The realization the fact that chronic pain can attain own disease value and special treatment forms and - to require, had mechanisms in the USA already in the 40's 20. Century led to the establishment of the first pain hospital. As a founder the 1994 deceased John J. Bonica is considered to the modern interdisciplinary pain therapy. In Germany there are pain-therapeutic mechanisms only for the 70's. The first pain hospital was furnished at the University of Mainz under Frey of Gerbershagen. First two cash-medical pain practices became in January 1982 in Frankfurt A.M. (Dres. and Hamburg (Dres. Jungck) of physicians based, who had before furnished pain outpatient clinics as at their departments.

Differences between acute and chronic pain

Acute pain is meaningful as Warner and as reference to the diagnosis of the underlying illness and possesses thus an important biological function. They have a clear cause. Causal treatment leads usually to it that the pain diminishes and disappears after a certain time, for which there are empirical values.

Chronic pain outlasts this period which can be expected, in which normally a healing takes place. With the patients concerned it is to be stated that there are several causal and perpetuating factors, which can always find within the somatic, psychological and social range or be assumed at least for this outlasting the pain. The treatment must consider additionally for the recovery of the cause also the Linderung or removal of the consequences with.

Chronic pain can become its own pain illness. The pain lost then their direction and warning function and developed to its own disease picture. This pain illness is defined beside the organic also by the konsekutiven (changes and further damages psychosocial from it the following), and it determines the whole life of the patient with its social relations.

As examples are mentioned certain head and back pain (also after several operations), blunt and phantom pain, postzosterische Neuralgien, Trigeminusneuralgie, cancer pain, pleasantly maintained, post office-operational and post office trauma tables pain, which can have and into a chronic pain illness change substantial psychosocial consequences.

Primarily chronic pain e.g. is.: cluster headache, Trigeminusneuralgie, postzosterische Neuralgie, blunt and phantom pain, Thalamusschmerz, cancer pain. Straight ones with such pain and with the Akutschmerzen, which are not to be eliminated after the time which can be expected, must be seized treatment measures, which work preventively, thus the development of the pain illness to work against in the situation are.

Chronic pain has - contrary to acute - a only one releasing or maintaining cause, them is multi-causal so well never.

Pain course

Pain represents in principle a warning signal and has thus a protective function. Pain leads on the one hand to fear reactions and increases the Sauerstoffverbrauch of the heart, on the other hand one strong pain can cause also a cycle insufficiency.

The pain sensation in the brain can be affected as follows:

1. Removal of the Noxe:
   1. Glucokortikoide ("Kortisone "= Steroidale Antirheumatika) restrain the inflammation.
   2. Spasmolytics waive painful cramping of the smooth musculature.
   3. Nitrate improves the heart blood circulation and waives the pain.
2. Influence of the pain receptors
   1. Restaurant anaesthetics the pain receptors (infiltration anaesthesia)
   2. Not Opiat analgesics lower the sensitivity of the pain receptors.
3. Restaurant anaesthetics interrupt the forwarding of pain impulses in peripheral nerves (line anaesthesia) and central nerve courses (back Mark anaesthesia).
4. Opiatanalgetika and Ketanest restrain the forwarding of pain impulses in back Marks and brain (Thalamus) by support of the descending restraining courses. They work over morphine receptors. Of the ascending pain course branches fibers off, which lead directly to the increase of attention/Wachheitsgrad and to the suggestion of the heart circulation system and the breathing system. A further direct connection exists to the limbischen system and involves the appropriate emotions.
5. Anaesthetics restrain the pain sensation in the cerebral cortex.
6. Psychopharmacologic drugs (Sedativa such as antidepressives, Benzodiazepine and Neuroleptika) affect the pain processing in the brain.

Pain treatment

Pharmakotherapie

the therapy with analgesics (Opiate and not Opiat analgesics) is, with CO analgesics, which waive the pain by removal of the Noxe (Kortison, spasmolytics, nitrate) and in the broader sense also with medicines, which are used in the anaesthesia (see 2.).

Anaesthesia

Restaurant anaesthetics

(e.g. Lidocain, Mepivacain, Bupivacain) the emergence and/or the forwarding restrains electrical impulse. Dependent on the isolation of the nerves with increasing concentration restaurant anaesthetic first the vegetative, then the sensitive and the motor nerves are finally blocked.

Restaurant anaesthetics serve for

• Surface anaesthesia (for wounds and mucous membrane)
• Infiltration anaesthesia (as intrakutane, subkutane or injection)
• Line anaesthesia (Umspritzung of peripheral nerves, nerve networks, nerve ganglia)
• Back-Marknear anaesthesia = injection in the Liquor, = PDA = injection outside of the Dura);
• therapeutic local anaesthesia

the restaurant anaesthetic can be combined with the PDA with a Opiat (i.d.R. morphine), or the Opiat is alone given; Indication of the move-Marknear Opiat Analgesie is tumor pain.

Kryoanalgesie (freezing up)

Full arcose/artificial coma

This measure for pain treatment is used only of relative to the bypass short and very painful conditions (operations, VOLKSWAGEN, Polytrauma etc.).

Articles in category "Pain therapy"

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