Chronic pain is one of the major problems facing modern human health and social development. In North America, chronic pain is the second most common disease after upper respiratory infections, and Jacobson and Mariano (2001) reported that the proportion of people suffering from chronic pain is as high as 30% of the total population in developed countries worldwide. The cost of chronic low back pain alone is tens of billions of dollars per year. The clinical treatment of chronic pain is also the main content of pain clinics in China. Because of its complex clinical manifestations, diagnosis and treatment, most patients need comprehensive treatment to achieve the purpose of pain relief, in which the use of adjuvant drugs also plays a significant role. How to face different patients or pain symptoms, reasonable with the adjuvant drug therapy, in the clinical sometimes can achieve twice the result with half the effort. A. Definition of chronic pain Chronic pain is defined as a type of pain without persistent pathological changes that extend beyond the normal course of the disease. This type of pain is often recurrent or mild and severe for a certain period of time (months to years) and does not heal. The clinical course is not only longer than that of acute pain, but more importantly, the clinical manifestations are more complex and diverse, and the pain cannot be satisfactorily relieved or completely controlled by general treatments or medications. At the same time, the patient’s emotional and psychological factors are significantly increased, and the ability of social adaptation, life or/and work is reduced. Second, the characteristics of chronic pain Compared with acute pain, chronic pain has many different characteristics. ①. The integrity of the nervous system? ②. Etiology ③. Mechanism of occurrence ④. The goal of comprehensive treatment of chronic pain is to ① increase the patient’s awareness of their own pain, build confidence and have the ability; ② break the vicious cycle state ③ reduce the type and dose of medication ④ implement effective pain rehabilitation projects to prevent or reduce the recurrence rate of pain ⑤ avoid unnecessary surgical treatment ⑥ adjust the abnormal body functions from multiple directions and levels, especially (6) Adjustment of abnormal body functions, especially the function of the nervous system, from multiple directions and levels. The adjuvant drugs used in the treatment of chronic pain are: glucocorticoids, vitamins, antidepressants, anticonvulsants, psycho-neuroleptics and other drugs. (a) Glucocorticoids Glucocorticoids – double-tough sword. Although there are different views on clinical use, it cannot be denied that glucocorticoids have been one of the commonly used drugs in the treatment of many pain disorders, as illustrated by a nationwide survey on epidural steroid injections conducted by Dr. Mehio of Harvard Medical School and Massachusetts General Hospital in July 2003. It is worthwhile to propose further and adequate discussion on the proper or rational use of hormones in the treatment of chronic pain. Types of corticosteroids 1. Oral drugs Prednisone tablets; Dexamethasone tablets; Estrogens; 2. Injectables (1), aqueous Dexamethasone; (2), suspensions Depo-Provera; Rimadex; Prednisone acetate; Methylprednisolone; Triamcinolone; (3), principles of glucocorticoid use In the process of clinical chronic pain treatment, emphasis should be placed on making specific analysis in combination with the patient and the disease itself, scientific and rational application In the process of clinical chronic pain treatment, emphasis should be placed on making specific analysis, scientific and rational application, and timely tracking of efficacy and side effects in the context of patients and the disease itself. Therefore, if you are worried about the obvious adverse reactions of hormones, you should not use them for patients who should use them, or you should avoid using them as conventional drugs because you fail to grasp the indications in the treatment. 1.Master the indications, try not to use or apply in small doses for a short period of time 2.Regularly apply in small doses as needed during treatment. 1, obesity, hypertension and electrolyte disorders, diabetes, etc.; 2, complication and aggravation of infection; 3, osteoporosis and muscle atrophy, delayed wound healing: Achilles tendon rupture, local subcutaneous tissue necrosis and osteonecrosis. 4, menstrual disorders and fetal development malformations 5, induced and aggravated ulcer disease, psychiatric symptoms; 6, medical adrenocortical insufficiency; 7, other: such as sleep problems or eye complications 8, rebound phenomenon or post-discontinuation syndrome. (2), vitamins vitamins as the repair process of the nervous system after injury coenzyme substances, to maintain the normal physiological function of the nervous system has an extremely important role, so in the clinical whether for nerve injury generated by the nervous system structure or function abnormalities or due to the nervous system stimulated by various factors in the treatment of functional disorders are of great significance. It is one of the most commonly used drugs in our clinical treatment of chronic pain in the vitamin class. 1.Vitamin B1? VB1 is an essential substance for sugar metabolism, which is combined with pyrophosphate to form transcarboxylase in the body, mainly involved in the oxidative decarboxylation of pyruvate and X-ketoglutarate in sugar metabolism. 2, vitamin B6? VB6 is converted into physiologically active pyridoxine and pyridoxal phosphate in red blood cells, which is involved in the synthesis of cytochrome. As a trans-enzymes on protein eggs, carbohydrates, fats of various metabolic functions role, also involved in the conversion of tryptophan, the conversion of niacin into 5-hydroxytryptamine. The γ-aminobutyric acid in the brain is made from the decarboxylation of glutamic acid, which has a role in regulating brain excitability, so patients who lack vitamin B6 can lead to restlessness, increased stress, convulsions and other central excitatory states. Combined with vitamin B12, it can promote the absorption of vitamin B12. 3.Vitamin B12? VB12 is a red compound containing cobalt, which is involved in many biochemical metabolic reactions in the body as a coenzyme and has a wide range of physiological effects, but it needs to be converted into methylcobalamin and coenzyme B12 before it can be active. VB12 can promote the transformation of methylmalonic acid into succinic acid, which plays an important role in the formation of lipoproteins in the nerve myelin sheath and protects the functional integrity of central and peripheral myelinated nerve fibers. VB12 has a strong affinity for nerves and has a role in repairing nerve myelin and promoting regeneration, but its deficiency can cause degeneration of the brain, spinal cord and peripheral nerves, and impairment of lipid acid metabolism. 4.Oral medication Micobal (methylcobalamin) tablets; vitamin B; compound vitamins;? 5.Injectable Micobal (methylcobalamin) injection; vitamin B: B1, B12. (3), antidepressants, anticonvulsant drugs 1, antidepressants For a long time antidepressants are widely used in the treatment of chronic pain accompanied by mental depression and some special types of neurogenic pain, in our clinical practice antidepressants are often used in the adjuvant analgesic treatment, they mainly through the inhibition of neurosynaptic 5-hydroxytryptamine They produce antidepressant effects and specific analgesic effects mainly by inhibiting the reuptake of 5-hydroxytryptamine and norepinephrine at the synapses, thus affecting the transmission of some central nervous system transmitters. The analgesic effect during long-term administration is associated with changes in the activity of substance P, metabotropic peptides, and Υ-aminobutyric acid. The main clinical side effects are due to central and peripheral anticholinergic effects, with some patients occasionally experiencing dry mouth, dizziness, palpitations, excessive sweating and excitement; attention should also be paid to the cardiovascular system and psychiatric side effects, such as tachycardia, upright hypotension insomnia or drowsiness, especially in the elderly and in patients with reduced function of important organs. Clinical oral use should start with small doses and gradually increase the dose later? Amitriptyline, which is most widely used clinically, appears to activate endogenous pain inhibitory mechanisms, with analgesic effects independent of antidepressant effects. Among tricyclic antidepressants, different types of tricyclic drugs have different receptor binding sites (at 5-HT, NE, histamine, cholinergic, and adrenergic neuromediators) and therefore differ in efficacy and side effects. In 30% of patients, pain can be relieved by more than 50%. Research data show some effect on burning pain and deep pain, sharp pain. It can be used routinely, but care should be taken to start with a small dose (e.g. amitriptyline: 12.5mg) and gradually increase the dose to maximize the efficacy of the drug and minimize side effects. It is contraindicated in patients with closed-angle glaucoma, benign prostatic hypertrophy, and acute myocardial infarction. Venlafaxine hydrochloride is a new antidepressant that is neither a tricyclic antidepressant nor a new SSIR drug. 2, antitussive drugs antitussive drugs (anticonvulsant, epileptic drugs) are also clinically used in the adjuvant treatment of chronic pain, especially chronic neurogenic pain, representative drugs are carbamazepine, phenytoin sodium, effective for nerve spontaneous lightning-like (electric shock-like) or knife-like pain. Anticonvulsants are sometimes not effective alone, and the combination of antidepressants can improve the efficacy. In recent years, gabapentin has been widely used for neurogenic pain, and multicenter, placebo-controlled data suggest significant efficacy in diabetic polyneuralgia. It is well tolerated by patients and does not require monitoring of blood levels. Recommended dose: Gradually increase every 3-7 days until significant pain relief or intolerable side effects occur. Clinical starting dose: 300 mg/day, maintenance dose averages 2100-3600 mg/day. The principle of action of this class of drugs is not fully understood and is considered to be related to the inhibition of abnormal firing or hyperexcitability of damaged neurons. Common side effects are drowsiness (15.2%), vertigo (10.9%), weakness (6.0%), the most serious is convulsions (0.9%), long-term application of this class of drugs can cause abnormalities in the liver, kidney, gastrointestinal tract and hematopoietic system, and should be applied under close monitoring or alternate use. 3, ion channel blocking drugs many information about the use of some anti-arrhythmic drug therapy for chronic pain treatment, due to peripheral nerve damage after its excitability increases, spontaneous release impulse abnormal increase is the main cause and material basis for the central sensitivity changes and the production of chronic intractable pain. Nerve tissues damaged or attacked by viruses are prone to increased persistent excitability of nerve fibers due to hypersensitivity of Na channels. Therefore, by blocking Na channels, the excitability of nerve tissue can be inhibited and analgesia can be provided. It is commonly used to have slow heart rhythm. In addition, data report that voltage-dependent Na channel blocking drugs mexiletine and topiramate reduce neurogenic activity by blocking voltage-dependent sodium channels, increasing GABA concentration at GABA receptor sites, and agonizing the kainate subtype of glutamate receptors. May be useful in chronic pain management. Contraindicated in bradycardia, AV block and severe cardiac, hepatic and renal insufficiency. 4, sympathetic blockers Since sympathetic factors play an important role in the development of many chronic pains, sympathetic blockers can treat this type of chronic pain. For example, colistin (antihypertensive drug) is a peripheral alpha-2 agonist, available in oral, transdermal and intrathecal forms. Some studies have reported that it is effective for diabetic peripheral neuralgia. (iv) Valium Oral valium drugs have a specific place in the treatment of chronic pain. For patients with chronic pain, the main therapeutic effect of Valium is to reduce the patient’s anxiety or restlessness, improve sleep quality, and enhance the therapeutic effect of analgesic drugs. 1.Valium; 2.Sulforaphane;? 3.Domecan;? 4.Sinox;? (e), improve muscle tension drugs 1, clozoxazone; 2, Miaona; 3, Chiropractic; 4, prednisone; (f), other drugs 1, calcium preparations: oral, injections; 2, anti-adhesion drugs: sodium hyaluronate, etc.; 3, hormone-like Chinese medicine: torch flower root, etc.