Many patients do not perceive chronic pain as such, which is why they often do not see a doctor. Basically, all pain that lasts longer than two weeks should be taken seriously. Self-therapy with painkillers should be avoided, because chronic pain can have serious causes.
What is Chronic Pain?
According to DigoPaul, pain is usually a protective function of the body in order to perceive physical disturbances. If chronic pain occurs, it sometimes persists without a physical cause.
The pain has then separated from the physical in its chronic form and continues to exist. Pain can be categorized on the basis of different characteristics, for example according to the origin or the nature of the pain. Chronic pain can be permanent or it can stop from time to time and return later.
Depending on the place of origin, a distinction is made between somatic pain in the muscles, joints or skin, neuropathic pain, synonymous with nerve pain, pain in the head area and pain in the internal organs. One speaks of chronic pain if it lasts for at least three months and the person is impaired in their everyday life.
Chronic pain is based on the independence of the nerve impulses. In severe injuries, nerve cells send impulses to the brain over a long period of time and this can change their metabolism. One speaks of the pain memory of the nerve cells. This incorrect polarity occurs in the spinal cord.
As a result, many stimuli, such as normal touch, cold or warmth, are perceived as painful. The same applies to psychological stimuli such as stress, grief, fear or the memory of pain. Other causes can be diseases such as rheumatism, herniated discs or severe inflammation.
Symptoms, ailments & signs
Chronic pain does not differ in its place of origin from pain that occurs acutely. Rather, in the case of chronic pain, the duration of its existence defines that the accompanying symptoms are considered to be chronic. A distinction must be made between attacks of recurring pain and persistent pain. It is typical of chronic pain that it persists over a long period of time. The severity of the pain can be just as different as the location of the pain.
The symptoms of chronic pain can be many. They depend on the underlying problem. This can be due to the operation or for other reasons. As a preliminary stage of chronic pain, acute burning, stabbing or dull pain can occur. These do not respond (sufficiently) to symptomatic treatment or keep recurring.
The symptoms of chronic pain take on a life of their own after a while. They are stored in the pain memory and, after becoming chronic, form an independent disease. Depending on the extent of the chronic pain, a pain syndrome can develop. With chronic pain, individual symptoms are often no longer perceived as such.
In the case of chronic back pain, only a complex pain sensation is perceived instead of individual strained muscle strands. If the pain can be assigned to a nerve, it is a neuralgia. Severe chronic pain can be accompanied by symptoms such as edema formation, circulatory disorders, sweating, depression or withdrawal from normal life.
Diagnosis & course
Diagnosis is time-consuming because the forms of chronic pain are very diverse. Exceptionally differentiated diagnostics are essential to find the right therapy.
The diagnosis includes the obligation of the patient to keep a pain diary. It records all the situations in which the pain occurs, and notes all the symptoms that accompany the pain. In some cases it can make sense to check the patient’s medical record for previous findings and to take a closer look at the living situation.
Often times, feelings and relationships influence the perception of pain. In addition, the patient fills out a scale for the intensity of the pain. This is accompanied by a thorough, physical, neurological and orthopedic examination, ultrasound, CT or magnetic resonance imaging and, if necessary, neurophysiological diagnostics.
In the case of chronic pain, complications can primarily arise if the patient treats them himself over a long period of time with the help of painkillers. Usually the pain relievers damage the stomach in the long run and should not be used over a long period of time. The further complications, however, depend heavily on the cause of the pain and can never be universally predicted.
In general, however, pain reduces the quality of life. The person concerned can no longer actively participate in social life and often suffers from psychological complaints. Pain also leads to stress and an aggressive attitude. It is not uncommon for pain to spread from one point to different regions and can also lead to discomfort and pain in unaffected areas.
The pain often leads to restricted mobility or other restrictions in everyday life. The treatment of the pain is always causal, but can primarily aim at relieving the pain. In many cases, therapy is needed to manage the pain.
It is not uncommon for physical treatment to be supported by psychotherapy. Whether the life expectancy will be reduced by the chronic pain cannot generally be predicted.
When should you go to the doctor?
Chronic pain, which can originate from different structures or organs of the body, is not always a reason for a regular visit to the doctor. Whether it makes sense to consult a doctor depends heavily on the individual case.
An initial visit to the doctor is primarily important to determine the cause of persistent pain and to find out about suitable forms of therapy. This serves, on the one hand, to ensure a possible diagnosis and, on the other hand, to enable the patient to act when the pain occurs.
If a cause has been found or the patient is well prepared for treating the pain, a further visit to the doctor is often not necessary. This is often the case, for example, when a helpful drug has been found for migraines or the chronic pain is not too severe and can even be alleviated with home remedies that do not have side effects.
A visit to the doctor is always advisable if the quality of the pain changes or if the treatment options currently available to the patient do not or no longer help. The species has several options here. A visit to the doctor often begins with an extensive examination to determine whether something has changed organically. Thereafter, the therapy can be changed or alternative healing methods can be included. In severe cases, a further visit to the doctor for chronic pain leads to a referral to a specialized pain therapist.
Treatment & Therapy
Chronic pain management targets the cause and the factors that make the pain worse. It can be achieved through medication, physiological, psychological, and social methods.
Medicines interrupt the faulty transmission of pain impulses. At the same time, the patient’s perception of pain is changed. Nonsteroidal anti – inflammatory drugs are used for mild pain, and opioids for moderate, severe and very severe pain levels. Some pain sufferers are dependent on pain medication.
In these cases, drug-induced pain may have occurred and withdrawal occurs. Depending on the type of pain, in some cases anticonvulsants or antidepressants have an analgesic effect. Anti-epileptics are often prescribed for nerve pain.
Treatment forms that can complement drug therapy are:
- Transcutaneous electrical nerve stimulation
- Autogenic training and exercise therapy
- physical therapy
- Local anesthesia
- Change of lifestyle
Outlook & forecast
Chronic pain is a permanent or recurring condition and its prognosis therefore depends on the pain therapy. In addition, the course of chronic pain depends on the underlying condition.
In the case of degenerative diseases that can no longer expect a cure, chronic pain usually worsens at the same time as the disease progresses. If, on the other hand, the chronic pain is due to a disease that can still be influenced in its course, then it can definitely get better again. If, on the other hand, they can be traced back to a permanent physical change such as the loss of a body part, the pain can also become permanent and require pain therapy.
In the meantime, modern medicine knows many effective chemical pain relievers that are suitable for at least a short period of time to combat pain. In the long term, on the other hand, pain therapy provides methods that are not based on medication, because many highly effective painkillers become dependent over time. If a patient with chronic pain is dependent on medication for a longer period of time, then in addition to pain, drug dependency and thus another problem that requires treatment can arise.
In the long term, the treatment of chronic pain is mainly about finding methods for the patient with which he can learn to endure pain or switch it off without causing unnecessary damage to the body or becoming dependent on medication.
In principle, exercise cannot do any harm to prevent chronic pain. Furthermore, it is important to take long-lasting pain seriously and to consult a specialist instead of combating it in self-therapy. Perceiving your own needs can also be important. Know what is generally good in life and what is better to avoid, where there are social or personal problems.
Depending on the type and intensity, the doctor will choose a treatment. It should eliminate possible complications and support the patient in his everyday life. The causes of chronic pain can usually not be remedied in this way. Therefore, follow-up care cannot aim to prevent recurrence.
After an initial diagnosis, the patient presents himself in an agreed rhythm. In the discussions, the experiences with the initiated measures are discussed above all. The improvement of the symptoms plays a decisive role in the further departure. Certain examinations are able to document the progress depending on the clinical picture.
Blood tests, imaging procedures (x-rays, ultrasound, CT) and neurological or internal medicine methods are all suitable. Medication can also arise. If necessary, a rehabilitation measure can be ordered. In this, those affected learn techniques how to deal with chronic pain in everyday life.
Relaxation exercises such as yoga, autogenic training or meditation support coping with the problem. In some cases, rehabilitation also introduces acupuncture or psychological support, which can then be continued at home. A rehabilitation measure does not have to be a one-off event. It can even prove useful several times.
You can do that yourself
The perception of pain is strongly influenced by the psyche, in particular by the importance attached to pain and how much attention is given to it. Especially with mild to moderate chronic pain, it can therefore be helpful to concentrate on something else in everyday life.
These can relaxation techniques such as yoga or autogenous training contribute. Anyone who is no longer employed should look for a fulfilling hobby or get involved in charity. The distraction generated in this way means that chronic pain is no longer the focus of one’s own perception. It also helps many patients to exchange ideas with other affected persons. There are self-help groups on site or on the Internet for this purpose.
Depending on the cause of the chronic condition, simple home remedies can also help. Heat is often very effective for nerve pain. Nerve pain is therefore treated with a red light lamp or, very traditionally, by placing a hot potato wrapped in a towel on top. Bathing in warm brine helps many patients with rheumatic complaints. Brine baths are offered in many health resorts. At home, salt from the Dead Sea can be used for bathing, which is available in pharmacies, health food stores and drug stores.
In naturopathy, a number of mild herbal remedies are also used. For rheumatic diseases and gout, preparations with devil’s claw are prescribed. Tea made from willow bark is used as a mild pain reliever. Chronic pain in the mouth and jaw area is treated with clove oil.