I. History of pain medicine
As early as the 1920s, anesthesiologists opened pain clinics in the U.S. Since the 1950s, many foreign hospitals have opened pain departments and established pain research and treatment centers. With the establishment of the International Pain Society in 1976, it marked the beginning of a time when medical professionals who were passionate about pain medicine could independently research and develop methods for the treatment of pain disorders.
The development of pain medicine in China can be traced back to the 1950s, when acupuncture paralysis (acupuncture numbness) emerged in China to treat a variety of chronic intractable pain. 1989 saw the establishment of the Chinese branch of the International Pain Society, followed by the Chinese Medical Association Pain Society in 1992. With the rise of pain medicine in China and the opening of pain departments in major hospitals, on July 16, 2007, the Ministry of Health issued a notice on the addition of “pain medicine” to the list of medical institutions’ diagnosis and treatment subjects, and determined that “pain medicine” is a first-class clinical diagnosis and treatment subject. The Ministry of Health issued a notice on the addition of “pain medicine” to the list of medical institutions on July 16, 2007, and established “pain medicine” as a first-class clinical diagnosis and treatment subject.
What is pain?
It is an unpleasant sensation and emotional experience associated with actual or potential tissue damage. It is the most primitive and widespread pain of human beings, and is listed as the fifth vital sign after respiration, pulse, blood pressure and body temperature.
Third, the barriers to the development of pain medicine
Influenced by the traditional concept and the limitations of knowledge, most patients, including some medical personnel do not understand the true meaning of pain medicine, the understanding of the field of pain medicine there are still some misconceptions.
Myth 1: Pain treatment is only a symptomatic treatment and does not address the root of the problem, which is called “treating the symptoms but not the root cause”.
This idea is obviously wrong, the traditional treatment means are analgesic drugs plus massage, traction, heat therapy, acupuncture, etc., which only solve the “pain” problem, but now the pain department adopts minimally invasive interventional techniques to nourish, decompress, condition, stimulate and even destroy the nerves, so as to achieve anti-inflammatory, analgesic, block nociceptive sensation and improve nerve function. The aim is to improve nerve function and to treat both the symptoms and the root cause of pain. The process of certain diseases is itself a vicious pathological cycle caused by pain, and the relief of pain is the treatment of disease, such as shingles.
Myth 2: Pain doctors only prescribe painkillers and nerve blocks
The pain department needs professional theoretical knowledge and operational skills to firstly diagnose various pains that are not well treated by the relevant clinical departments, and then treat them by drug or non-drug means, non-invasive or minimally invasive methods, for all kinds of intervertebral disc For patients with various types of disc herniation, trigeminal neuralgia and other chronic pain, the pain department has its unique minimally invasive technology, which does not require any incision, and minimally invasive surgery can be performed only under local anesthesia, which is less traumatic and less costly for patients.
Misconception 3: Patients are in a hurry to seek medical help, frequently looking for medicine, and misleading their condition.
For acute pain caused by primary diseases, we should consult the appropriate departments, such as sudden onset of angina pectoris we consult cardiology, sudden onset of acute abdominal disease consult general surgery, etc., while chronic intractable pain, including pain without a cause identified or found the cause can not be cured at present need to go to the pain department for treatment, if not timely and effective treatment, it will become a complex local pain syndrome or central pain, more intense, more difficult to treat. The pain is more intense and more difficult to treat.
Myth 3: There is no feeling after pain treatment
The nerves in the human body are divided into sensory, motor and vegetative nerves, etc. The treatment of pain only selectively blocks the conduction of sensory nerves or destroys nociceptive fibers, and does not affect other nerves.
4.Pain department treatment items.
1.Acute pain: acute injury pain of soft tissues and joints, post-surgical pain, obstetric pain, acute herpes zoster pain, gout, etc.
2, chronic pain: soft tissue and joint strain pain or degenerative pain, intervertebral discogenic pain, neurogenic pain, etc.
3, intractable pain: trigeminal neuralgia, post-herpetic neuralgia, intervertebral disc herniation, intractable headache, etc.
4, cancer pain: advanced tumor pain, tumor metastasis pain, etc.
5. special pain categories: thrombotic vasculitis, intractable angina pectoris, idiopathic chest and abdominal pain, etc.
6, related discipline diseases: early retinal vascular embolism, sudden deafness, vasospastic disease, facial spasm, allergic rhinitis, intractable eruption, peripheral vascular disorders, insomnia, etc.
V. Functions of pain physicians.
1.Promote the basic research on pain medicine
2.Check the patient carefully and make a correct diagnosis
3.Have a deep understanding of the neurophysiology and psychology of pain
4. To take good care of patients suffering from pain with love and patience
5.Be able to read radiological data, general medical examination, electrophysiological examination and psychological test data
6. Have in-depth knowledge of the clinical pharmacology of drugs related to pain management, and use analgesic drugs in a rational manner.
7.Will implement various new pain treatment techniques
6.The treatment methods of pain department.
1.Nerve block: block pain and other injurious stimuli to the central conduction, so as to break the vicious pathological cycle, both symptomatic treatment and etiological treatment
2.Physical therapy: including direct current therapy, drug ion introduction therapy, infrared (purple) therapy, ultrasonic therapy, etc.
3.Electrical stimulation therapy: pulse current stimulation can cause excitation of peripheral nerve thick fibers and impulse transmission to the central system, causing the release of enkephalin and endorphin, resulting in analgesic effect.
4.Radiofrequency therapy: It can selectively destroy the nociceptive fibers and preserve the sense of touch.
5.Laser therapy: low energy laser such as helium-neon laser is mainly used for physical therapy, which has anti-inflammatory, analgesic and tissue regeneration effects, and can treat local inflammation, skin ulcers, facial spasm, etc. Carbon dioxide laser diffusion irradiation treats sprains and contusions, arthritis, neuralgia, laryngitis, etc.
6.Psychotherapy: the use of psychological principles and techniques, through the role of language, expression, attitude, posture, behavior and the surrounding environment to influence and change the patient’s perception, emotions and behavior, so as to improve their psychological state, behavior and physical symptoms of the method
7, spinal endoscopic surgery: for various types of lumbar disc herniation, the spinal endoscopic system can be used to directly remove the nucleus pulposus that is compressing the nerve roots and release the nerve root compression.
There are also various minimally invasive treatment methods such as collagenase disc lysis, ozone injection, plasma radiofrequency ablation, anhydrous alcohol nerve destruction, etc., which have been introduced in detail in the article “The Eighteen Skills of Pain Medicine” on April 27, 2015.
VII. Prospects of pain medicine
Pain medicine is a comprehensive medical specialty with a high degree of interprofessionalism, a wide range of medical treatment, a large population coverage, complex patient conditions, effective and minimally invasive treatment modalities, and a broad clinical outlook. The development of pain medicine in China has been uneven over the years, and some famous hospitals have not set up pain departments, and some hospitals have carried out pain departments, but most of them are outpatient clinics, and most of them are part-time anesthesiologists.