"Not the pain, the fear is the problem"

Luise Heine has been an editor at since 2012. The qualified biologist studied in Regensburg and Brisbane (Australia) and gained experience as a journalist in television, in the Ratgeber-Verlag and in a print magazine. In addition to her work at , she also writes for children, for example for the Stuttgarter Kinderzeitung, and has her own breakfast blog, “Kuchen zum Frühstück”.

More posts by Luise Heine All content is checked by medical journalists.

A good 23 million Germans suffer from chronic pain. Dr. Dominik Irnich, Head of the Pain Clinic at the University of Munich, explains in a interview why some are more prone to chronic pain than others.

Dr. Dominik Irnich

Head of the pain clinic at the University of Munich.

Dr. Irnich, how much pain do you have to be able to endure?

Pain is part of life, you have to get used to this thought. The key is that you can take it well if it doesn't scare you. Take, for example, the soccer player who injures himself and continues to play. He really wants to score a goal and continues to run, although he may be in severe pain. He can still endure it well at the moment. It looks different if you don't know where the pain is coming from and it scares you.

And is that a problem with chronic pain sufferers?

Yes, in chronic pain patients there is often no clear cause of the pain. Or they have experienced that a reason for the pain has apparently been found, such as the intervertebral disc. But even though this has been treated, the pain remains. Something like that unsettled: "Could it be a serious illness?" The worry, in turn, increases the pain. It is not the pain, but the fear that is often the problem.

What do you do to prevent pain from becoming chronic?

First of all, it is important to treat acute pain well - caused by an injury, for example. Otherwise a pain memory can form. This means that acute pain leaves traces in the nervous system. It “remembers” the pain, even if the trigger has long been resolved. The problem is: we don't yet know exactly why some people develop acute pain into chronic pain and not others.

What could play a role in this?

Important factors are psychological as well as social pre-existing stresses. If someone depends on their knee for a living, for example a professional athlete, and injures themselves there, then this pain has a special meaning. He becomes chronic more easily than in someone for whom such an injury is less threatening. In general, internal factors such as suppressed or unprocessed feelings and social conditions, especially workplace factors, make pain chronic.

What do you mean?

For example, if a patient with a suspected malignant disease is operated on and the result is only communicated to him after a few days, then the fear mixes with the pain of the operation. This can encourage pain to be felt more intensely and possibly become entrenched.

Something similar is known from false-positive findings, for example in the case of breast cancer.

Correctly, even if the result is corrected, the emotions suffered leave traces on the patient - also in his pain perception. The major role played by the psyche can also be seen in the most important chronification factor, the workplace: Those who do not feel comfortable or valued here are more susceptible to chronic pain.

Is this also taken into account in the therapy?

Often not in routine care for non-specialists. Diagnosing and treating chronic pain is always very complex. Unfortunately, mostly only the somatic, i.e. the physical level is considered. This can lead to unnecessary interventions, false attempts at explanation with fixation on the physical cause and long-term medication with painkillers - this is not necessarily successful, especially not in the long term.

Because the psyche is not sufficiently involved?

Yes, that's one of the reasons. Chronic pain is always related to the psyche, i.e. internal factors. Good pain therapy involves both body and soul. We call this the so-called multimodal approach. In special facilities, a whole team of experts analyzes the patient from different angles during the initial examination. In addition to specialized doctors, psychologists and physiotherapists are also involved. Together, a diagnosis is made and an individual treatment concept is developed. In addition to meaningful therapies, it is about activating and motivating those affected to do something for themselves - this is how we improve the quality of life again.

That sounds very laborious - can a family doctor even do it?

In principle, I think yes, but more in the sense of long-term support. There are a few basic rules in dealing with pain patients, and medical skills are required. A doctor can quickly gain clues that the patient is suffering from chronic pain that cannot even be removed with an injection.

What do you have to pay attention to?

One should pay attention if someone reports that the pain is always the same and cannot be influenced by anything. Another indication of chronification is the constant change of doctors or therapies and recurring diagnostics - for example the third MRI appointment, although the first two times were already without results. It is also important to ask about internal and external stress factors such as feelings, psychological stress, work or leisure behavior. Of course, this requires a trusting doctor-patient relationship and time. However, it is worth investing this time at the beginning: This saves unnecessary measures and thus time again.

Many people now swear by yoga. Does this also help with pain?

Yoga, but also Tai-Chi and Qigong activate in a gentle way. The movement system requires flexibility, elasticity, coordination and body awareness. The corresponding exercises promote this. This means that the body's pain control system is also trained without undesirable side effects, such as those associated with painkillers, and one is then less sensitive to pain. The important thing is that we are talking about medical applications, not lifestyle or wellness applications. They are nice too, but they don't help our patients.

How long have patients been in pain on average when they come to you?

Very long - about twelve years. Tormenting yourself for so long doesn't have to be! I can only appeal to everyone who has been in pain for a long time to turn to a pain specialist.

What do you say to such long-term patients?

I can give them hope. Pain can still be treated successfully even after many years. They may not go away completely, but you can regain a lot of quality of life. There is a power that is within us - and it is stronger than the pain. We have to mobilize them.

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