30 Years of Pain Medicine in China: From Following to Leading

Source | "Medical" WeChat official account

Arturo castiglioni, a famous Italian medical historian, wrote in the History of Medicine: "When medicine was born, there was the initial expression of human suffering and the initial desire to alleviate it." Fan Bifa agrees with this sentence from the bottom of his heart.

Fan Bifa's career is closely related to the development of pain science in China, from anesthesiology graduate student to the fifth chairman and the eighth chairman-designate of the Pain Branch of Chinese Medical Association.

He said: "medicine is closely related to relieving pain, and the highest goal of medicine is to relieve human suffering." If you don't understand pain, you can't deeply understand the true meaning of medicine; If you want to have a deep understanding of medicine, you must first understand pain. "

Maybe this is a natural hobby.

Fan Bifa is a clinical undergraduate of Shanxi Medical University 1979. At first, he had no special interest in any subject, just wanted to study hard.

Later, he gradually discovered the magic of anesthesiology. "The progress of surgery actually has a lot to do with the progress of anesthesiology. Without anesthesia, patients can't stand the pain caused by surgery, and even minor surgery like appendectomy can't be done. " Therefore, he decided to apply for a master's degree in anesthesiology.

Analgesia is part of the purpose of anesthesia. Through study, Fan Bifa, who is studying for a master's degree in anesthesiology at China Medical University, learned about pain, and he had the idea of becoming a pain doctor. "Maybe it's his innate love."

1May, 989, the former Ministry of Health issued the Notice on Changing Anesthesiology Department into Clinical Department, which determined that Anesthesiology Department was a first-class clinical diagnosis and treatment discipline, and at the same time included the diagnosis and treatment of pain in the business scope, creating conditions for anesthesiologists to practice pain treatment in clinic.

The 1980s was the initial stage of pain department in China. Anesthesiologists in many hospitals began to set up pain clinics, and Fan Bifa was the first attempt. 1989 After graduating with a master's degree in anesthesiology in July, he was assigned to work in the Anesthesiology Department of China-Japan Friendship Hospital. In the same year, he applied to the hospital to open a pain clinic.

The initial pain clinic was very simple, even without a decent desk, and the daily consultation volume was not too large. "There are only a dozen patients a day." Fan Bifa recalled: "There are always some patients in big hospitals who suffer from diseases and the pain is unbearable. They may turn around when they see the pain clinic. "

Most patients who come to see a doctor are similar-I don't know why, but it hurts like hell; Refractory neuralgia, bone pain, medication has no effect, and it still hurts after operation. In addition, there is the pain caused by cancer.

One of his most impressive patients is an 80-year-old man who lives in the community opposite the China-Japan Friendship Hospital. "He came trembling with a cane. After a few steps, he told me that he was in great pain and asked me if I could treat him."

Fan Bifa judged that the old man was an "old cold leg" and now he is osteoarthritis. According to the comprehensive therapy of knee joint cavity and external cavity, Fan Bifa has been treated for about 3 times. The pain gradually eased. In the end, the elderly no longer need crutches to walk, but also can go out to buy food, and their quality of life has been greatly improved.

"He is very happy, and I am also very happy, because after I controlled his pain, a bunch of old people and old ladies in their community came to see a doctor. I treated them almost, and I felt very fulfilled." Fan Bifa said with a smile: "The enthusiasm of those who recognize you, think that your illness can be solved, and see you is the greatest motivation to support my progress. If no one comes to see a doctor, I certainly can't. "

In this way, the pain clinic of China-Japan Friendship Hospital gradually became famous. Sometimes there are twenty or thirty patients a day, and the number of doctors visiting the house has increased to four or five. However, the pain of some patients is very stubborn. Clinical practice makes Fan Bifa realize that the common people's demand for solving pain is huge and universal, and it is far from enough to learn knowledge only in their spare time.

To this end, in the 1990s, he went to Japan twice to study pain, and then he went to various countries irregularly to hold meetings, study, communicate with colleagues and introduce new ideas and technologies. "Our international communication has never been interrupted. Even when the epidemic is the worst, we will communicate online." He said.

Later, Fan Bifa became the deputy director of the Anesthesiology Department of China-Japan Friendship Hospital, managing the pain clinic and the doctors who went out from the pain clinic. Until 2003, the Pain Department of China-Japan Friendship Hospital was established.

"The hospital feels that since patients have this demand, our development momentum is also very good, and we are independent from the anesthesiology department. After independence, we have our own beds, and anesthesiologists who are interested in pain have also transferred from anesthesiology to pain department, and embarked on a more professional road. Our development speed is faster. " He said.

China has a pain department.

Pain is also a disease, which was not widely accepted by medical staff until 2 1 century. Nowadays, pain has been recognized as the fifth vital sign after breathing, pulse, body temperature and blood pressure.

Modern pain treatment originated in America. 196 1 year, the famous anesthesiologist Bonica founded the world's first clinical pain center in Washington university. The following year, Hideo Yamamura, a professor of anesthesiology at the University of Tokyo, Japan, founded the first "exotic pain" in Japan, and the international modern pain diagnosis and treatment gradually went to the world.

Compared with foreign countries, the research on pain in China started late. The China Pain Research Association, established by Academician Han Jisheng of Peking University on 1989, became the China branch of the International Pain Society the following year, and 1992 became the pain branch of the Chinese Medical Association. In the last general election, which ended on February 20, 2020, Fan Bifa was elected as the Chairman-designate of the Eighth Committee, and then served as the Fifth Chairman.

Painology has the characteristics of multi-disciplines, and many disciplines, such as neurology, surgery, orthopedics, oncology, rehabilitation and so on, have the demand for pain treatment. However, pain science is not a simple addition of clinical disciplines. It requires professionals to study and explore the mechanism, clinical trials, clinical diagnosis and differential diagnosis, treatment plan, rehabilitation and prevention of pain. In other words, it means "taking the road of professional development."

Led by academicians and appealed by the Pain Branch of Chinese Medical Association, on July 16, 2007, the former Ministry of Health issued document Wei 2007227, which confirmed that "Pain Department" was added to the list of medical institutions' diagnosis and treatment subjects as a first-class diagnosis and treatment subject, and all hospitals above the second level in China could carry out pain departments, marking the formal establishment of pain departments in China.

In the early days of the establishment of Pain Department, there were problems in staffing, promotion of professional titles, fees, etc., and the medical teaching and research system was not opened, so the development of the subject faced many difficulties.

Take China-Japan Friendship Hospital as an example. According to Fan Bifa, "Although the hospital attaches great importance to the pain department, we have the same status as other departments in the hospital. However, because there is no professional title promotion system for pain departments at the national level, it is very troublesome for pain doctors to promote their professional titles. "

In order to open up the growth path of subject talents and stabilize the team of doctors, in 2008 and 20 12, with the support of the former Personnel Department of the Ministry of Health and the Chinese Medical Association, the former Health Talent Center of the Ministry of Health successively launched the national examination for senior and middle-level titles in pain medicine, which opened the way for the promotion of titles in pain medicine.

In the process of clinical practice, Fan Bifa also found that only with standardized medical fees can the discipline develop continuously. "Without fees, we can only do some simple treatments, or we can't get the corresponding remuneration, which greatly limits the improvement of clinical business level."

First of all, it is necessary to establish a project for medical technology, determine what diseases can be treated and what means to treat them, and finally form the charging standard for medical technology services in the pain department. Since 2008, Fan Bifa, as the leader of the national pain diagnosis and treatment project, has been insisting on adding pain diagnosis and treatment technology to the medical technology catalogue in China.

"It is not enough to have charging items. Only with medical insurance reimbursement can ordinary people benefit. At first, I met many ordinary people. As soon as I heard that the treatment should be paid at my own expense, I forgot and died, which also limited the clinical development of the discipline. Therefore, we actively communicate with the medical insurance department and gradually incorporate some basic treatment items into medical insurance with the support and help of the medical insurance department. " He said.

In addition, the China Journal of Pain Medicine and the Chinese Journal of Pain Medicine were edited and published, and the Pain Branch of the Chinese Medical Association compiled the Clinical Diagnosis and Treatment Guide and the Clinical Technical Operation Standard. In the whole development process of pain department, Fan Bifa is a participant and even a pusher.

The development of pain department is endless.

From the follower, explorer and leader of the pain department, Fan Bifa has paid a lot along the way. He admits that in the early days of the development of the pain department, as an anesthesiologist, his income was almost half that of other doctors in the department. "Because I am obsessed with pain diagnosis and treatment, I rarely do clinical anesthesia."

"In fact, I was very young at that time, and my economy and life were under great pressure. Fortunately, my family is very supportive, "he said. "Without feelings and perseverance, I can't hold on. After gritting my teeth, I found that it promoted the development of the pain department and propped up a blue sky. I felt that all the efforts and efforts were worthwhile. "

Fan Bifa gets up before six o'clock every morning almost all the year round, and doesn't rest until after 12 o'clock in the evening. He is busy with clinical work, teaching and scientific research tasks, as well as academic exchanges and technical cooperation at home and abroad. Sometimes it's weird for children to stay at home for too long on weekends. "Why are you at home today?"

With the efforts of pain doctors represented by Fan Bifa, the development of pain science in China has now attracted the attention of the world, which makes Fan Bifa very proud. "Japan's pain science used to be very leading. I went to Japan for meetings, study and visit, and ran many times. Now Japanese colleagues think that their pain medicine has been surpassed by China, and they should learn from us. Because we are taking the road of specialist development, the Japanese parliament also held a special pain demonstration meeting to discuss whether Japan should also set up a pain department. "

Academician Han Jisheng also mentioned this point in his speech at the conference celebrating the 10th anniversary of the establishment of Japanese Department of Pain-"The 16 World Pain Conference held in in 2016 made a special report on China for the first time. It is worth mentioning that Professor Fan Bifa was invited to make a report to the Japanese Parliament during his participation in Japan, introducing the development status and further development trend of pain medicine in China, which attracted the attention of Japanese pain academic and political circles and clearly expressed his hope to learn from China's experience. "

As an ancient and young discipline, pain research has been developed in China for more than 30 years, but it still faces many challenges. Fan Bifa mentioned that in terms of scientific research, especially the original scientific and technological research with great influence, the pain discipline in China has not achieved much so far.

In terms of personnel training, pain, as a basic subject, has not been included in the general medical education in many universities. Especially in the training of specialists, it is necessary to improve the medical education system and establish a national training system for pain specialists.

There is also pain health education for the general public, so that ordinary people can obtain correct pain knowledge and improve their health awareness.

"We still have a lot of things to do. The more things we do, the more energetic we are. " Fan Bifa said: "We don't have to worry, just develop bit by bit. Academician Han Jisheng, the originator of pain department, often said that relieving pain for the people is an endless road. "

References:

1. Han Jisheng. China has a pain department-a speech at the celebration of the tenth anniversary of the establishment of the pain department.

2. Fan Bifa. Building Pain Department, Leaping Forward, Emerging Subject, Promising —— Written on the occasion of the 7th anniversary of building Pain Department.

3. Beletsk. Current situation of pain department construction in Beijing.

4. Fan Bifa. Yesterday, Today and Tomorrow of Pain Medicine

5. Life Times: "Doctor of Pain" Fan Bifa: I have suffered, but there is no need to endure the pain.

6. Chen Jinsheng Gao Chongrong. On the construction and development of pain department.