FREQUENTLY ASKED QUESTIONS
Welcome to our Questions and Answers page. Here you’ll find helpful information about our treatment methods and specific therapies.
What is pain?
Pain is a complex sensory and emotional experience that is often associated with tissue damage. Pain is an unpleasant sensation caused by actual or potential tissue damage. In its “healthy”/natural form, pain serves as the body’s protective mechanism, signaling that something is wrong or that an injury has occurred. Essentially, pain is a protective mechanism of our body.
There are different types of pain: acute pain, which is usually short-term and associated with a specific injury or illness, and chronic pain, which is longer-lasting and often has no apparent cause.
Pain can also be classified into different categories, known as pain types: nociceptive pain, which is caused by direct stimulation of pain receptors; neuropathic pain, which results from a dysfunction of the nervous system; and nociplastive pain, which can be considered a “special form” between the other two types of pain.
The perception of pain is always subjective and can vary from person to person. There are many different influencing factors, which complicates both the understanding of pain and its treatment.
Why do we feel pain?
Pain is, so to speak, our “alarm system.” Various stimuli—which may be mechanical, thermal, or chemical in nature—activate pain receptors in the tissue. Exposed nerve endings act as pain receptors—known as nociceptors—which transmit the pain stimulus to the central nervous system. The spinal cord serves as the first relay station, through which pain information is transmitted to the brain. There, the information is processed and integrated. Thoughts and emotions can also influence this process at this level. The conscious perception of pain occurs only in the brain. At the tissue level, we do not yet speak of pain, but rather of nociception. Nociception is the unconscious activation of the pain receptor and the transmission of the stimulus from the site of injury to the spinal cord via the nerves. Pain processing also takes place in the spinal cord and in lower-level brain structures.
What is acute pain, and what is chronic pain?
There are different types of pain. Acute pain, which is usually short-term and associated with a specific injury or illness, and chronic pain, which is longer-lasting and often no longer has an obvious cause. According to the WHO (World Health Organization), three months is the cutoff point between acute and chronic pain. However, pain can become chronic much earlier or significantly later.
Is all pain the same?
No. There are essentially two main types of pain. These so-called pain types are nociceptive and neuropathic pain.
Special forms include mixed, nociplast, and somatoform pain.
Nociceptive pain, also known as inflammatory pain, serves a vital warning function in its original form by signaling that an injury is present in the body. The intensity and location of the pain correspond to the trigger. The perceived quality of the pain is typically sharp, acute, well-localized, and subsides as soon as the underlying injury has healed. An example of this is the postoperative phase following the healing of a surgical wound.
In contrast, neuropathic pain is pain associated with damage to the nervous system. Sometimes nerve fibers send out pain signals on their own, without any external trigger. Although the pain originates in the nervous system (nerve, spinal cord, or brain), the perceived location of the pain may be elsewhere. The intensity and location of this pain are not proportional to the underlying cause.
Both types of pain can persist beyond the healing phase and develop into chronic pain.
What is an infiltration? How does it differ from an intervention?
An infiltration is a medical term used in various specialties (pain medicine, orthopedics, rheumatology, radiology). In general, an infiltration refers to the injection of a fluid or substance into tissue or a specific area of the body. In pain medicine, the term “infiltration” is often used to describe a technique in which a specific substance—such as a local anesthetic or an anti-inflammatory medication—is injected precisely near painful or inflamed tissue structures. The goal is to alleviate symptoms by directly treating the cause of the pain. An infiltration can serve both therapeutic and diagnostic purposes.
Broadly speaking, an “intervention” describes a decisive action taken against a disease process or a pain problem. In pain medicine, the term “intervention” refers to a small, minimally invasive procedure (injection). Virtually all interventions performed at the ISSZ are carried out with precision under X-ray and/or ultrasound guidance. These interventions cause only minimal discomfort to patients.
What is meant by “diagnostics”?
Diagnostics refers to the process of detecting, identifying, and evaluating diseases, conditions, or disorders in the human body. The goal of diagnostics is to determine the cause of symptoms or complaints, make an accurate diagnosis, and thereby lay the foundation for appropriate treatment.
What is a diagnostic intervention?
In diagnostic procedures (or infiltrations), this serves as a “test.” By selectively blocking pain signals through local anesthesia of nerves or joints, conclusions can be drawn about the cause of the pain, which can then be used to guide further treatment planning.
What is a facet joint injection?
In a facet joint block, medications such as local anesthetics and/or corticosteroids are injected one after another using thin needles into the small vertebral joints or at the affected nerve branches of the spine. The medication is placed safely and precisely under fluoroscopic guidance. This treatment method can be used in the cervical, thoracic, and lumbar spine regions. Facet joint diagnostics involves the diagnostic injection of a local anesthetic into the medial branches of the facet joints and is used to confirm suspected facet-related back pain.
What is thermocoagulation?
Thermocoagulation, also known as thermal ablation, is a procedure used to treat pain. Under X-ray guidance, the doctor inserts a needle near a small nerve branch called the medial branch. By heating the tip of the cannula with high-frequency electrical current, the nerve branch is ablated. This procedure can be performed as a supplement to a facet joint injection or as an extension of it (medial branch block).
What is an opiate? What is an opioid?
Opiates are a group of powerful pain-relieving substances that are derived from the sap of the opium poppy or can be produced synthetically. Opioids are synthetically produced substances that—like “natural opiates”—act on opioid receptors in the human body. Both affect the central nervous system. They are used to treat moderate to severe pain, such as that which may occur after surgery, in cases of cancer, or following serious injuries.
Some well-known opioids, which occur naturally in the opium poppy or are produced synthetically, include: morphine, codeine, oxycodone, and fentanyl.
It is important to note that opioids are potentially addictive and, if used improperly, can lead to abuse, dependence, and serious side effects. These include, among others, respiratory depression (slowed breathing) and overdose. Therefore, opioids should only be taken under strict medical supervision and in accordance with the doctor’s instructions. In some cases, opioids are used to treat drug addiction by replacing them with other medications, such as methadone or buprenorphine, which alleviate withdrawal symptoms and reduce cravings for opium derivatives.
Why is physical therapy important for musculoskeletal pain?
Physical therapy is important for musculoskeletal pain for several reasons.
On the one hand, pain relief can be achieved through various techniques—such as massage, stretching exercises, manual techniques, and electrotherapy—which aim to release muscle tension. On the other hand, improved mobility and flexibility can be achieved through targeted exercises and mobilization techniques, which in turn reduce pain and are aimed at improving function. At the same time, muscle function can be improved. Weakened muscles and muscle groups should be strengthened, and shortened muscles should be stretched. This helps restore muscular balance and correct improper loading that can lead to pain.
Preventing secondary problems is also important. By treating musculoskeletal pain and functional limitations, physical therapy can help prevent secondary problems such as muscle atrophy, joint stiffness, and postural issues.
Physical therapists often provide guidance and support in developing a personalized exercise and movement program, which helps patients manage their pain and improve their function in daily life.
Overall, physical therapy plays a crucial role in the treatment of musculoskeletal pain, as it not only relieves pain but can also improve function and quality of life for those affected.
What is multimodal pain management?
Multimodal pain management is a holistic approach to treating pain, particularly chronic pain. It combines and coordinates various treatment methods to address the patient’s individual needs. The focus is on treating pain not only on a purely physiological (biological) level, but also on taking psychological, social, and functional aspects into account.
Typical components of multimodal pain management may include:
- Medication
- Physical therapy
- Psychological support (cognitive behavioral therapy, relaxation exercises, and stress management to cope with pain and psychological stress)
- Social support (counseling and support in coping with social and occupational challenges)
- Interventional procedures (targeted injections, nerve blocks, or other interventional methods)
- Complementary therapies, including acupuncture, massage, and chiropractic care
What is the biopsychosocial model of pain?
Pain often has a physical or biological cause. However, all types of pain—but especially chronic pain—can also be strongly influenced by psychological and social factors. These factors can intensify the pain, make it harder to cope with, and impair quality of life.
The treatment of chronic pain therefore often requires a holistic approach that not only addresses the physical symptoms but also takes psychological and social aspects into account. This may require a multidisciplinary approach in which various specialists work together to develop the best possible treatment plan for each individual patient.
Injections and medications can be important components of this treatment plan to control pain and improve quality of life. However, it is also important to consider other non-pharmacological approaches—such as physical therapy, behavioral and relaxation therapies, and social support. Psychotherapy, and behavioral therapy approaches in particular, play a significant role in this context.
Communication and collaboration with the patient’s healthcare providers are crucial to ensuring a holistic approach and guaranteeing that all aspects of pain management are adequately addressed.
How does chronic pain develop?
Even though we have learned a great deal about pain over the past 50 years, it remains relatively poorly understood. The triggers of pain often remain unclear, and ultimately, the goal is “merely” to relieve the pain.
One hypothesis regarding the development of chronic pain posits a disturbance in central stimulus processing, leading to what is known as pain sensitization. This sensitization can persist even after an injury that occurred some time ago has healed. Ultimately, there are lasting—so to speak, “learned”—changes in the nervous system. However, these changes are (so far) undetectable by either imaging or laboratory tests. Yet the pain is very real.
Sensitization processes can occur either at the level of pain receptors—known as nociceptors—in the tissue, for example through the release of inflammatory mediators, or at the level of the central nervous system through a shift in the perception threshold. In the latter case, stimuli that are normally not painful can lead to pain sensations due to heightened pain perception. As a result of the reorganization and formation of new neural connections, nerve cells that normally do not play a role in pain transmission can become involved, causing the pain to spread. In some pain disorders, general hypersensitivity occurs, the causes of which are still relatively unclear. Repeated excitation of nerve cells leads, at the level of the spinal cord, to
What are treatment goals?
For effective and sustainable pain management, the underlying cause must be addressed. In the case of acute pain, this is often still possible. The goal is a cure, which usually results in the pain subsiding. Chronic pain conditions are more difficult to treat, so the goals are pain reduction, improvement in quality of life, and regaining independence (both personally and professionally).
For which procedures do you need to be sober?
For certain procedures, the patient must arrive on an empty stomach. Medically speaking, “on an empty stomach” means no solid food (including dairy products) for 6 hours and no liquids for 2 hours before the procedure. Explicitly excluded from this are medications, which are not considered food and may be taken at any time with a sip of water. The pre-procedural fasting rule is intended to prevent aspiration of stomach contents. As a general rule, a 6-hour fast must be observed for all procedures involving the cervical and thoracic spine, as well as for spinal canal infiltrations and all medication infusions. However, your doctor will also inform you of this in advance. If you have any questions, please ask our practice staff.
What should be considered when using blood thinners and performing procedures or infiltrations?
This should always be discussed on a case-by-case basis with the interventional pain specialist, as there are many different blood-thinning medications and various indications (reasons) for blood-thinning treatment. The benefits and risks of continuing, as well as of temporarily stopping, blood-thinning therapy must be weighed on a case-by-case basis. This also depends on the procedure itself. Overall, the risk of significant bleeding during pain management procedures is considered low. If you have any questions, please do not hesitate to contact us.
What should you keep in mind when taking pain relievers and driving?
This is an important question, but one that is not entirely easy to answer, as there are many uncertainties from both a medical and legal perspective. It can be stated that certain medications can impair a person’s ability to drive. The following key points should be considered.
- Schmerzmittelklassen: Some pain medications, particularly opioids, muscle relaxants, antidepressants, and antiepileptic drugs, can cause drowsiness, dizziness, and slowed reaction times, which can impair driving ability..
- Individual reactions: The effects of pain medications can vary from person to person. Some people may be more affected by the sedative effects than others.
- Consultation with a doctor or pharmacist: It is advisable to find out about the potential effects on your ability to drive before taking pain medications. A doctor or pharmacist can advise you on whether it is safe to drive while taking certain medications.
- Warnings on Medications: Many pain medications include warnings regarding the operation of vehicles or machinery.
- Alternative Transportation Options: If you are unsure whether you can drive safely while taking pain medication, you should consider alternative transportation options such as public transportation, taxis, or assistance from friends or family members.
Ultimately, it is the individual’s responsibility to ensure that they are able to drive safely without endangering themselves or others. If there are any doubts or concerns regarding fitness to drive, it is best to refrain from driving and choose a safer option.
Can interventional pain treatments be performed on an outpatient basis?
Almost all interventional pain management procedures can be performed on an outpatient basis. Ultimately, however, this also depends on the individual symptoms, pre-existing conditions, and diagnoses. With the exception of spinal neurostimulation, known as spinal cord stimulation, all treatments offered at the ISSZ are performed on an outpatient basis.
What is a spinal cord stimulator (SCS)?
A spinal cord stimulator is a medical device used to treat chronic pain. It sends electrical impulses to the spinal cord in order to block pain signals and thereby relieve pain.
A spinal cord stimulator is often used in patients with chronic pain who do not respond to conventional treatments. Commonly treated conditions include postoperative back pain, radiculopathies, complex regional pain syndrome (CRPS), and neuropathic pain.
How does an SCS work?
This has not yet been conclusively clarified, but several mechanisms are likely involved. The pulse generator sends electrical impulses to the spinal cord, which suppress or modulate pain signals. This is achieved through electrodes placed near the spinal cord and a pulse generator that is surgically implanted under the skin.