There are several types of chronic pain relief methods

Drug intervention, non-drug physics, behavioral cognitive adjustment, and minimally invasive. Most of the other folk remedies and health care products lack large-scale evidence-based medical evidence and are not yet included in the mainstream classification.

I just met a 26-year-old girl in the clinic last week. She has suffered from migraines for three years. Every time she had pain, she would stock up on ibuprofen and take it 4 days a week at most. She came to see a doctor last month when she started having frequent acid reflux. This is a typical case of incomplete understanding of drug intervention programs. In addition to the familiar non-steroidal anti-inflammatory drugs (ibuprofen, celecoxib, etc.), this type of method also includes different types of anticonvulsants, low-dose antidepressants, weak opioids, etc. To be honest, this type of program has always been controversial: many patients are afraid of becoming addicted when they hear about taking opioids. In fact, when they follow the doctor’s advice and use low-dose programs for chronic pain, the addiction rate is less than 0.1%. On the contrary, there are more cases of gastrointestinal damage caused by taking over-the-counter drugs on their own. There are also many people who will immediately question "I am in pain or not mentally ill" after receiving a prescription for antidepressants. In fact, patients with chronic pain for more than 6 months will have abnormal levels of serotonin and norepinephrine in the brain. This type of drug regulates neurotransmitters to reduce pain sensitivity, and the logic and dosage of medication are completely different from those for treating mental illness.

Of course, most people who are afraid of the side effects of taking medicine will first try non-drug physical methods. From conventional hot compresses, rehabilitation training, and low- and medium-frequency electrical stimulation to the more familiar acupuncture, massage, bone setting, and moxibustion, they all fall into this category. There used to be a 38-year-old Internet programmer who suffered from cervicogenic headaches for 6 years. When it was severe, he felt like vomiting even after staring at the screen for 10 minutes. He tried taking medicine to make his stomach uncomfortable. Later, he underwent cervical spine repositioning + myoelectric biofeedback in a regular hospital twice a week as planned. He also raised his head and moved his head for 2 minutes every half hour at work. After 3 months, the frequency of headaches dropped from 5 times a week to 1-2 times a month. However, there are also obvious differences between schools on this type of method: traditional Chinese medicine believes that acupuncture and bone setting can dredge qi and blood from the root cause and improve pain, while the evidence-based system of Western medicine currently only has clear high-level evidence for the efficacy of acupuncture for neck, shoulder, waist and leg pain, and there is insufficient supporting data for other types of chronic pain. ； Especially for cervical spine bone setting, the American Orthopedic Association clearly recommends that patients with vertebral artery stenosis and severe osteoporosis not try it. I personally encountered patients who fainted and were sent to the emergency room after bone setting in small clinics. You should be careful when choosing an institution.

What many people don’t know is that there is another type of method that seems completely unrelated to “pain relief”, but the results are often unexpected—that is, behavioral cognitive adjustment. This includes cognitive behavioral therapy (CBT), mindfulness-based stress reduction training, and pain self-management courses. There used to be a 52-year-old aunt with fibromyalgia. She had been in pain all over her body for 3 years. After repeated examinations, there were no organic problems. She even struggled to go out to buy groceries. When she first heard that she needed "psychological adjustment", she cried on the spot and said, "You all think I am pretending to be sick, right?" Really not. There are now clear brain imaging studies showing that patients with chronic pain have abnormalities in their pain perception circuits, which is equivalent to the brain's "pain switch" being stuck in an open state. Even if there is no substantial damage, the alarm will continue to sound. Cognitive adjustment is to help you slowly turn this switch back to its normal position. That aunt followed our mindfulness camp for eight weeks and took 10 minutes a day to adjust her breathing. Later, her pain score dropped from a maximum of 7 to 3, and she is now able to go out for square dancing with her husband.

If the above methods have been tried for more than 3 months but have no effect, and the pain has completely affected normal life, you can consider invasive minimally invasive options. Nerve blocks, radiofrequency ablation, spinal cord electrical stimulation implants, and intrathecal drug infusion pumps all fall into this category. There was a 70-year-old man who suffered from post-herpetic neuralgia for more than a year. His skin felt like a knife when he put on clothes and he couldn't sleep. Later, he underwent radiofrequency ablation of the semilunar ganglion and the pain was gone the same day. Of course, this type of plan also has the most concerns. Many people are afraid of sequelae when they hear that operations on nerves are required. In fact, these are minimally invasive, and most of the wounds are only the size of pinholes, and recovery is very fast. However, there are indeed clear contraindications. For example, it is not recommended for patients with coagulation disorders and serious underlying diseases. They must be evaluated by the pain department of a regular tertiary hospital before operating.

Of course, these categories are not completely separated. Nowadays, many new intervention methods, such as VR pain relief, combine scene distraction with biofeedback. They are cross-category solutions and there is no need to force them into a certain category. I have been in the pain department for almost 6 years, and my deepest feeling is that there is really no method that is "best". Many patients ask "should I take medicine or acupuncture" as soon as they come in. In fact, most of the time they use a combination: For example, the patient with lumbar prolapse who came for review last week, I The plan they gave was to take 1 celecoxib when the pain is severe, do core strength training twice a week, take 5 minutes a day to do mindful breathing, and don't sit for more than an hour. It's only been half a month. He had trouble putting on socks before, but now he can go downstairs and walk normally.

Oh, by the way, I would like to remind you that if your pain has lasted for more than 3 months, don’t take it hard, and don’t search for folk remedies to try on your own. Go to the pain department of a regular hospital for an evaluation first, and find the most effective solution for you.