Chronic Pain Syndrome

DW: At what point can pain be described as chronic and at what point is it "chronic pain syndrome”?

Andreas Kopf: Pain that lasts longer than three to six months is by definition chronic, but that’s not the key issue. Some people can have rheumatism, for example, or a tumour, and be in pain for as long as nine months, but they can still lead normal lives. Pain is chronic when it affects a patient’s entire life, their whole existence revolves around it, and they can no longer lead normal lives. What we call biopsychosocial risk factors come into play in these cases, i.e: physical and also mental problems, including conditions such as anxiety, depression and trauma, as well as conflicts in the patient’s personal or professional life. When these factors come together, the risk of chronic pain increases.

What forms can it take?

It’s chronic when the patient is suffering from pain they describe as unbearable. In contrast to acute pain, which patients can suffer after surgery, for example, and which can be efficiently treated with painkillers, patients suffering chronic pain have to deal with persistent, unbearable pain for years on end. If you ask them when they last experienced a pain-free day, they’ll probably tell you it was years ago. Moreover, the pain isn’t modulated but consistently intense. Patients often describe it as excruciating and unbearable.

Why does it often take a long time for doctors to diagnose chronic pain syndrome?

The condition doesn’t develop overnight. In some cases certain factors can be easily overlooked at first. The patients themselves as well as their doctors might be trying to find out what’s wrong and it can take a while before a chronic pain disorder is identified as the cause. Six months can go by, especially when patients are consulting several doctors at once, and by that point it’s hard to reverse the process of pain chronification. In many cases, the diagnosis comes too late. We would like doctors to develop a sort of early warning system, so that when a patient describes pain, they realize that it’s out of the ordinary and refer the patient to a specialist. This is why here in Germany, pain management has been made a compulsory subject in medical training. It’s the only country apart from France to have done so. It means doctors have enough basic expertise to prevent pain from becoming chronic.

What sort of treatment is available?

Biopsychosocial pain requires an appropriate treatment, one that we call multimodal. These days we know that patients suffering from chronic pain are not just hypochondriacs, but that there have been changes in their brains and nervous systems, explaining the pain. Painkillers don’t help, they are at best only one of many solutions. A combination of various treatments is called for, including customized physiotherapy, relaxation techniques and behavioral therapy. Combined, they should help the patient develop a new understanding of their body and relearn what is it to be pain-free.

What can patients themselves do?

Unfortunately, it’s pretty much completely up to the patient themselves. Patients suffering from chronic pain can seek advice from psychologists, physiotherapists and doctors but it’s up to the patient to out this advice into practice. This is why treatment should also include pain management training – the patient also needs to learn how to motivate themselves. So a lot is demanded of the patient. So long as the patient’s objective isn’t to be 100 percent pain-free, many manage to get to a point where pain is no longer the focus of their entire lives and they can return more or less to normality. German writer Hermann Hesse, who suffered from chronic pain himself, described the process in his work "A Guest At The Spa". It’s a process of finding a way of adjusting to pain as a fact of life and being able to live with it.

Andreas Kopf is the head of the Charité Clinic’s Benjamin Franklin Pain Management Center in Berlin.
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The interview was conducted by Marita Brinkmann