IN SORE NEED

In a search for “back pain” on Zhihu, a question-and-answer site in China, the first topic that pops up is “Why do young people suffer from back pain?” Health authority data shows that more than 200 million Chinese people experienced some type of back problem in 2015, and 15 percent of them suffered from lumbar disc hernia, second only to the number of people who had caught a cold. 　

Pain is virtually the only symptom of a herniated disc. The World Health Organization (WHO) defines chronic pain as one that lasts for more than four weeks. In 2018, the WHO listed chronic pain as an independent disease category. According to an epidemiological investigation on chronic back pain in China in 2017, 31.54 percent of Chinese people suffered from some kind of chronic pain.　

“Chronic pain is not only a sense of sorrow. It is a disease which requires treatment,” Fan Bifa, head of the pain clinic at the China-Japan Friendship Hospital in Beijing, told NewsChina.　

Jia tries to avoid bending down and all strenuous exercises. Every two years since her diagnosis, Jia receives one to two weeks of in-hospital physiotherapy, massage therapy and acupuncture. When she is home, she has to lie down most of the time.　

According to research, nearly a quarter of chronic back pain patients do not go to the doctor within three months after experiencing pain, and 36.79 percent of patients received no treatment. Only 40 percent of patients went to the hospital, and 20 percent of patients bought medication at a drugstore.　

“Pain is a warning signal to the human body of injury or disease,” Fan said. Diseases like the flu are curable, and the pain will disappear. For those in chronic pain, it might mean they are not aware of other types of disease as they are constantly living with pain. 　

Fan once treated a patient in his 80s who suffered from neuropathic pain after he was diagnosed with herpes zoster, commonly known as shingles, when he was 40. “Neuropathic pain caused by shingles is a typical chronic pain and 9 to 34 percent of patients will continue to suffer after their treatment ends,” he said. “Patients are very sensitive to pain, and just a slight touch is likely to cause pain all over. Some patients don’t even dare wear clothes.” Caused by nerve damage or nervous system problems, neuropathic pain is often described as a burning or shooting sensation, which can be chronic and severe. 　

Fan said that pain as a separate condition was ignored in the past when most people were struggling for sufficient food and clothing in China. “Nowadays, living standards have significantly improved, and people are paying more attention to their health,” he said. “However, the concept that chronic pain is its own disease which requires treatment is still not widely recognized.”　

According to a study on adult chronic pain in Shanghai by the Chinese Journal of Pain Medicine in 2015, the incidence rate of chronic pain in 30 residential communities and 13 major hospitals in Shanghai ranged from 92 to 98 percent, and 30 percent of residents and inpatients surveyed had a tendency to become depressed. The study also showed that chronic pain is closely connected with aging populations, and over 60 percent of patients suffered from pain for more than one year.　

Yang Yang, an associate chief physician at the pain department of the China-Japan Friendship Hospital, told our reporter that even at 7 or 8pm, there are likely to be at least a dozen seniors still waiting to be seen. “More than 90 percent of patients in the pain department are elderly people,” he said.　

Yang added that most patients in his department suffer from pain in the neck, shoulders, lower back and legs, and the most intractable diseases include neuralgia (pain caused by nerve damage), pain from cancer and headaches. According to the 2017 Global Pain Index, 91 percent of Chinese people have experienced some body pain, and 34 percent suffer from body pain every week, mostly in the neck, shoulders and back.　

Wang Jianglin, a professor at the pain clinic at Tangdu Hospital in Xi’an, Shaanxi Province, conducted a research into 1,545 chronic pain patients aged above 50, publishing his study in the Journal of Chinese Pain Science in April 2019. It showed that female patients and smokers are more likely to suffer from severe pain, and patients who received higher education have a lower tolerance to pain. 　

Min Baoquan, a doctor at the neurology department of Xuanwu Hospital in Beijing, has treated over 400 chronic pain patients. He discovered that psychological factors were the biggest reason and close to 30 percent of patients have some kind of psychological problem. 　

In 1992, the Chinese Association for the Study of Pain (CASP) was established. That same year, the Ministry of Health released a document and turned many anesthesiology departments into clinical departments where one of the major functions is pain management. A growing number of doctors with a background in anesthesiology offered outpatient services to treat pain. 　

“Few people knew about these outpatient services. The patients came to consult us after they saw flyers in the hospital corridor,” Xiong Donglin, dean of the pain clinic at Nanshan Hospital in Shenzhen, Guangdong Province, told NewsChina.　

Han Jisheng said that when he first brought chronic pain treatment to China, he had to organize doctors from disciplines such as anesthesiology, orthopedics and neurology to study the treatments. Lacking funds and staff, he found it difficult to put together a team.　

In 1995, CASP received a donation of US$100,000 from a pain research institute in France. With the funding, Peking University Health Science Center founded the Sino-French Pain Treatment Center, which provided 18 inpatient beds. Since then, the center has launched 13 training programs to train healthcare workers in pain relief.　

In 2004, the International Association for the Study of Pain launched the first Global Day Against Pain to raise awareness that pain relief is a basic right for patients. In 2007, China’s Ministry of Health announced that major hospitals could establish a pain department. Han Qide, vice chairman of the Standing Committee of the National People’s Congress, said at the news conference that these departments were not a prerequisite to treat pain, but hospitals should study chronic pain after accumulating the medical resources.　

Han Jisheng told NewsChina that “the establishment of pain clinics in hospitals is a strategic step. China is one of the global leaders in pain study and clinical treatment.”　

“Pain clinics have the function of bringing together different departments to consult on the treatment of chronic pain,” Fan Bifa, head of the pain department at the China-Japan Friendship Hospital, told NewsChina. 　

In 1989, Fan started offering outpatient consultations for pain sufferers at the hospital. 　

Xiong Donglin said that the treatment of chronic pain requires cooperation from multiple departments and tailor-made training programs. 　

“Training was previously done in the anesthesiology department. It’s not enough for doctors to just spend two or three months in the pain clinic,” he said.　

Nanshan Hospital has senior pain specialists. As a training center for pain clinicians, the hospital offers training programs for doctors from across the country. So far this year, at least 600 doctors and 49 nurses have been trained in pain alleviation at the hospital for three months.　

Song Xuejun, director of the Pain Medicine Center at Nanfang University of Science and Technology, said that more pain management training programs are being offered by medical schools and hospitals. However, it is time to standardize these programs to avoid low-level repetitive training and ensure they are recognized across the board. 　

“Chronic pain is unlikely to be completely eradicated through one traditional medical discipline,” he said. “It requires special training programs featuring content from a variety of clinical subjects.”　

Song added that it is necessary to offer courses on pain alleviation at medical schools. In March 2015, pain medicine was offered for the first time to undergraduate students of medical science at Peking University. Song was the chief designer of the teaching program. After joining Nanfang University of Science and Technology, he opened up the study of pain medicine to all students of the university regardless of discipline.　

“Everyone will experience some kind of pain, and if the public or at least college graduates are aware of pain management, public health will significantly improve,” he told NewsChina. “Doctors in pain management clinics should switch their attention to patients rather than diseases.”