Pain (acute and chronic pain)

Overview: What is acute and chronic pain?

Ouch – the metal railing is red-hot. Without thinking, we withdraw our hand. The pain serves to protect our body. We react reflexively and remove ourselves or the affected body part from the danger zone. Pain also helps to notice a disorder in the first place in the case of cuts or organ problems such as appendicitis or inflammation of the teeth. Acute pain signals that something is wrong with the body. This is how we can remedy the situation. Sometimes, however, the pain becomes chronic and lasts longer than three to six months. Then it loses its character as a warning signal. Often it is associated with chronic other diseases, but sometimes the pain takes on a life of its own. It is then no longer linked to physical complaints, but occurs without external cause. Chronic pain syndrome is considered a disease in its own right. In this case, relaxation methods and psychotherapy often help better than pain medication.

Pain (acute and chronic) – frequency and age

The back, the joints: around one in six adults in Switzerland suffers from chronic pain. Rheumatic diseases and arthritis are the most common causes, followed by so-called non-specific low back pain without an identifiable cause or, for example, the specific low back pain caused by herniated discs. Here, the three core clinics of the interdisciplinary spine center at the USZ (rheumatology, neurosurgery and traumatology) can assist them as a point of contact for the treatment of somatic causes of pain. In addition, they support the colleagues in the pain service, especially in the case of non-specific and chronic pain. In total, around 1.5 million people in Switzerland are affected. 39 percent of them are always in pain, 35 percent daily, 26 percent several times a week. For most sufferers, the problems are not new: on average, they have been struggling with chronic pain for 7.7 years. One in four has even been suffering from it for more than 20 years. This by no means only affects old people: In one large study, one in five of those suffering from pain was under the age of 30, and the average age was 48.

Pain: Causes

Humans have nociceptors throughout the skin, as well as in the muscles and many organs. These sensory cells react to stimuli – such as heat or inflammation – and emit electrical signals in response. Nerves transmit these stimuli to the spinal cord and the brain. Pain arises in the brain from these signals. There are different nociceptors in this process. Some are specialized to strong stimuli, others to chemical stimuli and heat, still others react mainly to inflammation. First, these signals come to the spinal cord, which can respond very quickly, for example by reflexively pulling back the hand or foot. Subsequently, the information is processed further in the brain. In this way, the pain enters our consciousness and ensures that we consider how we deal with the various pains.

This is how chronic pain develops

Some factors are suspected of favoring the transition to chronic pain syndrome:

• Anxiety or depression
• Pain that is not adequately treated at the beginning
• Ignoring one’s own stress limits
• Avoidance of movement for fear of pain
• Social problems
• Previous experience of pain and stress

Symptoms: Pain occurs in association with sweating and nausea

Pain can occur in different parts of the body and in graduated intensity. Headaches and back pain are particularly common. But joint pain also occurs frequently, for example in connection with osteoarthritis or rheumatoid arthritis. Affected persons sometimes report a throbbing pain, then again a pulling or stabbing pain. Pain often occurs together with muscle tension – where the pain can be the cause or consequence of the tension. Symptoms such as sweating and nausea associated with pain are also typical. Sometimes the facial features become distorted in pain: the squinting of the eyes is noticeable, for example when someone stubs their toe. Tense forehead muscles are often noticeable in headaches. Severe pain is often accompanied by sleep disorders.

Gentle behavior in pain: no solution

Anyone who suffers from pain in certain situations will avoid them in future. This sparing is useful for acute pain – for example, to allow a fracture or sprain to heal. However, if the physical cause falls away, such protective behavior can intensify the pain and lead to chronic complaints. Both fear of the pain and one-sided postures exacerbate the problems. In addition, many sufferers withdraw and reduce meetings with friends and hobbies in order to take it easy on themselves. However, this means that important components of relaxation are missing. In addition, this social withdrawal can lead to further health problems such as depression or drug dependency.

Pain: diagnosis with us

First, we ask about the cause of the pain – whether there was an accident or an acute illness. Then we address possible stress factors, for example in the family or at work. Depending on how long the pain has existed and the history of the disease so far, we get to the bottom of the pain with physical examinations. Imaging techniques in particular are used to find or rule out organic causes. Possible examinations for a pain diagnosis are:

• Ultrasound
• X-ray
• Computed tomography (CT)
• Electrocardiogram (ECG)
• Magnetic resonance imaging (MRI)
• Electroencephalogram (EEG)

Pain: prevention, early detection, prognosis

A healthy lifestyle generally helps reduce the risk of chronic pain syndrome. People who do a lot of sports or special gymnastics strengthen their backs and are thus less susceptible to typical back problems. Thoughtful movements also help, such as no heavy lifting in lateral rotation. If you do not smoke, are not overweight and follow a healthy, low-fat diet, the risk of developing rheumatism or osteoarthritis decreases. Regular exercise in the fresh air strengthens the soul and the immune system. Anyone suffering from pain due to an acute illness should talk to us about it and follow recommended countermeasures. Because if you stop painkillers too soon, you risk the pain becoming chronic. With the right therapy, however, we can also get chronic pain under control.

Course and prognosis for pain

Acute pain usually disappears on its own when the trigger is no longer present. Once the cut in the finger or the break in the leg heals, everything feels normal again. It is more difficult with pain that accompanies chronic diseases. Here it easily happens that the pain becomes detached from the actual disease. Pain chronicity quickly leads to dependence on pain medications. Here, (inpatient) painkiller withdrawal may be necessary. Depression and anxiety can also be a result of chronic pain. People who suffer from chronic pain and do not experience relief are often on sick leave for a long time or even have to apply for early retirement. However, we can usually also alleviate long-lasting chronic pain with a variety of treatment methods.

Self-help groups

Talking to people with the same condition can be a great support when coping with an illness. Advice on finding a suitable self-help group is available from Selbsthilfe Zürich. Self-Help Zurich and the University Hospital Zurich are cooperation partners in the national project „Health literacy thanks to self-help-friendly hospitals“.

Pain: treatment through relaxation methods

First, of course, we will try to eliminate physical triggers of pain. However, especially with chronic pain, the goal is to address physical and psychological causes together, such as fear of pain. That is why we often combine pain medication with psychotherapeutic approaches. A first approach is relaxation methods, which you can learn in a group or individually from a specialist:

• Autogenic training
• Progressive muscle relaxation
• Body journey
• Hypnotherapy
• Breathing exercises
• Yoga
• Biofeedback

Light physical activities that relax the body and prevent postural strain are also helpful. We recommend integrating small units into everyday life and logging them. This will teach you to plan realistic exercise sessions as well as appropriate breaks.