Could be chronic pain in your head

Chronic Pain: What is Pain?

In medicine, pain is described as an uncomfortably perceived sensory and emotional experience that is related to possible or actual damage to the body or tissue. Pain should therefore warn us of potential injuries or make us aware of them. When it comes to pain, a distinction is made between acute, temporary and chronic pain. H. persistent pain.

How does pain arise?

Pain can arise in two ways: on the one hand through external influences such as injuries, pressure, stretching, heat and cold and on the other hand through internal complaints such as inflammation of organs or muscles and through disorders of the nervous system. It is important to mention that pain does not arise in the brain, but in the respective part of the body. The brain has no pain receptors and is therefore insensitive to pain. Organs, muscles and other parts of the body have special receptors (nozi receptors) that respond to temperature, pressure, injuries and stretching. These pain receptors pass the information on to the brain via the spinal cord, where these pain stimuli are processed and interpreted as pain.

However, not all pain stimuli are passed on to the brain. If we put our hands on the stove top or cut our fingers with a knife, we automatically pull our hand away from the pain reliever. This physical reaction happens so quickly that the brain did not have enough time to analyze and evaluate everything. The body reacted reflexively to the pain stimulus. This reflex is controlled in the spinal cord and is intended to provide quick emergency help in the event of pain stimuli. With such reflex reactions, no pain is consciously perceived at the moment because the brain has not yet been able to process and interpret it. The throbbing pain in the cut finger only sets in after a short time, when certain areas of the brain have registered the injury.


Pain is not always pain

Pain is perceived and assessed differently by each individual. Thus the pain intensity and reaction to it are subjective. In extreme situations, the brain also specifically suppresses pain so that the body can continue to function. Only after the situation or the stress is over and the organism relaxes does the pain consciously spread.

Psychosomatic pain shows that pain cannot only have physical causes. They do not have a physical cause, but a psychological one, which manifests itself in physical pain. The psychological state of the human being therefore plays a decisive role when it comes to pain. Positive feelings can reduce pain, and negative feelings can make people more sensitive to pain.

In psychosomatic pain, the pain no longer fulfills its original function, that of the warning system. The same applies to chronic pain. There the pain has completely lost its warning function and can therefore be diagnosed as an independent disease.

Phantom pain

Phantom pain is a special form of pain that can be traced back to a neuronal change in the brain. Those affected experience pain in parts of the body that are no longer present, for example in the case of an amputation. In addition, 60 - 80% of people with amputations experience pain such as twitching, tingling and touch sensations in the respective body parts.

The brain has its own map of the body in the sensorimotor cortex, in which the respective sensations are represented. Although a part of the body is no longer physically present, the representation in the sensorimotor cortex still exists. The brain restructures itself after an amputation and receives stimuli from adjacent areas of the body. These stimuli are connected to the amputated body part, which leads to touch and pain impulses. If pain was already perceived in the respective body region before the amputation took place, the central pain memory of the brain takes effect. This pain memory is stimulated during the neuronal restructuring of the sensorimotor cortex, so that pain is projected into the missing part of the body and thus phantom pain is formed.

Neuropathic pain

Stimuli and signals are sent in our bodies via nerve fibers. If these nerve fibers are damaged, pain can also arise here. Neuropathic pain feels different from physical pain, such as B. cutting the finger. In contrast, each of us knows the funny bone (the soft spot above the elbow) and has bumped it before. The pain that this creates is electrifying and tingling. The same applies to pinched nerves that can result from tension or misalignment. Affected people often find it difficult to localize the origin of the pain because the nerves that trigger the pain provide incorrect information. It can happen that damaged nerve fibers simulate pain in places that are completely different. In everyday life we ​​often talk about the pain "radiating" to another part of the body or region. Phantom pain that occurs after amputations is a good example of this, as the painful part of the body no longer exists, but the damaged nerve fibers still transmit impulses to the brain.


Fibromyalgia - when the whole body aches

Fibromyalgia syndrome (FMS) stands for fiber muscle pain and describes an increased pain perception throughout the body. The muscles and tendon attachments in particular are particularly intensely affected. The pain can come in intermittent attacks that can often last for several days. In addition, those affected experience a persistent state of exhaustion and tiredness as well as difficulty concentrating and sleeping.

It is typical for patients with fibromyalgia that they react particularly sensitively to pressure on certain parts of the body. These so-called "tender points" are also used in diagnostics.

In Germany around 3% of the population are affected by FMS. The disease occurs mainly in middle-aged women.


Psychosomatic pain

Pain such as a graze on the knee or a sprained wrist are easy to understand and clear indicators of an organic injury to the body. Here the pain clearly indicates to us that the tissue has been damaged and that we should react to it.

However, there is also pain that occurs even though there is no organic damage. These pains are often indicators of psychosomatic, i.e. psychologically-related, problems. The resulting physical pain can be seen as a consequence of psychological processes that express themselves in this way, e.g. B. headache or backache can be indicators of excessive stress.


Chronic Pain - The Pain Memory

If pain occurs over a long period of time, it can become chronic, i. E. H. remain uninterrupted. Chronic pain is caused by biochemical and physiological changes in pain receptors in the spinal cord and brain. These changes ensure that pain impulses are constantly formed and passed on to the brain. These stimuli leave traces in the central nervous system and further increase the sensitivity of the perceived stimulus. Unfortunately, it is not yet possible to erase the pain memory, so therapies aim to learn how to deal appropriately with the perceived pain instead of causing physiological changes in the brain substance.


How common is chronic pain?

Chronic pain is very common in Germany. According to statistics, between 10 and 12 million people in this country suffer from chronic pain.

The most common chronic pain conditions include:

  • Back pain
  • muscle pain
  • Headache migraine
  • Osteoarthritis (joint pain)
  • Rheumatism (rheumatoid arthritis)
  • Nerve and tumor pain

Despite the high number of people affected, many pain patients are not treated adequately or inadequately. It takes about 8 years on average for an affected patient to start the pain therapy they need in a clinic (outpatient or inpatient) or specialized practice.

The pain experienced can be so intense that over 500,000 sufferers would have to receive strong pain medication (level 3 opioids: morphine, fentanyl, oxycodone, buprenorphine and hydromorphone). Level 3 opioids are so potent that they fall under the Narcotics Act in Germany. Instead, the required medication is only prescribed to around every 10th person affected.


Treat pain

In order to treat the multitude of different pains, which also differ in their severity and intensity, there are numerous therapy options. Whether medication, targeted acupuncture and nerve stimulation or relaxation exercises as well as behavioral and psychotherapy, the right treatment must be selected and adapted individually to the suffering of the person concerned. In general, a multimodal pain therapy approach is chosen for patients with chronic pain and fibromyalgia. This means that the therapeutic measures come from different medical fields and are combined with one another. Since permanent pain has an impact on one's own mood and can also affect other areas of life, such as B. to make sleep noticeable, psychotherapy is also used in the multimodal approach. Above all, cognitive behavioral therapy, in which those affected learn which thoughts and behaviors intensify, influence or change their own pain, is used in pain treatment.

Recommendations and pain relievers

The World Health Organization (WHO) has developed a step-by-step scheme in which recommendations for the use of drugs in pain therapy are to be regulated. These levels differ with regard to the subjective pain perception (the intensity of the pain experienced, the type of pain and with regard to the place of origin) of the person concerned and the aim is to achieve freedom from pain as quickly as possible and to avoid chronification of the pain. The WHO divides pain therapy into 2 phases. The first phase, the initial therapy, should bring about relief of the pain symptoms as quickly as possible. The maintenance therapy should then ensure that the pain-free state remains. The WHO level scheme is a recommended guideline, from which the attending physician can deviate in individual cases.

Non-opioid pain relievers

Non-opioid pain relievers include pain relievers that are used to relieve mild to moderate pain. These include:

  • Nonsteroidal Anti-Inflammatory Drugs (SNAR) - do not contain cortisone
  • aniline
  • Pyrazolones

Non-opioid pain relievers do not act directly on opioid receptors in the central nervous system; instead, they reduce the pain receptors' sensitivity to pain or inhibit the production of inflammatory hormones. These hormones, the so-called prostaglandins, trigger the actual pain sensations on the receptors and nerves. Non-opioid pain relievers therefore do not fall under the Narcotics Act and are freely available.

Opioid pain relievers

Opioid pain relievers are based on opiates, so that these remedies are used for stronger pain. Depending on the severity of the pain, different intensities of painkillers are selected or combined with one another. These include:

  • Morphine
  • Fentanyl
  • Oxycodone
  • Buprenorphine
  • Hydromorphone

Opioid pain relievers work by directly occupying or blocking the opioid receptors in the central nervous system. These receptors are mainly located in the spinal cord and brain and form interfaces between nerve cells. By blocking these interfaces, the pain impulses sent by the nerve cells cannot be passed on or interrupted. Since opioids fall into the class of narcotics, they are subject to strict regulations and require a prescription.

Acupuncture and nerve stimulation

In the treatment of chronic pain, methods are used with which nerve fibers are stimulated mechanically or electrically in a targeted manner. Acupuncture is a method from China that is more than 2000 years old, in which needles are inserted into the skin in certain parts of the body. There are 359 known acupuncture points on the human body, of which 10-20 acupuncture points are stimulated by needles for 10-30 minutes in one session. This method is intended to inhibit the neuronal transmission of the pain stimulus and stimulate the body to release happy endorphins such as dopamine.

Acupressure for pain

Instead of needle pricks, acupressure uses targeted massages to treat the acupuncture points associated with the pain stimulus. To do this, press the corresponding point with your fingertips for a few seconds. This pressure exerted at certain points is supposed to stimulate the underlying nerves positively.

Transcutaneous electrical nerve stimulation (TENS)

The transcutaneous electrical nerve stimulation takes place via electrodes that are attached to the skin. Weak electrical impulses are sent through them to the painful regions, which are intended to stimulate the nerves and nerve roots present there. Despite the use of electrical impulses, this method is not painful and can suppress pain for several hours. In addition, this method can also be carried out independently with the aid of technical devices, so that a visit to the doctor is not necessary every time.

Relaxation therapies

Relaxation techniques such as Jacobson's progressive muscle relaxation or autogenic training are effective and popular methods for relieving muscle tension and ensuring peace and balance. Regular use of these techniques can also have a positive effect on one's own pain perception. Relaxation therapies are used as additional methods of holistic pain therapy.

Behavioral therapies

Chronic pain and fibromyalgia have a direct impact on the person's quality of life. The pain causes secondary diseases and disorders that can also have a negative impact on mental health. Sleep disturbances, anxiety and loss of physical performance are common side effects of chronic pain. But interpersonal relationships, work, hobbies and free time are also significantly impaired by chronic pain.

For these reasons, cognitive behavioral therapy is included in the multimodal treatment of pain patients. In this form of therapy, those affected learn to deal with their pain and the thoughts and feelings associated with it. People who suffer from chronic pain or fibromyalgia develop fears about certain movements that can trigger pain. For this reason, they limit their activities, withdraw and lose hope of improvement more and more. A vicious circle of fears, pain, sleep disorders, hopelessness and increasing physical discomfort emerges. This is where cognitive behavioral therapy can come in to break these behavioral habits and improve the quality of life of those affected.

Physical therapy

Physically therapeutic measures such as physiotherapy, physiotherapy or thermotherapy are used in particular for acute pain in the muscles, joints and tendons. In the case of chronic pain, physical therapies complement the holistic treatment of the patient. The aim of physical measures is to make stiffened joints more flexible, to train stabilizing muscle groups, to train general physical resilience, to stretch muscles and tendons, to promote blood circulation, to loosen adhesions in the connective tissue and to relax the muscles. All of these measures are intended to relieve pain and contain its occurrence.


HelloBetter Training: Chronic Pain

At HelloBetter, we offer a specially developed multimodal training against chronic pain, the effectiveness of which has been proven by 3 large-scale scientific studies. In these studies, a sustained reduction in pain perception and a reduction in accompanying depressive symptoms could be demonstrated after completion of the training. The training is aimed at all people who suffer from chronic pain and want to learn tested methods to better deal with pain. In appealing texts, videos and audios, proven psychological techniques are conveyed that serve to improve one's own quality of life. A trained psychologist accompanies you throughout the entire training. The program can be flexibly integrated into your own everyday life so that you can access it independently at any time.