Dr. Ralf Oettmeier
Modern pain therapy should follow causal and individualized principles. In concrete terms, this means the evaluation of the main causes of pain, which are often associated with inflammatory processes. In addition, if local or regional treatments fail, the focus should be on a holistic view using segment reflector complexes, knowledge from TCM and regulatory medicine. It is also important to supplement essential vital substances in the case of proven deficiencies, to include biological dentistry and to use naturopathic analgesics with few or no side effects. The holistic pain medicine is rounded off by psycho-emotional harmonization techniques, which take into account the nature of pain as an unpleasant emotional experience.
The treatment of chronic pain is one of the greatest challenges of modern medicine and creates an enormous socio-economic burden potential. In Germany, Austria and Switzerland, for example, between 42 and 50 painkillers per head are consumed annually. More than half of them are bought over the counter in pharmacies. The remainder, for example, burdens the German health insurance funds with 7.3 billion euros (1). The associated side effects and deaths of regular use of non-steroidal anti-inflammatory drugs (NSAIDs) is serious. According to NOLTE et al, around 2,200 patients died in Germany in 2011 as a result of NSAID abuse. An additional € 750 million had to be raised for the treatment of NSAID side effects (2). A Swiss study was also able to show an increased rate of myocardial infarction and stroke with regular NSAID use when analyzing the data from 31 studies with a total of 120,000 people (3). In the United States, the official death rate from gastrointestinal bleeding due to NSAID abuse is around 16,500 annually (4).
This underlines the necessity of a paradigm shift in pain therapy: away from ostensible pharmaceutical intervention towards an individualized, causal and holistic concept. This article would like to dedicate itself to this premise.
To understand acute and chronic pain
According to the IASP, pain is an uncomfortable sensory and emotional experience that is associated with or described as real or potential tissue damage (5). It is therefore important to differentiate between physiological, biochemical and immaterial aspects at the various levels of pain processing. In the case of acute pain, the processing chain from the periphery to the brain up to the sensation of pain is easy (Fig. 1). Afferent nerve fibers in the periphery are stimulated by mechanical, chemical and physical noxae, which then set a stimulus conduction chain in motion. With the participation of mast cells, chemical substances such as histamine, substance P, bradykinin and prostaglandins are formed as stimulus intensifiers.
Figure 1: Model of the development of acute pain
The linear-mechanistic model is not sufficient to understand how chronic pain develops. To this end, practice-relevant models for defining receptive fields and neuroplasticity as the basis of pain memory were developed in the 1990s and are still valid today (6-9). As illustrated in Figures 2 and 3, there are both peripheral and central activating and inhibiting factors that modulate pain and ultimately influence its perception. Starting with the anamnesis, our attention should be paid to all of these components of the development of pain and the maintenance of its chronicity. This also makes it clear, that in complicated cases for an individual pain analysis a therapeutic team is necessary, taking the complexity of the topic as a whole into account.
Figure 2: Development of chronic pain (schematic)
Figure 3: Main components of the peripheral (left) and central (right) receptive field