"Pain" for a living
"China News Weekly" reporter / Li Mingzi
Published in the 960th issue of China News Weekly on August 17, 2020
Jia Ru was only 25 years old when she had a lumbar disc herniation. It was June eight years ago. When she woke up in the morning, she couldn't sit up no matter how hard she tried. "People are alive, and the lumbar spine is dead. I can't feel where my legs are." She carefully recalled that she had returned to Beijing from a business trip the previous afternoon. Back pain started on the plane, and the stinging pain like an electric shock spread from the lumbosacral area from time to time. After arriving home at night, Jia Ru changed the habit of working overtime and lay down quickly. The next morning, the pain was so bad that he couldn't get up, so he had to go to the hospital for treatment.
At that time, the "small problem" of back pain had been with Jia Ru for four or five years, but she had never paid attention to it. She always thought that she was still young and would not have any major issues until she went to the hospital and was diagnosed with a lumbar disc herniation.
In Zhihu, using "back pain" as a keyword search, the first topic that popped up was "Why do young people get back pain". In 2015, the number of patients with lumbar spondylosis in China exceeded 200 million. Patients with lumbar disc herniation accounted for 15.2% of the total number of people in the country, and the incidence rate was second only to colds.
Pain is almost the only symptom of lumbar disc herniation. According to the definition of modern pain medicine, pain that lasts for more than one month is chronic pain. In the International Classification of Diseases issued by the World Health Organization (WHO) in 2018, chronic pain was assigned a new disease code and became an independent disease. According to the "Epidemiological Survey of Chronic Low Back Pain in Chinese Residents" published in the "Chinese Medical Information Report" in 2017, the prevalence of chronic pain was 31.54%.
"Chronic pain is not only a painful feeling, but also a disease that can be cured." Fan Bifa, chairman of the Pain Medicine Branch of the Chinese Medical Doctor Association and director of the Pain Department of China-Japan Friendship Hospital, told China News Weekly.
"Good pain" and "bad pain"
Hengyi Shimochi, a professor at the Faculty of Medicine at Niigata University, Japan, attributed low back pain and shoulder pain to "diseases caused by human walking on both feet" in his popular science book "The Science of Pain Relief". Soreness occurs when the waist supporting the heavy upper body and the neck supporting the brain are overloaded. Especially in today's popularization of computers and video games, the problem of excessive use of the neck and waist is also exacerbated. "Modern people's work and entertainment have largely exceeded the anatomical structure and function of the human body."
The intervertebral disc, which acts like a small cushion between the lumbar vertebrae of the human body, plays a role of support, connection and cushioning. With age, the water becomes less and the flexibility becomes worse. When the lumbar spine is under pressure, the shape changes. When the intervertebral disc is herniated, Compressing the nerves and spinal cord will cause back pain and leg pain.
According to statistics, 80%-95% of patients with lumbar disc herniation have radiation pain. This pain often starts in the buttocks and gradually radiates to the back and outside of the thighs, the outside of the calves, and even the back of the feet, soles and toes. In severe cases, when coughing, sneezing or convenient, the intra-abdominal pressure will increase, and the pain of the lower limbs will be aggravated, like an electric shock, which is more severe than the waist pain.
"Why didn't you come earlier?" The doctor asked Jia Ru with a CT film, and then said, "This is a lifelong illness. You must be careful about everything in the future. You must not catch colds. You must wear socks in summer, high heels, and sitting for a long time... …" Jia Ru was stunned when he heard the doctor's instructions. "I always feel young. I never thought about such serious consequences. I feel that a certain aspect of the body has been sentenced to death."
Unlike a cold that is only a transient effect, the changes brought to Jia Ru by a lumbar disc herniation are long-term: she needs to avoid all the movements that require bending in her life, even the simplest things like picking up things on the ground. , Must also adopt a specific posture-squat straight with the waist and knees bent. After suffering from waist disease, she cannot engage in strenuous exercise, including the roller coaster she once liked the most.
Almost every two years after being diagnosed with lumbar disease, Jia Ru will have pain when he enters the hospital. Each time he takes 1 to 2 weeks of sick leave, he goes to the hospital for physiotherapy, traction, massage or acupuncture every day. The rest of the time he can only lie down at home. . When she was on sick leave, she was worried about delaying work and couldn't sit, so she lay on the bed and typed on the computer.
The "Epidemiological Survey on Chronic Low Back Pain in Chinese Residents" found that within 3 months of the onset of pain, nearly a quarter of patients with chronic low back pain did not seek medical treatment in time. However, due to insufficient awareness of the harm caused by chronic pain, pain tolerance and worry about burdens on family members, 36.79% of patients have not done any treatment for pain, and only 40% choose to go to the hospital for formal treatment. More than 20% of patients buy drugs in pharmacies by themselves.
"Pain is a warning signal sent by the human body." Fan Bifa explained that when the body is injured or diseased, it sends out a signal of pain. If your head hurts when you catch a cold, as long as the disease is cured, the pain will disappear. This kind of pain usually comes quickly and is usually severe. It reminds people to see a doctor as soon as possible or avoid danger. Fan Bifa called it "a pain".
But when the pain in a certain part lasts for more than one month, it is called "chronic pain", and this kind of pain has lost the significance of alarming. Because of its long duration and serious impact on physical and mental health, Fan Bifa called this type of pain "bad pain", mostly neuralgia, such as diabetic peripheral neuralgia, trigeminal neuralgia, glossopharyngeal neuralgia, etc.
Patients often ignore such "bad pain" as chronic pain. When Fan Bifa asked about his medical history in the outpatient clinic, one of the most common words he heard from patients was, "Forbearance and forbearance will pass." It is difficult for the patient to tell when the pain started. Sometimes the pain is severe when he gets up early, so he decides to go to the hospital and brush his teeth. The pain disappeared, and the incident of "seeing a doctor" was also left behind. He didn't come to the hospital until the frequent episodes or could not bear it. Fan Bifa once treated a patient with herpes zoster neuralgia in her 80s. She had herpes zoster in her 40s. After he was cured, he had painful symptoms. It took more than 40 years to treat the "pain".
"Post-herpes zoster neuralgia is a typical chronic intractable pain." Fan Bifa said. Shingles is caused by the varicella-zoster virus. Clusters of blisters appear on the skin and are distributed in bands. The disease itself is accompanied by burning or needle-like pain. However, after the skin symptoms are cured, 9% to 34% of patients will develop post-herpetic neuralgia. This type of pain is caused by nerve damage. One of the distinguishing features is that the patient is extremely sensitive to pain and touches gently. It may cause severe pain throughout the body, and some patients even dare not wear clothes to avoid irritation to the body.
Older patients often equate the character of "forbearance" and "forbearance". In the long years when the problem of food and clothing has not been solved, the minor problems of back pain and leg pain are not worth mentioning. "Eat hardship" and "bearing forbearance" are virtues. "Now that the economy has developed and living standards have improved, people are paying more and more attention to health problems, but the concept of'chronic pain is a disease and requires scientific treatment' has not been generally accepted." Fan Bifa said.
A survey on chronic pain among adults in Shanghai published by the Chinese Journal of Pain Medicine in 2015 showed that the incidence of chronic pain in 30 neighborhood committees and 13 outpatient clinics of tertiary hospitals was as high as 92% to 98%, resulting in more than 30% being investigated Community residents and more than 40% of outpatients have different degrees of depression.
At 7 or 8 o'clock in the evening on a normal working day, there are still more than a dozen elderly people waiting in the outpatient department of the China-Japan Friendship Hospital. "More than 90% of the patients in the pain clinic are elderly people." Yang Yang, deputy chief physician of the pain department of China-Japan Friendship Hospital, told China News Weekly.
The above-mentioned Shanghai survey also found that the high prevalence of chronic pain in adults is inseparable from the aging population. The average ages of the surveyed community residents and outpatients were 73 and 68 years old, respectively. About 60% of them had pain for more than one year.
According to Yang Yang, neck, shoulder, waist and leg pain is the most common among all patients who come to the pain department. The most difficult to treat is various types of neuropathic pain, that is, pain triggered or caused by primary damage and dysfunction of the nervous system. There are cancer pains and chronic headaches.
Statistics from the 2017 Global Pain Index report show that 91% of Chinese people have experienced body pain, and 34% of people experience body pain every week, the most common of which are neck, shoulders and lower back.
Find the reason
The "Categorization of Chronic Pain: Description of Symptoms and Signs and Interpretation of Pain Terms" published in 1986 only classifies symptoms such as painful location, body and internal organs, and does not consider factors such as the cause of chronic pain, natural history, treatment and prognosis.
To this end, the World Health Organization and the International Pain Society set up an expert group to discuss the principles and methods of chronic pain classification. In 2018, the 11th edition of the International Classification of Diseases included "chronic pain" for the first time and summarized seven subcategories for this new disease, including chronic primary pain, chronic cancer-related pain, chronic post-traumatic and postoperative Pain, chronic neuropathic pain, chronic secondary headache or maxillofacial pain, chronic secondary visceral pain, and chronic secondary musculoskeletal pain.
"Domestic pain patients are ranked first by chronic neuropathic pain, accounting for 32.43%." Wang Jianglin, a professor at the Institute of Pain Biomedicine, Tangdu Hospital, Air Force Military Medical University, and others conducted a survey of 1545 patients with chronic pain over 50 years old across the country, reporting " Investigation of the current situation of patients in the pain department based on the ICD-11 chronic pain classification was published in the April 2019 issue of the Chinese Journal of Pain Medicine.
The report pointed out that chronic pain is not a single-factor disease, and its pathogenic factors also include ethnic and cultural background, socioeconomic background, etc. The prevalence of chronic pain in the elderly population is relatively high. The proportion of severe pain in female patients is significantly higher than that in males. People who smoke more have higher pain sites and degrees than non-smokers. At the same time, the level of education increases and the degree of pain is aggravated. the trend of. The article analyzes that patients with a high level of education may have a lower tolerance for pain, and excessive attention to pain aggravates anxiety to a certain extent, and then aggravates pain; while those with low education level may be due to lack of pain tolerance. Correct cognition and ignorance of pain will not easily produce anxiety, thereby reducing individual pain experience.
However, some of the pain sounds "unreasonable."
Liu Ximei sometimes fell suddenly because of the pain in her left foot. "The pain of a very cold, frozen foot, sometimes like an electric current, sometimes like stepping on glass." Liu Ximei touched her left leg with a Sichuan accent. , This leg has been amputated for almost six years.
In July 2013, Liu Ximei was involved in a car accident in her hometown in a county in eastern Sichuan. After half a year, conservative treatment failed and her left leg was amputated. It was January 2014, which was in the middle of winter. When I woke up again after anesthesia, there was always a "frozen pain" on the instep of my left foot. The county doctor recommended her to go to Chengdu Grand Hospital for rehabilitation. Looking at the prosthesis she is becoming familiar with, she can still feel a faint pain in her left foot.
"My feet are gone, why do I still feel pain?" Liu Ximei found out on the Internet that it was "phantom limb pain." The results of the Chinese epidemiological survey show that among amputation patients, the incidence of phantom limb pain is about 72%. Studies have shown that 45% of patients’ daily lives are affected, 18% of patients lose the ability to work, and more than 80% of patients have insomnia. More than a century has passed since phantom limb pain was officially named, but modern medicine does not know more about its pathogenesis than it was a hundred years ago.
Under normal circumstances, after peripheral or central stimulation of the afferent nerve matrix, the stimulated part can be obtained fairly accurately, but the pain location of patients with phantom limb pain has a problem, and the brain feels that the stimulation is still coming from the incomplete limb. Vilayanur Ramachandran, director of the Center for Brain and Cognition at the University of California, San Diego, described phantom limbs in his 2011 book "The Storytelling Brain: A Neuroscientist Reveals What We Are Human" Pain: After the arm is amputated, the limbs are no longer connected, but the position of the arm remains on the neurological map of the brain.
At present, the clinical treatment methods for phantom limb pain mainly include four main methods: drug treatment, nerve block, surgical intervention and psychological support. Liu Ximei has tried all of them. The doctor prescribed analgesics for her. According to the doctor's instructions, the initial medication was 2 times a day, 1 tablet each time. If tolerance occurs after 2 to 4 weeks, the dosage can be increased.
Liu Ximei felt that the medicine was expensive and did not increase the amount of medicine, but the pain was too "deadly". For this reason, she went to eight hospitals to see orthopedics, rehabilitation, and nerve damage surgery, but they failed to stop the phantom limb pain. She is now working with her husband in Shenzhen. She is participating in a clinical trial of a product of spinal cord electrical stimulation system. After 3 months of the operation, although she will experience "severe pain" occasionally, it does not affect her daily life. Work as a temporary worker in a factory in the villager.
One of the practical difficulties of chronic pain not being treated in time is that there is no way to get a cure. Taking fibromyalgia as an example, clinical analysis shows that the misdiagnosis rate of primary fibromyalgia syndrome in China is about 87%. In 2011, at the 16th National Rheumatology Academic Annual Conference, a survey from Peking University People's Hospital showed that only about one-third of physicians knew the diagnostic criteria for fibromyalgia syndrome. Almost all patients who are diagnosed have had the experience of seeking medical treatment for several years. Studies have shown that Chinese fibromyalgia patients have seen an average of 3.7 doctors, and some patients even took ten years to get the diagnosis.
Even in the United States, where there was a diagnostic standard for fibromyalgia in the 1990s, the clinical misdiagnosis rate remained high, reaching 73%. Fibromyalgia is a common rheumatic syndrome, characterized by chronic and diffuse musculoskeletal pain, commonly known as "Princess disease", and is accompanied by many symptoms such as insomnia, fatigue, and mood disorders. But the problem is that the patient's CT, MRI and other examination results are normal, so they are often missed or misdiagnosed as other types of rheumatism or ankylosing spondylitis.
According to the diagnostic criteria of the American College of Rheumatology (ACR) in 1990, patients with extensive pain for more than 3 months and tender spots in at least 11 designated areas of the body can be diagnosed as fibromyalgia. The newly revised diagnostic criteria in 2016 give a more detailed explanation. Among them, the symptom severity scale includes changes in physical symptoms caused by "mood depression and/or depression".
The American singer Lady Gaga first disclosed that she suffered from fibromyalgia in a personal documentary broadcast in September 2017 and planned to spend seven weeks on treatment. The original European tour was cancelled as a result. This incident once aroused the attention of all walks of life to this strange disease.
The pain department, which focuses on the treatment of chronic pain, has become the last choice for pain patients desperate. "In fact, we hope that the pain department can become a home for pain patients. When we come, we will first control the pain, then find the cause and find the method." Fan Bifa explained that analgesia will not only delay the observation and treatment of the condition, on the contrary, It also helps medical staff find and treat diseases more quickly and effectively.
Some seemingly common pains have also found new causes in the clinic. Ni Jiaxiang, director of the Pain Department of Xuanwu Hospital of Capital Medical University, encountered a patient with dysmenorrhea. The gynecology department could not find the cause. After removing the uterus and ovaries, he still had abdominal pain. It was not a urinary problem or tumor. Finally, he found the pain department. It turned out to be "atypical". "The lumbar disc protrusion is caused.
"The common lumbar disc herniation is posterior protrusion, but in our clinical work, we have found that a considerable number of patients who seek medical attention for functional visceral pain have obvious lumbar disc protrusion." Ni Jiaxiang explained, this This condition is called "discogenic visceral pain". The Ni Jiaxiang team first wrote this discovery as a paper and published it in the international academic journal Pain Treatment.
The most "headache" for pain doctors is the patient who "aches everywhere". Ni Jiaxiang placed a stack of half sheets of A4 paper on the outdoor table of the outpatient clinic to instruct patients how to tell the patient’s condition. The paper reads "Main complaint: how long is the pain in my ___ part and how long is it worsening", and even carefully marked five The main content of the item: the location of the pain, the nature of the pain (swelling, acupuncture), the cause of aggravation or relief, the treatment process, and the physical condition.
"The pain department does not cure or manage all pain, but it is specialized in pain, which can be diagnosed clearly and play a role in triage." For example, Ni Jiaxiang said, he also received a trigeminal neuralgia patient, After seeing the skull base MRI, it was suspected that there was a tumor in the brain, and then he was consulted by a neurosurgeon in the hospital. After the tumor was diagnosed, he was transferred to Shenwai for follow-up treatment.
More than drugs
When He Jiahui, 69, was playing in Guangzhou in April this year, he suddenly felt a tingling pain on the top of his buttocks, and he was too painful to step forward. He guessed that the old problem of lumbar disc herniation had committed again. After registering, filming, and confirming the diagnosis at a Grade A hospital in Guangzhou, he immediately returned to his hometown in Shenzhen and went straight to the pain department of Shenzhen Nanshan District People's Hospital. "I was cured here 24 years ago. This time I fell ill again, so I just came here directly." He Jiahui said.
At noon on a working day in the spring of 1995, He Jiahui suddenly became ill on the way from the office to the cafeteria. "The electric discharge above the tail vertebrae is the same. If you score it, it will get a full score of 10 points." He Jiahui lay on the hospital bed and recalled the situation back then.
Because I didn’t want surgery, I had undergone conservative treatment for more than half a year. I had seen orthopedics, rehabilitation, and Chinese medicine for help. I also tried various remedies under the recommendation of friends, but none of them worked. Finally, I found out that there is a newly opened "pain clinic". ", "I wanted to stop the pain as soon as possible, then try again." He Jiahui said.
After medical treatment and physical therapy in the pain department were ineffective, Xiong Donglin, who was still an intern, recommended a minimally invasive surgery to He Jiahui. Xiong Donglin is now the director of the pain department. Minimally invasive surgery is to use a small needle knife to pierce the treatment site deep into the lesion, strip off harmful tissues, and achieve the purpose of pain relief and disease healing. He Jiahui was hospitalized for a month after the operation, and returned home before the Spring Festival in 1996. After that, he had no back pain for more than 20 years.
"Pain belongs to the subjective assessment of the patient, and we can only trust the patient's main complaint." Xiong Donglin said that clinically, the "visual analogue scoring method" (VAS) or "numerical rating scale" is often used to assess the degree of pain, from 0 to 10, respectively. For "painless" and "the most painful experience in this life", patients are rated according to the degree of pain.
The recurrence of low back pain this year was the 4th and 5th lumbar disc herniation. He Jiahui counted the steps by himself, and after walking about 200 steps, he needed to stop and rest. I tried drugs and nerve block in the Pain Department of Nanshan People's Hospital, but the effect was not obvious. He Jiahui was unwilling to operate, and finally chose the minimally invasive treatment with intervertebral foraminal mirror.
"Minimally invasive surgery has high safety, small wounds, and quick recovery of patients." said Liao Xiang, chief physician of the Department of Pain at Nanshan District Hospital. In simple terms, the foraminoscopic surgery removes the protruding tissue under the guidance of images, and the skin incision is only 7mm. About the size of soybean grains, one stitch after surgery, two hours in bed, you can go to the ground and be discharged in two or three days.
Based on his own clinical experience, Liao Xiang believes that “The Department of Pain is a specialist in the treatment of chronic and intractable pain based on a multidisciplinary joint diagnosis and treatment team, using minimally invasive interventional therapy techniques.”
Li Gang, a visiting assistant professor at the Pain Center of Stanford University Hospital, agrees with this understanding, but he believes that more emphasis should be placed on controlling and managing pain through a variety of methods. "For chronic and degenerative changes, we must have reasonable expectations." Li Gang told China News Weekly, "Foraminoscope has a certain effect, but it will be painful after two or three years." Li Gang is still the largest private pain company in Silicon Valley. Partner and director of medical education of the organization. The comprehensive methods he said include medicine, physical therapy, acupuncture, psychology, intervention, and minimally invasive.
For cultural reasons, pain, as one of the vital signs, is highly valued in the United States. A Chinese patient treated for breast cancer in Boston, USA, told China News Weekly that when she was discharged from the hospital two days after surgery, a black nurse chased her from the ward to the door and gave her a pillow before getting in the car. , Put it on the chest to prevent the seat belt from strangling the wound.
According to Li Gang, the United States has pain index scales from large general hospitals to specialist clinics. Once the patient's self-assessment score exceeds 5 points, doctors need to help patients relieve pain, and reduce the number to less than 5 points. This will also serve as a doctor's assessment. a part of. For acute pain, the fastest analgesic method is opioids, but in the treatment of chronic pain, this is not a long-term solution, because drugs can cause problems such as drug resistance and dependence.
Opioids can effectively relieve pain in the short term, including prescription drugs such as oxycodone and morphine. In the 1990s, under the promotion of American pharmaceutical companies and the federal government, opioids were widely used. According to statistics, the United States, which accounts for 5% of the world’s population, consumes more than 80% of the world’s opioids.
According to a survey by the American Institute of Drug Abuse, there were approximately 2 million people in the United States suffering from drug disorders related to prescription opioids in 2015. According to the US Centers for Disease Control and Prevention, in 2015, more than 33,000 people died from opioid abuse in the United States, exceeding the number of deaths caused by guns and car accidents for the first time, making it the number one cause of accidental death in the United States. US President Trump declared in October 2017 that the United States entered a "national public health emergency" in response to the crisis of opioid addiction and abuse.
"Unlike drug abuse in the United States, the domestic problem is that pain is not paid enough attention. In addition to drugs, there must be correct diagnosis and treatment, including minimally invasive, acupuncture and other techniques, as well as psychotherapy." Li Gang said.
Injecting or taking opioids can effectively relieve chronic pain, but this is not a cure. Figure/IC
"Heart disease" and pain management
In July 2020, the International Association for the Study of Pain (IASP) updated the 40-year-old definition of "pain". The new definition of pain is: related to actual or potential tissue damage, or similar unpleasant feelings and emotional experiences. Compared with the definition of "unpleasant feelings, emotional experiences, or descriptions related to actual or potential tissue damage" 40 years ago, the new definition emphasizes pain that cannot be expressed or even seen. IASP also made 6 annotation extensions to the new definition. The first is that "pain is always a personal experience, and this experience will be affected by biological, psychological and social factors to varying degrees."
The reality is indeed the case. When people experience "pain", they often have "pleasant or unpleasant" psychological changes. According to the "Science of Pain Relief", when the pain is mild, "pain" will be felt in the sensory area of the cerebral cortex, and when the pain is strong, the stimulation will be transmitted to the limbic system of the brain, making people feel "pain". When the limbic system of the brain is inhibited, the feeling of "pain" is reduced or disappeared, such as in a sleep state.
Based on the above explanation, it can also be said that pain is a mental activity. At present, there are many hypotheses about the consciousness mechanism that produces pain sensations and emotions, but they have not been elucidated in detail. But what is certain is that pain and unpleasant emotions are inseparably connected.
Research by Massachusetts General Hospital affiliated to Harvard University in the United States shows that people with chronic pain have more or less depressive tendencies. At the same time, a study by the Mayo Clinic in the United States also showed that most depression patients suffer from some chronic pain, especially headache and back pain.
"Nearly 80% of pain patients have functional causes, that is, psychological problems." Min Baoquan, deputy chief physician of the Department of Neurology, Xuanwu Hospital of Capital Medical University, told China News Weekly. He has roughly counted the causes of pain in more than 400 outpatients. Psychological causes account for more than half, and nearly 30% of patients have different degrees of psychological problems.
Ten years ago, Min Baoquan saw a young mother who was recommended by the immunology department of the same hospital. She was pushed into the clinic by her husband in a wheelchair, and kept repeating in a low voice, "Oh, it hurts, oh, it hurts." Min Baoquan asked her where it hurts, she said the arm. The doctor touched it lightly, and she jumped up and cried out for pain. The strange thing is that the patient's immune examination indicators are all normal, and there is no tumor or ischemic limb pain.
Min Baoquan invited the patient’s husband to the clinic and communicated in-depth through role-playing. He found that the patient and the child had been bullied by in-laws for a long time, and the husband’s indifference and negative emotional backlog caused her psychological changes, which led to functional pain. After crying in the clinic that day, the patient's pain eased. The next day, a colleague from the immunology department called Min Baoquan and asked him what medicine he used. The patient was 80% better, and he didn't scream for an injection. “Just let her vent,” Min Baoquan said. However, he also emphasized that for pain, "organic causes must first be ruled out."
Beginning in 2008, Min Baoquan prepared a psychological counseling team. Together with the irregular training students, there are now more than ten people, forming a unique consultation process. He will first ask about 3 to 5 minutes of medical history to rule out the organic cause of the patient's pain, and then ask the psychologist to lead the patient to the consulting room outside the hospital for a half-hour voluntary interview. Min Baoquan will discuss possible functional reasons with the counselor, such as growth, studies, work, or emotional experience, and then refer the patient to the clinic for treatment.
"We are doing special-needed outpatient services with the charges of ordinary outpatient clinics." Xiu Nv Ojin, the chief supervisor of Min Baoquan's psychological counseling team, joked. However, psychological counseling is a process, not all one-shot deals.
A 15-year-old high school boy has chronic headaches for more than a year. It can be clearly caused by anxiety, but the cause of anxiety is his native family. When the boy's parents went to work in Beijing, he successfully completed elementary and junior high school in Beijing, with excellent grades. He had to return to his hometown for the college entrance examination and transferred back to his hometown to study. He did not adapt to the exam-oriented education and his grades declined, so he did not want to go to school again. The parents didn't understand this and often beat and scolded him. In contrast, the parents cared for the second-born brother very much. The boy had committed suicide for this reason. His parents brought him to the neurology department to prove that the boy's headache had no pathological cause and was "pretending to be sick." Because the patient had a suicide experience, in addition to prescribing conventional anti-anxiety drugs, Min Baoquan recommended that they go to a psychiatric hospital for examination.
"Look, the doctor said that you have a psychological reason, and you will go to school tomorrow." The boy's father said angrily when he left the clinic. “The child needs professional treatment such as medicine and psychology, but if he wants to solve the anxiety problem fundamentally, his parents also need psychological counseling, which can not be solved by a single visit.” Min Baoquan said.
"Unlike many diseases that can be cured, it is good that chronic pain can be cured, but the treatment concept is mainly management and control, with the goal of not affecting daily life and work." Fan Bifa said.
The treatment plan for chronic pain may be a series of imperfect choices. "It depends half on the doctor and half on himself." The intern who took care of He Jiahui told him that after he was discharged from the hospital, he had to stop climbing the mountain every day, and he should not overuse his waist. He had to work and rest regularly, and control drinking and smoking..." You have to be careful when you sneeze anyway." He Jiahui responded jokingly.
Jia Ru heard these advices eight years ago, “This is the case with chronic diseases. It hurts to death when it attacks, but when the scar is healed, forget it.” To prevent sitting for a long time, she replaced the original water cup with a smaller glass. In this way, she must often get up to pour water. The height of the kitchen bar counter in the home has also been increased during the renovation, so that she can stand and work.
Due to work needs, Jiaru often travels on business, sometimes flying international long-distance travel for more than ten hours. If you can’t sit for a long time, it means you can’t sleep and rest during the journey. If you can’t get an upgrade, try to choose an aisle seat and get up and move around frequently without affecting others’ rest. Every time she travels, she wears various plasters for low back pain, but there are some situations that she cannot control. If the hotel's mattress is too soft and the sink sink is too low, it will inevitably burden her waist.
Now, Jia Ru’s "problem" lumbar disc has developed from one to three. Following the doctor's advice, Jia Ru will consciously maintain the "primary school student sitting", but her body's center of gravity will unconsciously shift to the right. In order to find a comfortable posture in the new balance, she will subconsciously raise her legs. This action reminds her all the time. , "You are a patient with a herniated disc, you can't sit like this".
(In order to protect personal privacy, all patients in the article are pseudonyms)
China News Weekly, Issue 30, 2020
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