Neurology-Online

Pain memory

Pain memory - what is it?

Many people suffer from chronic pain primarily from spinal disorders (please refer: Spinal disease symptoms). This chronic pain can lead to the development of a pain memory. Chronic pain is when the pain has been present for at least six months. They affect the patient not only physically, but above all mentally. In Germany, around ten percent of all people suffer from chronic pain.

Read more about the general topic here: Pain

How does a pain memory arise?

Pain memory can develop when pain persists over a long period of time and is not or only inadequately treated. Usually pain has one Warning function. It makes us aware that our body is exposed to something harmful. A simple example is the hot stove top, which almost immediately leads to short-term pain, so that you immediately pull your hand away again. If a pain memory has arisen, the pain has lost its actual function, and it usually suits it never mind more fundamental.

If there is a longer pain event, nerve tracts are constantly stimulated, with the result that the pain practically becomes independent. If you are exposed to a pain at regular intervals, it will be perceived more and more, although its intensity should actually be just as strong as the previous pain. It comes to one Potentiation of pain (Long-term potentiation - more on this under Limbic System - Hippocampus). In technical terms, one speaks of a Hyperalgesia (excessive pain perception) that results from long-term potentiation. Even touching it can cause pain under certain circumstances.

If this process is repeated over and over again, at some point no pain event / pain stimulus is necessary for the nerve cell to send a signal and thus trigger a pain sensation. This cell is then called spontaneously active. In this case it has to be no disease for example be present in the back which provokes the pain but the nerve cells are simply attached to one permanent activation used.

In the long term it can even come to that Gene level changes. These then lead to a changed cell membrane, which means that the affected nerve cells can be controlled more quickly and consequently a stronger experience of pain occurs. The processes that take place are similar to the processes that take place during learning.
Means Local anesthetics or Painkillers you can usually prevent this so-called long-term potentiation, i.e. the development of a pain memory. However, this is not possible with the help of general anesthesia or tranquilizers, as neither work on the spinal cord level.

Normally our body has a built-in protection mechanism against excessive pain, which is also supposed to prevent the creation of a pain memory. The body's own pain relievers (Opioids) or inhibitory amino acids are released that inhibit the pain-mediating nerve cells. These mechanisms are constantly active, but are activated again to a special degree under stress or when multiple pain stimuli are present.

If this system is insufficiently developed, one is more sensitive to pain and it is easier to develop a pain memory. These individually developed inhibition mechanisms mean that some people react more sensitively to pain than others and that it is easier for people to develop a pain memory.

How can one delete / switch off pain?

So far have been no options discovered how to erase pain memory with the help of medication. relief however, often provide methods like one transcutaneous electrical nerve stimulation, in which sensitive nerve fibers are controlled, a Acupuncture treatment, warmth- or Cold therapy.

These procedures are among the so-called Counter-irritation procedure. They are often able to inhibit the pain for hours to days beyond use. Typically, this can only be done through one limited period achieve freedom from pain or an improvement in pain. Of course, research is trying to get a grip on the problem of pain memory on a larger scale and is currently pursuing promising approaches.

Hypnotherapy

Hypnotherapy is also sometimes used for chronic pain patients. It is known as hypnotherapy. Hypnosis often changes the processing of pain noticeably. Most patients resort to hypnotherapy when all other methods have already failed. The patient is put into a hypnotic state by the treating therapist. A state in which all disruptive factors are hidden from the outside.

The therapist will assist the patient during this phase photos entered that distract from the pain should and one inner peace should achieve. This can ultimately ensure that the pain can be perceived differently. However, one should not go into therapy with too high expectations. Hypnosis works well with many patients, but complete freedom from pain cannot be achieved with hypnosis. The pain is often relieved or relieved for a limited period of time.Of course, one should also realize that hypnotherapy does not work for all patients.

Another method that comes close to hypnotherapy in principle, in that it also changes the perception of pain, is the relatively new method of "Relearning". The patient should have a Pain medication and consciously expose yourself to the movements / actions that normally cause severe pain. The expected pain does not occur in this situation. This method aims to try to work through the pain memory positive experiences to overwrite. Repeating this often can potentially counteract pain memory.

a headache

a headache are also a frequent localization for chronic pain, which is practically permanently present in the context of the development of pain memory. Migraine sufferers in particular sometimes feel this.

Toothache

Chronic pain not only occurs in typical places such as the back, but the teeth can also be affected. In some patients it occurs psychosomatic toothache. In this case, the cause is not the tooth or gum itself, but the patient's psyche causing this pain. Of course, it is a challenge for the treating dentist to recognize this fact first.

Psychosomatic pain is also used when a previous dental treatment has developed a memory for pain, although the underlying cause of the pain is no longer present. Is a person severe stress or a strong one mental stress exposed, the immune system also suffers. In this case, you need more time to recover from an illness, which under certain circumstances can lead to the formation of a pain memory.

Painkiller

Once a pain memory has developed so that the patient suffers from chronic pain, it is very difficult to use medication to relieve pain Painkillers to treat. At up to 50% this patient can no adequate pain treatment respectively.

The therapy not only uses painkillers, but also therapies such as physical therapy, psychotherapy and physical therapy (e.g. Cold or heat therapy).

Standard pain relievers such as Paracetamol or Ibuprofen used, but also very effective Opioids how Codeine and Morphine. In addition to pain killers, they are usually used simultaneously anti-inflammatory drugs used because substances are formed under inflammation that mediate / intensify pain.

If oral pain medication does not help relieve the pain, pain medication can also be delivered directly through a Infusion into the spinal cord be introduced (= intrathecal drug infusion).

Alternatively, a Neurostimulation carried out in which the signal transmission from overactive nerves is to be inhibited via current impulses.

The last resort is then a surgery by means of which nerves are blocked so that they can no longer transmit pain stimuli to the brain. However, this method can only be carried out if the cause of the pain can be localized.

Prevention

It used to be assumed that temporary pain would not harm the patient over time. It is now more the case that one cannot bear prolonged pain must, because relieving the pain with the help of a pain reliever also prevents pain memory from developing.

Weak pain relievers such as Paracetamol, but also very potent pain relievers, like Opioids, which also includes the well-known pain reliever Morphine counts. However, prevention can only be undertaken if an upcoming pain event is expected. Because usually the patients only go to the doctor when the pain is already chronic and a pain memory has already developed. In this case, prevention can no longer be undertaken.

The pain memory is created by a so-called long-term synaptic potentiationcausing awareness of pain. When pain develops, calcium flows into pain-mediating nerve cells. This influx is caused by glutamate receptors (NMDA subtype) mediated.

At this point, various prevention options can begin. For one thing, you can do the Glutamate release from the pain-mediating fibers, technically as nociceptive fibers denotes, reduce or completely prevent. For this one can use different ones in the spinal cord Anesthetic techniques apply, to toughen the Infiltration, Line- and Plexus anesthesia. On the other hand, you can use the so-called NMDA receptor (=Glutamate receptor) block with medication. For example, are suitable for this Ketamine or Memantine.