Pain Diagnosis and Treatment Department

The hospital established a pain clinic in 1992; in December 2006, the pain clinic became the first independent Department of Pain Medicine in the peninsula region; on March 19, 2013, it was relocated from the Jiangsu Road headquarters to the West Coast campus. The ward currently has 34 open beds. The Department of Pain Medicine has 20 medical and nursing staff, including 1 chief physician, 3 associate chief physicians and 4 in-service doctoral candidates. The department mainly treats various chronic pain patients using comprehensive methods such as multiple minimally invasive techniques.

The department has an expert outpatient clinic and a sterile treatment room at the Jiangsu Road headquarters, and an expert outpatient clinic and comfortable wards at the West Coast campus. Inpatient treatment is dominated by minimally invasive methods supplemented by non-invasive ones. Minimally invasive treatment is the main trend of international medical development; it has the advantages of small trauma, good effect, repeatability, few complications and high safety, costs less than traditional surgery, and greatly reduces the economic burden on patients and society. The department is Asia's first Sino-German international transforaminal endoscopy training center, the clinical demonstration hospital of the Pain Branch of the Chinese Medical Association — Transforaminal Endoscopy Technique Training Center, and a Shandong Province demonstration ward for standardized cancer pain treatment, with high visibility and influence in the domestic and provincial pain specialty.

The department has first-class modern minimally invasive treatment equipment: transforaminal endoscopes (2 sets) and DISC-FX high-frequency surgical system, Nd:YAG laser emitter, Smith & Nephew (USA) disc electrothermal treatment system, plasma ablation system, radiofrequency therapeutic device, ozone generator, silver needle heat-conduction therapy device, internal heat needle therapy device, transcutaneous electrical nerve stimulation analgesia device (TENS), super laser therapy system, ultrasound-guided drug thermotherapy system, pain workstation, etc.

The clinical scope of the department includes:

1. Neck, shoulder, low back and leg pain: lumbar disc herniation, lumbar spinal stenosis, cervical spondylosis, frozen shoulder (scapulohumeral periarthritis), tennis elbow, third lumbar transverse process syndrome, osteoarthritic pain, etc.;

2. Neuropathic pain: postherpetic neuralgia, primary trigeminal neuralgia, glossopharyngeal neuralgia, occipital neuralgia, phantom limb pain, etc.; atypical facial pain;

3. Chronic soft tissue pain and immune/metabolic system pain: myofasciitis and myofascial syndromes, ankylosing spondylitis, rheumatoid arthritis, gout, primary osteoporotic pain, etc., with minimally invasive and comprehensive treatment;

4. Vascular and neurogenic pain: migraine, tension headache, cluster headache, vascular headache, Raynaud's syndrome, erythromelalgia, functional abdominal pain, etc.;

5. Advanced tumor pain: various advanced cancer pain and related pain, relieving patient suffering and improving quality of life;

6. Other non-painful diseases: hemifacial spasm, facial nerve paralysis, intractable hiccups, cervicogenic dizziness and limb numbness of cervical or lumbar origin, etc.;

7. Painless (anesthesia) clinic services, including anesthesia and analgesia for day surgery such as painless abortion and diagnostic curettage, painless gastrointestinal endoscopy, etc.

Four featured treatments of the Department of Pain Medicine ——

I. Introduction to transforaminal endoscopic treatment of lumbar disc herniation

Patients with lumbar disc herniation often suffer from low back and leg pain and numbness, cannot sit or stand for long, and have symptoms aggravated by walking, seriously affecting work and quality of life. Transforaminal endoscopic treatment of lumbar disc herniation is a minimally invasive technique that has gradually developed and matured over the past 10 years and is the ideal minimally invasive technique for treating lumbar disc herniation. Its principle is to place an endoscopic system equipped with lighting, imaging and a working channel via the patient's lateral or posterolateral side through the intervertebral foramen to the protruded disc site. Under direct endoscopic vision, the protruded nucleus pulposus, compressed nerve root, dural sac and hyperplastic bone tissue can be clearly seen. Then, using various grasping forceps through the working channel, the protruded nucleus pulposus is removed, part of the hyperplastic superior articular process bone is resected, part of the thickened ligamentum flavum is excised, and the narrowed nerve root canal is enlarged, directly relieving nerve root compression; at the same time, the lesion site can be continuously irrigated for anti-inflammatory purposes, and radiofrequency electrodes are used to repair the annulus fibrosus, ablate neuro-sensitized tissue and block the ramus of the sinuvertebral nerve, relieving the patient's soft tissue pain. It features targeting, visualization, refinement and minimal invasiveness; patients can usually get out of bed early after surgery, return to normal life and work earlier than patients undergoing open surgery, with lower overall cost and lower fees than traditional open surgery. Indications: 1. lumbar disc herniation with a clear diagnosis that has failed formal non-surgical treatment; 2. recurrent cases with severe symptoms; 3. lumbar disc protrusion, extrusion and free fragments in the spinal canal; 4. central lumbar disc herniation with cauda equina compression injury; 5. lumbar disc herniation combined with lateral recess stenosis, localized spinal canal stenosis, etc. The indications are gradually expanding as the technique continues to improve.

II. Radiofrequency minimally invasive treatment technology

Radiofrequency emits high-frequency RF current through a magnetic field, causing molecular motion and friction in the target tissue covered by the needle tip; the resulting combined effect has a good therapeutic effect on damaged tissue, inflamed and edematous nerves, and inflammatory reactions within the spinal canal. It is one of the internationally recognized safe, fast-acting, low-suffering and low-risk minimally invasive pain treatment methods. It can be used for: 1. Radiofrequency of the dorsal ramus of spinal nerves, treating intractable pain in the corresponding innervated areas such as intractable low back pain. 2. Radiofrequency of sympathetic ganglia, treating pulsating vascular pain of the head, arm, hand, chest and abdominal wall, perineum or lower limbs, cyanotic ischemic pain, burning sympathetic pain, etc. 3. Radiofrequency of the spinal dorsal root ganglion for intractable pain or cancer pain of the head, occiput, neck, hand, chest and lower limbs, such as postherpetic neuralgia. 4. Peripheral nerve radiofrequency for severe pain in areas innervated by individual nerves, such as trigeminal neuralgia. 5. Radiofrequency thermocoagulation decompression of intervertebral discs for discogenic low back pain, neck and shoulder pain, cervicogenic headache, arm pain and lumbago-leg pain. 6. Radiofrequency for myofascial contracture, treating myofascial pain syndrome or nerve entrapment pain, etc.

III. Silver needle heat-conduction therapy for chronic intractable soft tissue pain

Silver needle acupuncture is suitable for intractable soft tissue pain that responds poorly to ordinary physical therapy and medication and would otherwise require surgical release; dense silver needle acupuncture achieves significant efficacy. In a sense, silver needle therapy appears to be traditional Chinese needle practice but is in fact a release surgery. It is suitable for: 1. chronic pain caused by soft tissue damage outside the cervical or lumbar spinal canal: neck, shoulder and upper limb pain; low back, buttock and leg pain; frozen shoulder; knee pain and heel pain, etc.; 2. clinical syndromes involving blood vessels and nerves associated with soft tissue damage. The Department of Pain Medicine took the lead in introducing this technique in the peninsula region in 2006, and has so far cured nearly 3,000 patients with intractable soft tissue pain.

IV. Comprehensive treatment of tumor pain

Tumors often cause severe pain, sometimes not even relieved by analgesics; patients are in extreme distress, diet and sleep are seriously affected, a series of adverse outcomes ensue, and treatment is often difficult. The department uses comprehensive methods dominated by minimally invasive treatment to block or interrupt pain conduction, relieve patient suffering, improve quality of life and reduce family burden. Common methods include: 1. peripheral and spinal nerve block or neurolytic techniques; 2. implantation of subcutaneous, intravenous, epidural or intrathecal analgesic pumps; 3. pulsed radiofrequency neuromodulation or radiofrequency thermocoagulation neurolysis; 4. three-step pharmacological therapy supplemented by symptomatic treatment, as comprehensive treatment. The department has won the honorary title of “Shandong Province Demonstration Ward for Standardized Cancer Pain Treatment”, becoming among the first batch of standardized cancer pain demonstration wards of the pain specialty in Shandong Province.

The department has 2 master's supervisors; members of the Chinese Medical Association; members of the Pain Committee of the Chinese Medical Doctor Association; vice-chairman of the Pain Branch of the Shandong Medical Association; member of the Pain Committee of the Shandong Association of Chinese Medicine; vice-chairman of the Pain Physicians Branch of the Shandong Medical Doctor Association; and chairman and vice-chairmen of the Pain Specialty Branch of the Qingdao Medical Association. In research, the department has won provincial projects from the Shandong Provincial Science and Technology Department and project approval from the Qingdao Municipal Science and Technology Bureau, published dozens of academic papers in international and national journals, and edited or co-edited more than ten monographs. “New progress in the diagnosis and treatment of chronic soft tissue pain” and transforaminal endoscopic techniques have been approved as national and provincial continuing medical education projects.