“Time Operates Against the Patient” -- MEDICA - World Forum for Medicine

“Time Operates Against the Patient”

Photo: Man holds hands on his back

A correct pain therapy is very
important; © ABDA

MEDICA.de spoke to Professor Holger Kaube, neurologist and head of the Pain Centre at University of Freiburg, Germany, about migraine, sunburn and chronic pain.

MEDICA.de: Mr. Kaube, according to a study many neurologist and experts of headache chose their profession because they suffer from migraine themselves.

Holger Kaube: So did I. Already as student I suffered from migraine, sometimes with heavy visual disorders.

MEDICA.de: So you often have headache. Is this similar to the general population?

Kaube: Thinking of facile pain this is correct. 80 to 90 percent of the people sometimes have tension headache. Based on heavy pain, not only headache but also back pain appears very often. In cases of 10 to 20 percent they even can lead to unemployment.

MEDICA.de: Pain is a sensory perception and subjective. Wherefrom do you know that a patient really has such heavy pain if he says?

Kaube: Primarily pain is subjective, that is correct. But there are also methods to measure the pain level. Neurologists use functional imaging or special EEG methods for example. The answers of the technique often agree with patients’ information. With EEG for example the doctor measures the electrical brain activity. The higher the activity is the larger the pain is. If the patient should classify his pain on a scale from zero to ten for example and he marks number six with a cross, the result of the EEG has a similar result very often. In this example it should notice six volt on a scale from zero to ten volt.

MEDICA.de: Can you describe how pain on level six is like?

Kaube: Touching the nerve with the dentist’s trepan it feels like pain on level ten. Six could be migraine for example.

MEDICA.de: Can you explain why we do feel pain at all?

Kaube: We often have pain due to a tissue injury. If a person has sunburn the nerve endings are damaged in this area. Sensory stimuli are transmitted via spinal cord to a certain place in the brain, which give the feedback “back pain”. But there are also pain whose origin is in the body like inflammations.

MEDICA.de: However, there are people who suffer from pain and their doctors cannot help them. Do these patients fake an illness?

Kaube: No, These patients have chronic pain. Here the pain is not an alarm signal due to tissue injury or inflammation anymore. The pain has self-developed to an independent disease. The nerve cells are damaged themselves and notify pain to the brain, where it does not exists.

MEDICA.de: How does this happen?

Kaube: The processing of sensory stimuli in the nerve cells is incorrect. If pain continues over a long time the metabolism changes in the nerve cells. In this case the nerve cells send impulses to the brain although the origin of the pain, an injury maybe, does not exist anymore. The pain becomes independent. If physicians do not recognize this process, the pain can become more intense. However, many doctors refer their patients to a special pain centre when they are at a loss. But this is often too late. The longer pain is untreated the higher is the likelihood that the pain gets more.

MEDICA.de: Is it only a matter of time until “normal” pain gets chronic?

Kaube: First of all it is important to choose the right pain therapy from the beginning of a disease because time operates against the patient. People often talk about a chronic disease if pain continues more than six month. However, that is partly correct. The intensity plays also an important role. If somebody has pain due to a rheumatic disease he has not necessarily be restricted. Often he even can go to work. In this case pain is not chronic. But if pain spreads out and the patient cannot manage his everyday life, than they are chronic. Sometimes this happens in few weeks, sometimes after six month. By the way, psychological stress can accelerate the development of chronic pain.

MEDICA.de: Is it possible to treat chronic pain?

Kaube: Yes, you can treat it. But it is important to choose a realistic aim of the treatment. Chronic pain cannot be eliminated completely. But it can be reduced so far that the patient can go to work again. Drugs are one part of the treatment. Moreover the patient must learn to change his way of life. He has to reduce stress and must learn to relax consciously. He has to accept the pain and should not suppress them anymore. This is a time-consuming process and requires the active cooperation of the patient.

The interview was conducted by Simone Heimann.