Spine-related pain clinically involves a number of medical specialties, anatomically involves a wide range of areas and scopes from head to toe, if the diagnosis is clear on the basis of targeted treatment, most of the cases can get more satisfactory results. Today, we propose common treatment methods from the perspective of clinical anesthesiology to discuss together. I. Common spine-related pain in pain diagnosis and treatment 1, headache 2, shoulder, arm pain 3, cervical spondylosis 4, chronic chest pain, abdominal pain, intercostal neuralgia 5, intervertebral discogenic pain 6, small joint pain 7, lumbar spinal stenosis 8, ankylosing spondylitis 9, tumor metastatic pain 2, spine-related pain clinical examination Clinical examinations of spine clinical related clinical examination 1, thoracic and abdominal cushion pillow test 2, spinal bending test 3, cervical compression test 4, cervical cuff test Cervical spine compression test 4, Cervical neck test 5, Brachial plexus nerve pull test 6, Thomas sign 7, Straight leg raising test 8, Femoral nerve pull test 9, “4” test Sensory examination (a) Superficial sensation includes touch and pressure on the skin and mucous membranes, nociception and temperature sensation. 1, touch and pressure sensation 2, nociception and temperature sensation. 2, nociception and temperature sensation. 3, cervical spine compression test. 1.Touch pressure 2.Nociception 3.Temperature sensation (2) deep sensation Arthralgia: gently break the patient’s fingers or toes, make passive extension and flexion movements, and ask whether they are aware of the direction of movement; or let the patient’s eyes closed, and then put their limbs in a certain position, and ask whether they can clearly state the position of the limbs. (C) composite sensation, including skin localization, two-point discrimination, entity discrimination and body surface graphic sensation, is the result of brain synthesis, analysis and judgment, so it is also called cortical sensation. Reflexes Reflexes caused by stimulation of surface receptors (e.g. skin, mucous membranes, etc.). Deep reflex Reflexes Reflexes caused by stimulation of proprioceptors in muscles, tendons, periosteum, and joints. Reversal reflex A reversal reflex, also known as an inversion reflex, is a special phenomenon in which a tendon reflex disappears while the reflex of its antagonist muscle or neighboring tendon appears or becomes hyperactive. Pathologic reflex An abnormal reflex that occurs when damage to the central nervous system, primarily the pyramidal fasciculus, results in a loss of inhibition of the spinal cord. Muscle system examination (I) muscle volume Observe whether there is atrophy and hypertrophy of muscles, measure the circumference of limbs, and judge the nutritional status of muscles. (II) Muscle tone Muscle strength rating standard The current generalization is. Six grades: Grade 0: muscle strength completely disappeared, no activity. Grade I: muscle can contract, joint inactivity. Grade II: Muscles can contract, joints are slightly mobile, but cannot counteract limb gravity. Grade III: Joints move against gravity, but cannot resist external resistance. Grade IV: the joints can move against external resistance, but the muscle strength is weak. Grade V: Normal muscle strength. Autonomic nerve examination Observe the skin color, temperature, sweat secretion and nutritional status. If dysfunction of the autonomic nerve occurs, it is manifested as redness, heat, moisture, hyperkeratosis and peeling of the skin, etc.; and when the nerve function is further impaired, it is manifested as cyanosis, coldness, dryness and thinness of the skin, or brittle nails, hair loss, and skin trophic ulcers in severe cases. Psychiatric examination of spine-related pain patients are sometimes manifested as a depressive state, depressed patients often with physical symptoms as the prominent complaints, but masked the actual presence of depressive symptoms, because the patient’s first complaint is the body-related pain, the majority of physicians are bound to be the first according to the pain of the symptomatic treatment; however, the prominent manifestations for the clinical physical examination can not be found with their complaints of the appropriate positive signs or test results. At this point, further detailed history and psychiatric examination can reveal the problem. Hamilton rating scale for depression (HAMD, a 24-item version developed by Hamilton of the University of Leeds, U.K.) is a commonly used clinical diagnostic criterion, and most of the items in the HAMD are rated on a 5-point scale of 0-4 points, with scores for each level as follows: 0=none; 1=mild; 2=moderate; 3=severe; 3=severe; and 4=mild. 3=severe; 4=very severe. The results were evaluated and analyzed using the total score, and it was generally considered that the first 17 items were greater than 24 for severe depression; 17-24 for moderate depression; and greater than 7 for mild depression; the changes in the total score before and after treatment were analyzed in order to evaluate and judge the results of the treatment. Third, the clinical treatment of spine-related pain The treatment of spine-related pain involves many clinical disciplines, can be said to be more varied, according to the arrangement of this topic mainly discusses the commonly used drug therapy and nerve block technology treatment principles. Pharmacological treatment 1, three-step treatment The term “three-step treatment” for chronic pain comes from the principle of three-step treatment for cancer pain formulated by WHO in 1982 in Rome, Italy, and its specific meaning is that: when treating all kinds of chronic pain, we should treat the patient according to the degree of pain in accordance with the corresponding drugs in the ladder. Mild pain: non-steroidal anti-inflammatory drugs (NSAID) + adjuvant drugs Moderate pain: weak opioids – represented by tramadol and codeine + adjuvant drugs Severe pain: strong opioids – represented by fentanyl and morphine controlled-release tablets + adjuvant drugs Adjuvant drugs: neuroleptic drugs: valium, haloperidol; antidepressant treatments: amitriptyline, doxorubicin, Prozac, and so on, are representative. Hormones and vitamins: Vitamin B, C and glucocorticoids and their long-acting preparations, etc. 2. Principles of medication ① Oral administration ② Timed administration ③ Stepwise administration ④ Individualization of medication, paying attention to the actual efficacy of specific patients. Nerve block The use of nerve block as the main method of diagnosis and treatment of pain is clinically known as nerve block therapy. Nerve block can be divided into the following categories: ① spinal nerve block ② sympathetic nerve block ③ spinal nerve and sympathetic nerve block at the same time ④ cerebral nerve block Mechanisms of nerve block 1, block the excessive pain conduction impulse, channel 2, rapid and effective blockage of the vicious cycle of pain 3, to improve the blood supply and metabolism in the region 4, to promote the structural repair of the damaged nerves and the function of the re-establishment.