Chronic pain: causes, treatment and support
Chronic pain can have a huge impact on everyday life, work and leisure Learn how to recognise chronic ailments early regain quality of life.
Key points at a glance
- Some 10% to 40% of the global population suffer from chronic pain. In Switzerland, the figure is around 1.5 million people.
- Back pain is the number one cause of chronic pain; it is the most widespread pain condition in Switzerland and throughout Europe.
- Successful pain therapy begins with your own pain management: those who take an active role increase their self-efficacy and alleviate their pain.
Pain is part of life. A twinge in the back, a pounding headache, stomach cramps – pain is a warning signfor our bodies, indicating that something isn’t right.
What causes pain?
Acute pain occurs suddenly and is usually a direct response to injury, such as a cut, burn or inflammation.
For example, if we graze our arm as the result of a fall, this causes in injury to the tissue. The cells in the tissue send a pain signal as a warning to the pain receptors located throughout the body.
These are the most common causes of pain in the body:
-
Musculoskeletal disorders
Back pain is the most common cause of pain, affecting around four out of ten people in Switzerland every year.
Osteoarthritis and rheumatic conditions are also widespread, often causing long-lasting joint and muscle pain.
-
Conditions with nerve damage
Alcohol abuse and various illnesses, such as diabetes or multiple sclerosis, cause long-term nerve damage. This causes neuropathic pain, also known as nerve pain.
These are the most common conditions that also damage nerves:
- Diabetes: High blood glucose levels cause diabetic neuropathy – damage to the peripheral nerves – often causing a burning pain, primarily in the feet and legs.
- Nerve injuries: Injuries caused by accidents, surgery or mechanical trauma can permanently damage nerves and thus trigger neuropathic pain.
- Infections: Shingles (herpes zoster) is a common example of this. The viral infection leads to nerve inflammation. Long-lasting pain symptoms can occur even after the infection has healed (post-herpetic neuralgia).
- Diseases of the central nervous system: Multiple sclerosis, strokes and spinal cord injuries damage neural pathways in the central nervous system. This can cause neuropathic pain.
- Cancer: Tumours can damage nerves as they grow – and the same applies to treatment methods such as radiation or chemotherapy used to treat them.
- Nerve toxins: Chronic alcohol abuse, certain medications or chemical nerve toxins can also cause nerve damage.
- Genetic diseases: Rare genetic defects, such as hereditary neuropathy, in which the peripheral neural pathways in the arms and legs are damaged, can also trigger neuropathic pain.
- Other causes: Herniated discs, autoimmune diseases and metabolic disorders can also damage nerves and lead to neuropathic pain.
-
Headaches and migraines
Headaches, including migraines and tension headaches, are widespread and are also one of the most common causes of pain.
-
Tumour diseases
Cancer often causes severe pain.
-
Chronic inflammatory diseases
Diseases such as rheumatism, fibromyalgia and chronic inflammatory bowel disease are associated with frequent pain.
-
Injuries and surgery
Accidents and surgery can also lead to long-lasting pain either directly or through the development of osteoarthritis.
-
Gender-specific pain
Certain pains only occur in women, including period pains in particular. If period pains persist despite painkillers, this may be a sign of endometriosis.
Endometriosis is an extremely painful condition in which cells similar to the lining of the uterus grow outside the uterus. One in ten women of reproductive age is affected by endometriosis.
Hormonal changes associated with the menstrual cycle also have an influence on other pain disorders. For example, certain headaches occur in connection with the menstrual cycle, and joint pain is more common before and during the menopause than before.
-
Psychosomatic pain
The mind can also cause physical pain.
Psychosomatic pain occurs when psychological stress, anxiety, depression, inner conflict or traumatic experiences affect the body and cause muscle tension, headaches, back pain or abdominal pain, for example – even without a recognisable physical cause.
For example, stress activates the nervous system, which can lead to muscle tension, poor posture and persistent pain.
Chronic emotional strain also affects hormonal balance and the immune system, which exacerbates or perpetuates physical complaints such as pain.
What’s more, anxiety or depression often lower a person’s pain threshold – pain is felt more intensely, even if there is no organic cause.
Definition: what is chronic pain?
Acute pain can also become a chronic condition if it is not treated properly.
If pain lasts longer than three months, it is considered chronic. Studies show that around one in five people in Europe has experienced chronic pain at some point. They also note that older people and women are often affected by chronic conditions.
“The physical impairments caused by chronic pain lead to the greatest societal burden caused by illnesses worldwide,” says Professor Konrad Streitberger, head of the interdisciplinary Pain Centre at Inselspital Bern.
What causes chronic pain?
Chronic pain is caused by a complex interplay of physical, neurobiological, psychological and social factors.
If pain persists, this leads to changes in the nerve cells in the central nervous system. Psychosocial stress factors in particular, such as stress or anxiety, cause the nerve cells to connect differently.
As a result, nerve cells react hypersensitively to pain signals or interpret them incorrectly. “This, in turn, has a negative impact on our pain processing and our pain memory,” says Streitberger.
Say a vertebral body in your spine is broken, for instance. Even though surgery is successful and the original damage to the bone, muscle and tissue heals, the pain persists.
Most common causes of chronic pain:
- Musculoskeletal disorders: Degenerative changes in the spine, osteoarthritis, rheumatoid arthritis
- Neuropathic pain: Diabetes, cancer, strokes or nerve irritation
- Chronic inflammation: Rheumatic diseases or chronic inflammatory bowel diseases
- Chronic pain disorders: Migraines, tension headaches, fibromyalgia or complex regional pain syndrome (CRPS)
- Injuries: Joint injuries to the knee, shoulder or hip, torn muscles, ruptured Achilles tendons, vertebral fractures and spinal cord injuries
- Surgery: Operations that cause severe tissue or nerve damage or are associated with an intensive post-operative pain phase often lead to chronic pain
- Poor posture: Hollow back, flat back, high shoulders and poor sitting posture at work
- Overloading: Persistent or repeated overloading of the muscles, joints and spine
- Mental illness and stress: Depression, anxiety or post-traumatic stress disorders
Can chronic pain be caused by psychological factors?
“With chronic pain, there are always several factors that contribute to the condition,” says Streitberger. These almost always include psychological factors such as stress, anxiety or social strain.
As Streitberger explains: psychological factors can exacerbate pain in acute situations and contribute to the development of chronic pain by causing sensitisation in the brain and therefore a heightened perception of pain.
Studies also show the reverse correlation: people with chronic pain are more likely to suffer from depression or anxiety than people without pain.
Furthermore, the psyche has an influence on how existing pain develops. “If someone is afraid that their pain will get worse or never go away, these fears can rearrange their nerve cells so that they amplify the perception of pain,” says Streitberger.
Symptoms and effects
The symptoms of chronic pain are complex. This makes it all the more important to know when sufferers should take a closer look: “If acute pain spreads regionally or is less severe over a longer period of time and then becomes more severe, you should seek medical advice,” says Streitberger.
In such cases, sleep disorders, digestive problems and recurrent sweating often occur as well.
Below is an overview of the symptoms of chronic pain that affect the body, mind and social life:
-
Physical symptoms
- Continuous or recurring pain, often stabbing, burning, dull or throbbing; the intensity and location may vary
- Stiffness and muscle tension
- Swelling, inflammation, soreness
- Loss of mobility and functional limitations in everyday life
- Tiredness and exhaustion due to constant stress
- Sleep disorders, often problems falling asleep or sleeping through the night
-
Psychological and social symptoms
- Depressive moods, lack of drive, loss of interest
- Increased irritability, concentration problems, lack of appetite and weight loss
- Anxiety, tendency to withdraw socially and loneliness
- Restrictions in professional life, leisure time and social relationships
- Loss of zest for life, negative thoughts and catastrophising
- Increased preoccupation with one’s own health, constant worries
-
Special characteristics of chronic pain
- Pain lasts longer than 3 months or recurs
- Often no clear organic cause can be found, the pain “takes on a life of its own”
- Impairs functions at work and in everyday life and impacts on quality of life
- “Pain memory”: the nervous system reacts more sensitively to pain stimuli in the long term
How does chronic pain affect the body? “Those affected often feel exhausted, withdraw socially and find it hard to work,” says Professor Streitberger.
The following effects most frequently impair our quality of life:
-
Physical effects
- Persistent fatigue, sleep disorders and reduced mobility
- Frequent concomitant conditions such as muscle tension, stiffness, digestive problems and cardiovascular strain
- Inactivity due to pain can lead to muscle atrophy, weight gain or loss, and generally poorer health
-
Psychological effects
- Stress, tension and anxiety
- Development of depression
- Sleep disorders, anxiety disorders, stress disorders
- Feeling of helplessness, which exacerbates negative thought patterns, such as catastrophic thinking or pressure to perform
-
Social effects
- Severe withdrawal from social contact; loneliness and isolation
- Common effects on working life: Reduced resilience, repeated absences, risk of job loss
- Often significant limitations in leisure activities, sport and everyday tasks, which diminishes overall enjoyment of life
How is chronic pain diagnosed?
When carrying out assessments, specialists first look for a physical cause, such as an injury, inflammation or tumours. “These need to be dealt with as quickly as possible,” says Streitberger.
However, psychosocial factors are also crucial when making a diagnosis. Where are there stress factors in the family, at work or in the social environment?
These factors are evaluated together with the patient – to see where changes could be made for a holistic therapy.
“There’s no use going from one injection or surgery to the next for back pain if the psychological or social problems that contribute significantly to the pain are not identified,” says Streitberger.
Experts such as Konrad Streitberger also recommend that those affected take action as early as possible if the pain persists. “The sooner those affected take action, the fewer pain-related changes occur in the central nervous system – and the better we can work with patients.”
But how soon is soon enough? There’s no one answer to that, says Streitberger. But if the pain lasts longer than a month – particularly if those affected are unable to work due to the pain – it is critical to assess whether psychosocial stress factors are at play and whether multimodal pain therapy is indicated.
Pain with no clear cause
However, doctors cannot always identify a clear trigger for chronic pain. This is the case, for example, with fibromyalgia. Those affected usually suffer from pain in muscles and connective tissue, the location and intensity of which often change.
In this context, pain researchers refer to primary chronic pain. Neuroscientists assume that the changes in the nerve cells in the brain are caused by genetic, physical and psychosocial factors.
How exactly this pain develops is not yet fully understood by scientists. What is clear, however, is that those affected genuinely suffer from it. In order to better understand this pain, a systematic assessment is needed – including pain intensity, sensitivity to pain and other sensory perceptions of pain.
Treatment options
When treating chronic pain, it is important that patients learn how to deal with their pain, says Streitberger.
Successful pain therapy starts with pain management. Various methods can help. These include:
- Physiotherapy
- Forms of relaxation, such as yoga or meditation
- Psychotherapy
- Changes to the working and social environment
“We’re always cautious when it comes to prescribing medication, because strong painkillers such as opioids can quickly become addictive,” explains Streitberger. And studies have shown that, with prolonged use, opioids even increase sensitivity to pain.
Exercise is also part of the treatment: “Those affected should remain as physically active as possible and not abandon exercise out of fear of the pain,” says the expert. Too much rest leads to tension and the breakdown of muscles, which in turn increases the pain.
In principle, taking regular walks is sufficient to stay active, but targeted exercises guided by a physiotherapist are usually needed to build up muscles and relieve pain in the long term.
Is there a cure for chronic pain?
Professor Streitberger often compares chronic pain with diabetes: “We can’t simply wave a wand to make the illness – in this case, chronic pain – vanish. But if those affected can learn to manage the pain well, it takes a back seat and they can largely regain their quality of life.”
Nevertheless, chronic pain can disappear almost completely within a year, especially in the early stages, and in rare cases even after years of progression.
This has to do with the fact that the nerve cells in the central nervous system and in the brain are constantly changing and can learn new, positive stimuli that reduce pain.
Daily life with chronic pain: tips and strategies
The first step towards a positive daily life with chronic pain is to accept it. This doesn’t mean putting up with the pain. It’s about learning how pain develops in the body and what you can do to improve your situation.
This increases your sense of self-efficacy. And this self-efficacy is the key to improved, independent pain management. “Chronic pain often makes those affected feel powerless, causing them to focus solely on the pain,” says Professor Streitberger.
That’s why it is important for them to take an active role in their pain therapy and, in doing so, gain greater confidence in themselves.
-
Accept the pain
Learn that pain is a part of you and not your opponent. This draws attention away from the pain – and helps overcome it.
-
Staying active
Exercise is often the best pain remedy. Test which movements help and which don’t. It is important to accept short-term increases in pain – without worrying that it will get worse.
Experts recommend that you get professional help with this, for example from a physiotherapist.
-
Enjoy life
Focus your attention on the things that bring you joy and pleasure: meet up with friends, and continue pursuing your favourite hobbies. This helps overcome the pain and reduce stress.
Studies show that pain patients who are able to distract themselves and maintain a positive mood have a higher pain threshold after physical training than those without a positive attitude.
-
Make time for yourself
What situations in your private life, at work and in your social environment can you change so that you are less stressed and feel better? Take more breaks in order to unwind.
-
Streamline your therapy
Don’t do too much at once, such as physiotherapy, occupational therapy, massage, osteopathy, acupuncture and meditation.
Make sure that your treatment covers both your physical and psychological needs. Seek advice on this from a specialist.
-
Find a care team
Discuss with your family doctor which specialists should be involved in your pain therapy and who should coordinate your care.
For example, these might include family doctors, pain specialists or other professionals trained in pain medicine. You can find appropriately trained personnel on the website of the “Swiss Pain Society”.
How can you prevent chronic pain?
Everything you can do yourself to support your health also helps protect against chronic pain. The most important preventive measures include:
-
Staying active
Exercise is an important element of good health. It reduces stress and promotes blood circulation, muscle strength and joint flexibility – all of which prevent pain.
Even moderate activities such as walking, swimming and yoga help ease tension and avoid poor posture.
-
Act early in case of pain
Have acute pain treated quickly if it doesn’t disappear on its own within a few days. Better to act too early than too late.
Adequate treatment of severe acute pain usually includes short-term use of painkillers prescribed by a specialist.
Physical measures such as cold or heat, immobilisation or exercise are also part of the treatment. These can be applied individually and should be discussed with a specialist.
If your pain persists, remember to check your psychological and social situation for possible stress factors and discuss these with your family doctor.
-
Reduce stress
Identify sources of stress in your daily life – at home and at work. Take measures to reduce them. “This is one of the most important preventive measures against chronic pain,” says Professor Streitberger.
Incorporate more relaxation exercises into your daily routine, such as progressive muscle relaxation, autogenic training, meditation and mindfulness. These help to avoid stress-related muscular tension.
Less stress helps prevent tension pain and psychomatic complaints.
-
Live healthily
What applies to your general health also helps against chronic pain: Eat a balanced diet, get enough sleep and avoid tobacco, alcohol and other substances.
-
Optimise your working environment
Avoid poor posture and make sure you have an ergonomic workstation. This prevents back pain and muscle tension.
Take regular breaks, because this reduces stress. If the stress gets out of hand, think about what you can change in your current situation.
-
Strengthen your mental well-being
Take care of your psyche. Mindfulness methods help you to become aware of your own well-being, feelings and needs, reduce stress and feel more emotionally balanced.
Take more time for self-care. This includes taking time for yourself, allowing yourself breaks and digital downtime, and setting healthy boundaries to avoid overload in your private life and at work.
Nourish your mental well-being through social connections – spend time with people who are good for you. This also reduces stress and soothes your psyche.
And focus your attention more on the positive things in your life. This reduces negative thoughts and thinking patterns – creating greater calm and balance, and lowering stress.
What support does health insurance offer?
Basic insurance covers part of the costs (minus the deductible and copayment) for the treatment of chronic pain, provided the therapies are medically necessary and recognised by the health insurer. These include:
- Treatment from your family doctor and specialists: consultations, diagnostics and treatment, including pain medication
- Physiotherapy: medically prescribed physiotherapy (9 sessions) to treat pain and strengthen muscles
- Psychotherapy: if medically indicated and carried out by recognised specialists
- Occupational therapy: for functional limitations in everyday life
- Medication: pain medication prescribed by a doctor and included on the specialities list
- Other methods: such as acupuncture, if carried out by medical professionals
Find out here exactly which costs are covered by Sanitas.
Higher cost contributions and additional benefits through supplementary insurance
Anyone who has taken out supplementary insurance in Switzerland benefits from additional services related to pain therapy, depending on the model they’ve chosen.
For example, alternative medicine methods such as TCM, osteopathy or homoeopathy, chiropractic treatment, non-medical psychotherapy, complementary therapies such as craniosacral therapy or shiatsu massage, specific pain therapy programmes and contributions to fitness centre memberships and courses.
Sanitas case management: supporting you through difficult times
The Sanitas case management team is on hand to help customers in the event of illness and accident, with psychological and psychosomatic conditions, and during reintegration into working life.
Our case managers also help coordinate suitable therapies, find medical aids and organise care at home.
