Chronic pain - what does that mean?

Chronic pain can be considered as an independent clinical picture. In the cases that it occurs, the causes of pain themselves are no longer relevant, but the chronic state of pain. This condition strains the psyche and severely limits the quality of life of the affected people. We speak of chronic pain when it persists for more than half a year or when it persists much longer than usual. An important interface to the development of chronic pain is established in the cells of spinal cord. There are certain neurons that play a crucial role when it comes to chronic pain. Chronification is the transition from the acute temporary pain condition to the permanent presence of the pain.

When does pain become chronic? And how often does it happen?

Most pain can be treated successfully within a few days or weeks or it even disappears spontaneously. In about 10-20% of cases - especially in industrialized countries - the pain persists longer than usual. They become chronic, although the cause of the pain no longer exists or it does not play an important role any more. About 70% of the cases of chronic pain are back pain, followed by joint pain and headache. About 8 million people suffer from chronic back pain in Germany.

These are the causes of chronic pain!

How does pain become chronic? A single cause for chronic back pain does not exist. Generally, if back pain lasts longer we are facing a reaction of our body to a multiple disrupted interplay of acute pain, false behavior, personal and professional problems. Let´s try to explain chronic pain in detail and to call the causes by their name: Stress, anxiety, depression, excessive stress, bullying, lack of exercise, negligence and time pressure.

Sometimes chronic pain appears after back surgery especially after repeated surgeries. In this case we are talking about the postnucleotomy syndrom. In other cases it appears after injuries, in polyneuropathy (i.e., diabetic polyneuropathy), in Sudeck's syndrome, in peripheral artery disease (PAD) also called arterial-occlusive disease, in cases with multi-level severe spine degeneration and arthrosis and after radiation, injury or inflammation. If it appears after amputations, we talk about phantom pain.

The post-nucleotomy syndrome is when patients complain of persistent back pain after a -atomically successful- disc surgery that can radiate to the leg. About 10% of all patients who undergo disc surgery develop a postnucleotomy syndrome. Doctors refer to it as the "failed back surgery syndrome". Basically: There are several possible causes for the development of the Postnucleotomy syndrome and these include severe prolonged damage to the nerve root by massive or long-term pressure from the disc hernia or spinal stenosis before surgery, inadequate postoperative behavior and follow-up, negative personal  and psychosocial circumstances, disturbances in healing process, the presence of severe multi-segmental spinal degeneration or the presence of other diseases like diabetes that disrupt the healing process.

Pain memory develops when pain persists for an extended period of time and remains untreated. The nerve pathways that guide the pain impulse through the body are constantly irritated, with the result that the pain is independent.

In a polyneuropathy, a part of the nervous system is disturbed in its function. Typically, the symptoms such as chronic pain or discomfort occur, especially in the feet, legs, hands or arms.

Pay attention to these symptoms

Usually, back pain is accompanied by pain which radiates to the leg, arms, and chest. Ultimately, though, they can arise anywhere. Not infrequently, it comes to side effects such as tingling, numbness or unpleasant sensations of touch. Patients are clearly limited in their usual private and/or professional activities - despite the constant use of painkillers.

The diagnosis begins always with the anamnesis

Your doctor will take his time! In order to do an accurate diagnosis, even the littlest information is important because specialists agree that chronic back pain is often due to many causes, so that you would explain your personal, professional and social problems. In a few words: Patients would be considered as a whole!

Depending on the type and duration of pain different diagnostic methods can be applied: X-ray, computed tomography (CT), MRI or laboratory tests, scintigraphy, or neurophysiological measurements.

That is how doctors will treat your chronic pain

How will chronic pain be treated? According to complaints, the neurological findings, and the MRI results, each patient receives an individual therapy recommendation. The first recommendation will concern all the possible conservative therapeutic measures. If pain persists despite the conservative treatments, then there could be another reason: new herniated disc (recurrence), spinal stenosis, neuroforaminal stenosis or instability. Once we find out where the origin of your pain is we would try to eliminate it. This usually happens with the help of microsurgery. If there is a massive scar, it could be removed. The surgical area can be infiltrated with the anti-scar gel by the  surgery to prevent the development of new scars. If necessary we treat inflammation. In other words, once we found a possible cause, if there's a specific one, we treat it. In many cases, however, there are no clear anatomical causes for the pain and consequently, the causal treatment is either not possible (severe wear) or not useful.

Therefore, in our clinic, we perform some minimally invasive procedures such as spinal cord stimulation (pain pacemaker) and the thermal denervation. If, for example, stress-related symptoms are present, further interdisciplinary treatment is recommended.

Basically, a sensible therapy for chronic back pain has to be individualized and adapted to the individual patient and his condition. Without a thorough specialist examination, no individual therapy can be successful or even performed.

You cannot live well without “La joie de vivre”

Whatever you do, the focus of your life should not be only to fight against pain, but to find a way to ENJOY YOUR LIFE even with some pain. There is a reason if experts recommend you to live everyday life according to the pleasure principle! It is the only way that can help you to break the vicious circle of fear and pain amplification! Living your life outside the social boundaries will promote stress, depression and pain!

What to do? – said Zeus

Just move! Which movements? As we already said, the ones that give you pleasure. Deeply recommended are cycling, walking, water aerobics, swimming, yoga. Physical activities are an advantage. And: refrain from heavy physical work.

It may also be a good idea to change a few things in your daily routine: ride a bike to work, use stairs instead of an elevator, eat a portion less.
As said - and that applies to all variants: JUST DO IT WITH JOY!

Dr. med. Munther Sabarini

Dr. med. Munther Sabarini
Specialist in Neurosurgery

The Avicenna Clinic in Berlin is always willing to help you

Since the year 2001, the Avicenna Clinic is based in Berlin. Our doctors have at least 25 years of international experience in their respective fields (neurosurgery, spinal surgery, anesthesia, and orthopedics).

If you have severe back pain, a herniated disc or a suspected herniation, please contact us using the following information:

Avicenna Clinic
Paulsborner Str. 2
10709 Berlin

Telephone: +49 30 236 08 30
Fax: +49 30 236 08 33 11