Pain

We normally want to avoid pain and not feel it. However, our ability to feel pain is essential for survival. Acute pain alerts us and prompts us to move out of the danger zone. Even if it lasts longer or is recurring, it can alert us to disturbing factors. However, the longer a pain lasts, the more difficult it usually becomes to resolve it causally. This can go so far that the pain takes on a life of its own and no longer indicates a problem, but becomes the actual problem.
In Germany, around 17% of the population is affected by chronic pain.

A pain stimulus can be triggered by chemical, thermal or mechanical influences and is transmitted to the brain via our nervous system. The actual sensation of pain only arises through processing in the cortex. In the so-called homunculus, the stimulus is assigned to a specific region ("my ear hurts"). In the frontal brain, it is compared with previous experiences, classified ("just like the middle ear infection") and evaluated ("can be treated well").

The intensity of pain, in turn, is based on processing in the limbic system, the area that is also responsible for our emotions. Fears can intensify pain (nocebo effect), and positive emotions such as trust or hope can alleviate pain (placebo effect).
The intensity of the pain experienced does not necessarily correlate with the extent of the somatic damage. Pain can also occur without any detectable tissue damage. It is then nevertheless real.

Parallel to the pain-perceiving system, there is also a pain-inhibiting system, which is particularly active in stressful situations, e.g. after an accident.
This can also be activated by competing sensations. In this way, blowing, which we mainly use when children have hurt themselves, can actually have a pain-relieving effect.
Our pain receptors are particularly active when tissue is damaged or inflamed. If a pain stimulus is repeatedly transmitted to the brain, this pathway is strengthened and the same stimulus is transmitted more easily. This results in sensitization. Pain can also become chronic in this way.

While a treatable cause can usually be found for acute pain, chronic pain has often already "taken on a life of its own". This often results in a doubly stressful situation for those affected: the pain itself and the frequent lack of understanding that goes hand in hand with other, invisible ailments, such as depression. If no somatic cause can be found, it is probably in the nervous system and from there the step to "psychosomatic" or even "psychologically caused" is a small one. Of course, this doesn't really help anyone.

Together with making everyday activities more difficult due to the pain, this often impairs the social life of pain patients. Sleep disrupted by pain also has a negative impact on well-being and health. In the long term, depression and addiction can be the result, to the point where life no longer seems bearable.

Chronic pain occurs more frequently in women. It is assumed that hormonal, genetic and social factors play a role here.

Even if a specific cause cannot always be found, the search for it should be the first priority. For those affected, an identifiable cause often also means validation of their suffering, because it is finally proven that they are "not just imagining it all". Pain is subjective and real. It has nothing to do with imagination. In addition, a diagnosis also offers the possibility of more specific and effective treatment.

As women's health issues have long been neglected in medicine, it is no coincidence that women's conditions in particular are often only diagnosed after a long odyssey. A typical example of a late diagnosis is endometriosis, as the pain associated with it is often classified as "normal" and no further investigation is carried out. More than 10% of women in this country are affected by endometriosis. One of the main symptoms is pain associated with the menstrual cycle, which is often so severe that women are unable to function at all on these days or can only do so with strong painkillers.
Another condition, PCO syndrome, is often overlooked, especially in women who are not overweight. Another example of underdiagnosed conditions is vulvodynia, which is estimated to affect 5-10% of women at least once in their lives. Vulvodynia is not even listed in the ICD10. It is now appearing for the first time in ICD 11. It often takes years before a diagnosis is made.

Diseases that affect women more frequently are of course not limited to the field of gynecology. Painful conditions such as temporomandibular joint dysfunction, fibromyalgia, osteoarthritis, low back pain, migraines and irritable bowel syndrome occur much more frequently in women.

Once the common causes have been ruled out, individual detective work often begins. Past infections, neuropathies, autoimmune diseases, hormonal disorders, intolerances, nutrient deficiencies or latent inflammation can all play a role.

Persistent nerve pain may, for example, be due to a shingles infection without visible skin symptoms (in which case treatment with antivirals may be advisable). Mast cell activation syndrome (MCAS) can also cause recurring pain. Here, antihistamines usually provide more relief than painkillers.

The list of possible causes is long. To find out, a thorough medical history and further laboratory diagnostics are usually required.

The right treatment for acute pain can prevent the development of chronic pain via pain memory.
Many of us are reluctant to take painkillers lightly. We feel that acute pain has a good intention, namely to protect us, and mistrust the side effects of medication. These side effects are a particular problem with long-term use. Like most medications, the effects of painkillers are primarily researched on men. Women often show a different reaction to painkillers.

In many situations, "home remedies" also help: heat relieves menstrual pain or tension and cold calms inflammation: For headaches, peppermint oil applied to the temples or rest and fresh air often help. If the headache is caused by low blood pressure, caffeine can help and it is of course important to make sure you drink enough. The list of acute causes of pain and suitable remedies is long.
In some cases, it can still be useful to take a painkiller to break the vicious cycle of pain, tension, stress and more pain. Painkillers such as ibuprofen or paracetamol also have an anti-inflammatory effect and can have a direct positive effect on the cause of acute earache or inflammation, for example.

If there is a specific cause, this should of course be treated. Pain that lasts longer than three months is considered chronic. In accordance with the care guidelines, an interdisciplinary diagnosis is then recommended. In most cases, a multimodal therapy concept that also integrates psychological aspects is the most effective.

In individual cases, this means trying things out and seeing what helps best and in what combination. In addition to conventional therapy elements such as painkillers, co-analgesics, surgical interventions, Botox (e.g. for migraines or bruxism) and physiotherapy, naturopathic or holistic treatment approaches can also be considered. The latter include acupuncture, nutritional therapy, relaxation techniques, hypnosis, aromatherapy and cognitive behavioral therapy. Even laughter releases endorphins, which act as natural painkillers.
The details of drug and multimodal pain therapy are too extensive for this article and every pain patient should have a professional contact person or medical support for this.

I would only like to go into two therapy options in more detail here:
A) acupuncture, because it has proven effective for pain, and
B) nutritional therapy, because so little attention is still paid to it in pain therapy.

Acupuncture relieves pain by promoting the release of endorphins and activating the above-mentioned pain-inhibiting system and other neurological mechanisms. The aspect of pain inhibition via competing sensations is even effective when needling points that are not actually classic acupuncture points. For this reason, even this type of sham acupuncture can bring relief from pain.

In addition, the targeted combination of acupuncture points can also influence the central nervous system, such as activity in the thalamus. This can lead to a reduction in the sensation of pain and a reduction in inflammation. Acupuncture has proven effective for both acute and chronic pain.

An anti-inflammatory diet based on foods that are as unprocessed as possible and contain as little sugar as possible can be particularly beneficial for pain patients. As a supplementary therapy component, this type of diet can reduce the need for painkillers and improve quality of life. Inflammatory processes play an important role in the physiology of pain. Sugar has a pro-inflammatory effect by increasing insulin production, causing insulin resistance, forming harmful molecules (AGEs) and increasing the activity of certain immune cells that intensify inflammatory reactions. Reducing sugar consumption counteracts these inflammatory processes and can also have a pain-relieving effect. Sufficient fluid intake and omega-3 fatty acids also have an anti-inflammatory effect.
In addition, nutritional therapy is always individual and requires an individual diagnosis. If there are vitamin or nutrient deficiencies, targeted substitution is advisable. For example, a vitamin D deficiency can increase sensitivity to pain and should be treated accordingly. B vitamins can be helpful for neuropathic pain, and magnesium can alleviate migraines and pain associated with muscle tension.
The diagnosis of intolerances and a diet based on this can also be helpful.
Histamine can cause pain and symptoms, e.g. in the case of high levels or intolerance. In these cases, reducing histamine-rich foods, for example, can alleviate the symptoms. The latter is also recommended for endometriosis and some of my patients report that a low-histamine diet noticeably alleviates their endometriosis-related symptoms.

With chronic pain, it is worth sticking with it and continuing to look for solutions.  While the goal of treatment for acute pain is freedom from pain, it makes sense not to wait for freedom from pain in the case of chronic pain, but to reclaim your life with or despite pain.