Pain is very common in outpatient clinics, as data show that two out of every three outpatients in China are accompanied by various pain conditions or symptoms; accounting for about 30% of the population suffering from various chronic pains. Then there is any difference between gender, age, and place of residence (urban and rural) among pain patients, and what kind of etiology is the main cause of pain. In order to further study the diagnosis, treatment and prevention of pain in a targeted manner, to improve the therapeutic effect of pain, and to provide a basis for future research directions, we are now conducting a survey and analysis of pain outpatients in our department from January 2008 to December 2008, and hereby report the results as follows.
Survey method
The patients who came to our pain clinic for the first time were recorded in detail with regard to gender, age, place of residence, time of onset, diagnosis (including location, etiology, and presence of pressure points), and finally statistical analysis was performed according to the above indicators. The diagnosis was based on Xuan jing human soft tissue surgery, and chronic soft tissue damage was considered as the cause of pain for lumbar disc herniation and osteophytes if the three tests of lumbar spine (scoliosis test; prone lumbar spine extension and flexion pressure test; tibial nerve flick test) were negative; chronic soft tissue damage was considered as the cause for those with pressure pain points at the corresponding musculoskeletal attachments.
Inclusion and exclusion criteria: chronic compression fractures, those with a history of trauma but the trauma had healed, and those with a history of surgery but the incision had healed were included in this statistical analysis; acute surgical conditions such as appendicitis, intestinal obstruction, gallstones, urinary stones, gynecological diseases, and acute fractures were excluded, and medical conditions such as hypertensive headache and angina pectoris were excluded.
Results
A total of 3246 cases were collected for the first visit.
Gender composition: 1418 cases (43.7%) were males and 1828 cases (56.3%) were females;
The composition of residence: 1123 cases (34.6%) were urban residents and 2123 cases (65.4%) were rural residents;
Age composition: less than or equal to 20 years old 183 cases, accounting for 5.7%; 21 to 30 years old 278 cases, accounting for 8.6%; 31 to 40 years old 728 cases, accounting for 22.4%; 41 to 50 years old 648 cases, accounting for 20.0%; 51 to 60 years old 700 cases, accounting for 21.6%; 61 to 70 years old 471 cases, accounting for 14.5%; 71 to 80 years old 176 cases, accounting for 5.4%; 62 cases older than 80 years old, accounting for 1.9%.
Time of onset: 1367 cases (42.1%) had pain for less than 30 d; 1051 cases (32.4%) had pain for 1 month to 1 year; 388 cases (12.0%) had pain for less than 3 years; 350 cases (10.8%) had pain for less than 10 years; 90 cases (2.8%) had pain for more than 10 years.
Etiology: gout 26 cases, accounting for 0.8%; herpes zoster and post-herpetic neuralgia 43 cases, accounting for 1.3%; trigeminal neuralgia 13 cases, accounting for 0.4%; rheumatoid arthritis, ankylosing spondylitis 14 cases, accounting for 0.4%; spinal compression fracture, rib fracture and history of trauma 112 cases, accounting for 3.5%; femoral head necrosis 12 cases, accounting for 0.4%; failure after spinal surgery syndrome 8 cases, accounting for 0.2%; residual limb pain 2 cases, accounting for 0.1%; facial palsy 2 cases, accounting for 0.1%; cancer pain (CA) 23 cases, accounting for 0.7%; there were corresponding pressure points and the diagnosis of chronic soft tissue injury was 2991 cases, accounting for 92.1%.
Departmental composition: 278 cases of head and facial pain, accounting for 8.6%; 609 cases of neck and shoulder upper limb pain, accounting for 18.8%; 427 cases of chest and back pain, accounting for 13.2%; 1666 cases of waist, hip and leg pain, accounting for 51.3%; 94 cases of abdominal perineal pain, accounting for 2.9%; 172 cases of generalized pain, accounting for 5.3%.
Discussion
Pain is one of the major diseases plaguing human beings, which causes a huge burden to the patients themselves and to the society. Many patients with chronic pain cannot be effectively controlled, which is related to the awareness of doctors who are engaged in pain diagnosis and treatment. Which groups of people, which ages, which diseases should receive important attention and which diseases need to be focused on are things that doctors engaged in pain diagnosis and treatment should know. In this paper, a statistical analysis of 3246 initial visits to pain clinics revealed that.
(1) Among the patients seen, there were significantly more female patients than male patients, with women accounting for 56.3%. If we add menstrual pain, labor pain and chronic pelvic pain with an incidence rate of 16.9% (this group usually goes to obstetrics and gynecology), female patients will account for an even higher proportion, so female patients’ pain should be given high attention and concern.
(2) In terms of place of residence, rural patients are nearly one times more than urban patients, with the former accounting for 65.4% and the latter accounting for 34.6%. One of the reasons for this situation is that the city where our hospital is located is a rural city, and the surrounding rural population is larger than the urban population, so there are more rural patients accordingly; another reason is that the economic conditions in rural areas are poor, the working environment is poor, and there are more opportunities to engage in heavy physical work, and there are more opportunities for strain pain to arise during work. The other reason is that rural areas have poorer economic conditions, poorer working environment, more opportunities to engage in heavy physical work, and more opportunities to produce strain and pain at work.
If we add the part of rural people who do not seek medical treatment due to poor economic conditions, the proportion of rural residents will be even higher. Therefore, it is worthwhile to explore the issue of using affordable methods of diagnosis, treatment and prevention of pain so that more rural pain patients can be well treated.
In terms of age composition, the majority of pain patients (64.0%) were in the age group of 30 to 60 years old, and if we expand the age group by 10 years, 87.1% of pain patients were in the age group of 20 to 70 years old. This age group coincides with the stage of work, which indicates that pain is related to work. Therefore, it should be studied how to improve certain bad habits and postures at work to prevent the occurrence of pain.
As far as the onset time is concerned, 42.1% of people with pain less than 30d, 32.4% of people with pain from 1 month to 1 year, 74.5% of both, 12.0% of people with pain greater than 1 year and less than 3 years, and 13.6% of people with pain more than 3 years, which indicates that most of the pain can be better controlled in the early stage, and the proportion of people who develop long-term pain is relatively small. Therefore, education and publicity should be done so that pain patients can receive treatment as early as possible to avoid long-term pain torment.
In terms of etiology, gout, herpes zoster and postherpetic neuralgia, trigeminal neuralgia, rheumatoid disease, femoral head necrosis, ankylosing spondylitis, residual limb pain, facial palsy, rib fracture, trauma, post-surgical failure syndrome of the spine, spinal compression fracture, and cancer pain accounted for 7.9%; while those with corresponding pressure points and diagnosed with chronic soft tissue damage accounted for 92.1%, which is similar to that of Claire Davies This percentage is very close to the 93% recorded by Clare Davis in “Pain Free”, which indicates that chronic soft tissue pain is the main cause of people’s pain, and the main effort should be spent on how to diagnose, treat and prevent such diseases in order to let more patients get rid of their pain.
From the onset of the site: head and face pain accounted for 8.6%; neck and shoulder upper limb pain, accounting for 18.8%; chest and back pain accounted for 13.2%; waist, hip and leg pain accounted for 51.3%; abdominal perineal pain accounted for 2.9%; and generalized pain accounted for 5.3%. This indicates that lumbar and leg pain is the main pain site, which is related to more weight-bearing opportunities in the lumbar and leg area and a large range of activities, which is also one of the main factors affecting the labor force and increasing the burden of patients and society, and more research should be conducted on such diseases.