Interview: What is pain?

Interview: What is pain?

If we hit our heads or accidentally touch a hot stove, we feel Pain. Pain is a warning signal from our body that something is wrong. University Prof. Dr. Frank Birklein, professor of neurology and neurological pain research at the medical faculty of the University of Mainz, explains in an interview what Pain is, how acute and chronic Pain differ and what you can do specifically against back pain and headaches.

What is Pain

Birklein: “As defined by the IASP (International Association for the Study of Pain), ‘pain is an unpleasant sensory or emotional experience associated with actual or potential tissue damage, or is described by affected individuals as causing such tissue damage .’

The definition states that Pain does not always have to have a clear structural cause but can also occur without an apparent physical reason. The causes of Pain can be harmless, but also extremely serious.”


Some pain is piercing, others stabbing or burning. What causes these different types of Pain?

Birklein: “Why exactly are there different forms of Pain? It has not yet been finally clarified. However, we know that various factors play a role:

  • The place of origin: We perceive Pain differently depending on the place of origin. Pain in the muscles, for example, is felt more like pulling or pressing, while Pain on the skin, on the other hand, has a burning or tingling character.
  • The Mechanism: When we cut ourselves with a kitchen knife, we feel the Pain at the exact spot where it originates. In other cases – nerve pain, for example – we feel the Pain where the nerve fibres go and not where the nerve damage occurred. An example of this is phantom Pain after amputations.
  • The nerve fibres: The pain impulse can be transmitted via various nerve fibres: some nerve fibres transmit the impulse very quickly, others rather slowly. The impulse is transmitted very quickly if we place our hand on a hot stove. Pain that is transmitted via fast nerve fibres is often perceived as stabbing. Then comes the Pain, which travels down slow nerve fibres — the burning sensation we feel after a second on the stovetop.”

Some people ignore their Pain. What consequences can this have?

Birklein:  “Pain has a warning function; it should draw our attention to the fact that something is wrong with our body. If we don’t listen to our body, we may overlook an illness: If you have stomach pains for several days, ignoring this, however, may risk an appendix rupture.

However, Pain can only be ignored if it is an acute Pain. For example, if we have an acute headache, we can try to suppress the Pain for a certain period. In chronic pain patients, on the other hand, this is not possible because the Pain is more vital to them.”


What is the difference between acute and chronic Pain?

Birklein: “The difference between acute and chronic Pain lies in the duration of the Pain. Pain that lasts less than three months is referred to as acute Pain. Pain that lasts longer than six months, on the other hand, is referred to as chronic Pain. The period between three and six months represents a grey area.

There is usually a reason for acute Pain that can be found and treated. For example, we have had Pain in our hand for three days after we put it on the hot stove. Chronic Pain, on the other hand, represents its clinical picture, and a clear cause can often no longer be determined.”

How does chronic Pain develop, and what role does pain memory play?

Birklein: “If you have pain over a longer period, the nervous system learns about this pain and stores it in the so-called “pain memory”. The learning does not take place consciously but unconsciously.

By learning about Pain, patients often perceive it as vital even when it is sustained only by weak nerve impulses. The Pain arises because the pain impulse is amplified at all levels of the nervous system. Even the slightest touch can cause severe Pain in such a case.

Pain memory should be used cautiously because it implies that the body – like swimming – learns something it can no longer unlearn. However, this is not the case with pain memory. However, it is difficult to unlearn Pain once it has been learned. Similar to other learned things, Pain cannot be actively unlearned.

However, it is possible to overwrite the pain memory. For example, if you feel Pain even with a light touch, you can overwrite this sensation by learning to feel normal again. The pain memory must be overwritten with normal sensory impressions. Despite Pain, average sensory impressions can be joy in movement or social participation.”

How can you treat acute Pain, and what can you do about chronic Pain?

Birklein: “Acute Pain can be combated with painkillers. However, if the Pain does not go away after a few days or if there are other symptoms – such as high fever or bleeding, a doctor should be consulted to clarify the cause of the Pain. If the cause is known, it is necessary to treat them.

In the case of chronic Pain, however, painkillers only help to a limited extent. For this reason, other drugs that are used to treat depression or epilepsy are usually also used in pain therapy. Although these are not classic painkillers, they affect the excitability of the nervous system and can thus help to alleviate Pain.

In addition, an essential aspect of the treatment of chronic pain patients is that the patients learn to accept the Pain and to live with the Pain.”


How many pain patients are in Germany, and what are the most common pain symptoms?

Birklein:  “It is estimated that around 5 million people in Germany suffer from chronic Pain. However, not all of this Pain requires treatment. An 85-year-old man who has suffered from back pain in a long and fulfilling life due to signs of wear and tear is also classified as a pain patient.

Chronic back pain is the most widespread in Germany. This is followed by headaches, joint pains and Pain due to nerve damage.”

What advice can you give to people suffering from back pain?

Birkein: “In the case of acute back pain, you should first check whether there are other complaints: if only your back hurts, you should remain active and not rest in bed or on the sofa. However, you should consult a doctor if there are other complaints, such as numbness in the legs. Then, the symptoms could indicate a herniated disc.

If the back pain lasts for several days, you should also go to the doctor to be on the safe side to clarify whether the Pain has serious causes. Fortunately, this is rarely the case. Much more often, there is a muscular cause behind the Pain. After all, back pain often results from sitting in the office all the time and not moving enough.

If muscular problems cause back pain, you should make sure you get enough exercise, adopt an ergonomic sitting position when working and – if you are very overweight – reduce your weight.”

Many people suffer from frequent headaches. What tips can you give them?

Birklein: “In the case of acute headaches, it is advisable to take a headache pill first. If the headaches don’t disappear after a few days, you should see a doctor. It’s essential to describe the Pain well to the doctor.

If you suffer from recurring or chronic headaches, you should always look for the trigger and then avoid it if possible. During a migraine attack, you should avoid exertion, light and noise and, for example, lie in bed and try to sleep. However, chronic headaches should always be treated by a specialist.”


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