Acute pain and chronic pain may feel the same, but they are two "completely different pairs of boots". Acute pain is a symptom of actual or impending tissue damage.
Chronic pain, on the other hand, is a disease in its own right that can be broken down into four characteristics:
1. chronic pain is associated with neuroplastic central nervous changes
Chronic pain is a secondary disease that has arisen as a result of inadequate (inappropriate) primary treatment of the initial pain.
On a physical level, neuroplastic changes are found in the area of:
- Pain recording
- pain transmission and
- pain processing
2. chronic pain is never physical or psychological, but always bio-psycho-social
Chronic pain is a bio-psycho-social process in which physical, psychological and social aspects of illness are present simultaneously. They reinforce and sustain each other.
With specialized pain medicine, there has been a shift from a dichotomous ("either or") way of thinking to a multimodal way of thinking.
3 Chronic pain goes hand in hand with psychovegetative changes
Chronic pain is accompanied by psychovegetative impairment, often in the form of psychovegetative exhaustion. The neuroplastic changes in the central nervous system do not directly trigger the perception of pain. These are experienced influences from the psychosocial and psychovegetative areas.
4 We are not defenceless against chronic pain
Chronic pain is not a hopeless fact and not a one-way street from the site of pain to the brain (bottom-up process).
It is the result of afferent (ascending) aspects that can modulate, change and soothe protective aspects (top-down mechanisms).
We are not defenceless against chronic pain. Since we have top-down mechanisms and psychological strategies, we have powerful tools to cope with it (coping mechanisms).
Around 17% of all Germans are affected by long-term, chronic pain @ Art_Photo /AdobeStock
With the knowledge of how chronic pain works compared to the ubiquitous and common acute pain, new therapeutic strategies have been developed.
While the focus with acute pain is on "getting rid of it", the guiding principle with chronic pain is: "...don't let pain become suffering...".
The primary goals are therefore
- Improving the quality of life
- Participation in social life
- Maintaining and improving social functioning
High demands on pain physicians
This requires a great deal of specialized knowledge that goes far beyond the requirements of a specialist qualification. For this reason, doctors can only begin training as pain specialists if they have a specialist qualification in the following areas:
In specialized further training, doctors learn and work very practically under supervision.
A practicing pain therapist must:
- Provide evidence of activity and success
- Pass an examination before the medical association
- Have a high level of equipment, facilities and personnel in the practice
- Hold interdisciplinary pain conferences,
- Undergo annual curricular training and
- Pass graded quality audits
These high requirements are the reason why there is a junior staff problem in the specialty and in the practices.
Before the pain specialist gets to the actual therapy, he asks himself a question with far-reaching consequences:
What is my patient's bio:psycho:social weighting?
If the ratio is 33:33:33, then there is an equal emphasis on:
- Physically oriented therapy approaches (e.g. injections, infusions)
- Psychological approaches (e.g. psychotherapies, hypnosis) and
- Social approaches (e.g. promotion of occupational rehabilitation, implementation in the workplace, granting of pensions)
Pain medicine has changed since the introduction of specialized pain therapy into the German healthcare system.
Initially, the focus was on the acute medical influences of the basic disciplines ("neurosurgeons operated, anesthetists injected").
In the meantime, there has been a sensitization to the psychological aspects of the field. More and more pain therapists went back to special training as psychotherapists.
It became clear that pain therapy could not do without specialized psychotherapy. And modern psychotherapy cannot do without neuromodulation with stimulation and infusion procedures (rTMS, tDCS, ketamine infusions). The consideration of all aspects is called modern pain therapy today.
In psychotherapy, the pain patientlearns to recognize their own behavioural patterns in dealing with stress and pain and to change them in small steps @ VadimGuzhva /AdobeStock
Finding the "best clinic" or "top clinic" for pain medicine is not possible, as specializations and areas of practice are significant.
The "Leading Medicine Guide" has identified and awarded the industry leaders in an elaborate selection process. The Leading Medicine Guide Certificate guarantees multimodal and interprofessional work at the highest level under constant quality control.
Only selected, highly qualified medical experts and specialists are presented in the Leading Medicine Guide. All pain medicine specialists have a high level of professional expertise and excellent experience in the field of pain medicine.