Pain tormenting, torturing, throbbing or stabbing. Sometimes they sting, burn, press, tingle or electrify. Many words are suitable to describe pain, because everyone feels and experiences it differently. Despite the variety of terms, one commonality can be found: pain fulfills a function. It signals: "Be careful, there is something wrong here."
Because normally it hurts when the body is threatened with damage – by external influences or illnesses. The importance of this function can be seen in those people who do not perceive pain at all or hardly at all. For example, diabetes: If the diabetes progresses, the nerves in the feet often no longer function. Such a polyneuropathy can make the feet insensitive to pain, lead to deformed toes as well as chronically infected wounds.
How pain arises
The alarm signal pain takes its origin in skin and organs. There the human body has special feelers, the nociceptors. They emit electrical impulses when exposed to cold, heat, electricity, certain chemical substances or high prere. Or in the case of injuries. The signals from the nociceptors are transmitted to the spinal cord via special pain fibers and processed there.
Reflexes can be triggered via the switching point in the spinal cord: For example, it activates those muscles that pull the hand from the hot stove top. The affected person does not yet perceive any conscious pain in the process. This only happens after the signals from the spinal cord have reached the brain and stimulated several control instances in the cerebral cortex, diencephalon and brain stem.
What influences the perception of pain
The many circuits and processing procedures influence the perception of acute pain. Not only the current state of mind plays a role here. Previous pain experiences are of great importance. This is because this information alters the nerve cells of the brain and spinal cord that inhibit or amplify incoming impulses and thus influence perception. The power of these countless agents of pain becomes apparent not least in exceptional situations: If, for example, athletes are injured during a competition, they often do not feel any pain, even in the case of serious injuries. The discomfort only becomes noticeable after exertion.
Injuries to the skin or mucous membrane, muscle trauma, bruises, broken bones or even operations activate the pain sensors in the tie and generate so-called somatic pain. If the cause lies in an organ, doctors refer to the complaints as visceral pain. This is the case, for example, with pancreatitis, tumors or a heart attack. Acute pain often requires immediate action: For example, a sprained ankle should be relieved, cooled, bandaged and elevated (PECH rule). A wound on the finger should be disinfected and treated with a plaster or bandage, depending on its type and size.
When pain becomes chronic
Pain does not always disappear. Sometimes they stay for weeks, months or even years – or they come back at regular intervals.
"The causes of chronic pain differ considerably", says Professor Christoph Maier, Head of the Department of Pain Medicine at the Berufsgenossenschaftliches Universitatsklinikum Bergmannsheil in Bochum, Germany. Sometimes they are based on a permanent irritation of the pain sensors (nociceptor pain). This is the case with certain chronic diseases such as rheumatoid arthritis, wound pain or abdominal cramps (colics).
Neuropathic pain
Damage to the nerve fibers that transmit pain signals can also be responsible for persistent pain. If the fibers are damaged or compressed at one point, they lose their function and constantly send out impulses. Those affected describe this neuropathic pain as tingling, electrifying or shooting in. It is often difficult to locate the pain precisely. Because the damaged nerves provide incorrect information.
They deceive the affected person, so that he or she often does not feel pain at the actual site, but somewhere else. An extreme example is phantom pain after an amputation: Here, patients feel pain in a part of the body that is no longer there. Neuropathic pain can also occur in the course of diabetes (diabetic neuropathy), in the case of herniated discs as well as after nerve inflammations such as shingles (herpes zoster) or after a stroke.
Nociceptor pain and neuropathic pain overlap in many clinical pictures. This is especially true for tumor pain.
Malfunctions and psychological stress
Another possible cause of chronic pain is dysfunctional control systems. Example of back pain: this often begins with the dysfunction of a muscle, a muscle tension. This causes further tension, which in turn increases the pain. Complex regional pain syndrome (Sudeck's disease) is based on a control error of the autonomic nervous system. In migraine attacks, the blood flow in the brain is probably disturbed; in tension headaches, the function of the neck muscles is probably disturbed.
For some chronic pain, on the other hand, no plausible explanation can be found despite all examinations and tests. This is especially true for some forms of persistent gastrointestinal complaints, heart or even low back pain. In such cases, it can be helpful to consider psychological stress as well as stress in the professional and private environment as the cause (psychosomatic pain).
The "pain memory
In some patients, the pain takes on a life of its own and becomes a problem in its own right. Doctors speak of chronification, patients often of pain memory. This popular term is used to describe the biochemical and physiological changes at receptors in the spinal cord and brain that cause constant pain. But contrary to what many patients ame, effective pain therapy is not about reversing the changes in the brain and thus erasing the pain memory that supposedly exists. Rather, sufferers should primarily learn to live with the pain and deal with the fear of it.
A multimodal approach has proven to be helpful, in which the therapy rests on various, individually tailored pillars. In addition to medication (painkillers), psychotherapeutic methods (behavioral therapy, individual and group therapy, relaxation methods), physiotherapy (e.g. massage, physiotherapy, lymphatic drainage, heat and cold stimulation, electricity), sports and occupational therapy and complementary methods (e.g. phytotherapy, acupuncture) are used.