Journal article Open Access

Chronic Pain> Treatment and Rehabilitation

Jayden Vaughan

1. The most important things in a nutshell

The treatment of chronic pain consists of several components and is called "multimodal therapy" or "special pain therapy". These include, for example, drug therapy, physiotherapy, psychotherapy as well as minimally invasive and surgical procedures. Active coping strategies and educating the patient about the importance of psychosocial factors are also important.

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2. Medicinal pain therapy

Medicines are an important part of pain management and often form the basis for other building blocks of pain management.

Depending on the type of pain, different drugs can be used:

  • Pain relievers (analgesics)
    • Non-opioid pain relievers inhibit the messenger substances that arise in the event of tissue damage or inflammation and are mainly used for mild to moderate pain. Many of these drugs also have antipyretic and anti-inflammatory effects. These include, for example, acetylsalicylic acid, paracetamol, ibuprofen, diclofenac, metamizole, or naproxen.
    • Opioids have a stronger effect than non-opioid substances because they inhibit the transmission of pain impulses. There are weakly effective opioids, for example, tramadol, codeine, or tilidine, and strongly effective opioids, for example, morphine, oxycodone, hydromorphone, tapentadol, buprenorphine, or fentanyl. Notes on the use of opioids among opiates and opioids.
  • Antidepressants
    can bring the imbalance of certain messenger substances back into balance and have a pain-relieving effect. They are often combined with other drugs. The antidepressants include, for example, Sertraline (Zoloft) or amitriptyline.
  • Anti-epileptics / anticonvulsants
    reduce the risk of seizures by lowering neuronal excitability. This can also help suppress cramping nerve pain. The antiepileptics/anticonvulsants include, for example, gabapentin, carbamazepine, pregabalin, or valproic acid. Buy Amphetamine online
  • Herbal pain relievers
    are sometimes used in addition to other pain relievers in order to lower their dose and thereby reduce side effects.

The health insurance company usually pays the costs for drugs that require a prescription. For many drugs, however, co-payments have to be made.

2.1. Cannabinoids

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Cannabinoids are chemical compounds that also occur in the human body (so-called endocannabinoids). If additional cannabinoids are added to the body, they have a pain-relieving effect, among other things. For more information, see Medical Cannabis.

3. Remedies

3.1. physical therapy

Physiotherapy aims to restore, improve or maintain the ability of the human body to move and function properly. In pain patients, it is primarily intended to reduce fear of movement and tension, strengthen muscles and train optimal movement behavior. Physical procedures can also help relieve pain.

The physiotherapeutic procedures include, for example:

  • Sports and exercise therapy, especially stretching and strengthening exercises
  • Thermotherapy:
    • Heat therapy, e.g. fango packs, hot rollers, hot baths, or warm light
    • Cold therapy, e.g. ice massages or Kneipp therapies
  • Massages (supportive)
  • Electrotherapy, especially transcutaneous electrical nerve stimulation (TENS)

In the case of chronic pain syndrome, a prescription contains 6 units, generally up to a total prescription of 18 units (indicative treatment amount), of which up to 12 units are for massage units.

Many pain patients also benefit from targeted training of the muscles through rehab sports and functional training. This can reduce pain caused by poor posture and tension. See the best place to buy Crystal Meth Online

3.2. Assumption of costs

The measures of physiotherapy and occupational therapy are recognized remedies and can be prescribed by a doctor. The patient has to pay 10% of the costs plus 10 € per prescription.

4. Acupuncture

Acupuncture is a treatment method used in traditional Chinese medicine. By stimulating selected acupuncture points, the transmission of pain impulses can be suppressed and the release of pain-relieving endorphins can be activated. 

5. Psychotherapy

Mental illnesses, especially depression, can affect the experience and sensitivity to pain.

In the event of mental illness, the health insurance company pays the treatment costs for certain psychotherapeutic procedures, for more details see psychotherapy.

In the case of chronic pain, a (cognitive) behavioral approach is usually chosen. The aim is to learn how behaviors that increase pain can be changed in a targeted manner.

6. Alternative treatment methods

In the case of pain, relaxation methods are mainly used, either in physical or psychological treatment. They reduce tension and stress, have an effect on the body and soul, and can reduce pain. Patients can learn many methods themselves and use them in a targeted manner. Rehabilitation clinics, occupational therapists, and physiotherapists or doctors provide instructions on the various relaxation options.

The relaxation methods that are used in pain therapy include, for example:

  • Progressive muscle relaxation according to Jacobson: Targeted tensing and relaxing of individual muscle groups.
  • Autogenic training: Method by which you can put yourself in a state of changed, deepened awareness of your own body. The patient imagines something, eg "I feel very warm", and the body follows the idea.
  • Yoga: Holistic physical exercises, breathing, and meditation techniques relax and stretch the muscles.
  • Biofeedback procedure: The patient is made aware of unconscious body processes and he learns to influence them.
  • Coping with stress through mindfulness (Mindfulness-Based Stress Reduction - MBSR) : mindfulness exercises for everyday life, in order to reduce stress.

Are also used hypnosis, tai chi, qigong, Feldenkrais Method, Imaginations- and meditation techniques. With these methods, patients “keep their distance” from their pain.

Of these relaxation methods, progressive muscle relaxation according to Jacobson, and autogenic training are covered by health insurance if it is offered by appropriately qualified doctors.

In addition, as part of their bonus programs and prevention courses, many health insurances offer partial or full cost reimbursement for relaxation courses, which are offered, for example, at adult education centers, sports clubs, fitness studios and occupational and physiotherapy practices.

7. Operations

7.1. Minimally invasive procedures

Minimally invasive procedures can be performed for chronic pain. In contrast to conventional operations, minimally invasive procedures affect the body very little and can therefore be carried out on an outpatient basis.

The minimally invasive procedures include, for example:

  • Injection therapy
    Pain reliever and anti-inflammatory drugs are injected into the painful area of the body, for example in muscles or nerve roots. Since only a small amount of medication is required, side effects on the entire body can be minimized.
  • Pain reliever
    pumps The pain reliever is injected directly into the vein or nerve tissue (e.g. in the area around the spinal cord) via a catheter and a connected pump, where it works. This is mainly used for very severe pain.
  • Nerve stimulation (neurostimulation)
    With nerve stimulation, electrical impulses are delivered to a nerve via electrodes in order to block the transmission of pain. Buy Ketamine online without a prescription
    A neurostimulation device can also be implanted under the skin and connected to a probe close to the spinal cord. The probe sends electrical impulses which "superimpose" the body's own pain signals in the spinal cord and prevent them from being transmitted to the brain. As a result, the pain is barely perceived or only felt to a lesser extent.

7.2. Conventional operations

In certain situations, surgery can provide long-term relief from chronic pain. But it also harbors risks. Freedom from complaints cannot be guaranteed.

One of the conventional surgical procedures for chronic pain is, for example, intervertebral disc surgery. In most cases, intervertebral disc tissue is removed to relieve irritated nerves. Intervertebral disc operations are usually only carried out if conservative methods, e.g. physiotherapeutic measures, do not have an adequate effect or a quick intervention is unavoidable, e.g. in the case of a complete disruption of nerve tracts.

Another surgical procedure for pain relief is Endoprosthetics . A joint destroyed by illness or accident or worn out due to natural wear and tear is replaced by an artificial joint (endoprosthesis). The endoprostheses that are frequently used include, for example, hip and knee prostheses. Common reasons for using a joint replacement are osteoarthritis and rheumatoid arthritis.

Operations can be performed on an outpatient or inpatient basis.

8. Medical rehabilitation

Medical rehabilitation services aim to maintain or improve the state of health. Medical rehabilitation measures can be performed on an outpatient or inpatient basis. As a rule, there must be a waiting period of 4 years between 2 measures. Buy Blue dream cannabis online 

8.1. The rehab process

Depending on the state of health, medical rehab can take place on an outpatient or inpatient basis.

Outpatient rehab offers the advantage that the treatment concepts developed can be applied directly to the patient's everyday environment. If problems arise, individual adjustments can be made as part of the rehab.

stationary rehabilitation is recommended if a time-consuming and interdisciplinary diagnosis and treatment are necessary.

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Contents of the rehab are for example:

  • Drug treatment: Adjustment based on the patient's needs
  • Physiotherapy and occupational therapy: Improvement of the physical resilience and learning of assistance for everyday life
  • Psychotherapeutic care: better processing of painful conditions and handling of chronic pain
  • Learning relaxation techniques

The aims of rehab are, for example:

  • Extension of the symptom-free period
  • Improvement of physical and mental resilience
  • Prevention of secondary diseases and improvement of the general state of health

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