Is old age really that painful?

Multimodal Therapy: Treating Chronic Pain

Status: 03/12/2021 5:25 p.m.

Pain is an individual experience. They are felt differently from person to person and from situation to situation and can become chronic. Multimodal pain therapy can help.

It has been scientifically proven that inadequately treated acute pain is one of the most important risk factors for developing chronic pain. Pain is chronic if it lasts for more than three to six months. According to the German Society for the Study of Pain, more than twelve million people in Germany live with chronic pain. Those affected often go through years of suffering before they actually find help.

The starting point for chronic pain are often diseases or poor posture of the musculoskeletal system such as muscle tension, osteoarthritis, osteoporosis and rheumatic diseases. Tension in one part of the body such as the pelvis can have a strong impact on the legs and back, sometimes up to the cervical spine.

Chronic pain reduces the quality of life

But also nerve pain - so-called neuropathic pain - as a result of operations, injuries, metabolic diseases or cancer can permanently impair the quality of life. The pain can occur in any area of ​​the body. The legs, hands, head and gastrointestinal area are often affected.

Chronic pain disorders also include fibromyalgia syndrome and complex regional pain syndrome (CRPS). In addition, pain can be the leading symptom of a mental illness.

This creates a spiral of pain

Acute pain is said to help the body. They signal: "Warning - something is broken." Several regions in the brain assess how intensely we perceive the pain. But if acute pain persists for months and is not properly treated, it can develop into chronic pain. You have lost the original function of pain as a warning sign of physical harm. Instead, they have become a disease of their own.

Persistent pain makes the nerve cells, the spinal cord and also the brain more sensitive to pain stimuli. The result is that even light stimuli are perceived as pain. In the course of the disease, a pain memory (central sensitization) develops, which persists while the actual cause of the pain is no longer present. A self-reinforcing mechanism is created - a spiral of pain.

Stress, social isolation, and depression can all result

The pain-related inactivity often leads to social isolation. Affected people lose their zest for life, avoid contacts, suffer from stress or even depression. At work, too, people with chronic pain quickly get sidelined - many are threatened with job loss or even early retirement.

The risk of chronic pain increases with age

Older people often complain less about their pain than young people. The widespread belief that pain is normal in old age means that it is rarely treated appropriately. Age-related changes in the brain, in turn, influence the perception of pain: the pain threshold is increased in old age, while pain tolerance is reduced.

Treatment with a multimodal therapeutic approach

Although chronic pain is recognized as a disease in its own right, it is often difficult to find the way to a specialist. Those affected must also be aware that therapy can be lengthy and difficult.

Pain can have different causes - physical as well as psychological.

In the meantime, so-called multimodal pain therapy is becoming more and more established: Several medical disciplines work closely together and try to find out what is acute and what is chronic pain and what the appropriate therapy looks like. Ultimately, treatment procedures from different specialist areas are intertwined, just as pain often has several, very different causes - physical as well as psychological.

In multimodal therapy, drug treatment, physiotherapy, manual therapy, massages, psychotherapy, occupational therapy and relaxation therapies such as meditation or progressive muscle relaxation can be used. If outpatient therapy is unsuccessful, an inpatient stay in a pain clinic can make sense. The central aim of treatment is to improve the quality of life - if necessary with the pain, which in many cases never completely disappears.

Individually adapted training

Physical training is particularly important, especially in the case of joint diseases or muscle tension. It should be adapted to the individual capabilities of the individual. In addition to flexibility, it is important to train strength and endurance as well as coordination and balance. The right amount of tension and relaxation is important.

Psychological measures, such as relaxation procedures, conversation therapies and aids in coping with the pain, support the therapy. In addition, social training can help find the way out of isolation and back into everyday life.

Discuss the use of pain medication with a doctor

Pain medication can actually make chronic pain worse. Opiates, for example, help with severe acute pain, but lose their effectiveness over a longer period of time. Those affected slowly become dependent and suffer from side effects in everyday life.

The long-term use of pain medication should always be under the supervision of a doctor and, if possible, be accompanied by physiological and, if necessary, psychological therapies. The task of painkillers is to permanently dampen the pain intensity and thus make the pain a little more bearable. Consequently, regular intake is strongly recommended. Pain reduction is often a prerequisite for exercise training and is therefore particularly important to counteract the causes.

However, great caution is advised when taking over-the-counter pain relievers, so-called nonsteroidal anti-inflammatory drugs (NSAIDs) - such as acetylsalicylic acid (ASA), diclofenac and ibuprofen. Long-term use can lead to significant side effects such as stomach bleeding and liver and kidney damage. In addition, pain medication must be carefully matched with other required medication to reduce the risk of unwanted side effects.

Experts on the subject

Dr. Jan-Henrich Stork, Head of Anesthesia and Intensive Care Medicine
Wiebke Turner, sports scientist
Dr. sc. hum. Sandra Kamping, graduate psychologist, psychological psychotherapist (VT)
Hospital Tabea GmbH & Co. KG in the Artemed clinic network
Koesterbergstrasse 32
22587 Hamburg

Dr. Wolfgang Wabbel, chief physician
Pain Therapy Department
Lubinus Clinicum
Steenbeker Weg 25
24106 Kiel


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