Numerous factors influence the pain

Numerous factors influence the pain

Pain is by far the most widespread health disorder in everyday life. It reduces the quality of life and overall satisfaction with life. This can be seen from data from the Federal Health Survey, a representative study by the Robert Koch Institute on the state of health of the population in Germany.

Pain is subjective

Pain is always a subjective sensation that is described very differently by those affected: they can instead express a feeling (“agonizing”, “paralyzing”) or refer to a sensory quality (“burning”, “stabbing”, “pressing” ).

In the consultation, this can serve as a first indication of the type and cause of the pain for the pharmacist. Pain perception and processing depend on different internal and external factors.

These influencing factors of pain include, for example:

  • Alter
  • gender
  • general condition
  • previous pain experiences
  • respective time of day


Types of pain show age-dependent frequency distribution.

In every phase of life, typical situations are associated with specific physical and mental stress and can cause acute pain. Training and studies are often accompanied by stress, tension and lack of sleep. If the recovery phases are insufficient, tension headaches can result. In the Federal Health Survey, 48.5 per cent of the women surveyed and 27.5 per cent of the men surveyed under 30 said they had suffered from headaches in the past seven days.

The incidence decreases with age and is only around half in the 60-69 age group. On the other hand, a lack of exercise and monotonous, sedentary activities characterize the modern working world – a high risk of tension and acute back pain. The frequency of these increases steadily throughout working life and is significantly higher by the age of fifty than 30.

Leg and hip pain also increase throughout life and are most common in old age. After all, strenuous and unfamiliar activities in particular can overwhelm older people and cause acute pain in the musculoskeletal system.

Chronobiology of pain experience

In connection with pain sensitivity, results from chronobiology, a science that studies the rhythmic changes in bodily functions, are exciting. The body’s processes are subject to physiological sequences that recur in specific periods.

Genetically determined inner timers and external clocks, such as the day-night rhythm, are responsible for this. Under natural conditions, the “internal clocks” are synchronized with the environmental cycle to which the environment’s periodic signals adapt. More than 100 different rhythms of varying duration are now known in humans.


The circadian rhythm

The most well-known biorhythm is the circadian rhythm, which every cell in the body follows and consists of a day and a night of around 24 hours. Pain sensations and reactions to pain stimuli also depend on daily rhythmic processes, as Professor Dr Hartmut Göbel, Director of the Kiel Pain Clinic: “The evidence of circadian rhythms in the concentrations of endorphins and enkephalins in the corresponding pain-processing centres in the brain confirms this.”

The pain sensation in the afternoon is only a third as intense as in the morning, which is why this time of day is particularly favourable for a visit to the dentist. Biorhythms can also modulate the effect of pharmaceuticals on different levels. Painkillers are much more effective in the evening than in the morning. “However, the day-night rhythm for pain sensitivity is more pronounced in women than men,” explains Göbel.

Gender-specific pain perception

As the data from the Federal Health Survey shows, women are almost twice as likely to be affected by acute pain over a year as men. Women also complain of more intense and longer-lasting pain, and their pain tolerance is at a lower level.

On the one hand, the causes lie in biological differences at the hormonal level; on the other hand, the body’s control system for pain acts differently in the sexes: women react to pain more emotionally. Men, on the other hand, use more instrumental and analytical strategies. They investigate the causes and try to solve the problem themselves.

Pain can, therefore, have different consequences for the sexes – in women, these are often fearsdepression and sleep disorders. Men ignore pain more often. This carries the risk that they become chronic more quickly and cause long-term damage from overuse.

Avoid certification

The body can learn about painful conditions. Repeated pain can lead to more intense and prolonged pain sensations since the pain threshold is lowered. Therefore, early and adequate pain relief is essential, with medication being used responsibly and supplemented by non-drug measures.

Painkillers with only a single active substance are recommended here. “Combined analgesics should be avoided in any case, as they are associated with an increased risk of chronic pain,” says Göbel.

Preparations with acetylsalicylic acid (ASA) are particularly suitable and recommended by the DMKG as the first choice. The active ingredient relieves headaches and acute back, muscle and joint pain. ASA inhibits the synthesis of prostaglandins (hormone-like substances), which, as pain mediators, increase the ability of pain receptors to be activated.


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