In October 2010, I arrived in the United States as a National Visiting Scholar and landed in Los Angeles, the beautiful City of Angels, where the warm sunshine and fresh air are everywhere. I visited the Ronald Reagan Medical Center at the University of California, Los Angeles (UCLA), the best medical center in the western United States named after former U.S. President Ronald Reagan, which has been ranked among the top 5 hospitals in the nation for many years, and their neurology and neurosurgery programs have been ranked among the top 7 in the nation for many years. Obviously, this is a general hospital with an excellent history and a level of excellence that will undoubtedly be very helpful and rewarding in all aspects for me with a year to study abroad. Yongsheng Hu, Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University
Before going abroad, I focused mainly on neurosurgical treatment of intractable pain since 2000 when I was a postdoctoral researcher at the Institute of Functional Neurosurgery in Beijing, when few neurosurgeons in China were focusing on this area. Under the guidance of Prof. Li Yongjie, we have carried out neurosurgical pain management procedures such as stereotactic intracerebral nucleus pulposus destruction, conduction bundle dissection, motor cortex electrical stimulation, posterior median spinal cord dissection, spinal cord electrical stimulation, posterior spinal cord root into the medullary area dissection to treat central pain, phantom limb pain, pain after brachial plexus injury, visceral pain and other intractable neurogenic pain, and accumulated more than 100 cases of surgical He has accumulated more than 100 cases of surgical experience.
This time, I came to UCLA to study mainly functional neurosurgery. Since I have been concerned about the work and progress in the field of pain in China, I paid special attention to examine and understand some related situations of pain medicine in the United States, and also took time to see two pain clinics in Los Angeles in my free time, one of which is owned by a Chinese doctor. Although the pain clinics here are small in size, they do have a lot of patients, with a daily outpatient volume of more than 20 people, and about 40% of pain patients require outpatient treatment. nerve stimulation, drug pump implantation, and other more specialized and technical treatments.
In the United States, the population of pain sufferers is very large, with statistics showing that there are at least 50 million chronic pain sufferers and that 1/4 of American adults take antipyretic analgesics several times a week or use some kind of home treatment device that can reduce pain. There is actually a huge pain medical market here, with sales of pain treatment products including prescription and over-the-counter drugs, devices, electrical stimulators, drug infusion pumps, etc. going from about $19.2 billion in 2002 to about $32 billion in 2010, and estimated to be over $45 billion in 2011. Such a huge demand for pain medicine has likewise attracted more and more physicians to focus on and devote themselves to pain medicine, and the income of pain specialists is increasing year by year.
In the late 20th century, the American Pain Society conducted a large sample of 35,000 questionnaires distributed to 500,000 U.S. households and screened 2,642 of the 29,474 questionnaires returned for eligibility.
The findings showed that approximately 9% of U.S. adults had moderate and severe chronic noncancer pain, with 43% having a VAS score of 5-6, 23% having a score of 7, and 34% having a score of 8-10. 94% of chronic pain patients had been treated by a physician, primarily by a family physician, internist, or orthopedic surgeon, and approximately 1/2 of chronic pain patients had changed doctors due to unsatisfactory outcomes. About 1/2 of the chronic pain patients have changed doctors due to unsatisfactory results, and even 1/4 of the patients have changed doctors more than 3 times, but only 39% of the patients have their pain controlled. Only 22% of all chronic pain patients were actually referred to and treated by a pain specialist or pain management center, indicating that pain treatment in the United States at that time was similarly lacking in expertise and relevance. Of course, this situation has changed significantly, with many new pain clinics and pain centers popping up across the United States, and more pain specialists with background knowledge and specialized pain management skills becoming accepted and recognized by patients.
The American Pain Society, founded in 1977, brings together most of the nation’s professionals, scientists, lawyers, and health insurance policy makers involved in pain medicine research, treatment, and social work, with more than 2,500 registered members in 2010, of whom 50.45% are physicians and 8.03% are nursing professionals. Among the physicians involved in pain management, the largest number were anesthesiologists, accounting for 40.55%, followed by physical therapists and rehabilitation physicians, accounting for 10.71%, and neurosurgeons, only 3.06%, which is largely consistent with the situation in China, where it is also physicians with anesthesiology backgrounds who are primarily involved in pain management.
As this article was about to be completed, I came across a new issue of Time magazine published on March 7, this year. The cover feature of this issue is “Understanding Pain”, which provides a comprehensive report and analysis of the causes of chronic pain, the current situation of pain patients, treatment options that differ from traditional methods, and recommendations from pain medicine experts. The article reveals that, according to the U.S. Health Statistics, the number of patients with chronic pain is increasing. The article reveals that, according to the latest data from the Center for Health Statistics, approximately 76.5 million Americans have chronic pain, accounting for about a quarter of the 300 million people in the United States, and up to 60 percent of those with chronic pain have joint and low back pain, mostly in women. With only an estimated 8,000 pain specialists across the country, and an average of 9,500 chronic pain patients per pain specialist, it is clear that there is a huge gap.
As a medical expert, Professor Mehmet Oz, Associate Director of Surgery at Columbia University Medical Center in New York, wrote a special article on how chronic pain is the most costly health problem in the United States, with total costs approaching $50 billion per year, and the most predominant patients are those with low back pain, joint pain, and chronic headaches. Low back pain is the most common, affecting about 70-85% of American adults, causing partial or severe functional impairment in about 7 million people, with a cumulative loss of 9.3 million workdays and more than $5 billion in treatment care annually. Joint pain can involve 4 million Americans, and no fewer than 4.5 million people across the United States suffer from chronic headaches.
For more than a decade, chronic pain treatment in the U.S. has relied primarily on medications, with opioid abuse posing serious health problems. Time revealed that U.S. doctors have prescribed 50 percent more opioids compared to a decade ago. CDC data further shows that from 2004 to 2008, the number of hospital emergency room visits for opioid abuse poisoning increased by 111 percent. In contrast, no satisfactory progress has been made in the treatment of chronic pain, and tens of millions of patients have to live with chronic pain for a long time, which makes the treatment of chronic pain more and more important and puts higher demands on the development of pain medicine.
Compared with traditional treatments such as analgesic drugs, nerve blocks, and local anesthesia, several new treatment options are beginning to emerge with varying degrees of analgesic efficacy. Pain management surgery is an important treatment tool, and one of the most satisfactory and most performed procedures is spinal cord electrical stimulation, which is particularly suitable for the treatment of lower back pain and extremity pain, which is also related to the composition of chronic pain patients in the United States. In addition, there are other treatments that are gradually accepted by American pain physicians and patients, such as massage, yoga, acupuncture, herbal medicine (except for thunderbolt), and biofield therapy represented by qigong, etc. Some of these treatments complement our Chinese traditional medicine, which confirms the role of traditional Chinese medicine and herbal medicine from one side, and is also in line with the concept of comprehensive treatment of chronic pain.
Compared with the current state of pain medicine in the United States, I feel that there are some issues to consider in pain medicine in China.
First, the population of pain patients in China is much larger than that in the United States, and it is estimated that the incidence of chronic non-cancer pain should be no less than 10%. This is undoubtedly a huge medical market, and also puts forward higher requirements for the treatment level and sustainable development of pain medicine. The differences in health insurance policies, quality of life requirements, and economic development levels in different regions of China will inevitably lead to different choices of pain treatment methods, which also determines the long-term coexistence and common development of different pain treatment methods.
Secondly, pain medicine started late in China, but the development momentum is rapid, and the professional organizational structure of pain medicine and pain department has been established early, and now the domestic general hospitals above the second level have gradually established independently compiled pain departments, but what is more crucial is how to further standardize the professional treatment and professional training of pain medicine, if coupled with the close cooperation of pain-related multi-specialties and multi-disciplines, it will definitely promote the benign development of pain medicine in China.
Of course, the improvement of related professional and technical access, treatment fees, medical insurance policies and other supporting measures are also essential to the healthy development of pain medicine. The annual income of pain specialists in the United States is much higher than the average income level of clinicians. If pain medicine in China hovers in a state of low fees, low levels and low efficiency from the very beginning, it will obviously not attract more doctors to join the pain medicine career. It will also affect the attention and investment of pharmaceutical and device companies and social forces in the pain medicine market, and will undoubtedly hinder the rapid development of pain medicine.
Finally, as a neurosurgeon, the pain patients are mainly those with persistent neurogenic pain that is ineffective or ineffective after conventional treatment, such as central pain, trigeminal neuralgia, phantom limb pain, etc. Although the proportion of chronic pain patients is small, the absolute number of cases is not small, and each of them is a difficult problem to treat. The existing spinal cord stimulation, motor cortex stimulation, cranial nerve root vascular decompression, inner nucleus pulposus destruction, nerve conduction bundle dissection, posterior spinal root medullary incision, program-controlled drug pump implantation, peripheral nerve decompression and other different neurosurgical pain management procedures have provided us with effective treatment means for different intractable neurogenic pain, especially the nerve modulation technology has provided a new treatment concept, a new treatment concept and a new treatment method for the neurosurgical treatment of pain. Especially, the nerve modulation technology provides a new treatment concept, advanced technical means, diverse possibilities and broad application prospects for the neurosurgical treatment of pain.
In fact, there has been a social factor that has plagued and affected the widespread development of neurosurgical pain management surgery, that is, how to make pain patients fully understand and actively accept neurosurgical pain management surgery, and this problem also exists in the United States and our country. Neurosurgeons are not directly dealing with a large number of patients with various types of pain, and patients with intractable neurogenic pain who really need and must be treated with neurosurgical pain relief surgery to effectively control their pain should have a more reasonable way and smooth channel to obtain knowledge and recommendations. The most important thing is to strengthen multi-specialty and multi-disciplinary complementarity and collaboration in pain management.