- 7 months ago
Chronic pain is a complex condition in which stimulus processing and the psyche can play a role. In Good Shape looks at new therapies like electrostimulation.
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00:00your eyes don't produce images nor do your ears actually hear words instead the sensory organ
00:14sends signals to your brain where they're translated into images or sounds it's the
00:20same with pain pain receptors send signals to your brain too it processes them and tells you
00:26how much something hurts with chronic pain faulty processing is sometimes the issue taking painkillers
00:33long-term can damage your liver and stomach so what can you do about persistent pain how about
00:40switching it off using electrical impulses time to find out more on in good shape
00:56for years jennifer isa has had severe pain in her back and legs soon though she may be able to switch
01:08it off by pushing a button doctors are about to implant an electrode in her spinal cord and she
01:16has to be conscious during surgery now it's starting to tingle on the left side of my bottom
01:25it's getting stronger now it's more on the right a few days earlier she'd gone shopping with her mother
01:34I need my mom a lot because I can't lift heavy things it feels like an elephant is standing on
01:42my back sometimes if I make a wrong move I can't move at all for 10 minutes her ordeal began with
01:52a slipped disc every therapy failed even spinal fusion surgery didn't help for years the young
01:59mother has relied on opioids the strongest of painkillers and they have debilitating side effects
02:04I get stomach cramps have almost no appetite I've lost 10 kilos I sweat a lot I have mood swings
02:14it's mentally exhausting some days I just sit in my room and cry
02:21the day of surgery philip krauss and his team prepare for the procedure
02:29Jennifer is having an electrode implanted to block her pain this is a model of the spine
02:38basically we place a wire on the spinal cord this area is the spinal canal where the nerves run we enter
02:51from the back this thin wire is the electrode it's pushed into the nerve canal through a hollow needle
03:00philip krauss monitors the x-ray closely searching for the right spot where the pain likely originates
03:08then the first current flows the aim is to silence the pain in the nerve Jennifer feels the first
03:21tingling I feel it in my thigh just a little more down in the back now it's moving into the back
03:31did I understand you correctly both in the back and the leg where the pain usually is you feel
03:39tingling now perfect that's right where we want to be we're almost done an initial success but the
03:50crucial phase lies ahead will the electrode really work the day after surgery the severe pain is gone
04:00but now I have this tingling that's much more pleasant I'm feeling the tingling right now and I
04:08don't have any pain in my foot anymore instead of pain I feel this tingling a first promising sign she
04:16gets a remote control for a home test here are the contacts 60 of them we look for the point that best
04:28targets the nerve causing the pain but now it's a case of wait and see any predictions it's great when
04:39patients feel positive and it's a good sign if they already think it helps but we need to check again
04:49after a few days once the initial euphoria subsides that's crucial one week later if the system is still
05:00working as hoped it can be permanently implanted Jennifer is convinced honestly it's amazing really amazing
05:10before she always said my back hurts now she doesn't say it as often with the remote Jennifer can control
05:18the pain herself I can adjust the strength how strong the electrical impulses are one last consultation and a
05:29clear decision the wireless receiver for the pain remote will also be implanted under her skin one final
05:36surgery for Jennifer is a for a new hopefully pain-free life pain can be an important warning sign if there's
05:46injury or inflammation somewhere in the body chemical messengers rush to the brain to tell it something's
05:52up the brain then responds by activating muscles by initiating an immune response or it tells us to rest and
06:05take it easy so acute pain has an important function but sometimes not even the best doctors can help us with
06:14problems like joint wear or chronic inflammation then pain can begin to dominate our lives
06:21for a long time this playing music without horrendous pain was unsinkable for Lucas Dietrich the 32 year
06:33old musician and student suffers from ulcerative colitis a debilitating intestinal disease until recently
06:41the condition and accompanying pain completely dominated his life
06:46at times I felt extremely ill
06:51partly due to this very painful disease which causes massive inflammation in the body I was also severely weakened by the strong
07:00inflammatory reaction and blood loss
07:03myriam is 16 and for the past five years has suffered from fibromyalgia a muscle fiber disorder that causes constant pain it's made life for her and her father very difficult at times basic tasks or just going to school have been impossible
07:20I had terrible back pain it felt like burning as if there were acid in my back or someone was burning it with fire it really weighed on me especially because when my friends were doing lots of things I had to say to them I can't anymore I don't have the strength
07:39The Institute for medical psychology at the University of Marburg in central Germany is Miriam's last hope here she's been undergoing treatment with
07:49Kati Tima for six months the medical psychologist has developed a therapy called electrostimulation in it electricity flows through the hand into the brain patients who suffer from chronic pain often have a dysfunction when it comes to processing its signals
08:06If patients have chronic pain for example or diabetes inflammatory or rheumatic diseases or even cancer then this mechanism is completely disrupted this means that the brain no longer senses what is happening in the body and cannot regulate it
08:25In healthy people this is a very simple mechanism
08:30Key to it all are neurons called baroreceptors ones that are located in the carotid artery measure blood pressure and transmit pain or stress signals to the brainstem
08:45When we apply stimuli of varying intensities we modify the blood pressure and so change the pressure conditions in the carotid artery
08:55This reactivates the baroreceptors and transmits this information to the brainstem which then works to regulate it
09:02Myriam is now quite used to the treatment and how it feels when the current flows
09:10They're like electrical impulses it's like briefly touching an electric fence it doesn't hurt
09:16Lukas Dietrich has also recently started treatment
09:22Electrical stimulation is always combined with behavioural therapy
09:27This helps patients learn not to let pain dominate their everyday lives
09:32The musician noticed improvements after just a few sessions
09:37The behavioural therapy relaxed me and helped me better recognise my stressors and change my behaviour in relation to my illness
09:47And the stimulation allowed me to really relax for the first time in a long time
09:52The body begins to regulate itself again and I noticed immediately
09:59Before the stimulation pain tests are carried out to precisely tailor the strength of the electrical impulses to each patient's needs
10:08The current then flows for two eight-minute sessions
10:15Patients with low baroreflex sensitivity and a high pulse often have very good chances of success with this treatment method
10:27Myriam's treatment is over for now
10:34Myriam's treatment is over for now
10:36She feels like a totally different person
10:38School, everyday life, everything is manageable again
10:41And she's excited about starting show jumping again
10:44I have a plan for the future and I'll see it through
10:51I want to improve my horse riding
10:54I want to do well at school, I just want to get things going
10:59Lukas Dietrich has also benefitted from the treatment
11:03He can now get back to touring with his two metal bands
11:06And make music without constant pain
11:09Even though when he first started treatment, he was skeptical about the outcome
11:14So I'm all the more amazed now at how much better I feel after such a relatively short time
11:21And I don't feel that these are just short-term improvements
11:24But that my life has been fundamentally realigned for the future
11:32After years of pain, both Myriam and Lukas now have good chances of finally leading normal life
11:38In 2018, around 500 million people said they experienced back pain
11:48Forecasts suggest this will rise to over 800 million by 2050
11:53What could reduce that number?
11:55Well, in 2025, Norwegian researchers found that walking can help
12:00The further study participants walked each day
12:03The less likely they were to suffer from back pain
12:06Speed didn't matter, but distance was crucial
12:09Meanwhile, studies suggest other remedies are less helpful
12:13Even opioid pain relievers were no more effective than placebos
12:17Tablets without any active ingredient
12:20But what about epidural injections, which try to address the problem at its source?
12:25This is where Sven von Panzer usually works, though not at the moment
12:32The doc worker is on sick leave due to pain in his lower back
12:36It runs down his right leg all the way to his ankle
12:40Sometimes more pain, sometimes less
12:42The doctor prescribed me an MRI scan
12:49Afterwards, they told me I had spondylolisthesis, spinal stenosis and a disc problem
12:54That I basically needed surgery
12:56That really scared me because the recovery process is so long
13:00He decided against surgery, opting instead for physical therapy and pain relief injections in his lower back
13:06For a while, things improved, but then the pain started up again
13:10It was so bad in his leg that he began limping
13:13He had more epidural injections
13:15The pain eased again
13:17The result didn't last forever, but while it did, it was great
13:22However, the 55-year-old realized that the pain relief injections wouldn't get things under control long-term
13:28So he sought advice at a specialist back clinic, where an interdisciplinary team of doctors, physical therapists and psychologists work together to treat patients
13:43Orthopaedic specialist Oliver Bachmann says that pain is caused by different factors
13:49First, a signal is sent from the pain receptors to the brain
13:55But the brain can also create it
13:58We look at what percentage of the pain is caused by the brain itself and how much is actually coming from the pain receptors
14:05It's clear that many of Mr. Panza's symptoms are produced by his brain rather than being transmitted to the brain from the spine
14:14The herniated disc revealed by the MRI does not appear to be pressing on any nerves
14:20Sven von Panza feels no pain during a test
14:27For me, that's an indication, not proof, that the nervous system is okay
14:33Nor is spinal canal stenosis the problem
14:37In cases of chronic pain like Sven's, epidural injections are usually ineffective
14:43That's according to a Canadian meta-analysis
14:46It summarized various international studies on back pain in the neck and lumbar spine
14:51The analysis made headlines
14:54Experts advise against injections for chronic back pain
14:58And injections in the spine are virtually ineffective
15:04However, injections can help in cases of acute herniated discs
15:09Sabina Kuhn was in so much pain, she could hardly walk
15:16I had to be brought to hospital by ambulance
15:20I was here for a week, on medication, trying to recover
15:24But painkillers didn't help
15:29So, her doctors suggested a PRT shot into the nerve root
15:35This involves injecting both a local anaesthetic and cortisone
15:42To calm the nerve and reduce the inflammation caused by the herniated disc
15:50A PRT, a targeted injection for herniated discs
15:54Is very effective and can often prevent patients from having to undergo surgery
15:58The injection provides short-term relief until the herniated disc heals on its own
16:05And the pressure on the nerve root subsides
16:09The big advantage is that patients can often start physical therapy earlier
16:15Because they're in less pain
16:17And if administered quickly, the injection can also help reduce the likelihood of the pain becoming chronic
16:23Whereas an injection after three or four months can no longer influence pain processing in the brain
16:35Another area where spinal injections can make a difference
16:39Is when someone has advanced osteoarthritis in the small facet joints between the vertebrae
16:44Injections in this region can't repair existing damage
16:48But can relieve pain for a while and help patients regain mobility
16:53Sometimes they can also delay the need for surgery
16:56When it comes to spinal canal stenosis
16:59A narrowing of the spinal canal, however
17:01Injections are controversial
17:03Neurosurgeon Oliver Haeser says they're rarely the right form of treatment for this indication
17:10Sometimes it has a very short-term effect
17:16As long as an anesthetic works for pain, so a few hours
17:19But the idea behind injection therapy for the back is to prevent the pain from becoming chronic
17:25So to slow down the brain's processing of pain and achieve a long-term effect
17:30But that won't happen here
17:33In cases of severe pain under stress or when walking becomes increasingly difficult
17:40The neurosurgeon recommends surgery sooner rather than later
17:44He points out that although operations have risks and side effects
17:48Supposedly harmless epidural injections do too
17:52Even a simple injection of just painkillers into the muscles can be harmful
17:56So Oliver Haeser recommends avoiding them
17:58Because they can trigger local inflammatory reactions
18:04We see a considerable number of patients each year who have inflammation of the spine
18:09After multiple injections around it
18:11I don't think it's a good idea to inject into the spine indiscriminately
18:19At the back center, physiotherapist Christian Rauscher takes a good look at the muscles and joints
18:25Of Sven von Panza's leg
18:27Which is giving him so much pain
18:34What we've discovered is that his gluteal muscle is hyperactive and works extremely hard
18:40Perhaps because he's been so careful about straining his back
18:44He's ended up putting a lot more strain on his glutes
18:47So my suggestion would be to strengthen the lower back with specific exercises
18:54This would then relieve the glutes and in turn hopefully reduce the leg pain
19:08Even if it hurts a bit, Sven von Panza needs to start putting some strain on his back
19:12I have to learn to trust my back
19:17He hopes this will help him get out of the cycle of pain
19:20Without any more injections
19:24Our viewer Ahmed dropped us a line
19:27He suffers from chronic neck pain
19:29And wants to know whether exercise can help sort it out
19:32Neck pain is very common
19:36Sometimes it's caused by a herniated disc
19:39Or wear on the cervical vertebrae
19:41If that's the case, avoid exercise until you've spoken to your doctor
19:47But usually the cause is tense muscles
19:50And then targeted exercises are just the thing
19:54Our in-house fitness coach, Tim Bertko knows one that focuses on stretching the neck and throat
20:01Achmed, this is for you
20:04And for the rest of you out there as well
20:06Today I'm going to show you a great exercise
20:10Which helps you to loosen the neck and shoulder area
20:14You stand upright with the chin slightly back
20:18Then you hold your head
20:21And you pull it slightly
20:24Aspetiva slowly down to the opposite knee
20:26Until you feel the first stretch in this neck area
20:31And then push this area actively down and back
20:39And back
20:50Keep the stretch for approximately 30 to 45 seconds
20:56And now do the same thing on the other side
21:00Pull it down towards the opposite knee
21:09Pull your arm down
21:12And again hold the stretch for approximately 30 to 45 seconds
21:17Keep breathing
21:20And only go as far as you feel comfortable
21:23And enjoy your stretch in this area
21:38We're waiting to hear from you
21:40Are you always stressed?
21:42And worried it's damaging your heart?
21:45Thinking about quitting smoking but not sure how?
21:49Maybe you just want to eat healthier
21:53Or you're looking for the right workout
21:55To ease back pain
21:58If you've got a health question
22:00In good shape has the answer
22:02Just drop us an email
22:07Does your child say they have a tummy ache
22:09Or feel sick to their stomach?
22:11Instead they might actually have a headache
22:14That's because young children struggle
22:16To properly describe this pain
22:18Not to mention toddlers
22:21And when kids enter school
22:22Stress can make headaches more frequent
22:26Although there's no clear link to the use of devices
22:30A lack of sleep
22:31And too little exercise can play a role
22:34If your child suffers from migraines
22:36Let your doctor prescribe the proper medication
22:39Otherwise taking too many painkillers
22:41Can actually end up causing more problems than it solves
22:45Happily there are alternatives
22:49Dancing to combat pain
22:51Myra is one of many young patients
22:53At this children's pain centre in southern Germany
22:55She has headaches every day
22:58They started three years ago
23:02Sometimes I can't concentrate
23:04It can be exhausting
23:06But sometimes I don't think about it
23:09The pain can get better or worse
23:13But it's always there
23:15The eleven-year-old has been at the centre for a week
23:18The kids stay without their parents
23:20Usually for a month
23:21A challenge at first
23:23I was nervous
23:24And felt a bit scared
23:25But now I'm doing pretty well
23:27Her parents visit twice a week
23:29Also to meet with the doctors
23:31Today, Mayra has an appointment with Dr Schroet
23:41He asks her where she feels the pain and what it's like
23:45Can she tell him how and why her headaches started?
23:53They started gradually
23:55But we don't know why
23:57Between 30 and 50% of children experience regular headaches
24:02And numbers are rising
24:03There's a wide range of reasons
24:05There are social factors
24:08So more stress
24:10Less exercise
24:12Maybe not enough sleep
24:14Media use
24:15Pressure at school
24:17Luckily for Mayra
24:22Her parents took the headaches seriously
24:24They've been trying to help their daughter for three years
24:27We've been to lots of doctors
24:32And tried lots of things
24:35But nothing has helped so far
24:39But she's never tried music therapy before
24:42Such activities are an integral part of treatment at the pain centre
24:46Painkillers can just make chronic headaches worse
24:49Doctors here are keen to find individual solutions that will work long-term
24:54Essentially, we try to strengthen self-efficacy in children and adolescents
25:01By providing them with tools they can use to manage the pain themselves
25:05Making music helps distract from the pain
25:10Music is so important because it's about emotions
25:15It's about feeling something on an emotional level again
25:18That can be difficult to do when you have a chronic illness
25:20Myra plays the flute at home
25:25She loves the music therapy
25:27And there are lots of other things I enjoy here too
25:31Sometimes we do crafts, which is also fun
25:35And we go on trips
25:37Myra's headaches haven't improved yet
25:39But the chances are good they will
25:43Of the 250 children treated here every year
25:46Around two-thirds really benefit from the therapy
25:50And are you already feeling the benefits of watching In Good Shape?
25:57We hope so
25:58We're already looking forward to the next one
26:01See you then
26:02Bye for now
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