Chronic pain

Martina Feichter studied biology with an elective subject pharmacy in Innsbruck and also immersed herself in the world of medicinal plants. From there it was not far to other medical topics that still captivate her to this day. She trained as a journalist at the Axel Springer Academy in Hamburg and has been working for since 2007 - first as an editor and since 2012 as a freelance writer.

More about the experts All content is checked by medical journalists.

Chronic pain affects the quality of life of countless people. The suffering of those affected often begins with acute pain due to an injury or illness. Over time, they develop into chronic pain, which persists even after the tissue damage that caused it has healed - the pain has become an independent disease. Read more about how chronic pain develops and how it can be treated here.

Chronic pain: description

Chronic pain refers to pain that has almost always been present for at least three to six months or that recurs frequently and affects the patient physically (loss of mobility, functional impairment), physically and cognitively (mood, mood, thinking) and socially. The pain is the predominant symptom ("leading symptom") of the complaints.

In contrast to acute pain, chronic pain (medically correct actually: chronic pain syndrome) is no longer a meaningful alarm signal that indicates damage to the body (injury, illness, etc.). Instead, they represent an independent pain disorder that often no longer has a clearly identifiable cause.

Chronic pain is often accompanied by other complaints, for example sleep disorders, lack of appetite, increased irritability and depressive moods. In addition, they can mean severe restrictions in everyday life, work and leisure life.

Chronification

A chronic pain syndrome often arises from acute complaints: Persistent pain stimuli cause the nerve cells to react more and more sensitively to the stimuli over time, i.e. the pain threshold drops. The repeated pain stimuli leave “traces of pain” and a “pain memory” develops. The patients perceive even the slightest pain stimulus or even touch as pain. The nerve cells can even send pain signals to the central nervous system on their own, even though the original cause of the pain (e.g. an injury) has long since healed. So it hurts even though there is no longer any organic cause for it.

Risk factors for chronic pain

Chronic pain syndrome can be favored by numerous factors. These include:

Persistent psycho-vegetative tension (someone is constantly "electrified")
History of anxiety and depression
Long-term experiences of stress or pain in the previous life story
relatives suffering from pain in the family
Tendency to “think about disasters” - someone always imagines the worst possible consequences
Constant ignoring of load limits, constant perseverance
Anxiety Avoidance Belief (for fear of increased pain, movement and physical activity are avoided)
inadequate pain management when the pain started
no talking about the pain
family conflicts
social problems in the environment (e.g. at work) or financial difficulties
Benefits resulting from the illness (e.g. early retirement)

Chronic pain: causes and possible diseases

In simple terms, chronic pain can be divided into three categories:

Chronic pain as an accompanying symptom of a physical disorder: On the one hand, this includes "normal pain" that accompanies a physical illness (such as rheumatism, osteoarthritis, osteoporosis) or nerve damage. On the other hand, this category includes “extraordinary pain”, such as phantom pain after an amputation. Complaints related to the complex regional pain syndrome (CRPS) are also included. This is understood as a constant, regional pain that is disproportionately long and intense. It bears no relation to the trauma that triggered it (e.g. nerve damage) and cannot be explained by other causes.

Pain that can be partially explained by the body with accompanying psychological illness (comorbidity): This includes chronic pain caused by tissue damage that is aggravated by psychological factors. One example is back pain radiating into the leg caused by a herniated disc in the lumbar spine (lumbar sciatica). For example, they can get worse from inadequate disease management, an anxiety disorder, or depressive disorder.

Chronic pain as an expression of a primarily mental illness: Chronic pain occurs primarily in connection with depressive disorders, but also with anxiety disorders, post-traumatic stress disorder or other mental illnesses.

Chronic forms of pain
The most common forms of pain that can take a chronic course include:

Headaches like chronic migraines, chronic tension headaches
Back pain such as chronic low back pain
Muscle pain as in fibromyalgia (chronic pain disorder that affects the tendons and joints in addition to the muscles)
Joint pain such as osteoarthritis, rheumatoid arthritis
Tumor pain

Chronic Pain: When Should You See a Doctor?

In any case, see a doctor if:

You have persistent or recurring pain for an unknown cause
the pain keeps getting worse
the pain is accompanied by other symptoms, for example chronic back pain with numbness in the legs or chronic headache with impaired consciousness
Your daily life and quality of life may be adversely affected by chronic pain

Chronic pain: what does the doctor do?

First of all, the doctor will have a detailed discussion with you about your medical history (anamnesis). The focus is on the following questions:

How long have you had chronic pain?
Where do they appear?
How does the chronic pain feel (pain character)?
How bad is the pain?
Are they triggered, intensified or alleviated by factors such as movement, cold, warmth, stress, etc.?

You should also provide information about pain-related impairments in everyday life, any other complaints (such as sleep disorders, digestive problems, etc.), previous and current diseases, operations and previous therapies against the pain.

Psychosocial information is also important for the doctor, for example information on training and occupation, job situation, satisfaction, family status and any current conflicts and stresses.

This is followed by a thorough physical examination. Depending on the type of chronic pain (e.g. headache, back pain) and information from the conversation, further examinations may follow. These include, for example, neurological, orthopedic or internal examinations. If necessary, imaging methods such as ultrasound, X-rays, computed tomography or magnetic resonance tomography can also be used. Blood tests and electrophysiological tests (such as measuring the speed of nerve conduction) can sometimes also help.

Chronic pain: therapy in conventional medicine

Chronic pain is treated in a variety of ways - depending on the type and intensity of the pain. For example, pain medication, physical therapies (such as massage, water applications, cold and heat treatments), exercise therapy (such as physiotherapy, sports), acupuncture and nerve stimulation (TENS) as well as psychological therapies are used to relieve chronic pain.

Chronic pain: you can do it yourself

You can also do a lot yourself against chronic pain:

Relaxation techniques: For those affected, chronic pain usually means permanent stress, paired with fear, frustration, despair and a depressive mood. Such negative emotions make the pain worse. Relaxation techniques help break this vicious circle. For example, autogenic training, biofeedback, meditation, yoga, progressive muscle relaxation and mindfulness training are suitable. They influence the perception of pain, support pain management and stimulate the body's self-healing powers.
Complementary healing methods: In addition to acupuncture, other complementary methods can also relieve chronic pain, such as acupressure, osteopathy, magnet therapy and reflex therapies. Check with an experienced therapist.
Schüßler salts: Schüßler salts are also one of the complementary procedures and can be tried in the event of complaints. For example, in the case of chronic pain in the back area, the Schüßler salts No. 9 Sodium phosphoricum, No. 11 Silicea, Number 1 Calcium fluoratum and No. 2 Calcium phosphoricum recommended. The tablets are taken in ascending order, first number 9 for about a week, then number 11 in addition, and so on. Let the tablets dissolve in your mouth. If the pain is mild, take the tablets once a day; in the case of severe chronic pain, it can be taken up to ten times a day.