© Karatara
March 31, 2026
Margit Hiebl
Chronic pain affects millions and is often misunderstood. Learn the key symptoms, why it develops, and which treatments provide real relief—explained by a pain specialist.
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Chronic pain is pain that lasts longer than three to six months and can develop into a condition of its own. It affects millions of people and impacts not only the body, but also mental health, daily life, and overall quality of life.
When you stub your toe against a chair leg, the cause is clear. But what happens when pain persists—for months or even years—without a clear explanation? For many people, this is where a long and often underestimated condition begins.
In Germany alone, around 12 million people are affected by chronic pain. According to the German Pain Society, this results in annual costs of approximately €38 billion—not only for treatment, but also due to sick leave and early retirement.
A pain specialist explains how chronic pain develops, when it becomes a condition in its own right, and which modern therapies can help.
Dr. Claudius Gall, A specialist in neurosurgery, with his additional qualification in 'Special Pain Therapy', is among the few specialists in this field in Germany. At the 'Pain Workshop' in Munich, he and his colleagues work on the backgrounds and new approaches to dealing with chronic pain.
What actually is pain?
Pain is first and foremost a "perception." This means every pain is real – there is no imaginary pain. Because the body is supplied with pain fibers everywhere except the brain. When these are stimulated – by whatever – it leads to pain. However, there are two different mechanisms that lead to the sensation of pain: the acute and the chronic.
What is the difference here?
Acute means: Hand on a hot stove. During tissue destruction, electrical impulses are released and end up in consciousness via the spinal cord-brain pathway. Chronic pain arises from a malfunction of certain nerves and can develop as a result of an acute pain experience.
A classic example is phantom pain, which hurts in a non-existent knee joint during weather changes.
This is pain that persists in the same region for more than 6 months and has at least a moderate intensity. Chronic pain also leads to side effects in all areas: It affects the sleep-wake cycle, mood, and even libido.
Thus, chronic pain becomes an independent condition - it has physical elements at the cellular level but also impacts many other social, private, and professional areas. Our task in pain therapy is to determine the relationship between acute and chronic pain, as both must be treated very differently.
Dr. Claudius Gall, specialist in neurosurgery
Chronic pain is often not visible from the outside. Many sufferers hear that their complaints are "imagined" - although pain is always a real perception. This complicates the diagnosis and often delays proper treatment.
What differences are there in treatment?
For acute pain, causal therapy is crucial: For a fracture, a cast is applied, and once it is closed, the pain stops. If the pain becomes chronic, a so-called Multimodal Pain Therapy is needed - an individual combination of different therapy components.
How do you classify chronic pain?
With us, all patients must first fill out the German Pain Questionnaire—a kind of preliminary screening. It asks about pain intensity, depression, tension levels, and a whole range of factors in the social context. However, the crucial assessment is the personal medical history, the initial personal interview, which lasts between 45 and 50 minutes. You have to take the time to classify and understand.
In what way understand?
To put it like this: In the German language, there is a distinction between pain and suffering. When pain becomes chronic, it turns into suffering. This terminology implies that the whole person begins to suffer from these symptoms.
Pain always has an anxiety component—because often you don’t know what the cause of this pain is. You just feel threatened and vulnerable. A correct diagnosis not only helps to find the appropriate therapy but also helps to alleviate patients' fears.
The first pillar is classic painkillers, the analgesics. In the modern approach, this is a combination of different substances, which are low in dose individually but very effective together, with minimal side effects. Co-analgesics are added, which are not painkillers themselves.but enhance the effect of painkillers, such as certain antidepressants.
The second pillar is movement therapy approaches. Initially, it's about patients establishing safe movement boundaries within which they can move without increasing pain. If I have chronic pain, it's a relationship crisis between the body and the brain.
Because normally we don't feel the body at all. Pain patients, however, feel it constantly. The first step in resolving this relationship crisis is to say: Okay, why don't you get to know each other again.
This is me. The pain, this is me. My soul or my psyche. And we both now have to try to exist in some way. The third pillar is pain psychotherapy. It is about identifying stressors and looking at how to deal with pain differently. Because often pain is also an expression of stress and the associated tension, which in turn intensifies pain.
When conservative methods for back and leg pain are exhausted, there has been the possibility of neuromodulation for several years now. The most important method is the so-called spinal cord stimulation. A small pulse generator with electrodes is implanted under the skin. These are placed on the spinal cord and thus on the pain pathway.
The transmission of pain in the pain pathway is reduced by electrical interference signals - so we achieve a halving of pain in 70 percent of our patients. This is controlled by the patient with a wireless remote control, allowing them to gain control over their pain.
There will be a lot happening in the foreseeable future - such as systems measuring and controlling the parameters themselves. There is also news in the field of chronic migraine: On the one hand, triptans that restore a normal vessel width in the brain's blood vessels during an acute attack. Or a vaccination that introduces receptor antagonists - substances that dock onto certain points in the vessels similar to the body's own, stabilizing the diameter over a longer period.
Yes, big ones. The question is always: How much resources does a person have to deal with pain? If someone has consumed a lot of their mental energy due to private or professional problems and stress, it will hit them harder than someone in a stable environment.
And of course, dealing with pain is also culturally influenced. In Northern Europe, the motto is still "an Indian knows no pain" - it's different in southern countries. There the pain has to come out with crying and screaming. That means we always have to include people's life situation and background.
I don't think so. However, women are more likely to seek medical treatment and are more open to changing perspectives. For men, this often succeeds through the connection to sleep. If you can significantly improve that, it opens a door to the pain lock for them.
I always say that the patient himself only inhabits certain rooms in this pain castle and has put a padlock on certain doors, throwing away the key. He doesn't want to go in there anymore. But perhaps there's a key to the room where the pain came from.
Chronic pain affects not only the body but also everyday life, relationships, and quality of life. It is crucial to find ways to manage the pain and regain more control.
What 'tricks' do you have up your sleeve?
I suggest a deal: You give me your pain through this or that therapy, and in return, you get pain relief or at least alleviation. However, for some patients, it is easier to keep the pain. For example, if it is an expression of post-traumatic stress disorder after sexual abuse at a young age. This patient will not give me the pain – if I'm really good, I'll have her ready for appropriate psychotherapy in half a year or three quarters of a year.
Can chronic pain be completely treated away?
Our primary treatment goal is to improve quality of life. Of course, I can bombard a patient with painkillers to the point where they just lie in the corner. Then they might not have pain anymore, but they also have no quality of life. In therapy, we try to reduce pain without triggering too many side effects, which can be more unpleasant than enduring the residual pain.
And it's also about a change in perspective: I want to turn the view from a half-empty glass into a half-full one. Patients compare themselves to their condition 20 years ago – as a doctor and therapist, I compare them to their peers. Also important: The complaints must be accepted, then you can teach patients to become self-effective step by step again. But it takes time for that.
