QUESTIONS & ANSWERS
FREQUENTLY ASKED QUESTIONS
What is pain?
Pain is a complex sensory and emotional experience that is often associated with tissue damage. Pain is an unpleasant perception caused by actual or potential tissue damage. In its ‘healthy’/natural form, pain serves as a protective mechanism of the body, indicating that something is wrong or that an injury is present. 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 more persistent and often has no obvious cause.
Pain can also be categorized into different types, known as pain types. Nociceptive pain, caused by direct stimulation of pain receptors, neuropathic pain, which arises from a dysfunction of the nervous system, and nociplastic pain, considered a ‘special form’ between the other two pain types.
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 experience pain?
Pain is, so to speak, our 'alarm sense.' Through various stimuli, which can be mechanical, thermal, or chemical in nature, pain receptors in the tissue are activated. Free nerve endings function as pain receptors, known as nociceptors, which transmit the pain signal to the central nervous system. The spinal cord acts as the first relay station, through which the pain information is forwarded to the brain. There, processing and networking take place. At this level, thoughts and emotions can also have an influence. The conscious perception of pain occurs only in the brain. In the tissue, we do not yet speak of pain, but of nociception. Nociception is the unconscious activation of the pain receptor and the transmission of the signal from the site of injury to the spinal cord via the nerve. Pain processing also occurs in the spinal cord and in subordinate brain structures.
What are acute and chronic pains?
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 obvious cause. According to the WHO (World Health Organization), 3 months is the threshold between acute and chronic pain. However, chronicity can occur earlier or significantly later.
Is pain the same as pain?
No. There are fundamentally two main types of pain. These so-called pain types are nociceptive and neuropathic pain.
Special forms include mixed, nociplastic, and somatoform pain.
Nociceptive pain, also known as inflammatory pain, originally serves a vital warning function by signaling that there is an injury in the body. The intensity and location of the pain correspond to the cause. The perceived quality of pain is typically sharp, acute, well-localized, and ends once the underlying injury has healed. An example of this is the postoperative phase after the healing of a surgical wound.
In contrast, neuropathic pain is associated with damage to the nervous system. Sometimes, nerve fibers independently send pain signals without an external trigger. Although the pain originates in the nervous system (nerve, spinal cord, or brain), the perceived pain location can be different. The intensity and location of this pain do not correspond to the underlying cause.
Both types of pain can outlast the healing phase and develop into chronic pain.
What is an infiltration? What is the difference from an intervention?
An infiltration is a medical term used in various fields (pain medicine, orthopedics, rheumatology, radiology). In general, infiltration refers to the introduction of a liquid or substance into the tissue or a specific area of the body. In pain medicine practice, the term "infiltration" is often used to describe a technique where a specific substance, such as a local anesthetic or an anti-inflammatory medication, is injected near painful or inflamed tissue structures. The aim is to alleviate symptoms by directly treating the cause of the pain. An infiltration can serve both therapeutic and diagnostic purposes.
An "intervention" generally describes a decisive action against a disease process or pain issue. In pain medicine practice, the term "intervention" refers to a small, minimally invasive procedure (injection, shot). Practically all interventions performed at ISSZ are targeted, under X-ray and/or ultrasound guidance. Patients are subjected to minimal stress through these interventions.
What is meant by diagnostics?
Diagnostics refers to the process of detecting, identifying, and assessing diseases, conditions, or disorders in the human body. The goal of diagnostics is to determine the cause of symptoms or complaints, establish an accurate diagnosis, and thus provide the basis for appropriate treatment.
What is a diagnostic intervention?
In diagnostic interventions (or infiltrations), this serves as a 'test'. By specifically blocking pain stimuli through the local anesthesia of nerves or joints, conclusions can be drawn about the cause of the pain, which can then be used for further treatment planning.
What is a facet joint infiltration?
In a facet joint blockade, medications such as local anesthetics and/or corticosteroids are sequentially injected with thin needles into the small vertebral joints or the affected nerve branches of the spine. The safe and precise placement of the medication is carried out under fluoroscopy. This treatment method can be applied in the cervical, thoracic, and lumbar spine areas. Facet joint diagnostics involve the diagnostic blockade of the medial branches of the facet joints with a local anesthetic and serve to confirm suspected facetogenic back pain.
What is thermocoagulation?
Thermocoagulation, also known as thermoablation, is a procedure for pain treatment. In this procedure, the doctor places a needle near a small nerve branch, the medial branch, under fluoroscopic guidance. By heating the tip of the needle with high-frequency electric current, the nerve branch is ablated. This procedure can be performed as an extension of a facet joint infiltration or as its enhancement (medial branch block).
What is an opiate? What is an opioid?
Opiates are a group of powerful pain-relieving substances derived from the sap of the opium poppy or synthetically produced. Opioids are synthetically manufactured 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 experienced after surgeries, in cancer, or severe injuries.
Some well-known opioids, which occur naturally in the opium poppy or are synthetically produced, include: morphine, codeine, oxycodone, and fentanyl.
It is important to note that opioids have the potential to be addictive and can lead to misuse, dependency, and severe side effects if used improperly. These include respiratory depression (slowed breathing) and overdose. Therefore, opioids should only be taken under strict medical supervision and according to 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 the craving for opium derivatives.
Why is physiotherapy important for musculoskeletal pain?
Physiotherapy is important for musculoskeletal pain for several reasons.
On one hand, pain relief can be achieved through various techniques such as massage, stretching exercises, manual techniques, and electrotherapy by attempting to alleviate muscle tension. On the other hand, an improvement in mobility and flexibility can be achieved through targeted exercises and mobilization techniques, which in turn reduces pain and aims at improving function. Additionally, muscle function can be enhanced. Weak muscles and muscle groups should be strengthened, and shortened muscles should be stretched. This helps restore muscle balance and correct imbalances that can lead to pain.
Prevention of secondary problems is also important. By treating musculoskeletal pain and functional limitations, physiotherapy can help prevent secondary issues such as muscle atrophy, joint stiffness, and posture problems.
Physiotherapists often provide guidance and support in developing an individualized exercise and movement program, helping patients manage their pain and improve their daily functioning.
Overall, physiotherapy plays a crucial role in the treatment of musculoskeletal pain, as it not only alleviates pain but also improves the function and quality of life of those affected.
What is multimodal pain therapy?
A multimodal pain therapy is a holistic approach to pain management, particularly for chronic pain. It combines and coordinates various treatment methods to address the individual needs of the patient. The focus is on treating pain not only on a purely physiological (biological) level but also considering psychological, social, and functional aspects.
Typical components of multimodal pain therapy can include:
- Medication therapy
- Physiotherapy
- Psychological support (cognitive behavioral therapy, relaxation exercises, and stress management to cope with pain and psychological stress)
- Social support (counseling and assistance in managing social and occupational challenges)
- Interventional procedures (targeted injections, nerve blocks, or other interventional methods)
- Complementary therapies, including acupuncture, massage, chiropractic
What is meant by the biopsychosocial pain model?
Pain often has a physical or biological origin. However, all pain, especially chronic pain, can also be strongly influenced by psychological and social factors. These can intensify the pain, make coping more difficult, and impair the quality of life.
The treatment of chronic pain often requires a holistic approach that not only addresses the physical symptoms but also considers psychological and social aspects. This may require a multidisciplinary approach where various specialists work together to develop the best possible treatment plan for the individual patient.
Infiltrations 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 physiotherapy, behavioral and relaxation therapies, and social support. Psychotherapy, especially cognitive-behavioral treatment approaches, holds significant importance in this context.
Communication and collaboration with the patient's healthcare providers are crucial to ensure a holistic approach and to make sure that all aspects of pain management are adequately addressed.
How does chronic pain develop?
This is still relatively poorly understood, even though a lot has been learned about pain in the last 50 years. The triggers of pain often remain unclear, and ultimately the goal is 'only' pain relief.
One hypothesis for the development of chronic pain is based on a disturbance in central stimulus processing, leading to what is known as pain sensitization. This sensitization can persist even after the healing of an injury that occurred a long time ago. Essentially, there are lasting, learned changes in the nervous system. However, these changes are not yet detectable by imaging or laboratory tests, although the pain is present.
Sensitization processes can occur either at the level of pain receptors, known as nociceptors, in the tissue through, for example, 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, normally non-painful stimuli can lead to pain sensations through enhanced pain perception. Due to the reformation and formation of new nerve connections, nerve cells that normally do not play a role in pain transmission can be involved, causing the pain to spread. In some pain disorders, there is a general hypersensitivity, the causes of which are still relatively unclear. Repeated excitation of nerve cells can lead to reformation of synapses (contact points between nerve cells) at the spinal cord level, or even the formation of new nerve connections. The brain 'learns' the pain, and the pain develops into an independent condition.
What are treatment goals?
For effective and sustainable pain treatment, the cause must be addressed. In the case of acute pain, this is often still possible. Healing is the goal, which usually results in the disappearance of the pain. Chronic pain conditions are more difficult to treat, so the goals are pain reduction, improvement in quality of life, and regaining independence (both privately and professionally).
For which interventions must one be fasting?
For various interventions, the patient must appear fasting. Medically, fasting means no solid food (including dairy products) for 6 hours and no fluids for 2 hours before the procedure/intervention. This explicitly excludes medication intake, which does not count as food and can be taken with a sip of water at any time. The pre-interventional fasting rule serves to prevent aspiration of stomach contents. As a general rule, for all procedures on the cervical and thoracic spine, infiltration of the spinal canal, and all medication infusions, a 6-hour fasting period must be observed. However, you will also be informed about this by your doctor beforehand. If in doubt, please consult our practice staff.
What should be considered regarding blood thinning and interventions/infiltrations?
This should always be discussed individually 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 pausing, blood thinning must be weighed individually. This also depends on the specific intervention. Overall, the risks of significant bleeding in pain management interventions are considered low. If you have any questions, please do not hesitate to contact us.
What should be considered regarding pain medication use and driving?
This is an important but not easily answered question, as there are many medical and legal uncertainties. It is clear that certain medications can impair driving ability. The following key aspects should be considered:
Classes of Pain Medications: Some pain medications, especially opioids, muscle relaxants, antidepressants, and antiepileptics, can cause drowsiness, dizziness, and slowed reaction times, which can impair driving.
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.
Consulting a Doctor or Pharmacist: It is advisable to inquire about the potential impacts on driving ability before taking pain medications. A doctor or pharmacist can provide recommendations on whether it is safe to drive while taking certain medications.
Warning Labels 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 medications, consider alternative transportation options such as public transport, taxis, or assistance from friends or family members.
Ultimately, it is the individual's responsibility to ensure they are able to drive safely without endangering themselves or others. If there are doubts or concerns about driving ability, it is best to avoid driving and choose a safer option.
Can pain interventional treatments be performed on an outpatient basis?
(Almost) all pain interventional procedures can be performed on an outpatient basis. Ultimately, it also depends on individual complaints, pre-existing conditions, and diagnoses. Except for spinal neurostimulation, known as spinal cord stimulation, all treatments offered at 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 to block pain signals, thereby relieving pain. A spinal cord stimulator is often used in patients with chronic pain who do not respond to conventional treatments. Commonly treated conditions include post-surgical back pain, radiculopathies, complex regional pain syndrome (CRPS), and neuropathic pain.
How does an SCS work?
This is not yet fully understood, but there are likely several mechanisms involved. The pulse generator sends electrical impulses to the spinal cord that suppress or modulate the pain signals. This is achieved through electrodes placed near the spinal cord and a pulse generator (stimulator) that is surgically implanted under the skin.
