[A chronic pain patient: modern diagnosis and concept of therapy]

Approximately 80 per cent of primary care patients seek their physician's attention due to pain. A fifth of the population suffers from chronic pain with medium to high intensity, and longer than 3 months. Especially those patients are treated insufficiently when only non-opioids and opioids are applied. Therefore it is necessary to tailor pain therapy by using an interdisciplinary, multimodal treatment regimen. This article presents a holistic concept to chronic pain treatment by using the five columns of pain therapy. Based on the bio-psycho-social approach, pharmaceutical, complimentary (first column), physio- and psychotherapeutic (2(nd) and 3(rd) column), social and invasive interventions (4(th) and 5(th) column) have to be considered. The 1(st) column includes the WHO ladder, in chronic pain patients with a large focus on co-analgesics like antidepressants or antiepileptics. Based on the individual history and factors achieved from the bio-psycho-social diagnosis, components of these 5 therapeutic are selected, always in agreement with the patient, and put together to one interdisciplinary therapeutic concept.