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Suffering for her art: the chronic pain syndrome of pianist Clara Wieck-Schumann.

Clara Schumann was an outstanding pianist, systematically trained as a child prodigy by her father Friedrich Wieck. Married to the composer Robert Schumann she gave birth to 8 children, however, was able to continue performing regularly in public. After the mental breakdown of her husband, she had to increase her public performance activities due to the need to earn a living for her large family. In this time, the first pains in the right arm occurred, which at the beginning were of shorter duration, however increasingly required prolonged periods of rest. Later, when attempting to work on the highly demanding piano works of Johannes Brahms, especially on his first piano concerto, she developed chronic pain, which forced her to interrupt any concert activities for more than 1 year. Obviously, Brahms' modern treatment of the piano in an almost orchestral way imposed technical difficulties which Clara Schumann was not properly prepared to deal with. Finally, she underwent a multimodal pain therapy in the private sanatorium of Dr. Esmarch, which consisted of an integrated interdisciplinary approach comprising pain medication, psychotherapy, physiotherapy and modification of playing habits. She fully recovered and successfully continued her career as an internationally renowned concert pianist. The case report impressively demonstrates the stressors an outstanding female elite musician had to cope with in the 19th century. Furthermore, it is a convincing example of how the intuition and mere experience of a sensitive and understanding doctor lead to the right conclusions and to a modern multimodal pain therapy in chronic overuse injury. Furthermore the case report demonstrates the important role of prevention, including physical exercises, self-awareness, and reasonable practice schedules.