New forms of treatment for chronic pain world

New forms of treatment for chronic painMultimodal pain management is multidisciplinary, simultaneous treatment by physicians from different specialties, psychologists, physical and occupational therapists, and massage therapists.

Pain is a life-saving signal – but it can also be hell. Researchers now understand the mechanisms better and better. That is why patients now have to help more with therapy.

D epression, loss of work, social withdrawal: pain that lasts for years can take over a person's life to such an extent that all being and thinking revolves around it. According to estimates, more than ten million people suffer from chronic pain in Germany alone.

"Pain has become a widespread disease," says Hartmut Gobel, professor and chief physician at the Kiel Pain Clinic. One reason is the growing percentage of elderly people. "After a certain age, everyone has pain."

Headaches, abdominal pain, back pain, knee pain, hip pain and general pain of the musculoskeletal system lead the list. "Much of the medical system is concerned with nothing more than directly or indirectly combating chronic pain," writes medical author Harro Albrecht in his recent book, Pain. Pain is a problem for the whole community, says Gobel. Also in financial terms: early retirement. Inability of pain patients to work causes immense costs. Although there are now pain centers and an increasing number of specialized doctors, the care structure is far from ideal.

An antiquated view of pain

One reason is that political decision-makers, as well as physicians and patients, often still have an outdated view of the phenomenon of pain. "According to this one-dimensional model, a stimulus is directed to the pain center of the brain via a nerve, and the pain is perceived," Gobel explains. "If the cause of the irritation is eliminated, everything is fine again."

However, the equation "no stimulus – no pain" does not work. In fact, pain is an extremely complex phenomenon.

There is a lot of evidence for this. For example, that placebo effects and hypnosis can significantly influence the perception of pain. The fact that some people continue to experience pain even after successful treatment of the triggering cause – or that no organic reason for their suffering can be found in the first place. That fakirs and medicine men can suggestively make themselves not perceive any pain anymore. Or also that amputees have phantom pain in missing limbs.

Psychological aspects come into focus

"Factors such as a person's own evaluation of pain, social aspects and the work environment are at least as important as the specific stimulus," explains Gobel. In stressful life situations, the risk of developing chronic pain is 13 times higher. In people with a stress disorder after a traumatic experience, the pain defenses can sometimes no longer be used at all. "You can no longer manage even minor pain."

To the astonishment of many scientists, brain analyses have shown that emotional pain is present in the same pathways and structures as physical pain, explains Gobel. "You can't separate that at all."

A recent study impressively demonstrated how strongly the psyche influences the perception of pain: people were given heat stimuli on the hand that varied in intensity over a period of ten minutes. After only a short time, the pain has very little to do with what is objectively happening, the researchers report in the journal Cerebral Cortex. The participants felt changes in pain, although the objective heat stimulus remained unchanged.

Placebos can also cause pain

"If pain lasts for a longer period of time, it obviously changes from a purely perceptual process to a very emotional process," says Markus Ploner of the Technical University of Munich. "Our results suggest that: The longer pain lasts, the more emotions one develops."

The researchers also showed the influence of an ineffective placebo cream: when it was rubbed on the back of the hand, participants reported feeling less pain. Conversely, this effect could also explain why some pain patients do not respond even to strong medications: "They have the negative expectation: 'Nothing helps with me. This is how they experience it then."

At the beginning of chronic pain, there is often really a concrete stimulus, explains Gobel. "For example, a pulled muscle in my back because I tense up, having been put to work too much by my boss." Over time, just going to the office was enough to trigger pain, even without an actual muscle problem. "Chronic pain develops via conditioning."

Pain therapy in clinics is "fatal"

Even in children and adolescents, the fear of certain teachers or school subjects can intensify pain that just happened to be there and would otherwise have gone away again. In such cases, it has a reinforcing effect if parents then do not send their child to school – a reward that supports the chronification of the pain.

Where, when and whom do they torment the worst?

New treatments for chronic pain world

For example, workers in building construction and civil engineering, nursing staff, cleaners and drivers are particularly affected

There are also major regional differences. More people are affected in the north than in the south, more in the east than in the west

It doesn't always have to be medication or even surgery to combat pain, experts advise

Back pain is not just a health problem. They also cause enormous economic damage

Fatal is also the usual pain therapy only as needed in clinics, adds Gobel. "The patient then gets attention when he demands a painkiller." This encourages passivity in dealing with pain. In addition, there are also risks associated with the medications themselves: "One in ten headache patients is due to self-medication."

Many people are not even aware that pain medication itself causes pain when taken over a longer period of time. In order to function in the job, some take daily tablets – which works in the short term, but is problematic in the long term. It becomes increasingly difficult to give up, because the body gets used to the daily dose and reacts with severe pain and withdrawal symptoms such as nausea.

Patients must cooperate

All this shows how much it is misleading to consider only the body in the fight against chronic pain. The fact that chronic pain is learned also means something else very crucial: It can also be unlearned. "It's like patching a bicycle inner tube with five holes," says Gobel. "Everyone has to be locked up so the tire doesn't go flat again."The pain stimulus is treated, psychotherapy and behavioral therapy are offered, and the patient is encouraged to be more active again – and this for years. "What has become ingrained over years does not suddenly disappear again."

Holistic pain therapy also means that the person affected has to be intensively involved. "Some patients still have the irrational idea that they don't have to do anything themselves," explains Gobel. "They want to be treated, not act for themselves."But this does not work. "Fifty percent of the healing process must be contributed by the patient himself."

Lack of specialists

Sometimes those affected are dissatisfied with this and prefer to start years of doctor hopping in a vain search for relief without taking the initiative themselves. In addition this is a reason for the fact that so many dubious offerers with all kinds of alleged remedies and miracle therapies can earn much money. "Pain patients try everything possible because the level of suffering is so high."

Men are ill differently than women

Women are about twice as likely as men to be affected by depression. Background is often stress. High demands in everyday life. Special forms such as postpartum depression tr . Some women experience baldness after giving birth.

About half of all men in their 40s are affected by erectile dysfunction Affected by erectile dysfunction, better known in the vernacular as erectile dysfunction. The causes can be both physical and . can also be of a psychological nature. Accordingly, the well-known sexual enhancer Viagra is not always suitable for treatment – or remediation.

While others only sweat in the summer, women often suffer from hot flashes, especially during the so-called menopause. A cool footbath is usually not a remedy here – often . even taking hormones the only solution.

Like many other men, former U.S. Secretary of State Colin Powell contracted prostate cancer and underwent surgery in 2003. A prostate carcinoma is the most common cancer b . ei men. Until now, erectile dysfunction has been most commonly found in men over 70; however, since more and more younger men are being screened, the average age has been steadily decreasing. Cure is more likely the smaller the tumor still is.

Dutchwoman Sylvie van der Vaart is just one of many women to develop breast cancer. In 2002, breast cancer caused 2.4% of all deaths in Germany . t (Statista 2009).

Premenstrual syndrome (PMS) and pain during menstruation exclusively affect women for anatomical reasons. While menstrual pain is usually easily treatable . PMS symptoms can range from headaches to depression.

It is a well-known phenomenon: men in particular are affected by hair loss, partial or even complete baldness is often the result. It cannot be prevented, but it can be treated . e for cause, but often without success. The more advanced baldness is, the more difficult it is to reactivate hair growth.

21 percent of deaths in Germany in 2002 were caused by a heart attack. Thereby men are affected more frequently and also earlier, than women. The symptoms can . Distinguish: Men usually experience chest pain, shortness of breath and nausea. Women take symptoms like shoulder-. Abdominal pain or nausea in itself often perceived differently.

A major problem at present is the lack of specially trained pain therapists. "Often there is a six-month wait for an appointment." Doctors would be allowed to treat a maximum of 300 patients per quarter. "Moreover, a pain therapist who is a neurologist by training can only set up shop where there is a cash slot available for a neurologist at the moment."Because of the complex and lengthy care involved, pain physicians often find it difficult to take on new patients after only three or four years.

However, it is also important to pay more attention to the proper management of pain in the training of all medical professionals and also in that of nursing staff, Gobel emphasizes. There are major deficits in the knowledge of pain mechanisms and pain treatment among health professionals, according to a declaration of the International Association for the Study of Pain (IASP). In the case of cluster headaches, which mainly affect men and are extremely painful, about eight years pass before the correct diagnosis is made and effective treatment is started, Gobel cites an example.

pain patients always have to justify themselves

For many of those affected, however, life becomes a torment not only because of the pain itself, but also because of stigmatization. If someone breaks his arm, he is intensely pitied – even though nothing usually hurts him, says Gobel. People with chronic pain, on the other hand, have to listen to non-stop bad things and are severely offended.

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