FAQ on the subject of pain

Acute pain activates receptors (i.e. "microphones” or "call buttons”) that transfer information via the spinal cord and other hubs to the central nervous system, or your brain. Once inside the brain, this information is interpreted through a number of complex processes. The resulting interpretation may be the sensation of pain, combined with a certain reaction (burning, stinging, jerking, throbbing, etc.) that is felt in a more or less precise area of the body. Pain may also be repressed by the brain, e.g. via distraction, exertion or concentration on an interesting job, or a more vital function such as fleeing danger or experiencing shock after an accident. Chronic pain can arise from acute pain, but several complex criteria must first be met.

Acute pain has a warning function; by eliminating the cause or treating the injury or underlying illness, acute pain can, in most cases, be alleviated quickly and permanently. Painkillers are usually effective for relieving acute pain.

Any substance that works on the central nervous system has the potential to become addictive. Morphine and other opiates are the classic examples of such painkillers. Today we know that regular doses of drugs which are released into the bloodstream gradually allow for a steady level of effectiveness which significantly reduces the risk of addiction. On the other hand, it is also a well-established fact that the administration of these substances by way of fast-acting preparations (drops, solutions, immediate-release tablets) leads to a rapid increase in the concentration of the drug and therefore to a relatively short-lived "kick” that leaves the nervous system quickly wanting more. Nevertheless, the fear of addiction should in no way justify having to endure pain without adequate treatment.

To treat pain, the Centre for Pain Medicine may use a number of highly potent analgesic drugs (painkillers), of which morphine is one example. After your initial assessment, our physicians will inform you whether they think one of these drugs is appropriate and necessary in your case.

Pain not only becomes “chronic” when it is "persistent” or "present for a long period of time”. Chronic pain is caused by several interrelated factors. Some of the signs that pain has become chronic include the spreading of symptoms throughout the body (in the affected areas or in new areas), as well as mental, emotional or social problems that arise as a result of the pain.

The best possible prevention against chronic pain is the prompt and adequate treatment of acute pain. If perfectly suitable treatments which have worked well in the past suddenly begin to have little or no effect at all, then one should consider that the pain may have evolved from simple, acute pain – and therefore take other factors into consideration.

Common chronic pain problems include headaches, back pain, neck pain, neuropathic pain (pain caused by damage to the nervous system) and multilocular or widespread chronic pain (such as fibromyalgia). In total, around 16% of all Swiss residents, or one in six, suffer from chronic pain. Most of these people suffer in silence and do not receive the care they need. A large number of patients with spinal cord injuries experience frequent chronic pain, which is often linked to muscle spasticity.

Just as the types of pain – and the way patients feel them – tend to differ, the initial triggers of an often long-standing pain history can vary considerably. Triggers often occur when a patient is faced with a difficult life situation or about to make a big change. Previous injuries, violent episodes or ongoing mental and social problems may also make patients vulnerable to the development of chronic pain.

It is widely acknowledged that chronic pain can only be explained in terms of the biopsychosocial model. The extent to which chronic pain is caused by biological, psychological or social factors depends on the individual. Chronic pain is accompanied by depressive moods (frequent), fear (on occasion) and sleep disruptions (extremely frequent). These symptoms must be examined on a case-by-case basis to determine whether they occurred before (and thereby perhaps facilitated the development of chronic pain), at the same time as or without having any impact on the pain, or whether they are effects of the pain itself. In each case, they must be taken into account during the overall pain treatment.

International studies have found that women experience chronic pain more frequently than men. For the past few decades, “gender medicine” has revealed considerable differences in the way various medical treatments (including medication) affect men and women.

Studies addressing quality of life have clearly demonstrated that chronic pain affects all areas of a person’s life.

An entire team is required to identify and diagnose chronic pain. An orthopaedist is unable to reliably evaluate a patient’s mood or make a psychiatric diagnosis, a social worker cannot judge the patient’s capabilities, limitations or resources and neither a psychiatrist nor a psychologist is in a position to assess the degree of physical damage or the chances of successful treatment via specific infiltrations or physiotherapy. But a team of pain specialists can satisfy the complex needs of patients and life situations by exchanging opinions and expertise and coming up with treatments collectively. The cooperation of the patient is a vital part of this process, from the collection of background information to motivation and participation during treatment. In addition to a diagnosis, patients usually receive a list of factors that have contributed to the emergence and persistence of their pain. Pain is a combination of several contributing factors: disease, suffering, disabilities, being the victim of an injustice ... and much more.

Neuropathic pain or neuralgia occurs after damage to a nerve, or a disease of the nerves or spinal cord and brain. Depending on the underlying nerve damage, neuropathic pain typically leads to a loss of feeling and to symptoms such as tingling or burning pain on the skin. Neuropathic pain is treated in a very different way to pain that stems from other causes (e.g. muscle pain). It is mainly relieved by medications that target the nervous system, such as antiepileptic drugs and antidepressants. Interventional procedures (nerve blocks, etc.) can also be used. In most cases, a neurological assessment and laboratory examination of the nerve function (neurophysiology) must be performed.

The gold standard for the treatment of chronic pain is interdisciplinary and multimodal pain therapy, which, whenever possible, is administered to a group. For this treatment to be successful, good patient selection is a must.

False promises do not help patients and invariably lead to disappointment. Nevertheless, many patients with chronic pain are encouraged by competent examinations and clear-cut information regarding the nature of their problem. By teaching patients how to manage their pain, we help them increase their activity levels, thereby allowing them – despite their pain – to work, enjoy hobbies and regain control of their lives.

The Centre for Pain Medicine is one of the largest interdisciplinary facilities for the assessment and treatment of acute and chronic pain in the German-speaking world. The Swiss Association for the Study of Pain (SGSS) is a scientific and interdisciplinary association. Its goal is to raise awareness about chronic pain, and encourage interdisciplinary dialogue, training and continuing education and research in the area of pain medicine. To this end, it has created a certification which people can earn by taking an advanced training course in pain medicine: “SGSS® Pain Specialist”. A list of certified SGSS® Pain Specialists can be found on the association’s website. Unfortunately, the FMH has yet to recognise pain medicine as an official discipline, which leaves a certain amount of leeway with regard to how pain is treated from a standpoint of medicine and therapy. Other European countries offer certified training courses and with them, corresponding qualification standards.