EN
When pain drags on for months it stops being merely a symptom and becomes a problem in itself. The person has already been through several doctors, tried painkillers that work less and less well, and gradually rearranged sleep, work and mood around the pain. German pain medicine starts from the position that such pain must be treated as a condition in its own right — and treated systematically, not by damping down the next attack.
When pain becomes a disease
Acute pain is a protective signal: it reports an injury or inflammation and passes as the tissue heals. But if pain persists longer than three months — the time in which the body normally recovers — it is regarded as chronic. That is how the current international classification of diseases defines it too.
The reason is that long-lasting pain changes the nervous system itself. The regions responsible for the affected area become over-excitable, the threshold of sensitivity falls, and pain arises ever more easily — sometimes without the original cause. A kind of “pain memory” forms. So phantom pain after an amputation, or pain that remains after shingles, is not imagination but a real fault in the transmission of the signal. In Germany about 17 per cent of adults live with chronic pain, which makes it one of the commonest reasons for seeking medical help.
First, work out the cause
The doctor’s task is not only to dull the pain but to understand where it comes from. So the assessment begins with a detailed conversation and a questionnaire: where it hurts, in what way, when it worsens, how it affects life. Then comes a targeted examination, checking of trigger points, imaging where needed (ultrasound, CT, MRI) and a neurologist’s opinion.
Importantly, pain is not regarded here only as a fault in the body. Long-lasting pain is almost always entangled with sleeplessness, anxiety and low mood — and they reinforce one another. So a psychologist is often included in the review of the case alongside the neurologist. That does not mean the pain is “in the head”; it means it is being tackled from every side.
How the treatment is chosen
There is no single tablet “for pain”, and a reliable sign of a good clinic is that it does not promise one. The German approach to chronic pain is called multimodal: several methods are combined for the individual rather than one thing being prescribed.
The range includes medication (anti-inflammatories, muscle relaxants, drugs that act on the transmission of pain and, where needed, therapeutic blocks and injections into trigger points) and methods without drugs: exercise therapy, manual therapy, massage, physiotherapy, shockwave therapy, lymphatic drainage and transcutaneous electrical nerve stimulation (TENS). Teaching the patient plays a part of its own — how to move, how to cope with an attack, how not to let pain govern the timetable.
What to expect realistically
This approach works with very different kinds of pain: back and joint pain (osteoarthritis, rheumatic disease), neuropathic pain after nerve damage, neuralgias and phantom pain, chronic headache, and muscular and myofascial pain. Each kind has its own combination of methods, and treatment often runs as a day programme: the patient goes through several procedures a day but does not stay in hospital.
In chronic pain the honest goal is not always the complete disappearance of pain but a return to normal life: that the pain becomes weaker and rarer, and that sleep, movement and the ability to work come back. The earlier sound treatment begins, the better the chance of that: in the early stages the changes in the nervous system are easier to reverse than after years.
This material is for information only and does not replace a consultation with a doctor. Whether treatment is possible, what it will involve and what it will achieve can be determined only after an examination at the clinic in person.