Chronic pain

What is chronic pain?

Everyone has experienced pain at some point in their life. Either after a fall, after banging your head or cutting your finger with a knife. This acute pain soon subsides.

Chronic pain involves pain perceptions extending beyond the phase of acute pain over a period 3-6 months or more. Pain contains a “sensory component” on the one hand that signals an injury and destabilisation as a physical sensation. However, in addition, all pain has an “affective component” as well, which we experience as a feeling of fear, depression, despair and loss of meaning.

What is it like if pain does not pass and becomes unbearable? This is impossible for normal powers of imagination and can only be genuinely understood by the person affected.

Pain patients reach the limit of what they can bear and often fear the pain far more than the actual illness. In particular, quality of life is severely restricted. Pain, as the prevalent symptom of an illness, often results in social isolation. The patient withdraws from friends and no longer pursues their hobbies.

The possibilities of modern pain therapy mean that pain can be decisively alleviated in all patients and in many cases they may become largely free of pain.

What are the causes and risks for the development of chronic pain?

Chronic pain is particularly common in cases of cancer. Some 70 per cent of cancer patients suffer from severe and extremely severe chronic pain. The pain in these cases may occur with no connection to the stage of the underlying cancer. It is by no means always a sign of the disease progressing.

Patients with advanced cancer often suffer from bone metastasis. This will lead to pain in the bones for between 60 and 90 per cent of cases. The development of this pain is complex.

What role does lifestyle play in chronic pain?

It is important for the pain patient to examine his own behaviour and experience and actively address reactions that increase pain. 

Patients can develop their own pain-reducing activities for their individual pain problem:

  • Weight normalisation
  • Ergonomic optimisation of the workplace
  • Shock-absorbing footwear
  • Use of prescribable aids and appliances
  • TNS (Transcutaneous Nerve Stimulation)
  • Endurance exercise and sport
  • Muscle-stabilising exercise with gym equipment and weights
  • Relaxation techniques (AT, PMR, MBSR, yoga, etc.)
  • Avoidance of self-medication that increases pain
  • Avoidance of excessive demands on oneself that increase pain
  • Initiation of social and cultural activities
  • Development of stabilising interpersonal relationships

How is chronic pain diagnosed?

A detailed diagnostic process is a prerequisite for all successful pain therapy. Pain perception cannot be recorded using equipment and its importance can often not be adequately assessed. This is why a detailed discussion with the patient is important.

If a patient experiences persistent pain over a period of several weeks or if he is a cancer patient, he should consult his doctor immediately.

The cause of the pain is important for selecting the right treatment. The cause is determined by the doctor in a detailed discussion with the patient. He can then prescribe the appropriate pain therapy based on the pain perception.

How is chronic pain treated?

Successful treatment of chronic pain diseases frequently requires the simultaneous involvement of different therapists, the use of several therapy procedures and the patient’s own activities.

Appropriate treatment of pain will lay the foundation for providing the patient with strength and energy by ensuring as long a period as possible without pain. Pain therapy should be started as early as possible because long-term, untreated pain is far more difficult to treat.

The focus of all pain treatment is the attempt to combat the cause of the pain in a targeted fashion. If it is not possible to treat the pain on the basis of the cause or with the aim of regulating it, symptomatic pain therapy is an option. This aims to suppress or sufficiently alleviate the “pain” symptom. Medicines, surgery, radiological and nuclear medicine procedures can be used, as well as invasive procedures.

While acute pain is principally treated with fast-acting and short-acting medicines, these are not enough for chronic, severe pain. In such cases, the doctor must use medicines with actions of as long a duration as possible. Appropriate pain relieving medication at the right dosage allows the patient to perceive little or no pain on a long-term basis.

The doctor and patient together work out the treatment stage and the relevant medication until satisfactory alleviation of the pain without high levels of side effects has been achieved.

Medicinal pain therapy can be divided into three stages:

Stage 1:
For mild pain, regular administration of non-opioid analgesics may be given to start with. These medicines are particularly active at the site at which the pain originates.

Stage 2:
If the effect of these analgesics is not sufficient, weak opioids can be given in addition. Opioids act on the central nervous system in particular.

Stage 3:
For severe and extremely severe pain, which is not adequately alleviated by Stage 1 or Stage 2 medicines, strong opioids, such as morphine, for example, are necessary.