There are several ways to relieve chronic pain

Mainstream relief methods for chronic pain can currently be divided into five categories: non-pharmacological intervention, drug treatment, minimally invasive intervention, neuromodulation, and surgery. The types of pain and tolerance groups applicable to different methods vary greatly. There is no absolute "optimal solution" and the choice needs to be combined with personal circumstances.

In the past few years of follow-up treatment in the pain department, the most common misunderstanding I encountered is that people look for a "once and for all" solution. They either feel that the pain can only be tolerated, or they want to directly operate to cut the "root cause" of the disease. In fact, it is completely unnecessary. Last week, a programmer who had been suffering from chronic lumbar pain for three years came to see a doctor. He couldn't sit still for 10 minutes. He had tried various Internet-famous massagers and folk remedies before, but none worked. When I asked him, I found out that he had never done even the most basic core strength training. In addition to going to work, he usually just slumps on the sofa and checks his mobile phone. The pressure on the lumbar spine is entirely carried by the intervertebral discs. It is strange that it does not hurt.

Let’s first talk about the non-pharmacological intervention that everyone is most exposed to. There are too many ways to do it, and the opinions of different schools are quite different. Most doctors in the rehabilitation department will recommend targeted exercise training, such as lumbar protrusion exercises, bird dog pose to strengthen the core, and deep neck flexor training for cervical pain. The essence is to build muscle strength, help bones and joints share pressure, and reduce pain stimulation from the root cause. ； The traditional Chinese medicine system also recommends whole-body conditioning exercises such as Baduanjin and Tai Chi, as well as acupuncture and massage, which are really effective in treating myofascial pain caused by muscle tension. To be honest, when I have stiff shoulders and necks, I will go to a rehabilitation practitioner I know to do a few massages. It is really comfortable after the massage. However, if you have radiating pain caused by nerve compression, such as the lumbar process has pressed against the sciatic nerve, and you go to a small restaurant to massage your waist, it may push the protruding nucleus pulposus further outwards and press the nerve root, which will make you unable to walk. Previously, an aunt massaged her cervical vertebrae at home in front of a short video. After the massage, her hands were numb for three days before she came to see a doctor. It was not worth the gain. There are also increasingly recognized mind-body interventions, such as mindfulness meditation and cognitive behavioral therapy. Some people may think that these are "psychological effects", but for fibromyalgia and systemic chronic pain caused by central sensitization, its effect is even better than ordinary analgesics - to put it bluntly This kind of pain means that your pain "switch" is stuck in the on position. Even if there is no external stimulation, the nerves will always send pain signals to the brain. At this time, just pressing the muscles and taking painkillers are useless. You must turn this overly sensitive switch back through cognitive adjustment.

Of course, if the pain is so severe that you can't even sleep well, and your daily walking or going to work is affected, there is no need to insist on not taking medicine. Many people still have the misunderstanding about painkillers that they become addicted after taking them. In fact, the first-line clinical drugs for chronic pain, such as pregabalin and duloxetine, are non-opioid and have extremely low addiction. As long as they are taken according to the doctor's instructions, there is no need to worry about dependence. There are also different academic opinions here: some conservative doctors feel that they will not take medicine if they can, and they will give priority to physical intervention for adjustment. ； Some doctors also believe that using a small amount of medicine to suppress pain in the early stage can avoid repeated pain stimulation that leads to central sensitization, and can instead reduce the subsequent dosage of medicine. Both statements are supported by clinical data. The specific choice depends on your own pain level and tolerance. Oh, by the way, don’t just buy ibuprofen and take it for more than a week. Taking NSAIDs for a long time can easily hurt your stomach. I once had an old man who suffered from back pain all year round and took ibuprofen by himself. He was hospitalized with stomach bleeding after taking it. I really can’t do this.

If conventional medication and physical intervention are tried for 1-3 months but still have no effect, you can consider minimally invasive intervention. Many people have never heard of this. To put it bluntly, a fine needle is used to puncture the painful location without an incision, and either a small amount of anti-inflammatory and analgesic drugs are administered to perform a nerve block, or radio frequency is used to "cool down" over-excited nerves. I once met a patient with trigeminal neuralgia who was over 70 years old. The pain was so painful that he dared not even chew food. He even cried when he drank water. After taking the medicine for more than half a year, the effect became worse and worse. Later, he underwent radiofrequency ablation for half an hour. He could drink porridge normally the next day. I was very happy. This type of method is less invasive and more effective. It can treat most neurogenic chronic pain with an effective rate of more than 70%, making it a very cost-effective option.

For more severe and intractable pain, such as post-herpetic neuralgia that has been painful for several years, or cancer pain in the late stage of cancer, if conventional methods are not effective, there are neuromodulation solutions, such as implanting a miniature electrode next to the spinal cord, which is equivalent to setting up a "toll station" for pain signals and blocking part of the pain signals from being transmitted to the brain. There are now portable external electrical stimulators that can achieve similar effects without implantation, but the price will be higher.

As for surgery, it is basically the last step. Only when the cause of the pain is clearly a structural problem, such as the lumbar process has pressed against the cauda equina nerve causing incontinence, or the joint is worn to the point that it is completely unable to move, then it needs to be considered. There is no need to demonize surgery. If the surgical indications are met, the postoperative quality of life will be significantly improved.

In fact, there are no particularly clear boundaries between the categories I mentioned above. Many people use them in combination. For example, after minimally invasive intervention, you still have to continue to practice core exercises. Otherwise, the pressure on the lumbar spine is not reduced and the pain will still occur after a year and a half. There are also plasters and moxibustion that people have asked a lot about. As long as they are products from regular manufacturers and you are not allergic or uncomfortable after using them, you can use them. They are supplements to non-drug intervention. However, don’t believe in any folk prescriptions that “cure all diseases” or “cure chronic pain”. Many folk prescription plasters with unknown ingredients add large doses of hormones and analgesics. I have seen skin ulcers and liver and kidney damage after long-term use.

In general, there is really no standard answer to the relief of chronic pain. A method that works for others may not work for you at all. If the pain persists for more than 3 months and has not been relieved, don’t force yourself to do it, and don’t try blind remedies. Go to the pain department or rehabilitation department of a regular hospital for an evaluation first, which is much more effective than searching online for half a day by yourself.