1.What is neuropathic pain Often we will hear patients say: doctor, I sometimes have hot pain here, sometimes it hurts like pins and needles, I can’t even touch it, I can’t sleep at night because of the pain, sometimes it doesn’t hurt but the skin is like ants crawling, what’s going on? And the doctor may say: you have neuralgia! In fact, neuralgia is the abbreviation of neuropathic pain (NP), which is pain directly caused by injury or disease of the somatic sensory nervous system, it belongs to a chronic pain, pain manifested as spontaneous pain, nociceptive hypersensitivity, abnormal pain and abnormal sensation and other clinical features.NP is one of the most difficult to treat human diseases, the incidence rate is about 7%, according to incomplete statistics of China about 16 million According to incomplete statistics, there are about 16 million cases in China. The most common NPs are postherpetic neuralgia (PHN) and painful diabetic peripheral neuropathy (DPN), and others include trigeminal neuralgia, glossopharyngeal neuralgia, and complex regional pain syndrome (CRPS). 2, why neuropathic pain is difficult to treat We regret to find that there are many patients with NP complaining: “I have been to many hospitals and departments with this problem, but they all say that the neuralgia is painful, and I have taken a lot of drugs but it never gets better. There are even some people who are in depression and have died because of the pain. We have to admit that NP is one of the most difficult diseases to treat. Surgery and neurology are more concerned with pharmacological treatment, including NP suppressants and various pain medications, neurotropic drugs, steroid hormones, etc. For milder cases of NP, there is a certain degree of pain and pain. They are effective in milder cases of NP, but have little or no effect in more severe cases with frequent painful flare-ups! We all know that it takes quite a long time to recover from nerve damage, and during this recovery period nerve conduction is abnormal, you will feel tingling, jerking, electric shock, fire, insect bite and other abnormal sensations. We need to provide a proper internal environment for nerve recovery and regulate the nerve conduction to help restore normal, which is similar to a person who is sick and needs a bed to rest and functional exercise to return to normal. However, the most critical thing is that if this recovery period is not handled properly, our nervous system will be sensitized to pain, which means that the cause of the nerve damage has been removed and the lesion is gone, but the pain information is still transmitted to the brain by the nervous system from time to time and continues to torment the patient, just like a person who has planted the root of the disease afterwards. For example, in the case of shingles, the rash has subsided but the pain still comes and goes. This is so terrible and difficult to treat that some people call postherpetic neuralgia (PHN) the “undead cancer”. I believe the story of Dayu’s water healing is not unfamiliar to anyone. The reason why he succeeded in healing water was that he learned from his predecessors’ lesson of blocking floods instead of dredging them, and made great efforts to dredge the river on the basis of controlling the size of floods, so that the river flowed eastward into the sea and no longer harmed the earth. The treatment of NP is quite similar to this, relying on drugs to suppress the effect is very little, and even the pain burst out like a flood of beasts, can not be resisted! Unfortunately, many doctors are only concerned with medication and do not even know that nerves need to be regulated. Pain doctors are not only able to control pain with medications, but also use nerve modulation techniques to regulate nerve conduction and get it back on the right track. The main advantages of a pain physician’s ability to diagnose NP and accurately determine the damaged nerve segments, and to modulate the nerve conduction of the damaged nerve segments based on pharmacological treatment, are: ① Good control of pain, especially explosive pain and its accompanying symptoms. The main advantages are: (1) good control of pain, especially eruptive pain, and its accompanying symptoms. (2) Restoring the structure and function of the damaged peripheral sensory nervous system, removing inflammatory stimuli, increasing nerve blood flow, promoting nerve repair, and reducing the occurrence of pain sensitization in the nervous system. Its neuromodulation means include: nerve block treatment; pulsed radiofrequency modulation and radiofrequency thermocoagulation; peripheral nerve electrical stimulation and spinal nerve electrical stimulation; intrathecal analgesic system implantation, etc. Its purpose is green and minimally invasive. Some people believe that NP can be treated by destroying the nerves that cause pain, but it is true that nerve destruction can eliminate pain, but it will bring abnormal sensation, which is sometimes more unpleasant than pain, and even the destroyed nerves will regenerate, and the regenerated nerve pain may be more complicated. The 2013 expert consensus on the treatment of neuropathic pain proposes four major treatment principles for NP: ① early intervention and active treatment of the cause; ② effective relief of pain and concomitant symptoms and promotion of nerve repair; ③ comprehensive treatment with rehabilitation, psychology and medication as appropriate; ④ restoration of body function, reduction of recurrence rate and improvement of quality of life. Therefore, pain experts believe that for the treatment of NP, the earlier the intervention of neuromodulation, the greater the possibility of complete nerve repair. The pain can be controlled and relieved by actively treating the nerve targets of the injury with precise guidance and removing the cause. In the past, NP medication was like a machine gun shooting at mosquitoes, which cost a lot of bullets but did not kill many mosquitoes, so you can imagine the effect. In contrast, the treatment of NP in pain medicine is like a laser-guided sniper rifle, with a clear target point and a point-to-point attack, which has obvious effects. Looking into the future of neuromodulation technology, we may be able to use a remote control device to regulate nerve conduction at will, inhibit or filter pain signals and maintain normal signals. So is neuropathic pain still terrible?