Health when pain determines life augsburger allgemeine

Dr. Hoffmann , you are head physician for anesthesia, intensive care and pain medicine at Wertachklinik Schwabmunchen . How does pain have to manifest itself or how long does it have to last in order to speak of chronic pain??

Dr. Gordon Hoffmann : This is less dependent on how long a pain has existed. Sometimes there is talk of at least three or at least six months. Much more decisive, however, are the mechanisms that maintain the pain and make it a problem for the life of the affected patient.

How can the patient decide whether he has a chronic pain?

Hoffmann : It becomes obvious when I as a patient notice that the usual therapies do not help me. For example, when I keep changing orthopedists. Patients with chronic pain often have a real odyssey through several doctors' offices behind them, receive different diagnoses from different doctors again and again, reach the limits of conventional medicine, so to speak, and feel misunderstood, becoming increasingly dissatisfied. And this condition alone can cause the pain to become even more unbearable. One speaks of a chronification factor. Anyone in this state should seriously consider seeking specialized help. Of course, it would also be good – and this is increasingly the case – that the various treating physicians come up with the idea and refer the patient to a pain therapist.

Is the general practitioner still the right contact for patients??

She fights against the often unrecognized pain

Health when pain determines life augsburger allgemeine

When the body is in constant pain

Pain illness often has not only physical causes

Hoffmann : Yes, in every case. Because quite importantly: Before I start with a merely symptomatic pain therapy, all treatable causes for the pain must have been excluded. Only if this is the case, the way leads to a specialist, who approaches the problem more holistically.

In which area of the body does chronic pain most commonly occur?

Hoffmann : This is by far back pain.

Does this mean that many sufferers could do something about their pain themselves with sufficient exercise??

Hoffmann : It is undoubtedly true that exercise is a very important factor in the prevention, but also in the treatment of back pain. But movement is only one of several components of chronic pain. You see, there are countless people who exercise far too little, never exercise, and yet have no back pain.

The sensation of pain is also different and quite individual.

Hoffmann : Pain is indeed something relative. For example, it is hardly possible to work out a standardized pain stimulus for study purposes that feels the same for all subjects. So doctors and patients need to understand that pain is much more than just the electrical excitation of a nerve being transmitted.

Pain is modulated by our brain quite decisively. And then factors become important like: Is the pain trigger associated with fear? What does the pain mean for my current life situation?? Or just think, for example, of the patients who are seriously injured after an accident and should actually feel unbearable pain. Colloquially, one often speaks of a state of shock. But in fact this is an achievement of our brain. It can considerably intensify pain, but just as well mitigate or completely hide it. It is a pity that we cannot activate this brain power at the push of a button.

Fibromyalgia, which is often accompanied by severe muscle pain, is certainly also a clinical picture with which patients come to you as an expert, isn't it??

Hoffmann : Yes, this is indeed a clinical picture that you see very often as a pain therapist.

Is it possible to find a cause at all as a pain specialist??

Hoffmann : A single cause rather not, because that is usually the core of chronic pain, that a single tangible cause is not present, but a variety of different factors play a role. This is also true for the fibromyalgia you mentioned.

Has chronic pain increased??

Hoffmann : Yes, chronic pain is a disease of civilization, and it is certainly the case that the number of patients affected is increasing.

What does the therapy look like?

Hoffmann : The buzzword is multimodal pain therapy. According to all scientific findings, this is the sharpest weapon in pain medicine.

What does that mean exactly?

Hoffmann : This means that different disciplines work together and several different therapeutic approaches are applied. However, the individual components of a multimodal therapy are not specified in detail. What is essential, however, and is also demanded by the payers, is psychological or even psychotherapeutic co-care of the patients. This in turn often leads to the misunderstanding that psychological problems are the cause of chronic pain, which in turn not infrequently leads to stigmatization of patients.

There are probably psychological problems due to the pain .

Hoffmann : This is also possible. But this therapy component is much more important, because our psyche can make a decisive contribution to coping with the pain. But – and this is really important – psychological problems are usually not the cause of the pain.

If the cooperation of different specialists is necessary, does that also mean that a treatment is only possible as an inpatient, or?

Hoffmann : An outpatient treatment would probably already be possible. However, there is no framework in our health care system that makes this treatment possible on an outpatient basis to cover costs. This leads to multimodal therapies being full inpatient or partial inpatient. The latter means that I am in the clinic during the day and can go home overnight.

How long does a therapy last?

Hoffmann : This varies; at the Wertach clinics, the inpatient stay usually lasts about 17 days.

What exactly can patients expect?

Hoffmann : The emphasis is on so-called active therapy methods, which the patient can also use on his own. This includes, for example, special movement exercises. Learning relaxation techniques. But the teaching of medical knowledge and nutritional seminars are also important components that give patients back their autonomy. Art and music therapy also often provide very valuable therapy results, because they help patients to discover completely new perspectives and also facets of their own personality.

Because – and this is also an important message – in order for a pain pattern that has existed for years to change, something must also change in the affected person or in his or her life. But drug therapy is also a component of multimodal pain therapy, although its importance is often overestimated. It is much more important to get the patient out of his passive experience of the disease and into an active position, where he himself has developed competencies and tools to deal with the pain and to influence it positively.

Lecture: On 26. September, 19.30 o'clock, speaks Dr. Gordon Hoffmann at the Infopavillon at the Mercateum in Konigsbrunn near Augsburg under the title "Chronic Pain – Limits of Medicine and Ways out of the Crisis.

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