Interview: What is pain?

If we bump our heads or accidentally touch a hot plate, we feel pain. Pain is a warning signal of our body, which indicates that something is wrong. Univ. Prof. Dr. Frank Birklein, Professor of Neurology and Neurological Pain Research at the University of Mainz Medical School, explains in an interview what pain is, what is the difference between acute and chronic pain, and what can be done specifically to help against back pain and headaches.

What is pain?

Birklein: "According to the International Association for the Study of Pain (IASP), pain is an unpleasant sensory or emotional experience that is accompanied by actual or potential tissue damage, or is described by individuals as causing such tissue damage . '

The definition implies that pain does not always have to have a clear structural cause, but can also occur for no apparent physical reason. The causes of pain can be harmless, but also extremely serious. "

Some pains are boring, others stinging or burning. How do these different pains come about?

Birklein: "Why exactly there are different forms of pain is not yet fully understood, but we know that several factors play a role:

  • The place of origin: Depending on the place of origin, we perceive pain differently: pain in the muscles, for example, are more likely to be felt as pulling or pushing, while pain on the skin, rather, have a burning or tingling character.
  • The mechanism: When we cut ourselves with a kitchen knife, we feel the pain exactly at the point where it arises. In other cases - such as with nerve pain - we feel the pain where the nerve fibers go, not where the nerve damage occurred. An example of this is phantom pain after amputations.
  • The nerve fibers: The pain impulse can be transmitted via different nerve fibers: Some of these nerve fibers transmit the impulse very fast, others rather slowly. If we lay our hand on a hot stove, the impulse is forwarded very quickly at first. Pain transmitted via fast nerve fibers is often perceived as stinging. After that comes the pain that passes through slow nerve fibers - the burning sensation we feel after a second on the stove. "

There are some people who ignore their pain. What can this have consequences?

Birklein: "Pain has a warning function, they should alert us to something that is wrong with our body, if we do not listen to our body, it may happen that we overlook a disease: Who has bruises over several days, but ignoring them may risk an appendectomy.

However, pain can only be ignored if it is acute pain. If, for example, we have an acute headache right now, we can try to eliminate the pain over a certain period of time. In chronic pain patients, however, this is not possible, because the pain gets more weight with them. "

What is the difference between acute and chronic pain?

Birklein: "The difference between acute and chronic pain is in the duration of pain, and in pain that lasts less than three months, we speak of acute pain, while pain lasting more than six months is called chronic pain. The period between three and six months represents a gray area.

For acute pain, there is usually a reason that can be found and treated: For example, we have three days pain in our hands, which we put on the hot stove. Chronic pain, on the other hand, is a disease of its own; a clear cause can often no longer be determined. "

How does chronic pain develop and what role does pain memory play?

Birklein: "If you have pain over a long period of time, the nervous system learns this pain and stores it in the so-called" pain memory. "Learning is not conscious, but unconscious.

By learning the pain, the patients often perceive the pain as strong, even if it is only supported by weak impulses from the nerves. The pain then arises from the fact that the pain impulse is amplified at all levels of the nervous system. Even the slightest touch can cause severe pain in such a case.

The term pain memory should be used with caution. Because it implies that the body - as in swimming - learn something that he can not unlearn. However, this is not the case with pain memory. However, it is not easy to unlearn once learned pain. As with other learned things, you can not actively unlearn pain.

However, it is possible to override the memory of pain: for example, if you feel pain even with light touch, you can override this sensation by learning to feel normal again. Here, the pain memory must be overwritten with normal sensory impressions. Normal sensory impressions can be joy of movement or social participation despite pain. "

How to treat acute pain and what can be done to prevent chronic pain?

Birklein: "Acute pain can be combated with painkillers, but if the pain does not disappear after a few days, or if there are other symptoms - such as high fever or bleeding, a doctor should be consulted to determine the cause of the pain known, it is important to treat them.

In chronic pain painkillers help only partially. Because of this, other medicines that are actually used to treat depression or epilepsy are usually used in pain therapy. Although these are not classic analgesics, they have an effect on the excitability of the nervous system and can thus contribute to alleviating the pain.

In addition, one important aspect of treating chronic pain patients is that patients learn to accept the pain and live with the pain. "

How many pain patients are there in Germany and what are the most common pain symptoms?

Birklein: "It is estimated that around 5 million people in Germany suffer from chronic pain, but not all of them are in need of treatment, and an 85-year-old man suffering from back pain in a long and fulfilling life due to signs of wear is considered a pain patient,

The most widespread in Germany are clearly chronic back pain. This is followed by headaches, joint pain and pain due to nerve damage. "

What advice can you give to people who suffer from back pain?

Birkein: "For acute back pain, you should first check whether there are any other complaints: If only the back hurts, you should continue to stay active and not be sparing in bed or on the sofa, but other complaints such as a numbness in the Legs before, you should definitely consult a doctor: Then the symptoms could indicate a herniated disc.

If the back pain lasts for several days, you should also go to the doctor for safety, to clarify whether the pain has serious causes. Fortunately, this is rarely the case. Much more common is a muscular cause behind the pain. Because back pain is nowadays often due to the constant sitting in the office and too little movement.

If the back pain is caused by muscular problems, you should be careful to move enough to occupy an ergonomic posture while working and - in case of severe obesity - to reduce his weight. "

Many people often suffer from headaches. What tips can you give them?

Birklein: "In case of acute headaches, it is advisable to take a headache pill first.If the headache does not disappear after a few days, you should definitely consult a doctor, it is important to describe the pain well to the doctor.

If you suffer from recurrent or chronic headaches, you should always look for the trigger and then avoid it as possible. In a migraine attack you should avoid effort, light and noise and go to bed, for example, and try to sleep. Chronic headaches should always be treated by a specialist. "

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