The therapy is oriented towards the various causes and factors that aggravate the disease. This is done both medicinally and by means of complementary procedures, which include physical, psychological and social components.
The goal of pain therapy in this context is to interrupt the conduction of pain (medicinal) on the one hand, and to change the affected person's perception of pain (non-drug) on the other.
The basis of many long-term treatments is often medication. According to the World Health Organization (WHO), pain therapy is divided into three stages (WHO stage scheme):
- Stage I: Non-steroidal anti-inflammatory drugs for mild pain.
- Stage II: Opioids for moderate to severe pain
- Stage III: Opioids for severe to very severe pain
Often, treatment begins with withdrawal of such medications as listed above, which may play a role in chronic pain chronification. An example is drug-induced headache, which develops when sufferers consume painkillers on more than ten days per month. Supplementary medications may be given for some forms of pain, such as anticonvulsants for colic. Some antidepressants sometimes have a very good pain-relieving effect as a positive side effect.
Furthermore, drugs from the group of anti-epileptics can also be used against continuous pain. This is especially true for nerve pain (neuralgia), where agents such as carbamezepine, oxcarbamezepine, oxcarbazepine, gabapentin, or pregabalin have been shown to have a markedly positive effect.
Depending on the form of pain, there are other forms of therapy to choose from in addition to psychotherapy and medication:
- Exercise therapy
- Behavioural therapy, such as stress management training or biofeedback
- Physiotherapy and manual therapy to strengthen or relieve muscle groups
- Transcutaneous electrical nerve stimulation (TENS) can be used to stimulate nerve structures by applying electrical impulses to the skin.
- Autogenic training
- Nerve blockades e.g. sympathetic blockade through the administration of guanethidine
- Pain pumps, which are implanted and continuously deliver active substances for painkiller administration
- Local or regional anaesthesia e.g. with peridual catheter
- Relief operations e.g. for carpal tunnel syndrome
- Palliative surgery to reduce pain in cases of cancer that cannot be cured
Sometimes simple methods such as a change in diet or a change of job can have a positive effect on pain.
Some pain therapies can only be carried out on an inpatient or outpatient basis in a pain outpatient clinic. Various experts work together here, such as anaesthetists, psychotherapists, surgeons, orthopaedists and neurologists.
In order to get a picture of the course and success, patients are encouraged to continue to keep pain questionnaires, pain diaries and progress documents at home.