Pain medicine | Specialists and information

It is only two and a half decades since pain medicine was officially established as a separate specialty in Germany. Compared to other European countries and the USA, this was quite late. Other specialties claimed the subject of pain for themselves because patients from these specialties (e.g. orthopaedics, surgery, neurosurgery) presented there with pain.

But what led to pain medicine being assigned its own field of work and now being widely recognized? It was the observation that the pain that became chronic over time no longer followed the laws of acute pain, that with increasing chronicity it could no longer be treated and changed with the methods used in acute pain treatment.

It is the distinction between acute pain and chronic pain that opened up and made necessary an independent field of work called "pain medicine". In retrospect, one has to wonder why it took so long for this realization. It is even more astonishing that three decades later this basic idea has still not gained widespread acceptance, with the fatal consequence that chronic pain is still mainly treated as acute pain and therefore incorrectly.

Find out more about the specialist field of pain medicine and the services of a pain doctor here - and find your pain specialist directly!

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Pain Medicine - Further information

Pain medicine: specialists for chronic pain

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).

Chronische SchmerzenAround 17% of all Germans are affected by long-term, chronic pain @ Art_Photo /AdobeStock

Pain medicine: the path to the optimal treatment strategy

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.

Therapeutic range of services offered by pain specialists

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.

Psychotherapie bei SchmerzpatientenIn 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

How do I find the best clinic or practice for pain medicine?

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.

What makes our doctors specialists in pain medicine?

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.

References

  • S1-Leitlinie "Chronischer Schmerz" der Deutschen Gesellschaft für Allgemeinmedizin und Familienmedizin: https://www.awmf.org/uploads/tx_szleitlinien/053-036l_S1_Chronischer_Schmerz_2013-10-abgelaufen.pdf
  • S2k-Leitlinie "Schmerzen" der Deutschen Gesellschaft für Neurologie: https://www.awmf.org/uploads/tx_szleitlinien/030-114l_S2k_Diagnose-nicht-interventionelle-Therapie-neuropathischer-Schmerzen_2019-09.pdf
  • S3-Leitlinie "Epidurale Rückenmarkstimulation" der Deutschen Gesellschaft für Neurochirurgie e.V.: https://www.awmf.org/uploads/tx_szleitlinien/041-002k_S3_Epidurale_R%C3%BCckenmarkstimulation_2013-07_abgelaufen.pdf
  • Deutsche Gesellschaft für Neuromodulation e.V. zur Neurostimulation: http://www.dgnm-online.de/patienteninfos/informationen-neurostimulation.php
  • Deutsche Gesellschaft für Neuromodulation e.V. zur intrathekalen Pharmakotherapie: http://www.dgnm-online.de/patienteninfos/informationen-pharmakotherapie.php
  • Deutsche Gesellschaft für Neurologie (DGN): www.dgnm-online.de/patienteninfos/informationen.php

[5, 8-10]

  1. Bushnell, M.C., et al., Effect of environment on the long-term consequences of chronic pain. Pain, 2015. 156 Suppl 1: p. S42-9.
  2. Jensen, M.P. and D.C. Turk, Contributions of psychology to the understanding and treatment of people with chronic pain: why it matters to ALL psychologists. Am Psychol, 2014. 69(2): p. 105-18.
  3. Tamme, P., Achtsamkeitsbasierte Schmerztherapie (ABST). Zeitschrift für Palliativmedizin, 2010. 11(05): p. P66.
  4. Tamme, P. and I. Tamme, Frei sein im Schmerz: Selbsthilfe durch Achtsamkeitsbasierte Schmerztherapie ABST. 2013: BoD–Books on Demand.
  5. Williams, A.C., Psychological therapies for the management of chronic pain (excluding headache) in adults. The Cochrane Library, 2013(2).
  6. Kuo, M.F., W. Paulus, and M.A. Nitsche, Therapeutic effects of non-invasive brain stimulation with direct currents (tDCS) in neuropsychiatric diseases. Neuroimage, 2014. 85 Pt 3: p. 948-60.
  7. Antal, A. and W. Paulus, Transkranielle repetitive Magnet- und Gleichstromstimulation in der Schmerztherapie. Schmerz, 2010. 24(2): p. 161-6.
  8. Zieglgänsberger, W. and S. Azad, Chronic Pain. Pathophysiology–New Therapeutic Targets.
  9. Müller, H., Neuroplastizität und Schmerzchronifizierung. AINS-Anästhesiologie· Intensivmedizin· Notfallmedizin· Schmerztherapie, 2000. 35(05): p. 274-284.
  10. Courtney Lee, M., * Cindy Crawford, BA,* and M. Anita Hickey, †, Mind-body therapies for the self-management of chronic pain symptoms. Pain Medicine 2014; 15: S21–S39, 2014. 15: p. 21-39.
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