The term “chronic” (from Greek χρόνος chrónos ‘time’) usually characterizes slowly developing, long-lasting diseases.

  • In general pain therapy terminology, "chronic" means the persistence of pain for a period of at least three months.
  • In the context of headaches, this time period is maintained for secondary headache disorders.
  • In primary headache disorders, which usually occur episodically in recurring attacks over a long period of time, the term chronic is always used when attacks occur on more than half the days for at least three months.
  • Trigeminal autonomic cephalalgias are an exception. In these cases, a chronic course is only diagnosed if the illness persists for more than one year without interruption.

When experiences recur over time, they can lead to lasting changes in behavior. This is generally referred to as learning . Learned information is stored in memory . Learning processes can occur in many different ways, involving numerous mechanisms.

Habituation allows us to filter out a recurring stimulus that contains no current, useful information. Examples include the ticking of a pendulum clock or passing cars. This avoids sensory overload, freeing up attention for other important stimuli .

Adaptation has a similar function . The eye, for example, adapts to the transition from darkness to light, thereby maintaining a medium range of brightness.

Numerous other complex learning mechanisms alter our perception and behavior. These processes occur continuously and largely uninfluenced by our will. Repeated sensory impressions, through repetition, create lasting electrical and biochemical traces in the brain. These are stored as patterns and can be triggered repeatedly. All bodily functions are involved in learning. It's well known that a full stomach isn't conducive to learning, and a lack of motivation or stress hinders memory formation. Conversely, positive emotions, interest, and enjoyment can significantly improve memory retention.

Chronic pain would hardly be a problem if it were subject to habituation and adaptation. Unfortunately, the processes unfold differently. Constant or recurring pain leads to strong, lasting changes in behavior and memory. Such memories are stored very persistently in numerous different areas of the brain. This is a key reason why pain is deliberately used in training and punishment.

The paradox of pain is that you can't get used to it. On the contrary: persistent pain always causes more and longer-lasting pain.

Instead of habituation, there is a massive increase in sensitivity; instead of habituation, sensitization is induced. This is referred to as the development of a pain memory. The pain perpetuates itself.

Enduring pain is therefore not a virtue. The most important measure to eliminate the basis of chronic pain is effective pain therapy. Under these conditions, pain has developed as an independent illness. Solely searching for the original cause is unsuccessful and unrealistic. Treatment must therefore also address the conditions that give rise to the pain disorder. The often diverse factors that perpetuate it must be identified and treated in a targeted, interdisciplinary manner. The pain is not simply numbed or masked; its underlying causes must be addressed. This requires considering physical, psychological, and social contextual factors.

These processes can also be used positively in therapy. Biofeedback therapy, for example, makes these processes consciously visible and perceptible, allowing them to be actively modified. Pain management programs modulate the evaluation and meaning of pain. Relaxation training can break the connection between pain, stress, and tension. Therefore, those affected don't have to passively wait for treatment; they have an active and self-determined role to play. If this role isn't acted upon, the chances of changing chronic pain are very slim. However, if these possibilities are used purposefully and proactively, the chances of effectively managing chronic pain are multiplied.