A female patient, 60 years old, retired technician. I am an introvert. A year ago (April 2003), she developed lumbar discomfort and lumbar spine osteophytes. I used the remedy “heat therapy scald”, i.e., using fried industrial salt on the skin of the area. Later, he began to experience burning pain in the trunk and the inner side of both lower extremities, pins and needles in the lower extremities, and throbbing pain in variable parts of the body. He was diagnosed at a large hospital as “painful small neuropathic possibility?” He was treated with vitamin B1, B6, Micropôle, nicotinamide and carbamazepine, but to no avail. He felt a burning sensation in the skin of his whole body except for his head and ankles of both lower limbs. He was treated with ganglion block in the pain department of another large hospital. As a result, he was in a bad mood for a long time and had burning pain in his lower back, abdomen and front and back of his chest, and he felt that there was no time when he did not have pain. The pain was worse after walking around for a long time. At the same time, he had erratic reflux, habitual constipation, and usually had poor sleep, but now he had insomnia and early awakening, and slept for only 5 hours at night, and had to take Valium. I have to take Valium. I am not eating well. He also used Chinese medicine. After the pain worsened for more than six months, she came to our outpatient clinic.
I also received another female patient, from Hebei, just 50 years old. At the time of consultation, she reported that she had been suffering from pain on the left side of her body for more than 11 months, and the pain had become more and more severe in the past half month. Through questioning, I learned that she often cried after the disease, was fatigued and weak, and lost her appetite; she had even lost her ability to work, who used to be a hard worker. I further understood the background of her condition: 13 months ago, she had a brain hemorrhage, which was controlled by medical treatment; 11 months ago, she was angry with her husband over a family matter, after which she developed coldness and excessive sweating on her left limb, which improved with local Chinese medicine; 5 months ago, she developed pain in her left limb and head, which worsened in paroxysms, accompanied by numbness in the limb and excessive sweating. The disease worsened 3 months ago, with abnormal pain, numbness and cold sweating in the left limb; half a month ago, he had difficulty moving around without any obvious limb movement disorder and symptoms such as fever, vomiting, blurred vision and dizziness. After receiving the consultation, I applied medication, but there was no significant improvement in the condition. Then the consultation was conducted again.
I learned about her family history: her father died at the age of 60, the cause of which was unknown; her mother died at the age of 80 from cerebral thrombosis; her nine siblings, the eldest brother suffering from liver disease; the eldest sister died at the age of 30 from rheumatoid; and the second sister committed suicide at the age of 30 from mental illness. As a doctor, the diagnosis and treatment of the patient should be rich in emotion and rational analysis: Why did she have pain? Why did the pain continue to this day? Why did the pain continue and get worse? This requires a combination of physical and psychological aspects. Generally speaking, the occurrence of limb pain is closely related to the damage to the organism (body). However, pain is an extremely complex clinical symptom with various causes. It is not proportional to the damage to the tissues and organs of the body, that is to say, with damage, for example, minor abrasions or severe numbness, one does not necessarily feel pain; and with pain there may not be an obvious limb injury. The following is an explanation of the extensive theory.
According to the relevant information: the incidence of chronic pain in the general population is 20% to 45%, including 11% in the UK, 11% in Canada, 14% to 24% in New Zealand, 40% in Sweden, and 2% to 45% in the United States. The incidence of chronic pain was 46.5% in a random survey of 5,036 people, etc. Chronic pain is one of the most common reasons for people to seek medical care, with 40% of outpatient visits for pain, up to 30% of middle-aged and elderly patients with chronic pain, and 76% of surgical inpatients with postoperative pain. This includes ethnicity, geography, natural climate, life structure (diet, habits, personal will, personal factors, etc.).
The International Association for the study of Pain (IASP) defines pain as an unpleasant sensory and emotional experience associated with and caused by tissue damage or potential tissue damage, and chronic pain as pain that lasts longer than normal tissue healing time (usually 3 months). pain. Most physicians, for practical reasons, consider pain that lasts longer than 6 months to be chronic pain. Pain is a disease in itself, and it should not be viewed as a symptom only. Severe chronic pain is very harmful to the human body and can lead to dysfunction of the body’s systems, low immunity and induce various complications, or even cause painful disability or affect a person’s life. Pain is classified by modern medicine as the 5th vital sign after breathing, pulse, blood pressure and body temperature, and it is closely related to psychology.
There is a psychosomatic disorder in medicine: persistent somatoform pain disorder. It is a persistent, severe pain that cannot be rationally explained by physical processes or somatic disorders. The pain may be caused directly by emotional impulses or psychological problems, but the examination does not reveal a physical lesion with a corresponding complaint. The illness is prolonged, often lasting more than 6 months, and impairs social functioning (work and school). Diagnosis requires exclusion of pain that is presumed to be psychogenic in the course of depression or schizophrenia, somatization disorders, and examination-confirmed associated somatic disorders with pain.
I. Psychological factors affecting pain.
Pain cannot be accurately measured by several particular indicators, and the evaluation of the degree and nature of pain relies mostly on verbal descriptions, nonverbal expressions, special tests (neurohumoral and endocrine) and the involvement of our emotions. There is a clear subjectivity, several phenomena such as phantom limb pain, stress pain, hypnosis that reduces pain, distraction, relaxation, fear, repression and family and social factors can also modulate the pain experience, all of which illustrate the influence of psychological state on chronic pain.
1, personality
Many studies have tried to reveal what kind of personality is predisposed to pain. It has been suggested that the kind of person who is not strong or healthy when encountering difficulties may show a decreased tolerance for painful stimuli and complain more about pain; it has also been argued that pain is a manifestation of guilt, confusion; Monti? s study showed a very high prevalence of personality disorders in patients with chronic pain; however, Weisberg?? s view that the experience of pain is not a selective manifestation of a personality disorder. et al. found that personality traits do not predict the loss of certain abilities in patients with chronic pain. At present, a unified and recognized pain personality has not been found.
2.Gender
Gender can influence people’s experience of pain. Many studies have shown that women have a lower pain threshold? are lower than those of men, and they are more likely to recognize pain, rate pain, and tolerate pain less well. In many studies, women have been reported to exhibit pain that is more severe, more frequent, and more prolonged than men. Women are more likely to experience recurrent pain and to have pain-induced loss of work capacity. The report also showed that not only do women exhibit more pain than men, but their pain is more psychological in origin and pain can be easily explained as a purely psychological phenomenon.
3. Age
Current research on the effect of age on pain is mainly in the elderly and children. Pain is a common problem in the elderly, and Wijeratne et al. showed that despite the high incidence and long duration of chronic pain in elderly patients, they are not more likely to develop depression due to pain than younger people, but instead they have less incidence of disability due to pain than younger people. This may be related to the fact that young people are impulsive personalities, whereas older people are apprehensive personalities. For children, Perqurth? s studies have shown that chronic pain occurs frequently in children and adolescents, with a higher incidence and severity, and a greater variety of pain, especially in 12-year-old girls. Few biopsychosocial analyses of this type of pain have been conducted. Another important but under-researched area: is the influence of children and adolescents’ pain experiences on their emotional and cognitive development.
4. Cultural background
Current research on the effects of cultural backgrounds has focused on the effects of different ethnicities on pain. Studies have shown that blacks complain more about pain, avoid activities, and are more likely to cause physical or psychological disorders than whites; in Hong Kong, studies of chronic pain patients have found that the incidence, form, and demographic characteristics of pain are the same as in Western countries. Analysis of the reasons for this suggests that racial differences affecting chronic pain may be related to differences in cultural composition between races. The study found that in New England, “psychosomatic dualism” is accepted by many chronic pain patients and therapists, leading to greater stress and self-awareness disorders; in contrast, among Puerto Ricans, “psychosomatic unity” is accepted by many chronic pain patients and therapists. In contrast, among Puerto Ricans, “mental-body unity” is accepted by many chronic pain patients and therapists. Thus, they believe that chronic pain is a biopsychological and social experience and that this theory leads to more interaction between patient and therapist and less self-awareness of the patient.
II. Pain associated with psychological disorders.
1. Tension pain
A young female teacher came to the hospital and reported that she had recently had constant tightness-like pain in her head. Ask the medical history, I and family life are very calm, work for more than a year has been adapted. So what has changed in life? She replied: It is the new semester when the school’s student population decreases and some teaching positions may be reduced. Because of her short working experience, she was worried about being laid off. This is entirely due to psychological conflicts. In addition to symptoms of tension, worry, insomnia, etc., it can be manifested as chronic pain headache, abdominal pain, toothache, shoulder pain, back pain, lumbago, etc. This is a way to reduce stress and get rid of the dilemma of psychological conversion, the obvious feature is that is with the waxing and waning of mental stress.
2, suggestive pain
A patient with some numbness in the corners of his mouth went to the doctor, the doctor thought it was the trigeminal nerve and asked him, does the trigeminal nerve hurt? The next time he visited the doctor, he had pain in this part of the body and did a number of tests without knowing the cause; in fact, medical implication is the cause of chronic pain. Later, it was cured by psychotherapy.
3, there are often clinical chronic pain accompanied by depression, while another part of depressed patients mainly discomfort for various chronic pain.
They visit general hospitals for physical pain, not knowing that some physical pain may be caused by mental disorders. The most frequent concomitant pains were headache, accounting for 94%; back pain, 62.5%; limb or joint pain, 56%; stomach pain, 6.3%; and chest pain, 6.3%, and the possibility of depression was high in those with two or more pains co-existing. Somatic pain is more common in middle-aged female depressed patients. Chronic pain is closely related to psychological and more closely related to depression. Negative effects resulting from the experience of pain include persistent feelings of frustration, anger, and disappointment, and negative self-evaluation is a common manifestation of persistent pain. Studies have found that the higher the level of pain, the greater the likelihood of depression. The main reason for this outcome is not simply the pain itself, but the psychological factor of the patient’s helplessness about chronic pain may play an important role. Once depression is present, it can significantly affect the development and progression of chronic pain. Chronic pain and depression interact through a repeated vicious cycle, with pain increasing unpleasant emotions and promoting unpleasant events, which in turn aggravate unpleasant emotions and contribute to the triggering of pain.
4.Anxiety pain
Commonly, it is tension headache, but also back pain, abdominal pain, chest pain, muscle pain, accompanied by obvious anxiety: nervousness, panic, shortness of breath, sweating, etc. The pain site is not as fixed as the site of depression. Since fear is a natural consequence of pain, avoidance of fear-inducing events is appropriate for the management of acute pain, but not always effective for the recovery of patients with chronic pain. Based on a case study of 87 cases of chronic back pain, it was concluded that avoidance of pain-provoking events was the greatest barrier to return to duty after functional recovery therapy. Fear-related causes of pain may increase the patient’s attention to somatic pain sensations. In addition, pain-related fear increases a physiological response that may have a role in the severity and persistence of pain. There is experimental evidence that fear increases the reactivity of the low paraspinal muscles, which predicts that patients may have more severe pain production in subsequent physical tests.
5. Pain in neurological disorders
The head often tightens and swells with a sense of pain, fatigue, insomnia, etc.
6.Suspicious pain
Pain nature site is more than fixed, lack of corresponding signs, with the characteristics of hypochondria: sensitivity, paranoia, anxiety, etc.
7, hysterical pain
Characterized by spasticity, seizures, and a clear relationship with suggestion, with imitation and exaggerated colors.
8.Pain of menopausal syndrome
Involving multiple organs, multiple parts accompanied by symptoms of autonomic disorders, emotional irritability and irritability. Patients with chronic pain have high expectations of life and work, and sometimes exceed their abilities, leading to increased psychological stress and strong psychological conflicts. If the cause is identified, try to lower your personal goals to make them more realistic. At the same time, learn to do relaxation exercises to relax muscles and relieve stress.
Cancer pain
or advanced cancer pain, is one of the main causes of pain for patients with advanced cancer. At this stage, patients are in considerable physical and mental pain, and quite a number of patients die not directly from cancer, but from severe pain. There are more than 100 million pain patients in China, among which 7 million cancer patients, about 51-62% have different degrees of pain, 30% of which are unbearable severe pain, and 80% of advanced cancer patients have severe pain. It is estimated that at least 15 million people in the world suffer from pain every day. Cancer pain has been recognized as a painful disease. After cancer metastasizes to vertebrae or ribs, invades spinal nerve roots or intercostal nerves, and cancer infiltrates into pleura, peritoneum or periosteum can produce severe pain; after cancer extends to cavity organs, the pain is often accompanied by nausea and vomiting; cancer pain is commonly found in thoracic back, head and neck, abdominal cavity, pelvis, bones and chest. In addition to the above-mentioned causes, surgery and radiation treatment can also cause new pain areas or form new sources of pain. When tumor cells invade or compress nerves, it can cause severe pain; tumor cells invade blood vessels and cause pain when blood supply is impaired; liver cancer invades the peritoneum of liver and causes pain in liver area; intra-abdominal implantation of cancer tumor can cause abdominal pain; intestinal tumor can cause abdominal pain due to obstruction of digestive tract; nasopharyngeal cancer invades trigeminal nerve and causes headache, etc. The tumor itself produces some hormone-like chemicals, metabolites of tumor and decomposition products of necrotic tissue, which can activate and sensitize chemoreceptors and pressure receptors and cause pain.
The characteristics of cancer pain: it is all-round pain, severe and unbearable pain, accompanied by strong vegetative nerve abnormalities, and accompanied by psychological abnormalities. Psychological evaluation and initial psychological support should be performed at the time of diagnosis. When anxiety is prominent, treatment should include analgesics and anxiolytics, and the choice and dosage of each drug is determined, to a large extent, by what the patient has previously taken. Significant pain with significant anxiety should be considered an emergency and requires a time commitment for its treatment.
The most psychological symptoms in patients with cancer pain involve anxiety and depression.
Anxiety is a feeling of apprehension or fear about an upcoming event that can cause an increased level of automatic alertness. Anxiety can cause increased nociception, increased threat to physical health as well as prolong the process of pain experience, and can even decrease pain to the point where patients experience pain for any pain.
Depressive states can alter the transmission of pain signals and reduce the patient’s ability to cope with pain. The reported prevalence of depression in patients with chronic pain ranges from 10% to 100%, with a centrally reported incidence of between 30% and 60%, and these differences may be related to the type of disease studied, diagnostic criteria, assessment tool scales, and the subjects of the sample studied.
Psychological assessment of patients is often required when their complaints of symptoms and pain are beyond the interpretation of physical signs and diagnostic treatments. Psychological assessment can reveal the patient’s psychological response to pain, such as work problems, family stress, depression, and other psychological disorders. When a physician decides to perform a psychological evaluation or intervention for a patient, it is best to consider whether it will have an improving effect on the patient’s symptoms and quality of life.
Potential negative factors in coping include: a tendency to catastrophize cancer pain; previous medical problems or poor surgical outcomes; social support system conditions such as family, job search, marital crisis; a tendency to “blame” or “self-blame”; somatic or Emotional disorders; history of substance abuse; psychiatric disorders, etc.
There is a wide range of pain disorders.
Headache, abdominal pain, dental pain, shoulder pain, back pain, lumbago, traumatic pain, inflammatory pain, cramp pain, neuralgia, muscle pain, ulcer pain, cancer pain …… proves that life has to endure many pains. Paul. Dr. Bland said, “Pain is God’s gift to man.” From the medical point of view, it is the uncomfortable pain sensation that has a protective effect on the body. How can we know if there is a lesion in an organ or tissue that is not painful? Growing pains, sports pains, and childbirth pains are pains followed by pleasure. The famous scholar Liang Shiqiu famously said, “The decline in tolerance of pain and suffering is the beginning of human degeneration”. Brave and strong people have a high tolerance for pain, and people who are afraid of pain are often afraid of suffering and hardship, with inferior willpower and fighting spirit, and their immunity is negatively affected. Being able to tolerate a certain amount of pain is good for your health. In modern society, people are tired of living, and there is always an endless amount of pain to be exhaled. Why is this? There are many reasons for this, but one of them must be a mistake that is often made – amplifying pain. We inevitably make mistakes in life, but if we confine ourselves to the mistakes in front of us, we do not generalize, we do not pursue the past, nor do we associate it with the future. In this way, the pain is embraced and confined, the suffering is weakened, and life is much easier.
In the book “Pain – The Gift No One Wants,” Dr. Brand’s research revealed that 4-year-old Danye was a leper and a “congenital painless” patient. Danye’s parents tried in vain to let her know that she could not bite her fingers. Seven years later, Danye is living a miserable life in a charity. She had her legs amputated for wearing various ill-fitting shoes that eventually caused lesions to her joints. Danye lost most of her fingers, her elbows were frequently dislocated, and she suffered from chronic sepsis due to ulcers on her arms and amputated limbs. Because of her tongue-chewing habit, her tongue was broken, causing severe scarring. Danye also lives in a constant danger due to the lack of “pain warning”. Dr. Brand’s research proves that the “sense of pain” that people avoid is actually an innate self-protection system. The unpleasant nature of pain is the key to protecting oneself. In his opinion, “only in competition with other sensory signals such as touch, smell and hearing, pain information can cross the so-called ‘spinal cord gate’ and reach the brain, and under the action of brain consciousness, make a ‘response ‘, such as to blow a burned finger, to rub a painful leg ……. For those with “congenital painlessness”, “pain” itself is one of the most beautiful and expensive gifts.” This research proves that the “discovery” is also a powerful reminder to us – that suffering is what life is all about, that it starts when a baby is born and cries, and that it is the reason we constantly need faith. Therefore, we must not use painkillers to put ourselves in greater danger of avoiding suffering, forgetting suffering, or ignoring suffering.
Mr. Han Jisheng, an academician of the Chinese Academy of Engineering, says that the view that pain is not a disease is outdated; pain is not only a symptom, but may also be a disease in itself. The distinction between symptom and disease is relative. When a chronic clinical symptom seriously threatens the patient’s quality of life and ability to work for a long time, it should be recognized as a disease. Examples include primary trigeminal neuralgia, herpes zoster neuralgia, post-stroke neuralgia, post-amputation affected limb pass and stump neuralgia, migraine, and myotonic headache. Some pains are just one of the symptoms of certain diseases and should not be treated as pain. For example, headache secondary to hypertension, headache during cold, abdominal pain during acute abdomen, surgical incision pain, labor pain, etc.
Pain is one of the main vital signs in humans, and acute pain can serve as a warning and is beneficial to the organism. However, chronic pain that persists for more than 3 months and is difficult to treat can only play a destructive role for physical and mental health and quality of life, and such pain should be eliminated. In the past, it was believed that treating pain would mask the condition and one-sidedly generalize the warning effect of acute pain. In 2004, the World Health Organization declared that “pain relief is a fundamental human right”. Pain is a clinically important health problem. Between 30-40% of the population has experienced or is experiencing chronic pain. However, the diagnosis of pain has long lacked adequate attention and effective treatment. Physicians relied only on patient descriptions to understand the nature and extent of pain. With the development of science, it is now possible to confirm that pain is caused by pathological changes in the central nervous system, and it is not correct to classify it simply as a symptom of an accompanying disease; chronic pain is a disease in itself. The application of modern EEG/functional brain localization maps, functional MRI, magnetoencephalography and even PET can help in diagnosis. A number of pain patients have psychological problems, depression is highly correlated with pain, and depression is often accompanied by somatic discomfort. The new view of pain medicine: pain not only affects mood, but also causes brain atrophy in severe cases. Long-term persistent pain can reduce a person’s judgment and make it difficult to make the right choices. Currently, not enough attention is paid to pain itself and its solutions. The fact that a significant percentage of people suffer from unbearable pain reflects a blind spot in our perception of health, and may reflect a lack of understanding of the concept of “quality of life. Severe pain can be far more damaging to the human nervous system than the side effects of painkillers.
In the past, psychological studies of pain have emphasized the relationship between psychosocial and physiological factors. Some researchers have now attempted to portray a model that integrates physiological, psychophysiological, psychological, and behavioral factors to define pain, explain symptoms, and observe patient response to treatment. Within the last hundred years advances in medical technology such as MRI and positron emission, and X-ray tomography have helped researchers to detect brain activity non-invasively. Psychological research has also made it possible to use these techniques to better understand and treat pain more effectively and to better understand the interplay between neurological, hormonal, endocrine, and psychological factors, such as: How are neurological anatomical and physiological processes altered by psychological interventions? How do physiological states and processes affect patients’ emotions, thoughts, and behaviors? How is memory organized, stored, and reproduced to influence the experience of pain? Research findings in these areas will lead to a better understanding and more effective treatment of pain. On the other hand, the duration of pain suffered by chronic pain patients typically takes years, and even if treatment is successful, the traces of psychological and somatic trauma and economic stress in their brains will remain for a long time and require rehabilitation. Recovery from pain is also not a cure for pain, but rather emphasizes continued symptom self-control or self-treatment. We are clearly wrong to view chronic pain as curable in the short term. If we view chronic pain as a lifelong disease, then like other chronic diseases, treatment should be expected to continue and require regular testing and ongoing care. From the perspective of a chronic disease, treatment does not work or cure in short phases or 3-4 weeks of rehabilitation. Therefore, we consider pain as a chronic disease.
The two female patients discussed in this article were able to improve their symptoms significantly after six months and a year and a half, respectively, after subsequent pharmacological treatment with cognitive and behavioral therapy. They were able to perform household chores to participate in outdoor activities and chat with people, and their quality of life gradually improved and recovered.