The biopsychosocial painmodel

The average clinical hospital, ambulance, praxis worldwide has to deal mainly with acute disturbances. According to this fact, the mechanistic approach that sees a clear, provable and mechanical damage behind every pain, is spread most common around the world. If one repairs this damage, the cause solves up and every one is happy again. This might be true in a lot of acute conditions.

But in the last decades science could show in chronic pain that it can develop rather shortly to a chronic paindisease that can be totally independent from "new" paininput. Further more such a chronic pain can cause deep suffering and massive influence on our wellbeing, our mood, can make us aggressive or helpless and can lead to strong social cocooning with increasing isolation in job, family and partnership.

This findings led to the conclusion that we should use a new, a broader painmodel that unifies physical, psychological and social aspects - the biopsychosocial diseasemodel was born! The international paincommunity established exact algorhitms, how to approach the very complex chronic paindisease.
Per definition we call it a chronic pain, if a pain has been lasting for more than 3 months with an intensity of >5 on a visual analogue scale (VAS) from 0=no pain and 10=worst imaginable pain.
The first step is, to exclude a "bad" cause of the pain - in back pain the so-called "red flaggs" of back pain like e.g. fracture, inflammation, carcinoma, discprolaps,...We can find such a red flag in less than 4% of painful backconditions. That means that in >95% of painful disorders we can't find any major structural damage. That doesn't mean that it can not hurt - but: THE INTENSITY OF PAIN AND THE SEVERITY OF THE CAUSE HAS A VERY BAD CORRELATION! The structures with the highest concentration of pain receptors are not the discs (just very few receptors on back side) or the bones. The nerveroot is also rather rare causing a backpain. It is the soft tissue with ligaments, joint capsules, tendons, fasciae,..that are innervated most with pain receptors. The good information is - MOST OF THE CHRONIC PAINFUL DISORDERS ARE NOT CAUSED BY STRUCTURAL DAMAGE BUT BY FUNCTIONAL DISTURBANCES! If you sufferc from chronic spinal pain it is mostly not possible to heal you from this pain, because you will have a genetical predisposition to get back pain. But an achievable goal for more than 90% of chronic spinal pain patients is to reduce the number, duration and intensity of painepisodes per year markedly.

How can this be reached: after a professional combination therapy by Dr. Stengg to stabilize the pain on a lower level, we train your superficial and deep spinal stabilizing muscles with a high-tech-approach of trainingtherapy in an intensive care setting. The youngest successful patient was 11 years old, the oldest one 91 years.

What is the therapeutic goal on the physical level? The strenghperformance regarding maximum voluntary contraction and strengh endurance will be improved as well as the body awareness and coordination abilities. Further more the heart-lung-endurance will be trained, shortened muscles will be stretched and reduced mobility will be normalized again as far as possible.

To improve parameters on the psychosocial level like stress-induced muscle hypertonus or hyperexcitation with low energy (like wheels that turn through in the sand) the following scientifically highly proven relaxation methods can be applied: The patient has the choice to select betwenn the Muscle relaxation of Jacobson, Biofeedback, Medical Hypnosis (as one of the best and fastest applicable relaxation methods in form of selfhypnosis at home) or cognitive-behavioural interventions. Here the main goal is to break through the vitious circle from:
overload pain - pain avoidance behaviour - muscle weakening as consequence  - just more local instability - excitation of painreceptors (s.a.) - just more pain

At the end the biopsychosocial model can support the recovery of the functional capacity of the whole human being. The therapeut wants to be seen as a coach in the team together with the patient, who opens different ways how to better cope with his pain - such an approach has been proven to be most successfull in finding a longlasting way out of the chronic paindisease.