Actually pain should be just a brief warning of the body to show that something is wrong. However, many people suffer from permanent pain – be it due to surgery, fracture, spinal disease or even psychosomatic reasons. While chronic pain was once considered a symptom, it is treated as a separate disease in modern medicine. Here’s what types of chronic pain you have, and what you can do about it.
Chronic pain – the pain memory
In Europe, around two thirds of the population suffer from pain at least once a week. Particularly affected: Patients with chronic, ie permanent pain. Here pain is considered and treated as a separate disease rather than a symptom of a disease. In several symposia the recognition of the last years that memory-like processes play an important role in pain diseases played an important role.
Frequency of pain
According to information from the German Pain League, eight to ten million people in Germany suffer from chronic pain, for example, as a result of spinal disorders or broken bones. Here the pain has lost its warning function.
Alone 250,000 children are affected according to the German Society for the Study of Pain. Twenty-five percent of older people suffer from persistent or recurring pain, which is often accepted as fate by the sufferer or physicians.
The pain memory
The body can develop a so-called pain memory if pain persists for an extended period of time and remains untreated. The neural pathways that guide the pain impulse through the body, are thus constantly irritated, similar to a permanent training effect, with the result that the pain is independent. At the Max Planck Institute of Psychiatry in Munich, researchers are investigating what happens in the case of pain in the cells.
Nervous cells in the spinal cord give a simple signal to the brain when injured or when there is inflammation in the body. If the stimulus occurs at regular intervals, the cell responds harder each time. Even if the stimulus does not get stronger, it sends nonstop signals to the brain. Prof. Zieglgänsberger from the Max Planck Institute for Psychiatry said in the ARD: “If we repeat this 100 to 200 times, then the cell becomes, as we say, spontaneously active, and then there is no longer any need to irritate the cell And that would mean that there may be no inflammation at all in such a situation in the periphery, in the hand or at the joint, and yet it still hurts because this nerve cell is in the brain says, here’s something else. “
Persistent pain even affects the genetic activity of the nerve cell. New protein chains are formed, which change the cell membrane so that the nerve cell reacts faster. The result: more pain.
Learning processes influence pain perception
In connection with pain memory, the research of the Mannheim scientists around PD Dr. Dieter Kleinböhl and Prof. Dr. med. Rupert Hölzl of importance: In one experiment, the sensitivity to pain of healthy study participants increased significantly, without them being aware of it. Conversely, the sensitivity could be lowered in the same way, depending on the consequences that followed the perception reactions.
For their study sponsored by the German Research Foundation (DFG), the researchers were honored at the German Pain Congress in Berlin with the prize of 3,500 euros for the Basic Research category of the 2006 Research Prize for Pain Research. The experiment went like this: The subjects were given a heat stimulus on the hand via a so-called thermode. They were allowed to regulate the temperature themselves.
Their task: they should keep the perceived stimulus intensity constant. “In healthy volunteers, getting used to just painful stimuli usually sets the temperature higher over time to keep the sensation the same,” Dr. Kleinböhl.
“In chronic pain, as in back pain, on the other hand, you can not get used to such stimuli – here is a sensitization, ie an increase in the subjective pain sensation.” The question was whether such altered perception of pain can arise through unconscious learning processes. To find out, the researchers examined healthy people under two conditions. The task of keeping the sensitivity of the heat stimulus constant remained.
In one group, a sensitization reaction was “boosted” by a subsequent further decrease in temperature. The habituation reactions, however, were “punished” by a subsequent temperature increase.
In the second group it was the other way around: habituation was intensified and sensitization was punished. It was found that in the group in which the perception of pain was intensified, increased sensitization reactions to heat stimuli occurred, while in the other group more habituation reactions were found. In the group with learned sensitization, it was also shown that with decreasing stimuli, the personal sensation remained the same.
Participants were unaware of this increased sensitivity to pain gradually increasing throughout the course of the experiment.
Pain therapy in three stages
The classic pain therapy is still working with drugs. Before a successful therapy is the exact diagnosis. The patient must be thoroughly examined, but above all, the pain must be assigned to the original trigger – that may be years ago. The doctor determines if the pain has a physical cause, such as a tumor, if it is a malfunction of the nerves or pain receptors in the brain, or if there is a very different cause.
The doctor also includes the psychological and social aspects in the diagnosis. For particularly intense chronic pain, it makes sense to visit the pain therapist.
The first stage consists of weak analgesics. Here drug ingredients such as acetylsalicylic acid , paracetamol or diclofenac are represented.
In the second stage, one uses medium-strong morphine-like agents, so-called weak opiates. These include the active ingredients tramadol, tilidine and naloxone.
In the third stage, morphine and other morphine-like painkillers are administered. These are active ingredients such as morphine sulfate, buprenorphine or fentanyl .
So it is not surprising that painkillers are the bestsellers in pharmacies. Its annual turnover in Germany is around 500 million euros. The most important active ingredients are acetylsalicylic acid, ibuprofen and paracetamol. As early as 2,500 years ago, Hippocrates successfully treated pain and fever with the bitter extract of willow bark. This extract contained a high proportion of salicylic acid, the prototype of today’s aspirin. Since then, salicylates and later advanced acetylsalicylic acid have been successfully used in pain therapy.
Body Painkillers and Placebos
Researchers like Prof. Zieglgänsberger are investigating whether pain memory can be erased. The body should learn to forget. Body-own systems are a key to this, such as the “endocannabinoids”, which are marijuana-like substances that the brain produces. Research is focused on how to promote these processes. Even abroad, researchers are working on new methods of pain therapy.
Painkiller in saliva?
Perhaps it will soon be possible to isolate an endogenous analgesic and use it without side effects. Because scientists have now found out that the human being produces in his saliva an endogenous analgesic. It is even said to be more effective than morphine.
Responsible for this is a small protein called Opiorphin, which very effectively nourishes pain, as the scientists in the magazine “Proceedings” of the US Academy of Sciences reported that the opiorphin had effectively reduced the pain of inflammation in experiments in rats and the treated rodents could last longer About steel nails run as untreated conspecifics.
Opiorphin is a morphine-like substance – it plays a key role in pain perception, but it also regulates emotional responses. Opiorphin and related substances activate an analgesic mechanism in the body, the scientists report.
Probably the substances inhibited the degradation of the body’s own endorphins – these are hormones that reduce the sensation of pain and cause happiness. Therefore, in the long term, an application Opiorphin in pain therapy and mood swings conceivable
In a next step, the researchers want to find out what conditions in the body cause the natural production of opiorphin.
The effects of placebo – dummy medications – is also being researched more and more. The Turin scientist Fabrizio Benedetti, for example, discovered how important it is that patients do not know about the placebos and expect an improvement in their state of pain – in theory, every human being is susceptible to placebo. Dr. Karin Meissner from the Institute of Medical Psychology at the University of Munich has shown that targeted placebo effects are possible even on organs.
In one experiment, 18 healthy individuals, divided into three groups, for example on different days, each received one tablet without any active substance. All participants were educated that the drugs increase, decrease or not affect gastric activity. The researchers measured gastric activity half an hour before and after placebo administration.
At the same time, they recorded the heart rate, respiration and electrical skin resistance of the subjects.
The result: the subjects reacted with significantly altered stomach movements – the other organs, however, showed no change. Karin Meissner is conducting further studies to reduce blood pressure with placebo drugs. Similarly, the placebo researcher Benedetti was able to show successful in patients who applied a drug-free cream for pain on the hand and feet.
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