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Widespread disease

This is why chronic pain is so difficult to treat

© Ortiz Many people with chronic pain often have depressed moods.

Nuremberg – Chronic pain is often unbearable and difficult to treat for those affected. Professor Winfried Meibner, president of the German Pain Society, explains the reasons.

Allegedly, at least one in four adults in Germany suffers from chronic pain. Are there really that many?

Professor Winfried Meibner: About 23 million Germans, or 28 percent, reported chronic pain in a survey. But not all of them require treatment. The number of chronic pain patients suffering from severe impairment and associated psychological problems is 2.2 million. This group usually needs therapy by pain specialists, combining different methods.

Winfried Meibner 59, Head of the interdisciplinary multimodal day clinic for pain therapy at Jena University Hospital. President of the German Pain Society since January. © Michael Szabo (UKJ)

How does pain become chronic??

Meissner: In most cases, they originally had a physical cause, but then took on a life of their own, so to speak. For example, back pain: for 95 percent, it's over after four weeks. For five percent, it remains – but not because the trigger, such as osteoarthritis, is particularly strong in them, but because other factors are added that make this pain chronic.

What are the factors?

Meibner: These are physical things, such as an altered immune system, but also many psychosocial risk factors, ranging from depression to anxiety to dissatisfaction at work.

Does it happen that no physical cause can be found??

Meissner: This is very rare. However, there are diseases like fibromyalgia that we have yet to really understand. In recent studies, it has been seen that in patients the wiring in the brain and also the immune system is somewhat different. A distinction must be made between mental illnesses, for example depression, which can manifest itself in the form of pain without any conspicuous findings.

Apparently, chronic pain is often accompanied by depression?

Meissner: We know that many people with chronic pain have depressive moods. In many cases, depression is the result. If the pain is treated, the depression also goes down. When depression is the primary psychiatric illness, people are often more sensitive to pain. Pain is in this case the consequence of the disease. It is an art to find out: Does the patient belong in pain therapy or does he primarily need psychotherapy? That's why it's so important to see experts from different disciplines, including psychotherapists and psychiatrists.

What is the impact of the pandemic?

Meissner: It is still very early to say something about it. In our outpatient pain clinic, we see three groups: For those who were already pain patients before the pandemic, there has been an intensification of the problems to some extent. We have people who say, for example, 'The distraction of drinking coffee with my neighbors falls away.' Comes in that some have not been able to keep their physical therapy appointments.

You see an indirect effect?

Meissner: So to speak. Then there are seriously ill covid patients who have been treated in the intensive care unit. We know from our own studies that about one third of all ICU patients suffer from pain six months after discharge. It's because of the long time they've been in bed and nerve damage that can occur. Then we have the third group: these patients were fit, then got covid and have been in pain ever since. That's probably not many. The main problems with Long-Covid tend to be exhaustion and fatigue.

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