Editor's note: This article is from WeChat public number "arterial network" (ID: vcbeat), the author of Wang Xiaoxing.
A thought-provoking reality is that many patients have not heard of pain rehabilitation units, or even do not know about them!
Pain Rehabilitation is a new discipline at the intersection of Rehabilitation and Pain Medicine that focuses on addressing pain in the pain outpatient and rehabilitation process.
China Rehabilitation Medicine Association Pain Rehabilitation Committee, Bi Sheng has pointed out in an article, modern rehabilitation medicine into China has been nearly forty years, from the original physical therapy-based auxiliary departments gradually to the transition to the clinical disciplines, the current layout of the rehabilitation medicine subspecialty is beginning to take shape, and chronic pain is gradually becoming a rehabilitation clinic concerned about the problem.
Based on this, in December 2017, the "Chinese Society of Rehabilitation Medicine Pain Rehabilitation Committee" was established, and at the inaugural meeting, Bisheng put forward the idea that "China's rehabilitation medicine should make up for the lesson of pain rehabilitation".
The majority of patients suffering from musculoskeletal pain in China will first visit an orthopedic clinic, while only a very small percentage of orthopedic patients require surgery, and the majority of patients receive medication. One of the reasons for this situation is that many rehabilitation doctors do not have the ability and means to accurately diagnose and manage chronic musculoskeletal pain, and even if patients come to the clinic, it is difficult to satisfactorily solve the patient's problem, which leads to a large number of patients with musculoskeletal pain to seek medical treatment.
Even for those pain patients who visit the rehabilitation department, the treatment they receive is the traditional means of rehabilitation medicine (physiotherapy mainly); the traditional means of rehabilitation medicine for chronic pain is mainly based on physical therapy, which has limited effect on some stubborn and intractable chronic pain and lacks immediate effect. Therefore, this poses a challenge to rehabilitation physicians.
But unexpectedly, in order to meet this challenge, the establishment of pain rehabilitation specialties has been set up as a new key development direction by many private rehabilitation hospitals. In actual development, its development speed exceeds the development of neurological rehabilitation and orthopedic rehabilitation. There is now growing evidence that pain rehabilitation will become a powerful tool to help private rehabilitation hospitals grow rapidly in the future.
Status of Pain Rehabilitation in China
The patients in the pain department have been suffering from various kinds of pain for many years, and have been to many hospitals, and have been "returned" due to poor treatment results.
In 2007, the former Ministry of Health issued a document determining the addition of the first-level diagnostic and treatment subject "pain department" to the List of Diagnostic and Treatment Subjects in Medical Institutions, according to which hospitals above the second level in China can set up a pain department to carry out diagnostic and treatment services focusing on the diagnosis and treatment of chronic pain.
Acute pain is most often an accompanying symptom of some disease or trauma, while chronic pain, especially neuropathic pain, is a disease in itself.
In reality, people used to have a big misunderstanding of pain, wrongly believing that "pain is a symptom, not a disease, and when the disease is cured, there will be no pain".
In fact most chronic pain is not just a symptom, it is a disease in itself, such as primary trigeminal neuralgia which has no manifestations other than painful symptoms. It is a classic pain disorder, and when you cure the pain, you cure the disease. Another example is postherpetic neuralgia, which is also a painful disease, because its pain is severe and persistent, and some patients suffer from persistent pain for decades, and patient suicides occur from time to time.
The distinction between symptoms and diseases is relative, and when a chronic clinical symptom threatens the patient's life and work for a long time and seriously, it should be recognized as a disease. The incidence of chronic pain in China is higher than that of malignant tumors and hypertensive diabetes.
However, the diagnosis and treatment of chronic pain has been equated with acute pain for quite a long time in the past and dispersed among various clinical disciplines, including neurology, surgery, orthopedics, oncology, rehabilitation, rheumatology and immunology, etc. These disciplines only provide routine diagnosis and treatment of pain and painful disorders from different perspectives, so that many patients with intractable pain do not receive timely and appropriate treatment, which causes great pain to the patients.
According to the statistics, about 30% of the chronic pain patients cannot find out the clear cause of the disease, which makes the treatment even more difficult. Facing these chronic pains, we must rely on professional theories to treat and professional skills to deal with them in order to achieve better therapeutic effects.
Pain learns concepts from rehabilitation and rehabilitation learns techniques from pain
Bi Sheng, the main committee member of the Pain Rehabilitation Specialized Committee of the Chinese Society of Rehabilitation Medicine, told Arterial.com that hospitals now basically have a rehabilitation department, some hospitals have a pain department, and the two departments address patients' rehabilitation problems and pain problems, respectively, and some hospitals also have a pain rehabilitation department or are called rehabilitation pain departments. The reason for establishing the Pain Rehabilitation Specialized Committee of the Chinese Society of Rehabilitation Medicine and engaging in research in the field of pain rehabilitation is to solve the following problems:
The development of China's rehabilitation field is relatively slow, and most hospitals' rehabilitation departments are still inadequate in their rehabilitation capabilities, and many pain problems that arise during rehabilitation cannot be solved yet, pain rehabilitation being one of them.
The Pain Rehabilitation Unit currently addresses two main areas:
The first area is the treatment of pain disorders such as neck, shoulder, back and leg pain, trigeminal neuralgia, peripheral neuralgia and other pain disorders in the pain clinic.
The second aspect is the problem of pain during rehabilitation, especially for hospitalized patients. For example, shoulder pain in hemiplegia, pain in the affected limb after amputation, central pain in stroke, neuropathic pain after spinal cord injury, and so on. In the past, some of the pain problems caused by these diseases could be solved by means of physical therapy in the rehabilitation department. Refractory pain problems do not work well and need to be addressed by the pain department with methods such as radiofrequency and nerve blocks.
The main reason why pain is not addressed well during rehabilitation is that physicians are not competent enough to address the needs of their patients.
Our pain doctors mainly come from anesthesiologists, the advantage of anesthesiology is that the technology is very good, but the anesthesiologists lack a complete solution for pain diseases, do not have enough understanding of rehabilitation, and are more likely to solve purely neurological pain problems through nerve blocks. Pain medicine also does not have a good solution for pain during rehabilitation.
Therefore, at the first annual meeting of the Pain Rehabilitation Specialty in 2018, Prof. Bisheng proposed that "pain learns concepts from rehabilitation, and rehabilitation learns techniques from pain". At present, the Pain Rehabilitation Specialty Committee has more than 90 members, of which more than 60 are rehabilitation doctors and more than 30 are anesthesiologists. The purpose of the Pain Rehabilitation Specialty Committee is to encourage rehabilitation physicians and anesthesiologists to learn from each other.
In view of the current development, pain rehabilitation in public hospitals is generally weak. The Specialized Committee on Pain Rehabilitation is mainly to help pain rehabilitation departments and rehabilitation departments to acquire the ability to solve pain problems.
Developing a pain rehabilitation unit is easy to see results and benefits
Pain rehabilitation units, which are not yet fully operational in public hospitals, are very popular in private rehabilitation hospitals.
Shen Minhai, president of Fujian Longyan Ci'ai Hospital, told Arterial.com that Longyan Ci'ai Hospital first started as a neurological rehabilitation, and then formed a rehabilitation specialty hospital featuring neurological rehabilitation, geriatric rehabilitation, and children's rehabilitation.
The hospital's pain rehabilitation specialty has been under construction for three years, and with the gradual maturation of the pain department, its latecomer advantage has become more and more obvious, and its development speed is much faster than that of the previous dominant disciplines. In the adult rehabilitation segment, the number of patients in pain rehabilitation has accounted for 10% of the total patients in the hospital.
The reason for the strong development of pain rehabilitation specialties, Shen Minhai expressed his views:
Although the state issued a document to encourage the construction of pain departments in hospitals above the second level, but most of the large and medium-sized public hospitals do not pay attention to the pain department, only part of the public hospitals opened a pain department outpatient clinic, but there are no beds, and the doctors are mostly anesthesiologists part-time, anesthesiologists themselves anesthesia business is very heavy, the doctor's efforts spent in the pain business will be greatly reduced.
The lack of attention from public hospitals provides an opportunity for private hospitals to take up the problem of pain rehabilitation.
Moreover, there is a difference between the services provided by the pain rehabilitation department of a rehabilitation hospital and the pain outpatient clinic of a general hospital. Pain outpatient clinics generally only help patients with their pain problems, whereas pain rehabilitation departments in rehabilitation hospitals focus on pain-related dysfunctions, such as muscle atrophy, psychological problems, neurological problems, etc., in addition to solving the patient's pain problems, so that the patient can enjoy a full cycle of pain rehabilitation.
These services are hardly available in public hospitals, where multidisciplinary consultations are mostly used for difficult cases.
It is also due to the industry situation of pain rehabilitation treatment that it is easy for private rehabilitation hospitals to establish pain specialties as the hospital's specialty department, become the discipline leader in the hospital's region, and even establish academic achievements.
In addition, Shen Minhai said that the reason why Longyan Ci Ai Hospital's pain rehabilitation has developed so rapidly is because the hospital has carried out CT, ultrasound-guided nerve block, radiofrequency and other treatments on the basis of the original Rehabilitation and Pain Departments, which has solved some intractable pain problems that were difficult to be solved by the Rehabilitation Department before. The ability to see patients has improved, and word of mouth has developed among patients, naturally attracting more patients.
On the other hand, with the accelerated arrival of the aging society, and the change of working lifestyle, especially the long-term computer operation, work at desk, play cell phone, driving and other bad postures, resulting in the incidence of neck, shoulder, lumbar and leg pain further increased, and there is a tendency to the development of the younger age (even some teenage young people have cervical spondylosis), the neck, shoulder, lumbar and leg pain is mainly manifested in the form of headache, neck pain, vertigo, shoulder pain, lumbago, pain and numbness of the upper or lower extremities, even affecting diet, sleep, stroke and hemiplegia, which seriously reduces the quality of life. or lower limb pain, numbness, and even affect the diet, sleep, stroke hemiplegia, seriously reducing the quality of life.
Globally 80% people suffer from neck, shoulder, low back and leg pain, which is the most prevalent disease with treatment costs >$50 billion/global/year, seriously affecting health and labor productivity. The huge market and will significantly help the revenue of private rehabilitation hospitals.
Xiao Ling, General Manager of the Rehabilitation Division of Hejia, said that pain, as the "fifth vital sign" after blood pressure, breathing, pulse and body temperature, is not only a vital sign but also gradually recognized as a disease as people's living standard improves and the public is unwilling to tolerate the torture of pain.
However, there are many causes for the onset of pain, and when patients visit public hospitals, they do not know how to register with the department because the causes of pain may be bone injuries, tumors, nerves, rheumatism, immunity and other diseases.
In public hospitals, because of the workflow, it is difficult for multiple departments to work around a single patient. This makes it difficult to determine the cause of the disease and the treatment will not be very effective.
However, private hospitals can easily form an integrated model of diagnosis and treatment, starting from diagnosis, with a patient-centered, multidisciplinary consultation to clarify the cause of the disease. In the course of treatment, human resources can also be organized to provide patient-centered treatment. This is determined by the system of private hospitals, which is more difficult to realize in public hospitals.
In addition, the technology of pain rehabilitation is relatively easy to master is also the advantage of private hospitals to develop pain specialties. The main means of rehabilitation for pain rehabilitation are minimally invasive and physical therapy, etc., and it is relatively easy for hospitals to train relevant talents and the cycle is not long.
In terms of dissemination, Xiao Ling believes that word-of-mouth effects of pain rehabilitation are easy to accumulate. The evaluation of the treatment effect of pain is pain and no pain, and it is also relatively easy to show results so that
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