Jiaru was only 25 years old when he had a lumbar disc herniation. It was June eight years ago. When she woke up in the morning, she couldn’t even sit up. She was alive, and her lumbar spine died. She couldn’t feel where her legs were She carefully recalled that the day before the afternoon from a business trip back to Beijing on the plane began to back pain, electricity like tingling from the lumbosacral spread from time to time. When she got home in the evening, Jia Ru changed her habit of working overtime and quickly lay flat. The next morning, she still had to go to the hospital for treatment.
at that time, Jia Ru had been accompanied by low back pain for four or five years, but she did not pay attention to it. She always thought that she was still young and would not have any major problems. Until that time, she went to the hospital and was diagnosed with lumbar disc herniation.
in Zhihu, the first topic that pops up is “why young people have low back pain” when searching for the key word “low back pain”. In 2015, China has 200 million people with lumbar spondylosis, and 15.2% of the total number of patients with lumbar disc herniation incidence rate is second only to the common cold.
pain is almost the only symptom of lumbar disc herniation. According to the definition of modern pain medicine, pain lasting more than one month is chronic pain. In 2018, the World Health Organization released a new disease code for chronic pain, which has become an independent disease. According to the report published on in 2017, the prevalence of chronic pain was 31.54%.
“chronic pain is not only a painful feeling, but also a disease, which should be treated.” Fan bifa, President of the pain medicine branch of the Chinese Medical Association and director of the pain department of the China Japan Friendship Hospital, said.
in his popular science book, ha dihengyi, who once served as a professor in the medical department of Niigata University in Japan, attributed back pain and shoulder pain to “diseases caused by human walking on both feet”. When the waist supporting the heavy upper body and the neck supporting the brain are overloaded, pain will occur. Especially in today’s popularization of computers and video games, the problem of excessive use of neck and waist is also aggravating, “modern people’s work and entertainment have largely exceeded the structure and function that the human body can bear”.
the intervertebral disc, which acts as a cushion to support, connect and cushion the human lumbar vertebrae, will become less water and less flexible with the growth of age. When the lumbar spine is under pressure, its shape will change. When the intervertebral disc protrudes, the nerves and spinal cord will be oppressed, and the lumbago and leg pain will be felt.
according to statistics, 80% – 95% of patients with lumbar disc herniation have radiation pain. This kind of pain often starts from the buttocks, and gradually radiates to the posterolateral thigh, the lateral leg, and even the dorsum of the foot, the sole of the foot and the toe. Severe patients in cough, sneezing or convenient, abdominal pressure increased, lower limb pain will aggravate, like the same, more severe than lumbar pain.
“why didn’t you come earlier?” The doctor questioned Jia Ru with a CT film, and then said, “this is a lifelong disease. In the future, we should pay attention to everything. We should not catch cold. We should also wear socks in summer, not wear high-heeled shoes for a long time, and we can’t sit for a long time…” Hearing the doctor’s advice, Jia Ru Mu gaped, “I always feel young. I didn’t think of such a serious consequence. I felt that my body was sentenced to death.”
unlike a cold which is only a temporary effect, the change brought by lumbar disc herniation to Jia Ru is long-term: she needs to avoid all the movements that need to bend down in her life, even if she just picks up the things on the ground, she must also adopt a special posture – straight waist and knees. After suffering from lumbar disease, she could not engage in strenuous exercise, including her favorite roller coaster.
almost every two years after the diagnosis of lumbar disease, Jia Ru would go to the hospital with pain once every two years, ask for sick leave for 1-2 weeks each time, go to the hospital for physical therapy, traction, massage or acupuncture every day, and can only lie down at home for the rest of the time. When she was on sick leave, she was worried about delaying her work and could not sit down, so she was lying on the bed typing at the computer.
it was found that within 3 months after the onset of pain, nearly a quarter of patients with chronic low back pain did not seek medical treatment in time. However, due to the lack of understanding of the harm brought by chronic pain, suffering from pain and worrying about the burden on their families, 36.79% of the patients did not deal with the pain, only 40% of them chose to go to the hospital for regular treatment, and more than 20% of the patients purchased drugs in the pharmacy by themselves.
“pain is a warning signal from the human body.” Fan bifa explained that when the body is injured or damaged by diseases, it sends out pain signals. If you have a cold, your head will ache. At this time, as long as you cure the disease, the pain will disappear. This kind of pain is generally urgent, usually more intense, to remind people to see a doctor as soon as possible or avoid danger, which is called “good pain” by fan bifa.
but when a certain part of the pain lasts for more than one month, it is called “chronic pain”, which has lost the significance of alarming. Because of its long duration and serious impact on physical and mental health, fan bifa called this kind of pain “bad pain”, with neuralgia in the majority, such as diabetic peripheral neuralgia, trigeminal neuralgia, glossopharyngeal neuralgia, etc.
patients often ignore the “bad pain” such as chronic pain. When fan bifa inquired about the medical history in the outpatient department, the most common sentence that the patient said was, “bear it and it will pass.” It’s difficult for patients to tell when the pain starts. Sometimes they get up early and have severe pain. When they make up their minds to go to the hospital and brush their teeth, the pain disappears. The matter of “seeing a doctor” is also forgotten. They come to the hospital only when they have frequent attacks or can’t help it. Fan bifa once visited a patient with postherpetic neuralgia in his 80s. He got herpes zoster in his 40s. After treatment, he had pain symptoms all the time. He endured for more than 40 years before he came to treat “pain”.
“postherpetic neuralgia is a typical chronic intractable pain.” Fan bifa said. Herpes zoster is caused by varicella zoster virus. There are clusters of blisters on the skin, distributed in belts. The disease itself is accompanied by burning or acupuncture like pain. However, after the skin symptoms are cured, 9% – 34% of patients will have postherpetic neuralgia, which is caused by nerve injury. One of the significant characteristics is that patients are particularly sensitive to pain, and slight touch may cause severe pain in the whole body. Some patients even dare not wear clothes to avoid the stimulation to the body.
elderly patients often equate the character of “endure pain” with “forbearance”. In the long years when the problem of food and clothing has not been solved, the small problems of low back pain and leg pain are not worth mentioning. “Suffering” and “forbearance” are virtues, but crying out for pain is despised. “With economic development and improved living standards, people pay more and more attention to health problems. However, the concept that” chronic pain is a disease and needs scientific treatment “has not been widely accepted Fan bifa said. A survey of chronic pain in Shanghai adults published in
2015 showed that the incidence rate of chronic pain in outpatient clinics in 30 residential committees and 13 third class A hospitals was 92% to 98%, which led to 30% or more depressed residents in community residents and 40% out of patients.
at seven or eight o’clock in the evening of a normal working day, there are still more than a dozen elderly people waiting for treatment in the pain clinic of China Japan Friendship Hospital. “More than 90% of the patients in the pain clinic are elderly people.” Yang Yang, deputy director of the hospital, said the pain.
the above Shanghai survey also found that the high prevalence of chronic pain in adults is closely related to the aging of the population. The average age of community residents and outpatients surveyed were 73 and 68 years old respectively. About 60% of them had pain for more than one year.
according to Yang Yang, neck, shoulder, low back and leg pain are the most common in all patients who come to the pain department. The most difficult to treat are all kinds of neuropathic pain, that is, pain caused by primary damage and dysfunction of the nervous system, as well as cancer pain and chronic headache.
according to the 2017 global pain index report, 91% of Chinese people have experienced physical pain, and 34% of them experience physical pain every week, of which the most common are neck, shoulder and back.
published in 1986, the classification was only based on the pain location, body and visceral symptoms, and did not take into account the causes, natural history, treatment and prognosis of chronic pain.
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 seven subcategories were summarized 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.
“chronic neuropathic pain is the leading cause of pain in China, accounting for 32.43% Wang Jianglin, Professor of pain biomedical research institute, Tangdu Hospital, Air Force Military Medical University, and others investigated 1545 cases of chronic pain patients over 50 years old in China.
the report points out that chronic pain is not a single factor disease, and its pathogenic factors include ethnic and cultural background, socioeconomic background, etc. The prevalence of chronic pain is higher in the elderly population. The proportion of severe pain in female patients is significantly higher than that in men. The location and degree of pain in smokers are higher than those in non-smokers. At the same time, with the increase of education level, the degree of pain tends to aggravate. The article analyzes that patients with higher education level may have lower tolerance for pain, and excessive attention to pain may aggravate anxiety to a certain extent, and then aggravate pain; while patients with low education level may not easily have anxiety due to lack of correct understanding of pain and ignore pain, so as to reduce individual pain experience.
Liu Ximei sometimes falls down suddenly because of the pain in her left foot. “It’s cold and cold. Sometimes it’s like an electric shock, sometimes it’s like stepping on a glass.” With a Sichuan accent, Liu Ximei stroked her left leg and said that the leg had been amputated for nearly six years.
in July 2013, Liu Ximei had a car accident in her hometown in the eastern part of Sichuan Province. After half a year’s conservative treatment, she lost her left leg and amputated her left leg. At that time, it was January 2014, in the middle of winter. Wake up again after anesthesia, there has been a kind of “frozen pain” on the left foot. County doctors recommended her to the Chengdu hospital for rehabilitation. Looking at her increasingly familiar prosthesis, she still felt a dull pain in her left foot.
“why do you feel pain when your feet are gone Liu Ximei herself found that this is “phantom limb pain”. The epidemiological survey in China showed that the incidence rate of phantom limb pain was 72% in amputated patients. Studies have shown that 45% of the patients’ daily life is affected, 18% of the patients lose the ability to work, and more than 80% of the patients have insomnia. It has been more than a century since phantom limb pain was officially named, but modern medicine does not know more about its pathogenesis than a hundred years ago.
under normal circumstances, when peripheral or central stimulation is introduced into the neural matrix, the site of stimulation can be quite accurately obtained. However, the pain localization of phantom limb pain patients has problems, and the brain feels the stimulation