When the medical staff to Mr. Li opened the electrode's working mode, the usual continuous electric shock pain in the arm was covered by a crispy electric current, Mr. Li instantly relieved, feel much more comfortable, only one word in his mind - "cool". This is like a science fiction movie-like scene, in fact, happened around us. The pain that tormented Mr. Li is medically called post nerve injury pain. In China, this is an often overlooked group of patients, suffering from the pain of electric shocks, struggling to stay out of the public spotlight.
Over the past five months, Mr. Li, 56, has been "tortured" by severe brachial plexus neuralgia: unable to move, unable to lie down, and hardly ever having a good night's sleep. Throughout the night, he can only sit up straight in bed, enduring the electric shock of pain, any position can not be maintained for more than three minutes.
How did this happen? This is post-damage nerve pain.
After the tumor was successfully removed, this pain followed
Two years ago, Mr. Li underwent radical resection for esophageal cancer at a local hospital, and was treated with radiation therapy after the surgery. Because the radiation dose is large, resulting in damage to his right brachial plexus nerve, the upper arm from the slight pain rapidly progressed to the entire forearm and the palm of the hand to produce continuous burning pain, electric shock pain. The excruciating pain not only severely affected Mr. Li's life, but also put his entire family on pins and needles. In just a few months, his right hand was no longer able to exert force or make a fist, and even gradually developed muscle atrophy. If there is no oral medication, every day for him, basically only the idea of self-exclusion.
He came to Huashan Hospital at a time of great helplessness. Doctors in the functional neurosurgery subspecialty group of the hospital's neurosurgery department recognized it right away - pain after nerve injury.
What is nerve injury? Nerve damage is mostly caused by traffic accidents, work-related injuries, etc. In mild cases, the nerve is temporarily dysfunctional, in severe cases, the nerve is severed, and in the most severe cases, there is a complete loss of sensory and motor functions. In addition, the cause of nerve injury can also be tumor invasion, brachial plexus anesthesia, heavy objects or radiation therapy, spinal cord surgery and so on.
The clinical manifestations of pain after nerve injury are as follows:
Partial or complete sensory and motor dysfunction in the innervated area;
The injury occurs before the pain occurs after the pain, which can occur immediately after the injury, or it can be delayed for a few months or a few years;
The pain can be small or large in size;
The great majority of the pain is persistent.
The nature of the pain includes electric shock, tearing, cutting, squeezing, pinching, cramping, burning, and tightness.
Top pain therapies that patients don't know much about
The question is, how to treat pain after nerve injury?
Medication (but no specific drug) Carbamazepine, gabapentin, pregabalin, tramadol, cilostro, etc.
Nerve blocks provide brief relief in some patients, and the effect is usually not long-lasting.
Rehabilitation It is important to overcome the misconception that if the surgery is successful, no other treatment is needed. Rehabilitation is very important and requires a variety of movement patterns depending on the location of the nerve damage and the muscles involved in order to achieve a better outcome.
Surgery Spinal cord stimulation (SCS) is more appropriate for patients who still retain some sensory and motor functions, not only to relieve pain, but also to increase the blood supply of the damaged nerves, and to promote the regeneration and repair of nerve roots. Spinal cord stimulation is currently the top treatment for pain in the international medical community, but many of our patients are still unaware of this new technology and there are many untapped therapeutic uses for it. It is excellent in the treatment of chronic intractable pain, including brachial plexus injury, residual limb pain, phantom limb pain, spinal cord injury or cauda equina injury, etc. It does not use any medication, does not destroy the nerves, and the surgery is less traumatic, less painful, and at the same time repairs the nerves, which is called the "green therapy".
Neurodegeneration is more suitable for patients with different degrees of sensory deficits, the efficacy of the treatment is accurate, the effect is long-lasting, and the main side effect is the corresponding segmental hyperalgesia or loss of sensation, which is irreversible.
The combination of these means can effectively increase the blood circulation of the damaged nerves, improve the nutrition of nerve regeneration, and at the same time prevent the joints from ankylosis, contracture, and muscle atrophy. The application of these means will certainly bring new treatment opportunities for the majority of patients to get rid of persistent pain, improve nerve function, and enjoy a higher quality of life.
A small electrode to repair damaged nerves
What happened to Mr. Li? After his systematic examination, the doctor found that his nerve damage was very serious and caused a tendency of pain sensitization due to long-term nerve pain, and even slight skin stroking, wearing clothes, and adjusting posture would induce severe pain. Meanwhile, the entire scope and extent of nerve damage was still progressing, with increasing oral doses of morphine painkillers. At the same time, Mr. Lee was experiencing severe anxiety and mood problems.
After considering all factors, the doctors decided to use the most advanced spinal cord electrical stimulation therapy for Mr. Li.
The entire spinal cord electrical stimulation surgery lasted only about two hours, the doctor implanted a small electrode into Mr. Li's spinal canal, covering the corresponding nerve segments in the arm, and then programmed the electrode according to certain instructions, the electrode can not only interfere with the brain's receipt of pain signals, but also stimulate the repair of the damaged nerves, to achieve the function of pain and reverse the progress of the injury, "two birds with one stone". "killing two birds with one stone".
Back in the ward, medical staff immediately opened the electrode to Mr. Lee's work mode, the usual continuous electroshock pain in the arm was covered by a crispy current, Mr. Lee instant relief. After a few attempts, he was able to lie down and rest without discomfort. Recalling the past five months of "inhuman torture", Mr. Li showed a long-lost smile, Mr. Li's daughter is to the surgeon called to thank: "It's amazing, really is a miraculous effect of pain relief, Dad can finally sleep a peaceful sleep!
After a week of experiential treatment, Mr. Li obviously felt much more relaxed, severe pain is greatly reduced, the original sleep ten minutes will wake up in pain torment no longer, and gradually returned to normal life, he finally decided to implant a permanent stimulator.
In order to further accelerate the repair of nerve damage, muscle atrophy and other problems, experts in the Department of Rehabilitation Medicine at Huashan Hospital developed a personalized training program for Mr. Li, and daily massage, hand stretching and other targeted training was carried out by a rehabilitation therapist on Mr. Li. Just a few weeks later, Mr. Li not only looks good, but also regained his appetite and sleep, and his arm joint mobility has returned to its former agility, which is a far cry from what it was when he was first admitted to the hospital.
By Hu Jie, Wu Yi, and Sun Bing (Hu Jie is the chief neurosurgeon and professor of neurosurgery at Huashan Hospital of Fudan University, Sun Bing is the deputy chief physician and associate professor, and Wu Yi is the director of the Department of Rehabilitation Medicine and a professor)
Edited by: Li Chenyin
Editor: Gu Jun
*These are the only articles in this article that have been published in the press, and they have been published on the website of the Chinese government, as well as in the press release of the Chinese government. Photo 丨Visual China