Pain is a life-saving signal – but it can also be hell. Researchers are now gaining a better understanding of the mechanisms involved. This is why patients now have to help more with the therapy.
Depression, loss of work, social withdrawal: pain that lasts for years can take over a person’s life in such a way that all being and thinking revolves around him. According to estimates, more than ten million people in Germany alone suffer from chronic pain.
“Pain has become a disease of the people,” says Hartmut Göbel, professor and chief physician at the Kiel Pain Clinic. One reason alone is the growing percentage of older people. “From a certain age all have pain.
Head, stomach, back, knee, hip and general pains of the musculoskeletal system lead the list. “A large part of the medical system is concerned with nothing else than the direct or indirect fight against chronic pain,” writes medical author Harro Albrecht in his current book “Schmerz”. Pain is a problem for the whole community, says Göbel. Also financially: Early retirement and inability to work of pain patients cause immense costs. Although there are now pain centres and more and more specialised doctors, the care structure is far from ideal.
An antiquated picture of pain
One reason is that political decision-makers, but also physicians and patients, often still have an outdated picture of the phenomenon of “pain”. “According to this one-dimensional model, a stimulus is transmitted via a nerve to the pain centre of the brain and the pain is perceived,” explains Göbel. “If the cause of the stimulus is eliminated, everything is fine again.”
However, the equation “no stimulus – no pain” does not work. In fact, pain is an extremely complex phenomenon.
There is innumerable evidence for this. For example, that placebo effects and hypnosis can considerably influence the perception of pain. That some people continue to feel pain even after successful therapy of the trigger – or that from the outset no organic reason for their suffering can be found. That fakirs and medicine men can suggestively induce themselves not to perceive any more pain. Or that amputees have phantom pain in missing limbs.
Psychological aspects come to the fore
“At least as important as the concrete stimulus are factors such as one’s own assessment of pain, social aspects and the working environment,” explains Göbel. In stressful life situations, the risk of developing chronic pain is 13 times higher. With humans with a load disturbance after a traumatischen experience the pain defense forces are sometimes no longer at all applicable. “They can no longer cope with even minor pain.”
To the astonishment of many scientists, brain analyses have shown that mental pain is present in the same ways and structures as physical pain, explains Göbel. “That cannot be separated at all.
The extent to which the psyche influences the perception of pain was recently impressively demonstrated by a study: people were exposed to heat stimuli that varied in strength for more than ten minutes. After only a short time, the pain has very little to do with what happens objectively, the researchers report in the specialist magazine “Cerebral Cortex”. The participants felt changes in pain, although the objective heat stimulus remained unchanged.
Placebos can also cause pain
“If a pain persists over a longer period of time, it obviously changes from a pure process of perception to a very emotional process,” says Markus Ploner of the Technical University of Munich. “Our results indicate this: The longer pain lasts, the more emotions you develop.”
The researchers also showed the influence of an ineffective placebo cream: if it was rubbed on the back of the hand, the participants stated that they had less pain. Conversely, this effect could also explain why some pain patients do not even respond to strong medications: “They have the negative expectation: nothing helps with me. This is how they experience it.
Göbel explains that chronic pain often starts with a concrete stimulus. “A strain in the back, for example, because I tense up, covered with too much work by the boss.” Over time, just going to the office is enough to cause pain, even without an actual muscle problem. “Conditioning causes chronic pain.”
Pain therapy in clinics is “fatal”
Already with children and young people the fear of certain teachers or school subjects can intensify pain, which coincidentally just were there and would have gone away otherwise again. In such cases, the fact that parents do not send their child to school is an aggravating factor – a reward that supports the chronification of pain.