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Pain therapy

Chronic pain: causes

Acute pain caused by an injury or after surgery, and chronic pain, often persisting for years, do not only differ in their trigger mechanism, but also in their treatment.

Acute pain constitutes a biologically sensible warning signal; the pain disappears once the cause has been removed (e.g. the rotten tooth extracted).

A pain stimulus persisting for an extended period of time, though, creates a kind of "pain memory" in the central nervous system, which can continue for a long time. The body's reactions to pain stimuli such as increased muscle tension can themselves over time become a source of pain, thus contributing to the chronification of symptoms. This can gradually lead to the development of an independent clinical picture with associated symptoms such as sleeplessness, lack of appetite, listlessness and depressive moods. In combination, these factors often lead to social isolation.

Chronic pain: forms of therapy

The realization that chronic pain is generally a multifactorial event explains why therapeutic success can rarely be achieved by isolated individual measures. Modern pain therapy has known for a long time that it make sense to develop an individual therapy concept made up from a range of different building blocks.

Possible therapy options could include:

  • Acupuncture
  • Manual therapy
  • Drug treatment
  • Neural therapy/Sympathetic nerve blocks
  • Administration of opioids close to the spine
  • Physiotherapy and therapeutic exercises
  • Pain management strategies
  • Relaxation techniques
  • Counter-irritation procedures (TENS)
  • Shock-wave treatment

It makes sense for medical specialists from different disciplines to work together in order to develop the best possible treatment concept and thus also to achieve commensurate therapeutic success. The patient should keep a pain diary to record the effect of the various therapeutic measures. Such diaries permit the exact and detailed recording of variations in pain intensity during the course of a day, dependence of the symptoms on a variety of external circumstances and physical activities. This allows the modification or correction of any therapy measures already put in place.

Chronic pain: clinical pictures

The following typical symptoms are amongst those that could indicate special pain therapy:

  • Headaches (tension headache, migraine, combination headache, drug-induced headache, cluster headache, etc)
  • Trigeminal neuralgia
  • Atypical facial neuralgia
  • Phantom pain (e.g. after limb amputations or mastectomies)
  • Postthoracotomy syndrome (after lung or heart surgery)
  • Pain after shingles/herpes zoster (postherpetic neuralgia - PHN)
  • Pain caused by tumours
  • Chronic back pain with a range of different causes
  • Polyneuropathy (e.g. associated with diabetes) and neuralgia of different causes
  • Pain associated with circulatory disorders
  • Pain associated with chronic disorders of the locomotor system (arthrosis, rheumatoid arthritis)
  • Sudeck's disease (reflex sympathetic dystrophy, complex regional pain syndrome - CRPS)

The cooperation of medical specialists from a range of disciplines (anaesthesia, pain therapy, orthopaedics and sports medicine, surgery, vascular surgery, internal medicine and psychotherapy) and well as specially trained physiotherapists permits a professional exchange of information and ensures effective treatment concepts for the treatment of acute and chronic pain.