Pain is one of the most direct and real feelings of the human body, and it is also a physical reaction that everyone will experience, not only will it involve many parts and organs, but also change the pattern to make the body devastated.
For the pain department, every time it looks for the cause of the patient's mysterious pain, it is like a thrilling chase, and it must be "solved" layer by layer.
01, severe pain struck, miserable
Mr. Chen, 58, is an authentic "Lao Guang", in the middle of November last year, an inexplicable pain suddenly wrapped around Mr. Chen, and the pain demon of his lower limbs that went deep into the bone marrow like a knife cutting, tearing, burning, and electric shock was trampling on him every day.
This kind of unexplained pain tormented Mr. Chen to such an unspeakable hardship that he could hardly take care of himself. To this end, he went to seek medical treatment, from orthopedics to private doctors, he underwent lumbar ablation, drank strange Chinese medicine, and even blindly carried out needle phlebotomy therapy for up to 10 days...
After several tosses, Mr. Chen's pain not only did not alleviate, but there were countless dense pinholes on his legs.
02, find out the culprit - atypical herpes zoster
After trying a variety of treatments, but the condition has never improved, this time it seems to have been cornered.
Just when Mr. Chen was desperate, he got the latest test results, and Huang Suixiang, director of the Pain Department, told him: "Your viral antibody test, all five viral antibodies are positive, it is likely that it is nerve pain caused by herpes zoster virus infection!" It is best to return to the hospital as soon as possible for further diagnosis and treatment. ”
After Huang Suixiang's step-by-step "investigation", the culprit of the pain that constantly tormented Mr. Chen was finally pulled out - atypical shingles.
Unlike typical shingles, Mr. Chen's shingles is very atypical, it does not have any skin abnormalities (such as rashes, blisters, etc.), only severe pain, which brings great difficulties to the diagnosis of the disease.
Fortunately, the culprit was finally identified, and Mr. Chen received a course of targeted treatment, and the pain was reduced by 80% or 90%.
First, nameless pain is difficult to diagnose, and orthopedic treatment is deadlocked
Herpes zoster, commonly known as "waist-wringing dragon" and "snake disc sores", is an infectious disease caused by "chicken pox-zoster virus". When the body's immunity is low, the virus that has been lurking in the ganglia for a long time will be "activated" and "multiplied" in large quantities, causing herpes zoster in the corresponding neurological innervation area.
Typical shingles usually occur unilaterally and manifest as significant blisters and papules. Atypical herpes zoster may not be rash and present only as pain, as mr. Chen did.
In the middle of November 2021, Mr. Chen's lower limbs suddenly felt like being stabbed by a thousand sharp blades, and the pain was like a tidal wave, sitting pain, lying pain, even sitting in a wheelchair, the foot could not be flexed and extended due to pain.
Mr. Chen has a history of lumbar disc herniation for more than 10 years, and he holds the idea of "old mistakes are committed, and patience will pass", and drags on at home day after day. Finally on the third day, he couldn't hold on any longer. The nearest Red Cross hospital was only a 5-minute walk away, but he was already unable to move and could not move, so his family had to dial the 120 emergency number.
There was no rash, just bone-chilling pain in the lower extremities, coupled with a multi-year history of lumbar disc herniation, the range of pain overlapped with the area of compression of lumbar disc herniation... Mr. Chen was admitted to the orthopedic department for treatment.
Soon after, he underwent lumbar disc radiofrequency ablation. I thought I could "get rid of the disease after the operation", but I didn't expect that at more than 2 o'clock in the morning on the day after the operation, he was awakened by the pain again, thinking: "It seems that this time it is really a tricky trouble." ”
The next day, his pain symptoms continued to worsen, and he could only undergo epidural hormone injection therapy, commonly known as "hitting the closure", to relieve the pain. Unfortunately, the good times are not long, the effect of "hitting the closure" has not lasted until the evening, the pain has recurred, and the treatment has reached an impasse.
【Doctor's comment】Atypical herpes zoster, deceptive
For the pain that was difficult to diagnose at the time, Huang Suixiang explained that atypical shingles like Mr. Chen, which has no representative symptoms of herpes, is easily confused with other diseases. If the lesion occurs in the left precordial area, it is easy to misdiagnose as angina, occurs at the rib margin and is easily considered as intercostal neuralgia, and occurs in the spine area, it is easy to misdiagnose osteoporosis or neuropathy.
As a result, many atypical shingles patients are unable to find the true source of pain, have to suffer for a long time, and may miss the optimal neurological repair period, leaving behind neuralgia.
Second, the pain and suffering are unspeakable, and I have no choice but to go astray in seeking medical treatment
In order to solve Mr. Chen's pain problem as soon as possible, the hospital arranged a multidisciplinary consultation. From the results of examinations such as magnetic resonance, the experts first ruled out new symptoms of compression and further used infrared thermal imaging to analyze the characteristics of patients' lesions.
"It can be observed from the picture that the temperature of Mr. Chen's lower limb on the affected side is significantly higher than that on the contralateral side, showing a typical yin and yang foot, which is a manifestation of neuroinflammation." Huang Suixiang explained that this is the opposite of the performance of the lumbar disc herniation compressing the lower limbs.
Infrared thermal imaging shows that the patient's foot shows a typical "yin and yang foot"
At this time, the diagnosis has a clear idea: since the pain belongs to neuroinflammation, what is the cause of this neuroinflammation? Huang Suixiang suggested that patients should be tested for five items of TORCH (i.e., antibodies to Toxoplasma gondii, rubella virus, cytomegalovirus, herpes zoster type I and type II viruses) and perhaps clues could be found.
At the time of the TORCH test, Mr. Chen had been hospitalized for more than a week, during which he could only rely on painkillers to relieve the pain, but once the effect of the medicine passed, the severe pain made him unbearable, and he was forced to the brink of collapse. Unable to wait for the blood test report to come out, he couldn't sit still: "I'm going to be discharged..."
After being discharged from the hospital, Mr. Chen found a jianghu doctor to perform a series of treatments such as needle and bloodletting. After more than 10 days, his legs were full of pinholes and scars, but the pain was never alleviated, and even intensified.
【Doctor's comment】Folk remedies, so can not
Huang Suixiang stressed: Most typical shingles have a certain self-healing power, and the rash will slowly subside in about two weeks, so it is not recommended to use these folk earth remedies! Many patients have had such experiences and tried folk remedies such as plastering incense burner ash, rubbing male yellow wine, and coating earthworm leeks.
On the one hand, these earthworks can deepen the wound, causing further skin damage and nerve damage; on the other hand, these earthworks are not hygienic, and some insects themselves contain parasites, which are likely to cause unnecessary infections or other diseases if used poorly. When suffering from herpes zoster pain is unbearable or cannot be cured for a long time, it is recommended to go to the pain department in time for targeted treatment.
Third, atypical shingles, the "culprit of pain" was pulled out
Although Mr. Chen has chosen to be discharged from the hospital, Huang Suixiang still has this difficult case in mind.
Finally, more than a week after the blood test, the TORCH test report came out, and Huang Suixiang and others came with a key evidence: Toxoplasma, rubella virus, cytomegalovirus, herpes zoster type I and type II virus antibodies all showed positive!
This time, they finally found the "real culprit" hiding behind the pain - shingles!
Huang Suixiang explained: "Mr. Chen was too tired and irregular during that time, which led to a decline in physical fitness, and the virus that was originally lurking in the body's ganglia was activated, multiplied, and then showed corresponding symptoms. ”
According to the pain area and range, Huang Suixiang chose pulsed radiofrequency therapy to achieve the purpose of safely not damaging nerves and effectively relieving patients' pain.
Postoperative thermal imaging showed that the patient's affected area had almost returned to normal
After a course of treatment, Mr. Chen's pain has been reduced by 80% to 90%. He told us half-jokingly: "Before the treatment, my VAS pain score was as high as 8, which was more intense than the 7 points of pain that women endured during childbirth. Now after the treatment, I can do everything 'handy'! ”
Postherpetic neuralgia is still a world problem, Huang Suixiang suggested that susceptible people over 50 years old should be actively prevented, you can choose to receive herpes zoster vaccine, after vaccination is expected to reduce the incidence of 90%.
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This article guides experts:
Huang Suixiang is the director and chief physician of the Department of Pain of Guangzhou Red Cross Hospital, and a member of the Central Pain Group of the Pain Branch of the Chinese Medical Association