14. November 2022
Between eight and sixteen million Germans suffer from chronic pain. The range shows how high the unreported number of sufferers must be who do not present themselves to a doctor. And even if this happens, one in five pain patients does not feel that they are being treated appropriately. The resulting consequences are devastating: withdrawal from social life, inability to work, and ultimately, not infrequently, a change in the entire personality.
First of all, it is important to distinguish acute from chronic pain. We speak of acute pain when it does not exceed a duration of three months. On average, this period is needed by the body to heal injuries such as broken bones or torn ligaments. Acute pain thus has a significant protective function and should lead to protection and thus the best possible healing. In chronic pain, the trigger is usually no longer active and it is the result of a hypersensitive nervous system or chronic inflammation. Thus, they no longer have a useful function and are more likely to cause suffering and complications, such as: sleep problems, poor mobility, inability to work or psychological stress.
The triggers for a chronic pain syndrome can be divided into three categories:
Here the pain occurs in the course of diseases such as rheumatism, arthrosis, fibromyalgia or osteoporosis. However, it can also be the result of nerve damage or occur as phantom pain in the case of an amputation.
Depression, post-traumatic stress disorders and anxiety disorders are the clinical pictures in which chronic pain is most frequently reported as an accompanying symptom.
Interaction of physical and mental illnesses
It is not at all uncommon for a physical illness (for example, headaches caused by a blockage of cervical vertebrae) to occur first and then worsen as a result of increasing stress and poor coping (chronic migraine). Likewise, a mental illness (such as an anxiety disorder) can cause permanent poor posture, which then leads to a chronic pain condition (back pain) in the long term.
As should already have become clear, the causes of a chronic pain syndrome are very diverse and cause suffering with far-reaching effects on the entire lives of those affected. If there is a prolonged suffering from chronic pain, it becomes a permanent companion and changes not only everyday life, but actually in some cases the whole personality. The International Diagnostic Manual for Diseases (ICD) gives an official code to precisely this phenomenon, thus making the condition a diagnosis: F62.80. The manual emphasizes once again that the pain must have lost its warning function and, in addition to the physical sequelae, psychological as well as social impairments in need of therapy have arisen, all of which are conditional on or intensify each other.
A personality change basically exists if there are indications of serious and lasting changes in perception, thinking and behavior in relation to the environment and the patient’s own person. However, these must not be caused by damage or disease of the brain. The changes are related to inflexible and maladaptive behavior, which, however, does not result from a pre-existing mental disorder. In the context of chronic pain, personality change occurs after or because of the severe stress and limitations caused by the pain. It is characterized by the following features:
The far-reaching consequences show how complex the chronic pain syndrome is and emphasize the importance of treatment so that, in the best case, personality changes do not occur in the first place. Since chronic pain, unlike acute pain, cannot be treated with conventional painkillers, it is important for sufferers to learn strategies that provide relief and enable them to cope with everyday life and improve their quality of life. The following measures can help, especially in combination:
At this point, both cognitive behavioral therapy and depth psychological treatment or hypnotherapy can come into play. All methods attempt to identify psychosocial as well as physical stressors and, coordinated with these, teach techniques for coping with pain. In many cases, patients are too focused on wanting to persevere and function, and must first learn to work with their bodies rather than against them.
Exercise is precisely what pain patients avoid most, fearing a further worsening of their condition. This may actually be true in some cases, however, for many it can be a great opportunity to try it first. The workload should be individually tailored to the cause of the pain and should not exceed a moderate intensity.
Yoga, meditation, progressive muscle relaxation, autogenic training or biofeedback are methods that have been proven to relax both the body and the mind and help to shift the focus away from the pain. Relaxation techniques can be particularly effective when sufferers find it difficult to feel what their own body needs or there is a permanent circle of thoughts around the pain. For pain patients who have already experienced a change in their personality, an improvement in their symptoms often seems impossible and they find themselves in a vicious circle of chronic pain, the resulting permanent stress as well as helplessness, fear and despair – which in turn increases the pain. For this very reason, it is important at the beginning of treatment to accept the chronic disease and the associated limitations for the time being in order to be able to spend the remaining energy on the things that are still possible. In the next step, professional support and a combination of the measures listed above ensure that the existing resources are strengthened and the quality of life is improved again.
Categories: Chronic pain