Chronic pain: treatment approaches in psychosomatics

We all know short-term pain. Our back, our head, our joints – every now and then our body sends us a warning signal that something is wrong. Sometimes there is a lack of exercise, sometimes stress goes to our head, sometimes the pain is a sign of a serious illness

Most of the time we get the pain under control again with the right treatment and a little patience. But what happens if this does not work? At the latest then a holistic treatment in the direction of psychosomatics should be initiated, in which chronic pain is considered on a physical and psychological level.

Chronic pain

Pain is considered chronic if it lasts longer than six months. Chronic or chronified also means that the pain has lost its original warning or signaling function. They then no longer call attention to an acute “problem” in the body, but have taken on a life of their own. The permanently overstimulated nerves send pain signals, even if these are no longer physically justifiable. The pain then often occurs in episodes. These episodes can be triggered by stress, incorrect strain or incorrect nutrition, among other things.

Excursus: Recently, chronic pain has been recognized not only as a symptom of an underlying disease (see below), but as a disease in its own right. This condition is called “chronic pain disorder.” This has advantages for the billing of the necessary therapy measures with the health insurance.

Typical diseases with chronic pain

There are different causes for the development of a chronic pain disorder. On the one hand, a pain disorder can develop in parallel with a disease that is itself chronic. Second, acute pain can become chronic even if the underlying cause has been resolved. Furthermore, mental illnesses and cancer can trigger a chronic pain disorder. The following diseases are particularly likely to cause chronic pain:

  • Psychological illnesses: Depression in particular is associated with a reduced pain threshold. Thus, pain can quickly arise from the psychological stress (e.g., headache, back pain or abdominal pain), which can become chronic over time. No physical diagnosis can then be made.
  • Chronic diseases: Rheumatic diseases (for example, ankylosing spondylitis), nerve diseases (for example, fibromyalgia), neurological diseases (for example, multiple sclerosis), inflammatory diseases (for example, shingles) or intestinal diseases (for example, Chron’s disease) are examples of chronic diseases that are classically associated with long-term and severe pain.
  • Acute diseases: Herniated discs, injuries or burns are accompanied by severe acute pain. Even if the original physical condition is largely restored, the pain can persist in the form of a chronic pain disorder and be accompanied by enormous psychological stress.
  • Cancer and cancer treatment: Tumors and their treatment by radiation or chemotherapy can cause acute severe pain. This acute pain can also develop a life of its own, and persist even after cancer treatment is completed.

Medical treatment approaches of chronic pain
On the one hand, medical treatment revolves around the professional treatment of the physical or psychological cause of the pain. Thus, patients are prescribed appropriate medication depending on the underlying disease, such as anti-inflammatory drugs for rheumatic complaints. In addition, the pain itself is treated.

Painkillers such as paracetamol or opioids are used for this purpose. In addition, there are accompanying therapeutic measures, such as the administration of antidepressants to treat the psychological side effects of pain. Complementary treatments such as physiotherapy, sports therapy and acupuncture have proven to be particularly important in the treatment of pain.

Chronic pain on a psychological level

The individual’s approach to a chronic pain disorder is crucial for the degree of perceived suffering. Therefore, the psyche plays a special role in a chronic pain disorder. Various interactions occur between body and psyche, here is an example of a possible interaction:

Permanent pain leads to psychological stress and suffering pressure -> Psychological stress lowers pain tolerance -> Reaction to even the smallest pain signals -> Pain is evaluated negatively -> Psychological stress develops ->

The interaction of pain and psychological evaluation creates a whole bandwidth of negative feelings and thoughts. In the word cloud we have collected typical snippets of thoughts, feelings, worries and topics that are the order of the day in a chronic pain disorder.

Influence on the entire life
If the chronic pain persists, the pressure of suffering can increase immeasurably. It is not uncommon for the disease to be accompanied by job loss and loneliness. Those affected withdraw in order not to be a burden to the people around them. They are ashamed of their illness and resent their fate. Yet it is precisely such behavior that is unfavorable for the development of the pain disorder. Psychosomatic treatment attempts to change these unfavorable coping strategies and help sufferers to regain their quality of life.

Chronic pain in psychosomatic treatment

Psychosomatic treatment for chronic pain takes a holistic approach to the disease. Thus, on one hand, the physical causes are treated (soma) and, on the other hand, the psychological effects of the pain disorder are individually illuminated (psyche). Those affected learn coping strategies for dealing with their illness and reactivate resources and sources of strength from the time before the illness. The following three components are essential in the psychosomatic therapy of chronic pain.

Acceptance and letting go

It sounds paradoxical, but often it helps to give up the inner fight against the pain. The new basic attitude of acceptance and letting go can refocus the power that was previously uselessly spent fighting the pain. This strength can now be used to turn to the remaining beautiful things in life. To learn this acceptance, practices such as mindfulness or meditation help.

Excursus: The acceptance approach is not meant to convey that the pain is irrelevant or that the suffering of the sufferer is exaggerated. Acceptance does not mean giving unqualified approval to something. Rather, acceptance means accepting the present and giving up the struggle against reality.

Activity Building
Social skills training, sports and joint activities with fellow patients can lay a foundation for sufferers to no longer let life be dominated only by pain. At the same time, the activities provide a reduction in psychological stress and thus to an improved handling of the pain attacks.

Working with loved ones
Chronic pain disorders change the entire life of those affected. The family environment also suffers, because it is difficult to bear to see loved ones in constant pain. In addition, conflicts can arise, because pain patients are understandably often irritable and gruff.

The entire situation puts a strain on togetherness and carefree moments together become increasingly rare. Psychosomatic treatment therefore also addresses the relationships and communication behavior between patients and their relatives. Positive togetherness prevents misunderstandings, frustration and recriminations.

Professional psychosomatic treatment of chronic pain disorder can play a decisive role in the quality of life of those affected. Those affected should not hesitate to seek this help!


(1) Betanet (2019, Guide to Pain, available at


Categories: Chronic pain

Verena Klein
Autor Verena Klein
"Die LIMES Schlosskliniken haben sich auf die Behandlung von psychischen und psychosomatischen Erkrankungen spezialisiert. Mit Hilfe des Blogs möchten wir als Klinikgruppe die verschiedenen psychischen Erkrankungen näher beleuchten und verschiedene Therapien sowie aktuelle Themen vorstellen."

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