Published on 03. January 2019

Pain, go away ...

Actually, we have a lot to thank pain for: it warns us when we are in danger. For people who suffer from chronic pain, the original function of pain as a warning signal has become a disease in its own right. And that, in the worst case, can mean a long period of suffering.

Ellen has accepted it as part of her life. She gets up with it and usually goes to sleep with it. It is there in her daily work routine, and it goes shopping with her – for almost six years. And if it were suddenly gone? "Then I would probably miss it," the 47-year-old tax clerk from Charlottenburg answers dryly. This doesn't mean a pet, a good friend or a loving partner. Ellen's daily companion is pain. This makes she to be one of the approximately 17 percent of all Germans who are affected by long-lasting, chronic pain, which means she is one of 12 million people. On average, her history of suffering lasts around seven years, with more than 20 percent of them suffering for over 20 years. More than half of all people with chronic pain wait more than two years to receive effective pain treatment. And only one-tenth of all patients are even presented to a specialist. However, they suffer not only from constant pain, but also from increasing physical limitations in everyday life. The consequences are often depressed mood, anxiety, sleep disturbances and reduced concentration. The World Health Organization (WHO) has decided to include "chronic pain" as a separate diagnosis in the classification of diseases. Thus, it is accepted as a disease with specific characteristics that requires its own treatment and from which people all over the world suffer.

Pain becomes a companion

If patients complain of pain over a period of at least three to six months, which affects them physically in terms of loss of mobility and restricted function, and psychologically and cognitively in terms of their state of mind, mood and thinking, as well as socially, then doctors speak of chronic pain. This occurs most frequently in the back, in the joints and in the head, for example as migraine. It is often caused by diseases or malpositions of the musculoskeletal system, such as muscle tension, osteoarthritis, osteoporosis and rheumatism. For example, tension in the pelvic region can affect the legs, the back or even the cervical spine. Nerve pain, that appear after operations, injuries, cancer or metabolic diseases also have a considerable influence on the state of health. They can be felt in all areas of the body, increasingly in the legs, hands, head and gastrointestinal area.

The pain memory reacts

The connections are complicated, partly because pain can become burned into the central nervous system, so to speak. This is how the so-called pain memory develops, which initiates a pain spiral: The nervous system becomes hypersensitive to constant pain stimuli; it already reacts to harmless and light stimuli, such as touch, with pain signals. The body's own pain control system is no longer able to sufficiently dampen and control what is happening, and a self-reinforcing mechanism sets in: The pain persists even though its cause may no longer be present. This is one reason why patients with chronic pain often commute from one doctor to the next without receiving a diagnosis. However, one should not conclude from this that they are imagining the pain or are malingerers. Around one fifth of sufferers feel misunderstood and left alone with their pain. It is not surprising that the market for painkillers is booming: in 2019, sales totaled 565 million euros, almost a fifth more than in 2013.

Enhancing quality of life again

Patients suffering from chronic pain participate less in life, their social and family environment is severely impaired, and they often suffer from social isolation. They often lose their zest for life, avoid contact, feel stressed and develop anxiety and depression. Many are threatened with the loss of their job, and in the worst case with early retirement. Those affected should not put off going to the family doctor or pain therapist. In the context of a multimodal therapy – here treatments of different specialist areas interlock – medicines, physical, psycho and occupational therapy, manual therapy, massages, relaxation therapies such as meditation or progressive muscle relaxation can be used. If outpatient treatment does not lead to success, an inpatient stay in a pain clinic may be appropriate. The goal is to help sufferers achieve a better quality of life, if necessary even with the pain, which in many cases never completely disappears. A first step is therefore to accept it as part of one's own life in order to be able to live with it. This was also the case for Ellen from Berlin, who did not completely lose her pain during her stay in the clinic, but has learned to deal with it.

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