What should pain therapy consist of?
The first results of a recently carried out model project by the German Ministry of Health: “To improve the lot of patients suffering from pain” indicated that the therapy used during the outpatient treatment for patients with chronic back pain had, in ge
neral, only little effect. According to the study, too few of the patients received adequate pain therapy. The results of an analysis of 379 patients who underwent the pain therapy treatment over a one-year period as an outpatient showed that only 280 patients had considerable pain reduction, namely a reduction in value according to the pain scale (VAS) of 50% or more.

Back pain is still the most common pain
Today, back pain accounts for by far the largest amount of pain therapy reports which are of concern to most people. However, many people also suffer pain in the extremities. This could be darting, burning, tingling or throbbing pain which may reach into the neck or back. Often hands and feet go to sleep. Also neck pains resulting in tension headaches are often present. The Hamburg surgeon Omar-Pasha knows that, “It is not uncommon for these patients to have an odyssey of tales of unsuccessfully going from one doctor to another to be given such diagnoses as “tennis elbow”, “neck pain” or “lumbar” pain. The problems these patients suffer from are frequently caused by trapped, irritated or compressed arm and leg nerves.

What is pain?
Pain which one feels is a reaction to signals that damage is being done to the body. These signals come from the source of the pain and travel along the spinal chord into the brain where the signal will finally be perceived as pain. This means: Pain can be controlled in as much that the signals can be hindered to prevent them from reaching the brain. The pain channels can be influenced by various measures to the spinal chord nerve fibres before they reach the brain. However, with many patients the actual cause of the pain is often no longer present. These patients slip through the net of the clinical diagnostic network of nerve measurements or other technical investigations which many doctors rely too much on.

Omar Omar-Pasha says, “However, more that 10% of those affected, despite pain and clearly visible illness, have normal conductivity measurements. Today’s computer tests have become so accurate, in a dubious sense, that they can display changes about virtually every patient above a certain age without the person actually having any obvious signs of illness. The situation is also aggravated in some patients who often have other illnesses present at the same time. In particular, vertebrae illnesses can increase the susceptibility of peripheral nerves.

The experience of a doctor is important
Besides the actual test results, the experience of the doctor is important for the diagnosis. Where the problem actually lies is frequently found from the illness history and tracing the symptoms rather than from x-rays and expensive neurological diagnostic procedures.

“Peripheral nerve damage, for example, can be treated with very good results following a successful diagnosis - however the doctor must first think carefully about the problem”, says Omar-Pasha, who frequently deals with such patients. In simple cases, relieving pressure and padding the damaged nerves can bring alleviation. Frequently nerves must be operated on to release entrapment. In most cases relief then occurs immediately. In very stubborn cases patients can be treated with an electrode connected to an electrical spinal chord stimulator.

Spinal cord stimulator
In principle this is a “pain pacemaker” whose electrical pulse intensity is controlled by the patient and can be adjusted as needed. In an ideal case the pain signals will seem to be neutralised.

First of all, a stimulation test phase is carried out lasting about a week, after which the control unit is implanted under the skin. In Germany, peripheral nerve stimulation using an electrode placed over the nerve has rarely been carried out, even though it is well known in the USA, where it has become so successful that it is bordering on a miracle, even with patients previously thought beyond treatment.

A morphium pump can also be sensible idea
Many doctors are today of the view that palliative therapy must be given space in German medicine alongside standard medicinal practice. This applies particularly to patients in severe pain whose doctors should not feel that they have to hold back from administering pain killing drugs. Also, the implantation of a morphium pump should be taken into consideration if all other methods show no adequate effect. “A useful pain reducing therapy should not be refused due to the need for a lengthy official authorisation process to take place”, explains Omar-Pasha.

In most cases the Health Insurance Services will pay for treatment.
Most treatments will be paid for by the health insurance services if the treatment can be shown to be necessary. Difficulties may arise in isolated cases with individual health service providers where it may be necessary to make a convincing argument, but they will invariably pay in the end.

It is significant that today nearly all operations can be carried out in outpatient clinics. Not only does this reduce costs, it also means that patients recover quicker when not taken from their own home surroundings. One should not simply put up with chronic pain under any circumstances.
The old saying, “one has to live with it,” should not be uttered by a professional doctor today.

“People say so lightly these days that ones spine is to blame for all their pain” Omar-Pasha continues: “There are many ways of giving treatment and just about every form of pain can be treated today.” Naturally that is not so simple for the patient or for the doctor. An optimal pain therapy should be done in stages until the patient is free of pain and can return to daily routines without any substantial reduction in their quality of life.
„Pain can be controlled by preventing the signals from reaching the brain.” “There are many methods of treatment, and any kind of pain can be treated today." Source (german article): Orthopress, Jahrgang 5, Großraum Hamburg, Ausgabe 1/02, Seite: 5 - 6.

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