered by the continuous irritation of the nerves. The so-called pain memory solidifies the excessive sensitivity of the nerves: Pain is already perceived with small stimuli, in extreme cases even upon touch.

What causes chronic pain?

The chronification of pain can have various causes:

• Physical disorder: An injury or illness leads to pain that becomes independent.
• Physical disorder with a psychological component: Pain resulting from an injury or illness is intensified by a mental illness or disorder such as stress, depression or anxiety.
• Physical illness: An impairment of mental health, such as depression or post-traumatic stress disorder, leads to a persistent sensation of pain.

What are the risk factors?

Chronic pain syndrome considerably impairs the quality of life of those affected and can lead to physical discomfort and mental illness. For this reason, chronic pain syndrome should be recognised and treated as early as possible. The following risk factors favour chronic pain:

• Pain disorders in the family
• Negating or relativising one's own pain by means of relieving postures or endurance strategies
• Persistent psychological strain, such as stress, anxiety or depression
• Social or economic conflicts in the family or work environment
• Pessimistic attitude
• Overestimation of healthy body functions and possible illnesses as a result

Symptoms

Chronic pain usually has no physically identifiable cause. In addition to the actual pain as the main symptom, loss of appetite, depressive moods and sleep disorders can occur. Tiredness, exhaustion and concentration problems often accompany the actual pain.

The pain and its accompanying complaints can affect everyday life and quality of life to such an extent that those affected increasingly restrict their lives and isolate themselves socially. Working life can also be affected by the illness.

The family doctor should be consulted if the symptoms

• become independent, i.e. the complaints are persistent or recurrent
• occur with less and less irritation or become stronger
• are accompanied by other complaints, or
• affect the quality of life.

Diagnosis

If a chronic pain syndrome is suspected, various procedures are used to arrive at a diagnosis. At the beginning, a medical history is taken.

What happens during the anamnesis?

The anamnesis is a detailed interview with the patient, which should give the doctor an impression of the symptoms. The patient is asked the following questions, among others:

• When did the complaints first start?
• Where does the pain occur?
• What does the pain feel like?
• What makes the pain worse, what reduces it?
• On a scale of 0 (no pain) to 10 (unbearable pain), how severe is the pain?
• Is your sleep disturbed by the pain?
• What other symptoms occur?

As part of the anamnesis, the doctor also asks for the patient's medical history:

• What other diseases are currently present?
• What diseases have you had in the past? How were they treated?
• How has the current pain been treated so far?

In addition, during the anamnesis, the doctor inquires about the patient's psychosocial situation by asking about his social and economic situation and his emotional state.

What tests are carried out?

The medical history is followed by a number of examinations that are intended to provide information about physical health and the function of the nerves. Usually imaging techniques such as ultrasound , computed tomography(CT) or magnetic resonance imaging (MRI)are used.

The physical examinations are usually interdisciplinary: The general practitioner works with various specialist colleagues, such as neurologists and orthopaedic surgeons, to make the most accurate diagnosis possible.

Laboratory tests, for example on the blood, may be advisable depending on the type of chronic pain.

Treatment of chronic pain

In the treatment of chronic pain, a wide variety of therapies are combined - depending on the type and intensity of the complaints.

Although the treatment does not erase the pain memory, it can influence it. Only in rare cases does the pain disappear completely as a result of the therapy. The aim of the treatment is to learn to control the pain and thus to improve the quality of life.

Multimodal pain therapy combines various treatment methods that are individually tailored to the patient. This includes the following treatment options:

• Medication: Painkillers can relieve the persistent or situational symptoms.
• Physiotherapy: Exercise therapy stimulates joints and muscles and overcomes relieving postures. Possible methods include massages and physiotherapy, heat and cold stimulation and electricity applications.
• Neurosurgical pain therapy: Surgical interventions on the central nervous system interrupt pain pathways, relieve painful areas or implant stimulation systems that activate pain-relieving systems and inhibit pain transmission.
• Psychological therapy: The aim of this pain therapy is to reduce the fear of the next attack and manage the pain. In addition to individual therapies and group sessions, relaxation exercises and creative therapies are also available.
• Social counselling: If social problems provoke or intensify chronic pain, this can be remedied in therapy.
• Mindfulness training: This treatment serves to reduce and prevent stress as a risk factor for chronic pain.
• Complementary procedures: In addition to conventional medicine, acupuncture, phytotherapy and Schüssler salts are also available to relieve chronic pain.

Prevention

How can chronic pain be prevented?

Chronic pain often develops from acute symptoms. The most important measure to avoid chronification is to take acute pain seriously. They must be treated early and completely, including the cause, so the pain does not become self-sustaining.

Risk factors should also be avoided. This includes individual stress management and the use of support services for family or professional problems. A healthy diet, regular exercise and sufficient sleep can contribute to a positive attitude towards life, in addition to active leisure activities. This helps to prevent pessimism and an excessive focus on possible complaints.

How can new attacks of pain be prevented in case of illness?

Those affected not only suffer from pain. The fear of the next relapse of the illness leads to stress and depressive moods, which increases the sensation of pain. This can be counteracted with relaxation exercises. Yoga, meditation and autogenic training are recommended to control the pain and fear of it.