Pain Management and Musculoskeletal Conditions
Conditions we treat
Arthritis
A joint condition causing pain, stiffness, and swellin
Arthritis generally refers to inflammatory diseases that occur in human joints and surrounding tissues and are caused by inflammation, infection, degeneration, trauma, or other factors. It can be divided into dozens of types.
The etiology of arthritis is complex, mainly related to factors such as autoimmune reactions, infections, metabolic disorders, trauma, and degenerative diseases. According to the etiology, arthritis can be divided into bony, rheumatoid, tonic, reactive, gouty, rheumatic, purulent, etc.
Classification
Clinical manifestations voice
Most arthritis has a long course, lingering and difficult to heal, and treatment is quite tricky. Therefore, early detection, early diagnosis, and early treatment will help prevent the progression of arthritis and improve the prognosis of patients.
1. Joint pain
Is the most important manifestation of arthritis. Different types of arthritis can show different pain characteristics.
2. Joint swelling
Swelling is a common manifestation of joint inflammation and the result of the progression of inflammation, and it is not necessarily related to the degree of joint pain. Generally proportional to disease.
3. Joint dysfunction
Joint pain and inflammation caused edema of the tissues around the joints, the protective spasm of the surrounding muscles, and the destruction of the joint structure, resulting in limited joint activities. Patients with chronic arthritis may cause permanent loss of joint function due to long-term limitation of joint movement.
4. Signs
Different types of arthritis have different signs, including erythema, deformity, soft tissue swelling, joint swelling, exudation, bony swelling, bone friction, tenderness, muscle atrophy or weakness, limited range of joint motion, and nerve root compression, And other signs.
Treatments:
Traditional Chinese herbal medicine can be used for the internal treatment of this symptom, External treatments include acupuncture and massage.
Acupuncture can not only help with arthritis pain and stiffness, but TCM methods can help keep the joint tissues strong and healthy, reduce inflammation, and prevent further damage due to osteoarthritis.
g, commonly affecting mobility and quality of life.
Back Pain
Most low back pain is caused by muscle contractures, trauma, spinal deformation or caused by systemic diseases
The symptoms are radioactive pain, soreness, squeezing pain, cough pain, and stretching pain in the waist, back, shoulders, and legs, etc., which can affect normal life, damage health, and loss labour capacity.
With the acceleration of the social rhythm, the increase of work pressure, the improvement of people’s living standards and living and working environment, the incidence of low back pain is increasing at an alarming rate, which may be related to factors such as people’s extended working hours at desks, reduced activities, and obesity. Related, it is necessary to increase people’s understanding of low back pain, understand the corresponding treatment plan and health care knowledge, achieve the purpose of prevention, early diagnosis, early treatment, and prevention of recurrence.
Acupuncture and Chinese herbal medicine have long history of treating back pain.
Carpal tunnel syndrome
A condition causing numbness, tingling, and weakness in the hand and arm due to pressure on the median nerve.
Carpal tunnel syndrome is the most common peripheral nerve compression disorder and the most common surgical treatment performed by hand surgeons. There are many non-surgical treatments for carpal tunnel syndrome, including brace immobilization and corticosteroid injections. If the conservative treatment plan does not relieve the patient’s symptoms, surgical treatment should be considered.
Carpal tunnel syndrome is the most common peripheral nerve compression disorder and the most common surgical treatment performed by hand surgeons. The pathological basis of carpal tunnel syndrome is that the median nerve is compressed in the carpal tunnel of the wrist.
The incidence of carpal tunnel syndrome is higher in women than in men, but the cause is not clear. Common symptoms include paresthesia and/or numbness in the area innervated by the median nerve (thumb, index finger, middle finger, and radial half of the ring finger). Numbness of the fingers at night is often the first symptom of carpal tunnel syndrome, and many patients experience numbness of the fingers at night. In many patients, the discomfort of finger numbness can be relieved to a certain extent by changing the posture of the upper limbs or shaking hands.
The diagnosis of carpal tunnel syndrome is mainly based on clinical symptoms and characteristic physical examination results. The diagnosis requires an electrodiagnostic examination. The most important basis for diagnosis is that the patient has typical clinical symptoms, that is, numbness and discomfort in the median nerve distribution area, which worsens at night. In addition to subjective symptoms, objective examinations are also very important. It is clear that decreased or lost finger sensation and large thenar muscle atrophy are manifestations of a serious condition, and therapeutic intervention should be carried out before these manifestations.
Acupuncture treatment combined with herbal supplementation can reduce inflammation and help with the regeneration of nerves and other tissues. According to TCM theory, carpal tunnel syndrome is usually attributed to “wind” or cold invading the muscles and ligaments, along with Qi and/or blood stasis causing blockages
Traditional Chinese herbal medicine can be used for the internal treatment of this symptom, External treatments include acupuncture and massage.
Chronic pain
Persistent pain that lasts for weeks or months, often without an obvious cause, affecting physical and emotional health.
Chronic pain refers to pain that lasts for more than one month (previously three months or six months). Some people also liken chronic pain to undead cancer.
Chronic pain is a major symptom of distant injuries. The pathology of chronic pain diseases is widespread in each of us.
Chronic pain is a symptom that occurs from distant injuries. The occurrence of chronic pain also indicates a decline in the body’s physical fitness or a possible health crisis in other parts. Due to the pain caused by its onset, it can cause sleep disturbance, lack of appetite, mental breakdown, and even personality distortion, and home restlessness. Many patients choose to commit suicide because they cannot tolerate long-term pain. It has a serious impact on the life and quality of life of the elderly.
The main cause of chronic pain is remote injury. Although there are different names in medicine, the pain that occurs in different parts of the body is actually the same disease. The cause is the same, that is, the soft tissue damage that has occurred in a long time. The fixed lesions are clearly visible.
Treatment is to treat the visible lesions. The purpose of the treatment is to remove the lesions. The disappearance of pain and normal movement of the limbs occur naturally on the basis of the elimination of the lesions.
The main treatment method is the rubbing method created by Zhang Yicao. The rubbing method is a combination of traditional multiple-treatment methods and eliminates harm to the body.
For specific operations, rub the affected area with the palm of your hand or finger. Silk, smooth materials, etc. can also be used. During the rubbing process, it is necessary to keep the medicine infiltrated, so that the remote injury is fully revealed, and there should be no changes in the skin where there is no remote injury.
Before the end of the treatment, let the patient move, and observe the patient to see if there is any pain or movement disorder. If there is, follow the patient’s instructions and perform additional rubbing to finally relieve the pain and resume movement quasi.
After the treatment of the same part, the next treatment will be performed one week apart, and multiple parts can be treated daily or every other day in batches. Within 2-3 days after the first treatment, if there is pain and other obvious symptoms, it can be treated at any time without a week limit, because there are still untreated areas in the treated area.
Rubbing to cure is a radical cure, and a radical cure must be the elimination of the lesion. But often when the lesion is not completely eliminated, the symptoms have disappeared. Do not end the treatment because there is no pain. It is best to continue the treatment until the lesion is eliminated so that you can rest assured that there will be no more pain in the future.
Traditional Chinese herbal medicine can be used for the internal treatment of this symptom, External therapies include acupuncture and massage.
Traditional Chinese acupuncture involves the insertion of extremely fine needles into the skin at specific “acupoints.” This may relieve pain by releasing endorphins, the body’s natural pain-killing chemicals, and by affecting the part of the brain that governs serotonin, a brain chemical involved with mood.
Fibromyalgia
Fibromyalgia syndrome is a type of rheumatism, characterized by diffuse muscle pain, often accompanied by a variety of non-specific symptoms; a typical situation is that the patient has tenderness in certain specific parts of the body and does not require a specific laboratory or disease. Physical examination to help diagnosis.
Patients with fibromyalgia syndrome may have a previous history of physical or mental trauma. The most prominent symptom of fibromyalgia syndrome is diffuse pain throughout the body, lasting for more than 3 months, and some other clinical manifestations, including sleep disturbance, physical stiffness, fatigue, and cognitive dysfunction. Fibromyalgia syndrome is difficult to treat and is currently an incurable chronic pain disease.
1. Central nervous system sensitization
Central nervous system sensitization is one of the main causes of fibromyalgia syndrome. Long-term chronic pain can lead to “central sensitization”, which is manifested in the elevation of serotonin (5-HT) and substance P in the cerebrospinal fluid of the patient. In addition, functional MRI technology also shows that the brain is associated with pain in patients with fibromyalgia. Related regional functional activities are enhanced.
2. Immune disorders
Some studies have reported the appearance of anti-thyroid antibodies in the serum of patients, and the levels of interleukin (IL)-1, interleukin-6 (IL-6) and tumor necrosis factor in the serum of some patients are elevated.
3. Infection
Some people think that FS is related to infection, especially Epstein-Barr virus, parvovirus, Burgdorferi spirochetes infection.
4. Heredity
The prevalence of first-degree relatives of fibromyalgia patients has increased significantly, suggesting that genetics play a certain role in pathogenesis.
Treatment
Fibromyalgia syndrome is an idiopathic disease. Its pathophysiology is still unknown. Therefore, treatment is difficult and requires the cooperation of doctors from multiple disciplines. Current treatments are mainly focused on improving sleep status and reducing the sensitivity of pain receptors.
Chinese medicine treatment
Fibromyalgia syndrome belongs to the category of arthralgia of traditional Chinese medicine. Traditional Chinese medicine treatment is implemented to soothe the nerves and nourish the blood. To dredge the tendons and collaterals, invigorate blood circulation to remove blood stasis, promote Qi and relieve pain, so as to relieve the pain and sleep disturbance.
Frozen shoulder
Frozen shoulder is also called periarthritis of the shoulder joint, commonly known as frozen shoulder and fifty shoulders. The shoulder pain gradually developed, especially at night, and gradually aggravated. The movement function of the shoulder joint is restricted and gradually worsened. After reaching a certain level, it gradually relieves until the final recovery is the main manifestation of the shoulder joint capsule and its surrounding ligaments, tendons, and tendons. Chronic specific inflammation of the bursa. Frozen shoulder is a common disease with shoulder joint pain and inconvenience as the main symptoms.
Cause
1. Shoulder cause
(1) This disease mostly occurs in middle-aged and elderly people over 40 years old, with degenerative soft tissues and a weakened ability to withstand various external forces;
(2) Chronic injury caused by long-term excessive activity and poor posture;
(3) After upper limb trauma, the shoulder is fixed for too long, and the tissue around the shoulder is atrophy and adhesion secondary;
(4) Inappropriate treatment after acute contusion and traction of the shoulder.
2. External factors
Cervical spondylosis, heart, lung, and biliary tract diseases caused by shoulder pain, caused by persistent spasms and ischemia of the shoulder muscles due to the long-term unhealed primary disease, the inflammatory lesions formed, which turned into a true frozen shoulder.
Treatment
At present, conservative treatment is mainly used for frozen shoulders. Oral anti-inflammatory and analgesics, physical therapy, partial closure of pain points, massage and massage, self-massage and other comprehensive therapies. Perform joint function exercises at the same time, including active and passive abduction, rotation, extension and flexion, and circular movement. When the shoulder pain is significantly reduced and the joints are still stiff, it can be loosened under general anaesthesia to restore the range of joint motion.
The steps and methods of self-massage are:
1. Use the thumb or palm of the contralateral side to rub the front and outside of the affected side’s shoulder joint from top to bottom for 1 to 2 minutes. You can use your thumb to tap for a while at the local pain point.
2. Use the second to fourth fingers of the uninhibited hand to press and rub each part of the back of the shoulder joint for 1 to 2 minutes. If there is a local pain point during the rubbing process, you can also use your finger to click for a while.
3. Knead the upper arm muscles of the upper limb on the affected side with the joint action of the thumb and the rest of the fingers on the contralateral side, from bottom to top to the shoulder, for 1 to 2 minutes.
4. In the case of suffering from shoulder abduction and other functional positions, use the above-mentioned method to massage, and massage in all directions of the shoulder joint.
5. Finally, knead the palm from top to bottom with the palm for 1 to 2 minutes. For the part that cannot be massaged at the back of the shoulder, the patting method can be used for treatment.
General well-being
A holistic concept encompassing physical comfort, mental resilience, and emotional balance, promoting an overall state of health. General well-being refers to effective measures taken to maintain and improve people’s physical and mental health. Including the prevention of various mental illnesses caused by work, life, environment, etc., or various physical diseases caused by mental factors. Although it can’t directly improve the individual’s mental health, it can prevent the occurrence of unhealthy mentality and behavior of the individual.
Traditional method
Health care has a long history in China. As early as the Spring and Autumn Period and Warring States Period, the classic Chinese medicine “Huang Di Nei Jing” comprehensively summarized the pre-Qin period’s health preservation experience, and clearly pointed out that “the saint does not cure the disease before he cures the disease; No chaos… The husband’s disease has become a disease and then the medicine, the chaos has become the medicine, and the chaos has become the cure. It’s not too late if you are thirsty and go through the well, fighting and casting a cone!” The concept of health preservation is the development of traditional Chinese preventive medicine and health preservation. Foundation. For thousands of years, the traditional Chinese medicine experts and health care experts of the past generations have continuously accumulated and summarized the health care experience that has been passed down to the people, and have written a large number of health care monographs, which has promoted the development of traditional Chinese health care. There are many schools of traditional health-preserving in China. Generally speaking, they are mainly divided into six schools: spirit, movement, solid essence, qi regulation, food nutrition, and bait. The health doctrine of each school has its own system, each has its own strengths, and eclectic all aspects, forming a unique health-preserving and health-care method in China.
Many health-preserving concepts in Chinese medicine are similar to modern life sciences. Many traditional health-preserving methods, such as massage, cupping, diet therapy, acupuncture, Wu Qin Xi, Tai Chi, calligraphy and painting, Qigong (inducing qi, abdominal breathing), etc., Except for acupuncture and moxibustion, anyone can do it personally. Frequently using these convenient methods has special effects on health preservation, physical fitness, and disease prevention.
Headache
Headache is a kind of dull pain, mostly continuous total headache. Headache is often accompanied by swelling, or dizziness and a heavy head. If it is painful or heavy pressure in the temples, it may be due to brain fatigue. Various intracranial, extracranial and systemic diseases can cause headaches.
Cause
(1) Physical and chemical factors
Intracranial hyperalgesic structures are affected by inflammation, injury, or compression, traction, extension, displacement and other factors that cause head swelling and pain.
Blood vessels are compressed, pulled, stretched or displaced
Commonly seen in the following diseases:
(1) Intracranial space-occupying lesions: such as tumors, abscesses, hematomas, etc., which cause the blood vessels to be compressed, traction, stretched or displaced.
(2) Increased intracranial pressure: such as hydrocephalus, cerebral edema, venous sinus thrombosis, brain tumor or cerebral cysticercosis compression and blockage.
(3) Intracranial hypotension: such as a lumbar puncture or spinal anesthesia, or after surgery or trauma, more cerebrospinal fluid is lost, resulting in intracranial hypotension.
Dilation of intracranial and external arteries
Such as acute intracranial and extracranial infections, pathogen toxins can cause arterial dilation; metabolic diseases such as hypoglycemia, hypercapnia and hypoxia; toxic diseases such as carbon monoxide poisoning, alcoholism, etc.; brain trauma, epilepsy, hypertension Emergency (pheochromocytoma, acute nephritis, etc.).
The meninges are chemically stimulated
(1) Bacterial meningitis: such as meningococcus, pneumococcus, streptococcus, staphylococcus, Escherichia coli, Pseudomonas aeruginosa, Campylobacter, Neisseria gonorrhoeae, Aerobacter, Pneumoniae, Mycobacterium tuberculosis, Brucella Bacillus, etc.
(2) Viral meningitis: such as enterovirus, herpes virus, arbovirus, mumps virus.
(3) Infectious meningitis of other organisms: such as Cryptococcus, Leptospira, Rickettsia, Toxoplasmosis, Amoeba, Cysticercosis, Schistosomiasis, etc.
(4) Bloody cerebrospinal fluid: such as subarachnoid hemorrhage, lumbar puncture accidentally injured blood vessels and brain trauma, etc. cause hard and soft meningitis and inflammation of the arachnoid.
(5) Cancerous meningitis: such as meningeal metastasis of cancer, meningeal infiltration of leukemia and lymphoma.
(6) Reactive meningitis: such as secondary to systemic infections, poisoning, and ear and nose infections.
(7) Intraventricular or intrathecal injection of drugs or contrast agents: whether water depth or non-water depth is used as a chemical factor, animal experiments have confirmed that they all cause meningitis.
Long-lasting contraction of head and neck muscles
Such as the continuous contraction of the head and neck muscles, neck diseases caused by reflex cervical muscle tension, such as cervical spine joint disease, neck trauma or disc disease and so on.
Compression or inflammation of cranial nerves, cervical nerves and ganglia
Common trigeminal neuritis, occipital neuritis, tumor compression and so on.
Diseases of eyes, ears, nose, paranasal sinuses, teeth, etc.
Radiation pain can be diffused or reflected on the head and face.
Endocrine factors
It is common in women that the first onset of a migraine is usually in adolescence, with a tendency to occur during menstruation, ease during pregnancy, and stop menopause. Tension headaches are often aggravated during menstruation and menopause
Mental factors
It is common in neurasthenia, hysteria or depression.
Massage
1. Ear work
Massage the ear helix on both sides 18 times with both hands, then cover the ear canal with both hands on the thenar, place the fingers on the back of the head, press the middle finger with the index finger and slide down and flick the back of the head 24 times, you can hear the sound of a bang.
2. Push Yintang
Use your thumb to push from the bottom up to the forehead, gradually from mild to moderate, until local flushing.
3. Rub your temples
The temple is located between the eyebrows and the outer corner of the eye, one inch backward in the lacuna, rub it with your thumb or index finger, first light and then heavier, and push it from the temple to the Fengchi acupoint (in the 1.5-inch depression behind the mastoid), and then take the wind The number of Chi points, Jianjing points (the middle of the seventh cervical spinous process and the acromion) 18 times.
4. Rub the forehead
Curl your index finger and stroke the forehead with the inner side 30 times, from the middle of the forehead to the temples; rub the temples with the middle finger 30 times; do dry-cleaning movements with the palm of the hand 10 times.
5. Prunella chrysanthemum pillow
Prunella vulgaris and chrysanthemum in equal parts, put in a pillow, sleep at night, can cure a variety of unhealed headaches.
Others
In addition to massage, pay attention to a reasonable diet, ensure sleep, and regular exercise play a very important role in preventing head pain.
Indeterminate aches and pains
Persistent, unexplained discomfort in various body areas, often affecting daily activities and quality of life. Sometimes the pain is a clear indication of diseases such as rheumatoid arthritis or osteoarthritis. Other times, pain is not fully classified as a clearly described diagnosis. In this case, the pain may be due to the disease after the virus infection, or the cause of the pain may be unknown. Pain is not limited to a few localized areas of the body, but may also be more extensive throughout the body. Pain may be long-term, and it may come and go. Regardless of the diagnosis, drug treatment usually involves powerful anti-inflammatory drugs, which require higher and higher doses over time, but the relief effect is getting worse. Once the medication is stopped, the pain often recovers completely.
Knee pain
Knee joint pain is one of the common clinical symptoms, often accompanied by knee joint swelling and limited extension and flexion. Common causes include knee osteoarthritis or degeneration, rheumatoid arthritis, gouty arthritis, trauma, tumors, congenital deformities, etc. The above problems can damage the joint structure and cause knee pain.
Treatment
Different methods are adopted to treat knee joint pain caused by different causes.
Knee joint pain caused by overwork does not require special treatment, and rest can relieve itself; traumatic knee joint pain is mainly given by immobilization and then appropriate functional exercise; gouty knee arthritis is mainly treated by medicine.
Types of Acute knee pain
If your ligaments are torn, or your bones are dislocated or broken, acute knee pain often occurs. If you have a fracture, you may suddenly swell, be painful, and be unable to put any weight on your limbs. If you are dislocated, your knee may become deformed and swollen, and you will feel extreme pain. A torn ligament can cause joint instability. If the knee locks in place, the meniscus may be injured. Sudden swelling, pain, and redness without obvious damage may be infection or gout. All these conditions require immediate medical attention, because if left untreated, it may cause knee disability.
Chronic knee pain
This type of knee pain is usually related to degenerative diseases, such as osteoarthritis or rheumatoid arthritis. The first thing to do in the morning is to cause pain during exercise.
Signs and symptoms
The type of symptoms you experience will vary, depending on the cause of your knee pain. It may include:
Unable to bear the weight of the affected limb; Stiffness and swelling; Redness, pain, and heat in the area; Deformed or abnormal appearance; Creaking, rubbing, or cracking; Unable to straighten the leg;Inability to bend the knee, or lock the knee, and Numbness, tingling, and discoloration of the skin.
Musculoskeletal Conditions
Musculoskeletal disorders (MSDs) refer to conditions that include nerves, tendons, muscles, and bones that support the structure of the body. For example, carpal tunnels, tendinitis, chest outlet syndrome, neck tension syndrome, tennis elbow, back pain, etc. are all examples of musculoskeletal disorders. Frequent, repetitive behaviors and incorrect postures can all lead to MSDs. The types of symptoms vary depending on the location, such as regional musculoskeletal disorders (R-MSD), repetitive cumulative damage (CTD), and repeated administration Strain Injury (RSI). All these terms refer to different types of soft tissue disorders.
Risk factors
The awkward posture-incorrect posture of the neck, shoulders, wrists, elbows, back and legs, static posture-long-term sitting in the same position and repetitive work-continuous typing, moving the mouse, organizing documents or writing, affected by Force-hitting the keyboard, holding the mouse tightly, contact pressure-contacting the surface of the wrist can cause pain in the wrist joint.
Signs of symptoms
Numbness or burning in the hands
Reduced grip
Swollen or stiff joints
Pain or discomfort in the wrist, forearm, elbow, neck, or back
Obstruction of shoulder, neck, or back behavior
Dry, itchy or sore eyes
Examples of symptoms
Tendinitis-Inflammation of the tendon
Golf elbow-pain inside the elbow
Shoulder Pain-Injury to the soft tissues of the shoulder
Thoracic outlet syndrome-neuralgia that passes through the neck to the arms or underarms
Wrist complications-weakness or pain in the hands including the pinky and ring fingers
Tennis elbow-pain on the outside of the elbow
Prevention method
1. Maintain the correct posture of the neck, shoulders, elbows, wrists, back and legs in front of the computer
2. Regularly stretch and relax, and ensure at least a short rest every hour to prevent the occurrence of RSIs
3. Keep the mouse and keyboard on the same level
4. Avoid holding the mouse tightly and using excessive force
5. Use appropriate ergonomics methods, do not put your wrist on the edge of the table when using the mouse or typing, put it on the wrist pad or armrest
6. Sit upright. Make sure the chair can stand to support your spine.
7. Regular cardiovascular exercise
8. Always maintain a good posture
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Neck pain
The neck muscles and ligaments are the sources of our soreness. Incorrect posture and insufficient muscle and ligament strength for a long time require us to change postures frequently. When the nerves are pressed, it is easy to cause discomfort, and incorrect postures are more likely to cause bone spurs. And our muscle tissue cannot withstand long-term pressure and grind.
The reason
Poor posture: It is the most common cause of cervical spondylosis, such as lying in bed, watching TV, reading a book, sleeping on a high pillow, sitting in a sleeping position, etc.; sleeping in a lying car, poor muscle protection when sleeping, and neck injuries when braking.
Chronic infection: mainly pharyngitis, followed by dental caries, periodontitis, otitis media, etc.
Wind, cold and dampness factors: The wind, cold and dampness factors in the external environment can reduce the body’s tolerance to pain, causing muscle spasm, contraction of small blood vessels, slowing of lymphatic drainage, impaired blood circulation in soft tissues, and subsequent aseptic inflammation. This is also a common cause of cervical spondylosis.
Dysplasia of the cervical spine structure: congenital small spinal canal, cervical degeneration, etc. are common causes of cervical spondylosis.
Strain: If you keep your head and neck in a single posture for a long time, such as working with your head down for a long time, cervical spondylosis is prone to occur.
Head and neck trauma: 50% of the causes of cervical spondylosis are related to neck trauma. In some patients, the cervical spinal canal is in a critical state of stenosis due to cervical spine hyperostosis, cervical disc bulging, and soft tissue lesions in the spinal canal. Neck trauma often induces symptoms.
Treatment
Symptoms of cervical spondylosis have appeared, and it is even more urgent to eliminate cervical pain and discomfort. Generally speaking, hot compresses are very effective for relieving cervical pain and discomfort. In addition, correct massage and targeted drugs can have a good effect when neck and shoulder pain is aggravated or movement is restricted. “It is important to remind that the cervical spine should not be massaged at will, and you should go to a regular hospital for a specialist. Under the guidance of the doctor, otherwise, he may become hemiplegic.”
Mitigation method
One is not to keep the head and neck in a single posture for a long time, such as working with your head down for a long time, surfing the Internet, playing mobile phones, and scanning WeChat, etc. This will cause strain on the neck muscles.
The second is to get rid of those bad sitting postures in life, such as lying in bed, watching TV, reading a book, sleeping on a high pillow, etc.
The third is to keep the neck warm. Because wind, cold, and damp factors can reduce the body’s tolerance to pain, it can cause muscle spasms, contraction of small blood vessels, slowed lymphatic drainage, and blood circulation disorders in soft tissues, followed by aseptic inflammation, leading to cervical spondylosis.
The fourth is to strengthen the exercise of the neck and back muscles. Dumbbell exercises can exercise upper body shoulder straps and back muscles; gnash the teeth to exercise the front muscles of the neck; brisk walking or swimming can exercise the muscles of the whole body, but be careful to keep the water temperature above 26℃ during swimming. Cold irritation.
Neuropathic pain
Neuropathic Pain is directly caused by damage to the somatosensory system or disease. The disease can be caused by injury to peripheral nerves, posterior roots of the spinal cord, spinal cord and above central nerves caused by trauma and/or disease.
Causes and common diseases:
Age, gender, the intensity of pain, emotional and cognitive abilities, etc. indicate that the formation of chronic pain is the result of a combination of multiple factors, not simply caused by neurological damage.
Differential diagnosis:
1. Greater occipital neuralgia:
Refers to paroxysmal or persistent pain within the distribution range of the greater occipital nerve (posterior occipital region), which can also be exacerbated on the basis of persistent pain. The clinical manifestations are acupuncture-like, knife-cutting or burning-like pain on one or both sides of the posterior occiput or both sides. The patient does not dare to turn his head when it is painful, and the head and neck are sometimes in a straightened state. On physical examination, there is tenderness at the exit of the greater nerve, and the distribution area of the greater occipital nerve (C2-3) from the top of the ear to the hairline hyperalgesia or hypoalgesia.
2. Sciatica:
Refers to sciatic neuropathy, a group of pain symptoms that occur along the sciatic nerve pathway, namely the waist, buttocks, back of the thigh, posterior and lateral calf, and lateral foot. The sciatic nerve is the main nerve trunk that innervates the lower limbs. Sciatica refers to pain in the sciatic nerve pathway and its distribution area (buttocks, back of the thigh, back of the calf, and outside of the foot).
3. Intercostal neuralgia:
Refers to the frequent pain that occurs in one or several intercostal areas, with episodic aggravation. Primary intercostal neuralgia is rare, and secondary ones are mostly related to viral infection, toxin stimulation, mechanical damage and foreign body compression. The pain is mostly tingling or burning, and it is distributed along the intercostal nerves. When intercostal neuralgia occurs, the pain is seen from back to front, radiating in a semicircular shape along with the corresponding intercostal space; the pain is tingling or burning. Pain worsens when coughing, deep breathing, or sneezing. The pain is mostly on one nerve on one side.
Physical examination:
The standard examination of patients with neuropathic pain should include the following aspects: touch, acupuncture, compression, cold stimulation, thermal stimulation, tremor and “total”. Responses to these stimuli are classified as normal, decreased or increased pain sensation. Stimulus-induced (positive) pain is divided into hyperalgesia and pain paresthesia and is classified according to whether the stimulus is dynamic or static. The tactile sensation can be assessed by gently stimulating the skin with cotton, acupuncture sensation can be assessed by stimulating the skin with sharp needles, deep pain sensation can be assessed by gently pressing muscles and joints, and cold and hot sensations can be assessed by measuring the response to warm stimulation. The response of the tuning fork is evaluated for tremor.
Treatment principles:
(1) Medicine treatment:
The choice of medication for neuropathic pain should be based on the basic pathogenesis of each patient.
(2) Neuromodulation:
The neuromodulation method of stimulating the spinal cord or cerebral motor cortex by placing electrodes in the epidural space or cerebral cortex has gradually been widely used to treat intractable central and peripheral neuropathic pain. The principle of this method is to appropriately stimulate the target nerve that can produce pain through electrodes, thereby producing a numb sensation to cover the painful area, so as to achieve the purpose of pain relief. Clinical indications: neuropathic pain (such as back surgery syndrome, radiculopathy, chronic regional pain syndrome and peripheral nerve injury), ischemic pain (such as peripheral vascular disease and angina), seizures, Parkinson’s syndrome-related movement disorders (such as tremor, paralysis, rigidity, and movement disorders) and other dysfunctions. The main methods of neuromodulation are spinal cord stimulation (SCS) and cerebral motor cortex stimulation (MCS).
Osteoarthritis
Degenerative osteoarthritis, also known as osteoarthritis, degenerative arthritis, senile arthritis, and hypertrophic arthritis, is a degenerative disease caused by age, obesity, strain, trauma, joint congenital abnormalities, joints Degeneration and damage of articular cartilage, joint edges and subchondral bone reactive hyperplasia caused by many factors such as deformity.
This disease is more common in middle-aged and elderly people, and it is more common in weight-bearing joints and joints with a lot of activity (such as the cervical spine, lumbar spine, knee joint, hip joint, etc.). Excessive weight-bearing or use of these joints can promote the occurrence of degenerative changes. The clinical manifestations are slow development of joint pain, tenderness, stiffness, joint swelling, restricted mobility and joint deformities.
Cause
The etiology is not yet clear and may be related to factors such as advanced age, female, obesity, and occupational overuse.
Clinical manifestations
The main symptom is joint pain, often rest pain, which manifests as pain after rest, which is relieved after a short period of activity, but after too much activity, the pain increases. Another symptom is joint stiffness, which often occurs when you get up in the morning or after the joints stay in a certain position for a long time during the day. Examination of the affected joints reveals joint swelling, tenderness, friction or “clicking” sounds during activities. In severe cases, muscle atrophy and joint deformities may occur.
Check
1. Imaging examination
â‘ X-ray films showed unequal width or narrowing of the joint space, osteoporosis at the joint, bone hyperplasia or joint enlargement, and even joint deformation, hardening of the subchondral bone plate and osteophyte formation. â‘¡CT can clearly show different degrees of joint bone hyperplasia, intra-articular calcification and free body, and sometimes meniscus can also be shown.
2. Laboratory inspection
There were no abnormal changes in the blood cell sedimentation rate and blood picture, and the heat agglutination test was positive. The synovial fluid is often clear, yellowish and highly viscous. The white blood cell count is often within 1.0×109/L, mainly monocytes. The mucin clot is firm.
Diagnosis
According to the relevant medical history, clinical manifestations and X-ray findings, the diagnosis of this disease is not difficult. If necessary, joint synovial fluid can be checked.
Treatment
The main treatment for this disease is to reduce the weight-bearing of the joints and excessive and large-scale activities to delay the progress of the disease. Obese patients should lose weight and reduce the load on joints. Crutches or walking sticks can be used when the joints of the lower limbs are diseased to reduce the burden on the joints. Physical therapy and proper exercise can maintain the range of motion of the joints. Splints and canes can be used when necessary to help control the acute symptoms. Anti-inflammatory and analgesic drugs can reduce or control symptoms, but they should be used with caution after assessing the patient’s risk factors and should not be taken for a long time. Cartilage protective agents such as glucosamine sulfate have the effects of relieving symptoms and improving functions, and long-term use can delay the structural progression of the disease. For advanced cases, under the condition that the whole body can tolerate the operation, artificial joint replacement is currently recognized as an effective method to eliminate pain, correct deformity, and improve function, which can greatly improve the quality of life of patients.
Post-operative pain
Discomfort following surgery, varying in intensity and requiring management for effective recovery.
Pain after surgery is a kind of acute pain. It is mainly caused by acute trauma (incision) and/or internal organ damage and stimulation and drainage caused by the surgery itself. The general peak period is surgery. After 24 to 48 hours.
Cause
The pain after surgery is closely related to the size of the surgical trauma, the intensity of the invasion of internal organs and the length of the operation time, as well as the mental state of the patient.
Clinical manifestations
1. symptom
The patient complained of pain, manifested as pain at the incision or deep pain.
(1) Pain at incision wound: This type of pain is caused by skin sensation, and the pain is relatively superficial. When the patient is resting, the pain is dull; when the patient takes a deep breath, coughs or turns over, the incision is traction, which can cause intense pain, mostly sharp pain. If there is a subcutaneous hematoma, incision inflammation, and ischemia, the pain will aggravate.
(2) Deep pain: This type of pain is mostly caused by the pulling and tearing of the internal organs in the operation, and the pain is deep. Poor drainage after thoracotomy can cause pleural effusion or hemorrhage, and gas storage in the stomach and intestines after laparotomy can aggravate the pain.
2. Mental state
Patients often produce various emotional abnormalities due to painful stimulation, such as depression, anxiety, irritability, and abnormal sleep.
3. Pain assessment
Clinically, a variety of scoring methods are used to evaluate the degree of pain, such as the oral depiction scoring method, digital scoring method, visual analog scoring method, McGill pain questionnaire, etc. According to the World Health Organization standards and the clinical manifestations of patients after surgery, some people divide the pain degree into the following four levels:
Grade 0 (no pain): The incision is painless when the patient coughs.
Grade 1 (mild): mild tolerable pain, can live a normal life, sleep is not disturbed; feel a slight pain in the incision when coughing, but can still cough effectively.
Grade 2 (medium): moderate persistent pain, disturbed sleep, analgesics are needed; the patient is afraid of coughing, afraid of minor vibrations, and the incision is moderately painful.
Grade 3 (heavy): Intense and continuous severe pain, sleep is severely disturbed, analgesics are needed to relieve the pain.
Pain after surgery is mostly the subjective feeling of the patient, and related examinations are greatly affected by the patient’s
psychology and tolerance.
1. Laboratory examination
It can be seen that the secretion of various hormones such as catecholamines, angiotensin II, aldosterone and adrenal cortex hormones have increased.
2. Pulmonary function tests
The measurement of maximum ventilation and forced expiration in the first second has a certain effect on the evaluation of pain after chest and upper abdominal surgery.
Diagnosis
Diagnose according to the nature and location of the pain, the time when the pain appears, and the patient’s emotional performance. Need to rule out the pain caused by other organic diseases.
Treatment
The treatment methods for postoperative pain are mainly the general application of narcotic analgesics and local nerve block. General anesthetic analgesics are mainly opioid analgesics, and they are administered in various ways, such as oral, intramuscular injection, and intravenous injection. With the application of patient-controlled analgesia (PCA) technology, both general anesthetic analgesics and local nerve block can be administered by PCA technology, allowing patients to inject a predetermined dose of drugs into the body through a micro pump when they feel pain. Following the principle of “analgesia on demand”, a satisfactory analgesic effect can be obtained with the smallest dose.
Rheumatoid arthritis
An autoimmune disorder causing painful inflammation in the joints, leading to swelling, stiffness, and potential joint damage.
Rheumatoid arthritis (RA) is a chronic, systemic disease with inflammatory synovitis of unknown etiology. It is characterized by multiple joints, symmetry, and aggressive joint inflammation of the hand and foot facet joints, often accompanied by involvement of extra-articular organs and positive serum rheumatoid factor, which can lead to joint deformities and loss of function.
Cause
The onset of RA may be related to heredity, infection, sex hormones and so on. The pathology of RA arthritis mainly includes a proliferation of synovial lining cells, infiltration of a large number of inflammatory cells in the interstitium, and the formation of microvessels, the formation of pannus, and the destruction of cartilage and bone tissue.
Clinical manifestations
1. prone People
Women are more common, and the incidence rate is 2 to 3 times that of men. It can occur at any age, with a high incidence of 40 to 60 years old.
2. Symptoms and signs
It may be accompanied by systemic symptoms such as weight loss, low fever, and fatigue.
(1) Morning stiffness The subjective feeling of inflexible joint movement when getting up in the morning is a non-specific manifestation of joint inflammation, and its duration is directly proportional to the severity of inflammation.
(2) The manifestations of joint involvement â‘ Polyarticular involvement presents symmetric polyarthritis (often ≥5 joints). The susceptible joints include the hands, feet, wrists, ankles, and temporomandibular joints. Others may include elbows, shoulders, cervical spine, hips, and knees. â‘¡Joint deformity The deformities of the hand include fusiform swelling, ulnar deviation, swan neck deformity, button pattern deformity and so on. Foot deformities include supine toe deformity, valgus deformity, metatarsophalangeal joint subluxation, curved hammer toe, and foot valgus deformity caused by the downward subluxation of the metatarsal head. â‘¢Other carpal tunnel/tarsal tunnel syndrome caused by the compression of the median nerve/posterior tibial nerve, the knee joint cavity squeezes into the back of the joint to form a popliteal cyst (Baker’s cyst), cervical spine involvement (the second and third cervical vertebrae are more See) There may be neck pain, neck weakness and difficulty in maintaining its normal position, atlantoaxial subluxation, and corresponding manifestations of spinal cord compression and insufficient blood supply to the vertebrobasilar artery.
(3) Extra-articular manifestations ①General manifestations may include fever and rheumatoid nodules (organized granulomas, which are related to high titer RF, severe joint destruction and RA activities, and are more common in elbows and joint olecranon processes, Sacrum and other joint carina and frequent compression), rheumatoid vasculitis (necrotizing arteritis that mainly involves small arteries, which can be manifested as finger and toe necrosis, skin ulcers, peripheral neuropathy, etc.) and lymph nodes Swelling. ②Heart involvement can have pericarditis, pericardial effusion, epicardium, myocardial and valve nodules, myocarditis, coronary arteritis, aortitis, conduction disorders, chronic endocarditis, and heart valve fibrosis. ③Respiratory system involvement may include pleurisy, pleural effusion, pulmonary arteritis, interstitial lung disease, and nodular lung disease. ④The renal manifestations mainly include primary glomerular and tubulointerstitial nephritis, renal amyloidosis, and renal damage secondary to drug therapy (gold preparations, penicillamine and NSAIDs). ⑤ In addition to the symptoms of peripheral nerve compression, the nervous system can also induce neurological diseases, myelopathy, peripheral neuropathy, ischemic neuropathy secondary to vasculitis, muscle hypertrophy, and neurological diseases caused by drugs. ⑥Anemia is the most common extra-articular manifestation of RA. It is anemia of chronic disease, often mild to moderate. ⑦The digestive system can be caused by RA vasculitis, complications or drug treatment. ⑧Uveitis may occur in young patients and scleritis in adults, which may be caused by vasculitis. There may also be sicca conjunctival keratitis, scleral softening, scleral softening and perforation, and corneal dissolution.
(4) 1% of RA patients with Felty syndrome may have splenomegaly, neutropenia (and thrombocytopenia, decreased red blood cell count), and often have severe joint disease, high titer of RF and ANA positive, belonging to one type Severe RA.
(5) Relieving seronegative, symmetrical synovitis with pitting edema syndrome (RS3PE) is more common in men, often onset after 55 years of age, with acute onset, with symmetrical wrist joints, flexor tendon sheaths and small hand joints Inflammation, there may be pitting edema on the back of the hand. Morning stiffness lasts for a long time (0.5 to 1 day), but RF is negative, and X-rays usually have no bone destruction. 56% of patients are HLA-B7 positive. Therapeutic response to NSAIDs alone is poor, while low-dose glucocorticoids have a significant effect. It usually resolves spontaneously after 1 year, and the prognosis is good.
(6) Adult Still disease (AOSD) is a rare type of RA in which acute onset and relief of high fever, arthritis, rash, etc. alternate. It is named for its clinical manifestations similar to systemic-onset juvenile rheumatoid arthritis (Still disease). Some patients turn into typical RA after several episodes.
(7) Senile-onset RA often begins at the age of 65, with small gender differences, mostly acute onset, and rapid development (part of the initial manifestation is OA, and typical RA manifestations appear after a few years). The prominent manifestations are hand and foot edema, carpal tunnel and tarsal tunnel syndrome, and polymyalgia. Morning stiffness is obvious, 60% to 70% RF is positive, but the titer is mostly low. X-rays are mainly osteoporosis, with few invasive changes.
Sciatica
Pain radiating along the sciatic nerve, often caused by compression, resulting in sharp or burning sensations down the leg.
Sciatica is a syndrome mainly caused by the sciatic nerve pathway and distribution area pain. Most cases of sciatica are secondary to sciatic nerve stimulation and compression and damage to the sciatic nerve and surrounding structures, called secondary sciatica;
Clinical manifestations
1. General symptoms
(1) The pain is mainly limited to the distribution area of the sciatic nerve, the back of the thigh, the posterior side of the calf and the foot. Patients with severe pain can assume a unique posture; waist flexion, knee flexion, and toe landing If the lesion is located in the nerve root, the pain will increase when the pressure in the spinal canal increases (coughing, exertion).
(2) The degree of muscle weakness can vary greatly depending on the cause, location of the disease, and degree of damage. There may be all or part of the sciatic nerve innervating muscles weak or paralyzed.
(3) With or without tenderness of the sciatic nerve trunk at the sciatic notch.
(4) There is sciatic nerve traction sign, Lasege sign and its allelic signs are positive, the existence of this sign is often parallel to the severity of pain. Local anesthesia of the sciatic nerve root or nerve trunk can disappear.
(5) The Achilles tendon reflex decreases or disappears, and the knee reflex may increase due to stimulation.
(6) There may be a decrease or disappearance of various sensations in the area innervated by the sciatic nerve, including a decrease in vibration sensation in the lateral malleolus, and there may also be very mild sensory disturbances.
2. Sciatic neuritis
Often accompanied by various types of infections and systemic diseases, such as upper respiratory tract infections. Because the sciatic nerve is relatively superficial, sciatic neuritis is prone to occur when damp or cold. When sciatic neuritis occurs in systemic diseases, attention should be paid to whether there are complications such as collagen disease and diabetes.
Sciatica is mostly unilateral, without lumbar and back pain. The pain is generally persistent or episodic. Symptoms aggravate when the pressure of the spinal canal increases, and it can also radiate along the path of the sciatic nerve. Sciatic nerve trunk tenderness is obvious, gastrocnemius tenderness exists; pain and muscle weakness are not parallel, generally, pain is heavier, and muscle weakness is not obvious, because it is difficult to judge motor function due to pain in the acute stage, foot drop, gastrocnemius, tibialis anterior muscle can be detected Atrophy; the Achilles tendon reflex is reduced or disappeared, but the Achilles tendon reflex can also be normal, the knee reflex is normal, and the superficial sensory disturbance is obvious.
3. Secondary sciatica
(1) Lumbar intervertebral disc herniation is the most common cause of sciatica. It mostly occurs in lumbar 4～5 and lumbar 5～sacral 1. About 1/3 of the cases have a history of acute lumbar trauma. Most patients are between 20 and 40 years old. It is characterized by low back pain for several weeks and months, and sciatica of the lower extremity. In addition to the general symptoms of sciatica, the physical examination also has tight back muscles, restricted lumbar movement, scoliosis, and tenderness of the spinous process at the lesion.
(2) Lumbar osteoarthropathy is more common in people over 40 years of age, subacute and chronic onset, often with a history of long-term low back pain, difficulty in standing for a long time. It can be clinically manifested on one or both sides Symptoms of sciatica and waist.
(3) Congenital malformations of the lumbosacral spine. Lumbar sacralization, sacral lumbar sacralization, and recessive spina bifida. In addition to sciatica, the latter often has a history of enuresis, physical examination often has foot deformities, and lumbosacral skin abnormalities, such as The small depression behind the anus and the small hemangioma on the midline of the sacrum often objectively and accurately indicate the unhealed part of the lamina.
(4) Sacroiliac arthritis is common rheumatoid and tuberculosis. When the joint capsule is exuded and destroyed, it stimulates the 4 to 5 nerve trunks of the waist. Some patients may have symptoms of sciatica.
Sports Injuries
Physical injuries sustained during athletic activities, often requiring targeted treatment to aid recovery and restore performance.
Sport injuries can affect almost any part of the body, including the muscles, bones, joints and connective tissues (tendons and ligaments).
Sprains and strains are the most common type of sports injury. The difference between a strain and a sprain is that a:
– sprain happens when one or more of the ligaments are stretched, twisted or torn
– muscle strain (“pulling a muscle”) happens when muscle tissues or fibres are stretched or torn.
Symptoms of a sprain or strain can include pain, swelling, bruising and tenderness around a joint or in a muscle. You may also find it difficult to move the affected body part.
Sprain of the soft tissues of the limbs refers to the sprain of the muscles, tendons and ligaments around the shoulders, elbows, hip joints, knees and ankles due to twisting or pulling without fracture…… they pertain to the category of “impairment of tendons”(Shang Jin 伤ç‹) in Chinese Medicine.
Acupuncture: local points (Ashi points), ear points
Tuina Chinese Medical Massage
Tennis elbow
Pain around the outside of the elbow, typically due to overuse of arm muscles, impacting strength and daily activities.
The tennis elbow is characterised by pain and tenderness over the lateral epicondyle of the humerus. It is the most common condition in people aged between 40 and 50 years. Tennis elbow is also considered an overload injury, and it typically happens after minor trauma of the extensor muscles of the forearm. Primarily, it is a type of tendonitis though the muscles and bones of the epicondyle joint can probably also be involved. And, pain can appear on the inner side of the elbow. Although it is generally self-limiting, the symptoms of tennis elbow can persist for 1.5 to 2 years or even longer in a minority of people.
Generally, acupuncture can stimulate the nervous system and cause the release of neurochemical messenger molecules. The result of biochemical changes can also influence the body’s homeostatic mechanisms. Therefore, it can help physical and emotional well-being. In addition, certain acupuncture points would be able to stimulate areas of the brain that help to reduce the sensitivity to pain and stress. Finally, it can promote relaxation and deactivate the brain that is responsible for anxiety.