Pain Centre

Pain is a complex phenomenon that occurs in many ways on many levels. The complexity of the pain phenomenon requires an approach that not only takes into account the pathophysiological mechanisms of chronic pain, but also the interrelation of somatic, psychological, social and spiritual aspects involved in each individual case. Chronic pain affects an individual’s well-being and quality of life along with their behaviour and social interaction. Multimodal therapy concepts that therefore address the different dimensions of pain have become increasingly important.

In comparison to other federal states, Berlin has significantly fewer opportunities to receive specialised inpatient, inter-disciplinary and multimodal pain therapy. We would like to address this demand with our service while additionally offering patients suffering from chronic, therapy resistant pain a unique treatment programme that includes the possibility of receiving anthroposophical medicine.

People with chronic pain in stage 2 and 3 of the Gerbershagen scale. Patients classified at such a stage of chronic pain should, where possible following an outpatient or inpatient examination, be admitted to hospital if existing pain therapy approaches have been unsuccessful, if outpatient treatment is adjudged to be too high a risk, and if the patient is motivated to find new and improved ways of dealing with pain through a multimodal approach to pain therapy that includes adequate medication, physiological and psychotherapeutic support as well as artistic therapies.

Inpatient pain relief therapy can also be necessary for the emergency treatment of acute pain. Hospitalisation is also advisable for patients suffering from complicating psychiatric and internal comorbidities, several concurrent medical conditions, medication dependence where outpatient withdrawal treatment is not feasible, as well as those suffering from severe maladaptive pain.

Improving quality of life

Our goal is to identify the causes of chronic pain on all levels (biological, psychological and social) and to treat it in a differentiated manner. The focus here is mainly on working towards a therapy goal that is mutually defined with our patients and leads to an improved individual quality of life and functionality. Quality of life can only be defined on an individual basis. 


Long-term pain relief is essential to improving an individual’s quality of life, for example, via a regular pain medication based on a regimented time schedule as well as the prevention or stoppage of so-called breakthrough pain.

The aim is to avoid further complications associated with long term, continuous pain.

Improved functionality

We aim to help patients improve their mobility and functionality by supporting their active skills in relation to their individual circumstances and capacities. An important aspect here is not only the individual’s organisation of their life situation and personal fulfilment, but also the opportunity for them to reintegrate into their job or participate in working life via alternative means.

We want to enable the patient to look beyond their pain.

Here we would like to indicate a few therapy resistant forms of illness and situations associated with pain for which a multimodal inpatient pain therapy may be required (listed in alphabetical order).

• Facial pain
  • Patients with facial pain in somatoform disorders
  • Facial pain with persistent discomfort
  • Facial pain with a high amount of comorbidities
• Head pain

  • Patients with medicine-induced head pain, status migrainous,
  • Head pain in somatoform disorders, where outpatient medication withdrawal treatment has been unsuccessful or is not possible,
  • Head pain associated with maladaptive pain and incorrect medical treatment procedures
  • Head pain in elderly patients suffering from a high amount of comorbidities
• Chronic back and musculoskeletal pain

• Patients with back pain
• Nonspecific and specific (radicular) back pain
• Post-nucleotomy syndrome, fibromyalgia
• Joint pain
• Pain syndromes following osteoporotic vertebral fractures
• Neuropathic pain syndromes

  • Patients with post-herpetic neuralgia
  • Phantom pain
  • Pain in the central nervous system

  • Circulatory disorders

• Complex regional pain syndromes such as Sudeck's atrophy (CRPS I / II)
• Consumptive use of opioids and other analgesics 

  • Pain patients who take opioid analgesics, mostly the rapid-acting kind, primarily do so to satisfy their addiction. We offer these patients the possibility of a gradual inpatient withdrawal treatment accompanied with a new course of pain management. Many patients suffering from medication-induced head pain, such as from triptans and NSAIDs, require an inpatient detoxification treatment. Patients with tumour pain who can’t be effectively treated on an outpatient basis and where a differentiated medical approach or interventional measures are necessary, such as with Pancoast tumours, plexus or spinal cord infiltration or chordoma infiltration.

I. Multimodal non-invasive pain management

Progressive muscle relaxation (PMR) techniques as developed by Edmund Jacobson

Nerve stimulation therapy
TENS (Transcutaneous electrical nerve stimulation) can be used for most pain conditions.

Pharmacotherapy
Advanced and differentiated pharmacotherapy in accordance with the World Health Organization’s three-step pain ladder. This includes the use of non-opioids, differentiated opioid therapy, antidepressants, anticonvulsants and corticosteroids, etc. The objective of medical therapy is to bring about long-term relief through the regular use of pain medication based on a regimented time schedule along with the prevention, or stoppage, of so-called ‘breakthrough pain’. This type of pain can be induced by stress or for no other apparent reason and occurs temporarily during an otherwise stable period of pain. Different methods of application are performed depending on the clinical situation: oral, enteral, transdermal, subcutaneous, intravenous (port, CVC), peridural, intrathecal and intraventricular.

Psychotherapy
Individual therapy or group therapy methods carried out in close interdisciplinary cooperation with physicians of the Psychosomatic Unit and/or psychologists. Pain management training, relaxation techniques, behaviour therapy and psychoeducational procedures are applied. 

II. Anthroposophical medicine therapies
The aim of anthroposophic therapies is to activate the individual’s health-generating abilities and stimulate the creative faculties that positively influence an illness’ progress. 

Anthroposophic art therapy

Painting therapy

Various life experiences and concepts can be expressed through painting therapy, including ways to deal with pain in both the biographical as well as cultural sense.

Music therapy
Cognitive and positive emotional experiences obtained through music can have a significant influence on the way a patient views and deals with chronic pain.

Clay modelling
This can contribute to enhancing a pain patient’s self-esteem and self-confidence.

Massage

Rhythmical massage as developed by Ita Wegman
This form of massage promotes heat generation that improves blood circulation and stimulates metabolism, thereby creating a relaxed state and a deep sense of wellbeing. This positive awareness of the body is one form of pain distraction. It is also a way to once again ‘make friends with one’s own body.’

Undulating massage as developed by Dr. Pressel

This is a stimulating and activating rhythmical form of massage performed as a dry brush massage. No longer actively used areas of the body are reconnected as an entity during this enlivening process that reinvigorates the entire organism. This kind of massage is very effective in states of exhaustion.

Eurhythmy
This is an artistic movement therapy that specifically addresses the communicative aspects of pain at different levels. It focuses on the creative abilities to deal with pain from an anthropological approach.

Phytotherapy: The predominantly empirical knowledge of the medical effects of plant parts and plant extracts is often the starting point for the development of conventional medical drugs. In contrast to conventional medicine however, the effectiveness of the individual substance is not considered as a crucial factor, but instead the natural composition of the ingredients. Classical phytotherapeutic analgesics are, for example, arnica for inflammatory or wound pain, urtica (stinging nettle) for joint pain, chamomilla (chamomile) for mucosal pain, belladonna and fennel for colic, aconite (monkshood) for muscle pain, and devil's claw (harpagophytum) and Mandrake (mandragora) also for joint pain.

Havelhöhe has established anaesthetic procedures at its Pain Centre where surgical procedures are also performed.


Indications: Pain pumps are advisable where a more advanced stage in the WHO three-step pain ladder is reached and analgesics are no longer effective or lead to intolerable side effects. The implantation of a pain pump is usually done only after testing to ensure a placebo effect is avoided.

Epidural neurostimulation systems: SCS - spinal cord stimulation


Indications: Vascular defects, e.g., peripheral artery occlusive disease, refractory angina pectoris, scleroderma or isolated neuropathic pain syndromes (such as radicular pain) that are not effectively treatable with other therapy methods.

Destructive process – Neurolysis


Coeliac plexus neurolysis


Indications: Pancreatic carcinoma or hepatocellular carcinoma with typical upper abdominal pain


Intrathecal neurolysis


Indications: Cervical carcinoma or rectum carcinoma


Intercostal neurolysis


Indications: Isolated intercostal neuralgia through tumour infiltration or other causes.

Peripheral analgesia techniques


Blocks for nearly all peripheral nerves and plexuses.

Neuraxial analgesia techniques

Epidural or intrathecal administration of corticosteroids, opioids, etc. as a "single shot" or via catheter.


Indications: Spinal disc herniation (cortico-steroids), analgesia to break the "spiral of pain" to enable a multimodal pain therapy.

Sympathetic nervous system blocks

These are, for example, GLOA's (ganglionic local opioid application), stellate-ganglion blocks, thoracic and lumbar sympathetic nerve blocks.
Indications: Sympathetically maintained pain, e.g., following postherpetic neuralgia, CRPS (M Sudeck), etc.

It is essential for pain therapy to be interdisciplinary in order for it to be successful. For this reason, we have a multidisciplinary internal and external network with many partners.

What forms of cooperation are in place at the Havelhöhe Community Hospital?

An institutionalised cooperation exists between the following units at the Havelhöhe Community Hospital to address specific questions related to treatment ("Clinical Pathways"). These include the units of General Internal Medicine and Diabetology (Dr. Girke), Gastroenterology (Dr. Matthes), Cardiology and Pulmonology (Dr. Fried ), and surgical units for Visceral Surgery (Dr. Lemmens), Traumatology (Mr. Herrgesell), Gynaecology and Obstetrics (Dr. Herbstreit).

A special cooperation is carried out with the Department of Psychosomatic Medicine (Dr. Quetz). As part of our interdisciplinary approach, hospitalised pain patients receive regular psychosomatic and/or psychological assessment while also taking part in the psychoeducational programmes run by the Psychosomatic Unit.

Doctors from the Psychosomatic Unit regularly hold joint meetings for the diagnosis and (depending on the symptoms) the mutual planning of therapeutic approaches with pain patients stationed in the Pain Centre and also in some cases the Psychosomatic Unit.

Tel. 030/36501-160
Fax 030/36501-161
E-mail: schmerzzentrum@havelhoehe.de


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