the pain behind.

. According to the International
Epidemiological
Survey, the incidence of chronic pain is about 30% of the total population and is considered to be the third leading health problem after
cardiovascular
diseases and tumors. In 2017, pain is the most expensive disease burden in the United States, costing $635 billion a year, more than
the combined consumption of cardiovascular
diseases ($309 billion) and tumors ($243 billion). However, in our country, pain itself is a disease, the need for early
diagnosis
and treatment and other medical community
consensus
, still unknown to the public. Behind the dilemma of pain treatment is the lack of common sense, the limitation of traditional medical model and the constraints of social and cultural concepts.
pain itself is a disease
pain comes very suddenly. The needle-like sharp pain bursts on the cheek every moment, and dominates the whole theme of day and night. Work, life, sleep all stand aside. "He's the kind of guy who's normally very patient, and when I find out that he can't show restraint, we think there must be a big problem." The day after the pain, Ada took her family to a hospital in Beijing.
"We judged it to be facial nerve pain, and it was the number of neurology." "The doctor went to the doctor, asked about the symptoms, and soon gave
a diagnosis
: trigeminal nerve pain. However, "there is no effect after taking the medicine according to the doctor's instructions". In the midst of the pain, it's a year. Three days later, Ada and his family went to a second triple-A hospital. This time, the doctor prescribed painkillers directly. The result is still invalid. "That's when I was worried,"
. Ada said, "The medicine is not right, the patient is very anxious, because it is so painful." "When she was looking for her next target hospital, she started searching the web for all the keywords she could think of, such as "continuous facial pain" and "nerve pain." A strange disease suddenly appeared in her vision - "the after-the-skin nerve pain of shingles". Repeated lying, the family this only recalled, some time ago in the area above the temple had a small piece of humble rash.
shingles is a common disease with an annual incidence rate of three to five per thousand. Chickenpox-shingles virus (Varcella-Zoster Virus. VZV) like an underground guerrilla, through the upper respiratory tract or the eyelid conjunctiva of the eyes into the body, along the sensory nerve intrusion ridge nerve section or brain nerve nerve section, lurking in the human body. When
infected with
,
immune
low function, the latent virus re-activates, replicates in large numbers, and transfers along the sensory nerve to the skin associated with the nerve knot, resulting in shingles.
because of the high incidence of the torso, appalling herpes belt and severe pain, the disease is commonly known as "waist-tinted dragon", but many people do not know that shingles also occur in the head and face, sometimes does not appear obvious rash. What more people don't know is that shingles itself is not difficult to treat, but about 9% to 34% of patients will encounter this dilemma: the rash is completely good, but the pain is stubbornly left behind. This is the "striped herpes after-effect nerve pain" (PHN). PHN is known as an indie cancer in
clinical
because of the severity of pain.
Ada searched several papers online. According to the mailbox left in the paper, she almost hopelessly sent an e-mail to an author. I didn't expect the professor in a foreign country to write back soon. He told Ada that the family had a high probability of PHN and suggested that she go to a pain unit at a triple-A hospital for a diagnosis. The e-mail became a lifeboat in the sea of pain. In the pain department of the third hospital, doctors prescribed a prescription for PHN. On the first night of taking the medicine, the pain eased, and the family slept for the first time in ten days, and a month later, he recovered.
Ada on the network to share the medical trip, did not expect to receive a large number of inquiries soon, we all have similar symptoms, suffering, long-term cure. A netizen had to give up his long-term work abroad in order to accompany his sick mother. A few months later, he contacted Ada again, thanking him - and according to Ada, his mother was finally diagnosed and curated.
the disease was Ada's first exposure to the "pain department." She recalls seeing the strange term on a promotional ebrasion when she sat in a second hospital. Although pain was the subject of all life at that time, Ada never thought about turning to it. In many years of medical experience, low back pain to see orthopaedics, headache to see neurology,
stomach
pain to see
digestion
, toothache to see oral medicine, "pain department" treatment what? It seems to cure everything, and it seems to cure nothing.
For Yu Bifa, director of the pain department at the China-Japan Friendship Hospital in Beijing, the president of the pain doctors branch of the Chinese Physicians Association, and the former chairman of the Pain Credit Association of the Chinese Medical Association, "what is the pain department to cure" he explained for 30 years. Now, the pain department of Sino-Japanese Friendship Hospital is the national pain
medical
and
research center, the national
clinical
key specialties, receiving patients from all over the country, there are 30 beds, advanced equipment inpatient department.
1989, the Sino-Japanese Hospital opened a "pain clinic", which belongs to the first batch of large-scale general hospitals to open pain clinics. That year, He Bifa sat at half a desk to visit the doctor. There are only two or three patients in an outpatient clinic. Patients don't know what the clinic is looking for, and doctors in other departments don't know. He remembers communicating with other professional doctors when he first rose to professor ship many years ago. They were curious about his pain professor. "One of the experts asked me what a cure for trigeminal nerve pain was, and I told him about the treatment of pain. Another asked: What if your foot hurts? I said I had a way. There are experts said: you are from head to toe wow! "
pain department is not all pain." Medically, pain is usually divided into two categories, one is good pain, the other is bad pain. "When the body is injured, disease, etc. , pain warning is quickly issued, which is medically known as acute pain, which reminds us to avoid danger or see a doctor in a timely manner, which is good pain. But when pain lasts more than a month in the body, it is called chronic pain. This pain has lost the meaning of the alarm, will cause harm to the human body, this is the pain department of the
diagnosis and treatment
range.
june 22, 2018, the World Health Organization (WHO) released the 11th Revision of the International Classification of Diseases. A new disease code is given "chronic pain syndrome". PhN, which confuses Ada and her family, is one of the common chronic pains. According to the
Epidemic
survey in Western countries, the incidence of chronic pain is about 30% of the total population and is considered to be the third largest health problem after cardiovascular disease and tumor. China does not have a related epidemiological investigation, said Yu Bifa, China's incidence rate is only high or low.30 years ago, it was not surprising that people knew nothing about the pain department. In the 1980s, chronic pain was also an emerging field of clinical medicine. This has long been a blind spot in medical development. In the 18th century, pathology and physiology began to determine the location of abnormal tissues to explain how the body's function can be disordered. The discovery of bacteria, viruses, and chemical deviations identified the causes of local tissue variation. Pathology gradually became a pointer to the whole modern medicine. People try to find some kind of definitive pathology to define and explain the disease, and doctors use this to develop rational and scientific treatments, trim out abnormal local tissue, and eliminate
infections
. The goal of medicine is to treat disease, not pain.
1973, The American doctor John F. J. J. Bonica founded the International Pain Society and is considered the ancestor of pain medicine. Bonica's interest in pain stems from his clinical doubts. During World War II, he joined the U.S. Army Medical Corps and was assigned to the Madigan Army Hospital in Fort Lewis, Washington, where he served as the director of anesthesiology. Bonika was shocked by the chronic pain that wounded veterans were experiencing. Take "phantom limb pain" as an example, many veterans' limbs have fully healed and recovered, without any signofe of infection, and it is reasonable to say that medicine has healed them and accomplished their mission, but these veterans will still feel years after years that their lost limbs have been "stinged", "electric shock" "needles" "fire" "knife cuts" "squeezed" and "crushed". There is no pathological basis for these pains.
for pain, the most common misconception is, "pain" word, disease in front, pain in the back, pain is only a symptom of the disease, cure the disease, the pain disappeared. But in fact, "pain is not only a symptom, but also a disease." "Chronic pain is divided into primary and secondary sex." Bifa explained. Primary pain is not accompanied by any other disease; secondary pain is caused by some injuries and illnesses, but the original disease has recovered and the pain itself has long been left behind. This is the case with "phantom limb pain" and the shingles-like nerve pain that afflicts Ada's family. Pain itself constitutes everything to the disease. If the pain is gone, the disease will not exist. Pain medicine provides different perspectives and methods for the treatment of these diseases, going straight into the pain.
I followed Bi to send out an outpatient clinic. The patient scored from all over the world, and the pain varied widely. Many people have a headache. In the case of common migraines, 50% to 70% of migraines cannot find the cause. In the 1990s, he remembers a 48-year-old middle-aged woman who had been entangled with migraines for 40 years, and was in no pain in the physical period. In other departments, the cause can not be found, treatment will not be able to talk about. The most popular pain treatment at the time - local nerve blockand and nutritional nerve to improve pain treatment mode, after a course of treatment, the recovered patient smothered his hand, feeling tears.
a lot of people come to see back pain. In the U.S., the market for back pain is more than $100 billion. In Japan, back pain is known as national disease. "Treatment for low back pain is a slow-moving process." "When the earliest medicine was not perfect, the people used all kinds of methods to deal with back pain, " he said. With the advance of surgical technology, various operations to treat back pain began. "The pathological basis for surgery is that it is widely believed that one of the common causes of pain is the lumbar disc lesions or protrusions that compress the nerve fiber strain that transmits the sensation.
but in fact, "only 15 percent of the 100 people with lumbar disc problems may feel pain in imaging." Surgery does not solve all back pain problems. The cause of back pain is still a modern medical problem. I met a 60-year-old male patient in the clinic, lumbar spine has been surgically hit nails, but the pain can not go away, a day oral morphine 18 pills, or not to use. He was hospitalized and planned to treat the patient with electrospinal stimulation (SCS). Pain doctors will implant a special electrode into the outer cavity of the lining of the vertebral membrane, guided by imaging equipment, and stimulate the spinal nerve with microspheres released by the electrodes, directly modulating or blocking pain signals to the brain.
neglected pain
in 1989, while sitting in a pain clinic at the Sino-Japanese Friendship Hospital, he graduated from the Chinese Medical University with a master's degree in anesthesiology. Some people say that he is the anesthesiologist doctor "do not do the right thing", only to cure pain, not cure the disease, not much use. The blue hair is not in the sense. "Doctors go to the clinic and know that one-third of patients come to see the disease because of all kinds of pain. If an anesthesiologist can solve some problems, why not? "He knows too much about the cruelty of pain. He had received a call from a hospital asking him to consult a patient with severe headaches. He booked his trip for the next day. Didn't expect half a day of kung fu, the phone came again. It was this short half-day, the patient could not bear the pain, suicide. At one clinic, a woman suddenly knelt in front of her bifa, and he was startled. Her father took the medicine and committed suicide and is being resuscitated. The cause of suicide is severe shingles after the residual nerve pain. There is also an old man, for many years felt toothache unbearable. For each tooth pulled, the pain can be reduced for a while. A mouthful of teeth are pulled out, but also pain can not, the final diagnosis is trigeminal nerve pain.
however, "pain is really life-threatening", but not before the time of no way, but people generally despise the treatment of pain. Oriental culture emphasizes patience, one of the characteristics of noble heroes is the ability to endure pain, fearless, fear of pain is the weak, cowardly mark. For the pain, many people's first reaction is to endure. One of the most patients he met, 40 years old got shingles, 80 years old really can't stand, to treat the after-effects of nerve pain.
many patients think of pain pain very simply, feel that nothing more than to take painkillers. A patient with a headache for 20 years has poured 28 pain medications out of his bag. There are doctors' prescriptions, and they are bought according to newspaper advertisements. He advised him to stop taking all the drugs, and slowly, the patient's head was out of pain, which was a substance abuse headache. But the more common problem is that even if the doctor prescribes painkillers, the patient does not take it on time. Years of anti-drug education have made people particularly wary of "addiction". In fact, pain is a "natural antagonist" for addiction, and the requirement of the cerebral cortex is pain relief, not "euphoria". The probability of addiction is extremely low under the scientific, standardized and reasonable guidance of doctors. There is also a situation in which the patient thinks that the painkillerist is not the cure: "eat does not hurt, do not eat or hurt, useless." "
management of chronic pain
is chronic disease
management
, painkillers for pain are like insulin

diabetes, however, no one will feel that insulin is not treated." Bifa said.from a medical point of view, these contempts and patience for pain are dangerous behaviors. As with any disease, chronic pain requires early diagnosis and early treatment. "A lot of people have been in pain for more than 20 years, " he said. The patient told me that it was a small pain, and finally became stubborn pain, and finally pain to make people desperate, even lose the courage to survive."
pain medicine has a concept called "sensitization". Simply put, neurons and neural pathways that are excited by prolonged pain stimulation are not back to normal.