Every pain, especially if it is inadequately treated or persists for an extended period of time, it carries the risk of becoming chronic. The cause is a change of nerve cells at the level of the spinal cord and the brain. Learn more about chronic pain disorders.

Acute pain as a protective reflex

Everybody knows pain, for example after a cut in the finger or after a bruise . Pain has been used by nature as a warning sign: When you reach for the hot stove, free nerve endings pick up the pain stimuli and transport them in the form of electrical impulses to certain nerve cells in the spinal cord. There, a protective reflex is triggered with acute pain – the hand is taken from the hot stove.

The spinal cord transmits the stimulus to the brain. There, the actual pain processing takes place. In the thalamus the pain becomes conscious, in the limbic system the affective-emotional component is added, in the cerebral cortex the place of origin of the pain is recognized and the feeling is stored as experience.

When the cause of the pain is resolved, the information is likely to be erased within a short time. The pain has served its purpose, the organism moves to the agenda.

Emergence of a pain memory

If the pain-processing nerve cells are exposed to strong stimuli for a long time, it can lead to the development of a pain memory. That is, the brain is still pain signals even if the root cause has long been eliminated.

Ultimately, the involved nerve cells become more sensitive and even treat light stimuli or touch as pain or pass on pain impulses without a cause.

A pain memory is not erasable

If it has already come to a  pain chronicity  , it is currently not possible to erase an acquired pain memory pharmacologically.

So-called counter-irritation procedures such as transcutaneous electrical nerve stimulation ( TENS ) or electro-acupuncture can in some cases reduce the increased sensitivity of the nervous system in the spinal cord.

Not every pain becomes chronic

Acute pain, especially inadequate treatment, can be painful chronic pain. But not every acute pain becomes chronic. This points to the body’s own factors that preclude chronification. Such anti-chronification factors are poorly understood.

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7 most common pain disorders

Pain disorders can express themselves in many different ways. The symptoms range from headaches to rheumatic pains to neuropathic pain and can lead to permanent health problems. Here we show you the 7 most common chronic pain diseases and their development.

1. headache

Headache is one of the most common pain syndromes. Over the course of a year, the majority of Germans experience one or more headache attacks. The consoling news: The incidence of headaches in men and women decreases with age.

Distinguish two groups of headaches:

  • The so-called primary idiopathic headache is understood as meaning pain that has no other cause ( migraine , tension-type headache).
  • Secondary symptomatic are those headaches that can be attributed to a cause, such as a hangover after heavy drinking or the headache, which is caused by a cerebral hemorrhage .

Read More: Chronic Pain

2. Back pain

Back pain is one of the leading health problems in Germany. This is proven by several studies in recent years. Every second to third German suffers from back pain today.

Back pain is usually caused by the following triggers :

  • lack of exercise
  • Defective loads of the spine
  • emotional conflicts
  • professional stress

3. Osteoporosis

Osteoporosis affects every fourth woman aged 50 and over and every sixth man; In total, an estimated six to eight million Germans are affected.

The altered statics of the skeleton (reduced bone mass and altered bone structure) can cause pain.

4. Rheumatism

An estimated 15 percent of the population are receiving medical treatment at least once a year for rheumatic ailments, and more and more young people.

We distinguish soft-tissue rheumatism ( fibromyalgia ) with pain in muscles, tendons and ligaments of the rheumatoid arthritis, in which the joints are either inflamed ( chronic polyarthritis ) or damaged by wear ( osteoarthritis ).

5. Cancer

Many tumor patients have severe pain; in the final stage it is about 90 percent. The pain arises either through tumor growth / metastasis or through side-effect-rich therapies.

6. Nerve pain

Neuropathic pain is caused by direct damage to nerve fibers and pathways.

The most common neuropathic pain syndromes include diabetic polyneuropathy(about 10 percent of all diabetics suffer from it) and postzosteroid neuralgia(about 20 percent of all patients have long term pain after shingles ).

7. Phantom pain

Phantom pain affects up to 70 percent of all amputees. The phantom pain can occur after amputations, when the pain-processing nerve cells of the amputated limbs are sensitized by a long-lasting irritation. You then send signals months after the procedure.

The pain is attack-like in most cases and often accompanied by severe muscle spasms.

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Therapy and alternative treatment

In addition to drug therapy, the treatment of chronic pain includes exercise therapy, physiotherapy and alternative procedures. In addition to the treatment of the causes of pain, the symptomatic therapy has a high priority, but also the psychological side of the disease must be considered.

Medical therapy

In 1986, the WHO developed a phased plan scheme for the treatment of cancer pain, which is now being applied to other chronic pain with a strict selection of patients. In addition to the basic analgesic, the scheme also considers appropriate concomitant medications, such as:

  • antidepressants
  • anticonvulsants
  • neuroleptics

When using strong opioids , the use of laxatives to treat the most common side effect constipation is essential. Anti-emetics (anti-vomiting agents), but also non-pharmacological measures such as physical therapies or psychological measures should also be considered.

In the treatment of chronic pain, alternative therapies ( biofeedback , TENS and acupuncture) are becoming increasingly important. 

Biofeedback: Learning to influence body functions

Biofeedback measures body functions that are normally conscious, such as muscle tension, heart rate, and blood flow. The results are reported back to the patient via a computer screen.

During the treatment the patient learns to consciously influence his body functions. Biofeedback is particularly suitable for the treatment of migraine and tension-type headache in the area of ​​pain .

Transcutaneous Electrical Nerve Stimulation (TENS)

In this method of counter-irritation, electrodes are stuck to the skin, which release weak current stimuli. These current stimuli should cover the pain sensation. Treatment with a high current frequency prevents the painful nerves from passing pain impulses to the brain. A low-frequency TENS application stimulates the release of endorphins, which temporarily attenuate pain perception.

For example, TENS is used to treat neurogenic pain, phantom or stump pain .

Acupuncture as an alternative pain treatment

Also under acupuncture an increased release of endorphins can be observed. Acupuncture is used for various types of pain. This includes:

  • Headache and migraine
  • back pain
  • arthritis
  • Trigeminal neuralgia
  • neuropathies

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