This article will help you understand pain knowledge and eliminate misunderstandings

Author: Han Wenyong, Chief Physician of Beijing Electric Power Hospital

Reviewer: Fan Lei, Chief Physician, Beijing Electric Power Hospital

Illustration: Jiang Jingan

Each of us will inevitably experience various pains in our lives. People have different views on pain, but there are some misunderstandings. October 16th is this year's World Pain Relief Day, a special commemoration day set up by the international community for pain. Let us work together to eliminate misunderstandings about pain and standardize pain treatment.

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1. Understand the basics of pain

In recent years, pain-related issues have received increasing attention in the field of medicine and health. In 1995, Professor James Campbell, President of the American Pain Society, proposed that pain be regarded as the "fifth vital sign" after body temperature, blood pressure, pulse, and respiration. In 2001, experts attending the Asia-Pacific Pain Forum proposed the concept that "eliminating pain is the basic right of patients." In 2002, the 10th International Pain Society IASP Conference reached a consensus that "chronic pain is a disease." In 2007, the Ministry of Health issued a document to add the "Pain Department" diagnosis and treatment subject to the "List of Medical Institutions' Diagnosis and Treatment Subjects." So far, the "Pain Department" has truly become a new clinical first-level diagnosis and treatment subject that patients can directly choose to see for "pain diseases." The International Pain Society announced that starting from 2004, the third Monday of October each year will be set as "World Pain Relief Day." This series of pain-related events fully demonstrates the vital role of pain in the health and life of the masses.

Pain is a subjective and very unpleasant internal feeling and a complex emotional feeling. It is a warning signal sent by the body after being stimulated by some kind of injury, which may come from inside or outside the body. There are many factors that cause pain, and the feeling of pain varies from person to person, but generally speaking, pain is harmful to the human body. Pain needs to be treated in a timely manner and cannot be simply treated symptomatically. Treating the symptoms will not fundamentally solve the pain problem. It must be treated in accordance with scientific, reasonable and standardized principles. The pain diagnosis and treatment procedure first needs to clarify the cause of the pain, and then provide appropriate analgesia on the basis of actively treating the primary disease that causes the pain.

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It is necessary to be cautious when using analgesia in advance for acute pain associated with some emergency diseases before a clear diagnosis is made, because analgesia may affect or mask the progression of the disease and cause clinical misdiagnosis, leading to delayed treatment and even affecting the patient's prognosis.

2. Eliminate misunderstandings about pain

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Guan Gong scraping his bones to treat poison is a well-known historical anecdote about pain. Guan Gong's fearless spirit in the face of pain has been passed down for thousands of years and has always been regarded as a unique image and temperament of a hero. In that era with extremely limited conditions, there was no other way to save lives and cure diseases except to endure, and enduring pain was a helpless act. Influenced by many factors such as history and reality over the years, there is a certain space for the idea that pain is inevitable and normal. Some people, including some professional medical personnel, still have the inherent concept and habitual catchphrase that how can surgery not be painful. The splendid and long history of our country has precipitated a rich cultural heritage. Although the prescription of "Ma Fei San" by the famous doctor Hua Tuo has long been lost, this invention is enough to prove that my country already had mature cognitive thinking and processing capabilities for pain management at that time. With the development of pain medicine and the updating of knowledge, misunderstandings about pain need to be clarified.

Misconception 1: Taking doctors as the main body of pain judgment

The subject of pain should be the patient. Therefore, using the doctor's subjective evaluation to determine whether the patient is in pain and the degree of pain, and using this as a measure of whether the patient needs analgesia, is not in line with pain science and needs to be completely changed. Pain is a subjective feeling. Therefore, whether there is pain or not should be based on the patient's personal feelings and statements. Just as the slogan "eliminating pain is the basic right of patients", every patient has the most say in their own pain. Pain that affects the quality of life should be reasonably and effectively treated, and the right of patients to analgesia must be firmly protected.

Myth 2: Painkillers can be addictive

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When talking about pain, some people first think that the use of analgesics will lead to addiction. The fear of addiction makes them prefer to endure the pain and resolutely refuse to use analgesics. This kind of thinking leads to many misunderstandings about pain treatment, which has become a major obstacle to pain treatment. Although some opioid analgesics used in pain treatment may cause physical or mental dependence after long-term use in large doses, which is what we often call addiction. However, in most cases, under the scientific and reasonable guidance of professional pain physicians, short-term use of appropriate doses of opioid analgesics will not cause addiction. In addition to opioids that may cause addiction, many non-opioid drugs that are not addictive can also be used alone or as an adjuvant according to the condition of the disease, which can also produce good analgesic effects. In addition, a variety of non-drug pain treatment methods also have broad application in the field of pain treatment.

Myth 3: Pain treatment must be completely pain-free

Patients can easily misunderstand the target effect of analgesia. Some people think that analgesia is only effective when the patient is completely pain-free. This is not only unscientific, but is also likely to become one of the root causes of conflicts between doctors and patients during pain treatment.

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Pain is a subjective feeling, so it is difficult to evaluate pain objectively like other quantitative examination and test indicators. However, as part of medical science, pain treatment requires objective evaluation methods and quantitative evaluation indicators. At present, some simple and easy-to-understand descriptive scales are often used in clinical practice to evaluate pain. For example, the widely used visual analog scale (VAS score) quantifies pain into numbers between 0 and 10, where 0 represents no pain at all and 10 represents the most painful. 1 to 3 points for mild pain, 4 to 6 points for moderate pain, and 7 to 10 points for severe pain. The patient uses numbers to describe the pain state he is in. Generally, moderate to severe pain requires the pain score to be controlled below 4 points, which is mild pain.

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Myth 4: Making simple analogies between individuals

Pain has individual characteristics and cannot be simply compared. Some people say that the same pain situation is not painful at all, while others say that it hurts so much that they die. They may even blame others, saying, "Why are you so delicate?" These statements are actually neither scientific nor correct. Everyone's pain threshold is different, and there are different degrees of differences in the acceptance and perception of pain. The human body perceives pain through pain receptors, and there are individual differences in both quantity and sensitivity. The mechanism of pain is extremely complex, and many factors including environment, emotions, and psychology can affect pain. Therefore, there is no absolute analogy between different people, just as most people, except Guan Gong, cannot calmly endure scraping bones to treat poison. Some people are born afraid of pain, which cannot be simply defined as hypocritical. Most people still have a deep fear of pain, especially severe pain, and may even be accompanied by severe physical reactions. Therefore, simple analogies cannot be made mechanically. This also reflects the complexity and individual characteristics of pain treatment.

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3. Scientific and standardized analgesia treatment

The mechanism of pain is very complex and has not been fully studied so far. Many of them are still speculations. The pain discipline still has a long way to go in the future. The treatment of pain must be systematic and standardized. The reception of each patient needs to go through a detailed history collection, careful physical examination, necessary auxiliary examinations, diagnosis, differential diagnosis and multiple steps. While confirming the diagnosis, it is necessary to avoid misdiagnosis. The case reports of patients seeking medical treatment for pain, but the attending doctors did not conduct in-depth examinations and only treated the symptoms, resulting in the loss of the best treatment opportunity for the primary tumor are very distressing. It is suggested that pain diagnosis and treatment cannot be perfunctory. For difficult, complex and rare cases, multidisciplinary experts need to be jointly consulted. Pain not only affects the patient's mood, but also can cause sleep disorders, reduce the body's immunity, lead to increased blood pressure, increased heart rate, and even heart attack. Those who are not cured can develop into chronic pain. The treatment options for pain include simple drug therapy, physical therapy, local drug patch or local injection of analgesics, intervention and nerve block therapy, etc. Rare special pain may also require surgical treatment. Chronic intractable pain requires long-term and multiple courses of treatment.

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In short, pain is a disease and should be treated actively. According to literature reports, the total amount and per capita use of analgesics in my country are still relatively low compared to some developed countries. Due to differences in the understanding of pain, various conditions, differences in the distribution of medical resources and other factors, the stubborn malignant pain of some patients with advanced tumors cannot be treated promptly and effectively. Improving the quality of life, giving patients dignity, popularizing pain science knowledge, eliminating misunderstandings about pain treatment, reducing the occurrence of pain, and providing a safe, reliable, and comfortable pain-free experience requires the joint efforts of the whole society.

References

[1] Ni Jiaxiang, Sun Haiyan, translators. Pain treatment technology[M]. Beijing, Peking University Medical Press, 2011.

[2] Deng Xiaoming, Yao Shanglong. Modern Anesthesiology[M]. Beijing, People's Medical Publishing House, 2014.