Pain Rehabilitation: A Strategic Pathway for Private Rehabilitation Hospitals to Achieve Rapid Growth
A thought-provoking reality is that many patients have never heard of the Pain Rehabilitation Department, and some are even unaware of the Pain Management Department!
Pain Rehabilitation Is a New Discipline,It is an interdisciplinary field bridging rehabilitation medicine and pain management, primarily addressing pain issues in outpatient pain clinics and during the rehabilitation process.。
Bi Sheng, Chairman of the Pain Rehabilitation Professional Committee of the Chinese Association of Rehabilitation Medicine, once pointed out in an article that modern rehabilitation medicine has been introduced to China for nearly four decades. It has gradually transitioned from a supplementary department primarily focused on physical therapy to a clinical discipline. Currently, the sub-specialty framework of rehabilitation medicine is beginning to take shape, and chronic pain is increasingly becoming a key focus in clinical rehabilitation practice.
In light of this, the Pain Rehabilitation Professional Committee of the Chinese Association of Rehabilitation Medicine was established in December 2017. At the inaugural meeting, Bi Sheng put forward the view that “Chinese rehabilitation medicine needs to make up for deficiencies in pain rehabilitation.”
In China, the majority of patients with musculoskeletal pain initially seek care in orthopedic departments. However, only a small fraction of these patients require surgical intervention, while most receive pharmacological treatment. One contributing factor to this pattern is that many rehabilitation physicians lack the expertise and diagnostic tools necessary to accurately diagnose and manage chronic musculoskeletal pain. Consequently, even when patients consult these specialists, their conditions often remain inadequately addressed, leaving a significant number of individuals with musculoskeletal pain without access to effective medical care.
Even among pain patients who seek care in rehabilitation departments, the treatments they receive are primarily traditional rehabilitation medicine interventions, dominated by physical therapy. Traditional rehabilitation approaches to chronic pain rely mainly on physical modalities and have limited efficacy for refractory and difficult-to-treat chronic pain, lacking therapies that provide immediate relief. This poses a significant challenge for rehabilitation physicians.
However, unexpectedly,To address this challenge, many private rehabilitation hospitals have established specialized pain rehabilitation departments and designated them as a new key strategic direction.。In actual development, its growth rate has surpassed that of neurological rehabilitation and orthopedic rehabilitation.. Growing evidence now suggests that pain rehabilitation will become a powerful tool driving the rapid development of private rehabilitation hospitals in the future.
Patients in the Pain Management Department are those who have been plagued by various types of pain for many years, having visited multiple hospitals only to be “sent back” due to unsatisfactory treatment outcomes.
In 2007, the former Ministry of Health issued a document to add “Pain Medicine” as a first-level clinical specialty in the Catalogue of Clinical Specialties for Medical Institutions. In accordance with the spirit of the document, hospitals at Level II and above in China may establish Pain Medicine departments to provide diagnostic and therapeutic services primarily focused on the diagnosis and treatment of chronic pain.
Acute pain is mostly a concomitant symptom of certain diseases or injuries, whereas chronic pain, especially neuropathic pain, is itself a disease.
In real life, there has been a significant misconception about pain in the past, with people mistakenly believing that "pain is a symptom, not a disease, and it will naturally subside once the underlying condition is cured."
In fact, most chronic pain is not merely a symptom but a disease in its own right; for example, primary trigeminal neuralgia presents with no manifestations other than pain.. It is a typical pain disorder; resolving the pain effectively cures the disease. Similarly, postherpetic neuralgia is also a pain disorder. Due to its severe and refractory nature, some patients suffer from persistent pain for decades, and suicide cases among these patients occur from time to time.
The distinction between symptoms and diseases is relative; when a chronic clinical symptom poses a long-term and severe threat to a patient’s life and work, it should be recognized as a disease. In China, the incidence of chronic pain is higher than that of malignant tumors, hypertension, and diabetes.
However, for a considerable period in the past, the diagnosis and treatment of chronic pain were equated with those of acute pain and dispersed across various clinical specialties, including neurology, neurosurgery, orthopedics, oncology, rehabilitation medicine, and rheumatology and immunology. These specialties merely provided routine diagnosis and treatment for pain and pain-related disorders from their respective perspectives, leaving many patients with intractable pain without timely and appropriate care, thereby causing significant suffering.
Statistics indicate that approximately 30% of patients with chronic pain have no identifiable etiology, making treatment even more challenging. To achieve favorable therapeutic outcomes in managing such chronic pain, it is essential to rely on specialized theoretical frameworks for assessment and professional skills for intervention.
Bi Sheng, Chairman of the Pain Rehabilitation Professional Committee of the Chinese Association of Rehabilitation Medicine, told VCBeat that most hospitals now have a rehabilitation department, and some have a pain management department. These two departments separately address patients’ rehabilitation needs and pain issues. Some hospitals also have combined departments known as Pain Rehabilitation or Rehabilitation and Pain Management. The establishment of the Pain Rehabilitation Professional Committee of the Chinese Association of Rehabilitation Medicine aims to conduct research in the field of pain rehabilitation, primarily addressing the following issues:
The development of the rehabilitation sector in China has been relatively slow. The rehabilitation capabilities of most hospital rehabilitation departments remain inadequate, and many pain-related issues arising during the rehabilitation process are still unresolved; pain rehabilitation is one such area.
The Department of Pain Rehabilitation currently focuses on addressing two main areas:
The first aspect is the treatment of pain-related conditions in the pain clinic, such as neck, shoulder, lower back, and leg pain, trigeminal neuralgia, and peripheral neuropathic pain.
The second aspect is pain management during the rehabilitation process, particularly among inpatients.. For instance, shoulder pain in hemiplegia, phantom limb pain after amputation, central post-stroke pain, and neuropathic pain following spinal cord injury. In the past, rehabilitation departments could alleviate some of these pain conditions through physical therapy. However, refractory pain often responded poorly to such interventions and required management by pain specialists using techniques such as radiofrequency ablation and nerve blocks.
The reason why pain issues were not well managed during the rehabilitation process,The primary reason is that physicians lack sufficient capacity to address patients' needs.。
Pain specialists in China are primarily recruited from anesthesiologists. While anesthesiology boasts strong technical expertise, anesthesiologists often lack comprehensive management strategies for pain disorders and have insufficient knowledge of rehabilitation. Consequently, they tend to address purely neuropathic pain conditions mainly through nerve blocks.. For pain during the rehabilitation process, the Pain Management Department also lacks effective solutions.
Therefore, at the inaugural annual conference of the Pain Rehabilitation Specialty Committee in 2018, Professor Bi Sheng proposed the concept that “pain management should learn from rehabilitation in terms of philosophy, while rehabilitation should learn from pain management in terms of techniques.” Currently, the Pain Rehabilitation Specialty Committee has more than 90 members, including over 60 physicians from rehabilitation departments and more than 30 anesthesiologists. The committee aims to foster mutual learning between rehabilitation specialists and anesthesiologists.
"From the current development perspective, pain rehabilitation in public hospitals is generally relatively weak."The Pain Rehabilitation Specialty Committee primarily assists the Department of Pain Rehabilitation and the Department of Rehabilitation in mastering the competencies required to diagnose and manage pain conditions.。
Pain rehabilitation departments have yet to be fully implemented in public hospitals, but they are highly popular in private rehabilitation hospitals.
Shen Minhai, President of Fujian Longyan Ci’ai Hospital, told VCBeat that the hospital initially built its foundation on neurological rehabilitation and has since evolved into a specialized rehabilitation hospital distinguished by its expertise in neurological, geriatric, and pediatric rehabilitation.
The hospital’s Pain Rehabilitation specialty has been under development for three years. As the Pain Department matures, its late-mover advantages have become increasingly pronounced, with a growth rate significantly faster than that of the hospital’s previously established leading disciplines.。In the adult rehabilitation sector, patients receiving pain rehabilitation account for 10% of the hospital’s total patient volume.
Shen Minhai shared his perspective on the vigorous development of specialized pain rehabilitation services:
Although the government has issued policies encouraging hospitals at Level II and above to establish pain management departments, most large and medium-sized public general hospitals do not prioritize this specialty. Only a subset of public hospitals offers outpatient pain clinics, but without inpatient beds. Physicians in these units are predominantly anesthesiologists serving in dual roles; given their already heavy anesthesia workload, the energy and attention they can devote to pain management are significantly compromised.
Insufficient attention paid by public hospitals has created opportunities for private hospitals to address pain rehabilitation needs.
Moreover, there are differences between the services provided by the pain rehabilitation department of rehabilitation hospitals and the pain outpatient clinics of general hospitals.Pain clinics typically focus solely on alleviating patients’ pain, whereas the Department of Pain Rehabilitation in rehabilitation hospitals not only addresses pain but also manages pain-related functional impairments, such as muscle atrophy, psychological issues, and neurological disorders, thereby providing patients with comprehensive, full-cycle pain rehabilitation treatment.。
Such services are difficult to obtain in public hospitals, as multidisciplinary consultations there are primarily reserved for complex and refractory cases.
It is precisely due to the industry landscape of pain rehabilitation therapy,Private rehabilitation hospitals can readily establish pain management as a specialty department, positioning themselves as regional leaders in the discipline and even achieving academic distinction.。
Additionally,Shen Minhai stated that the rapid development of pain rehabilitation at Longyan Ci’ai Hospital is attributed to the introduction of CT- and ultrasound-guided interventional treatments, such as nerve blocks and radiofrequency ablation, building upon its existing Rehabilitation and Pain Departments. These advanced techniques have effectively addressed refractory pain conditions that were previously difficult to manage within the conventional rehabilitation framework. As clinical capabilities improved, positive word-of-mouth among patients naturally attracted a larger patient base.
On the other hand, with the accelerating arrival of an aging society and changes in work and lifestyle habits—particularly poor postures associated with prolonged computer use, desk-bound work, mobile phone usage, and driving—the incidence of neck, shoulder, lower back, and leg pain has further increased, showing a trend toward affecting younger populations (with some teenagers even developing cervical spondylosis). The main manifestations of neck, shoulder, lower back, and leg pain include headache, neck pain, dizziness, shoulder pain, lower back pain, pain or numbness in the upper or lower limbs, and may even affect eating and sleep, lead to stroke-induced hemiplegia, and severely reduce quality of life.
Globally, 80% of the population has experienced neck, shoulder, lower back, and leg pain, making it the most prevalent condition. Annual global treatment costs exceed $50 billion, significantly impacting health and labor productivity. This vast market will substantially boost the revenue of private rehabilitation hospitals.。
Xiao Ling, General Manager of the Rehabilitation Division at Hejia Co., Ltd., stated that pain, regarded as the “fifth vital sign” following blood pressure, respiration, pulse, and body temperature, is increasingly recognized not merely as a vital sign but also as a disease in its own right. As living standards improve, people are no longer willing to endure the torment of pain.
However, there are many causes of pain. When patients visit public hospitals, they often do not know which department to register with, as pain may be caused by conditions such as orthopedic injuries, tumors, neurological disorders, or rheumatic and immune diseases.
Due to workflow constraints in public hospitals, it is difficult for multiple departments to coordinate care around a single patient. This hinders accurate diagnosis and leads to suboptimal treatment outcomes.
However, private hospitals can readily establish an integrated model of diagnosis and treatment. From the initial diagnostic stage, they adopt a patient-centered approach, conducting multidisciplinary consultations to pinpoint the etiology. During the treatment phase, they can also mobilize human resources to deliver patient-centered care. This advantage is determined by the institutional structure of private hospitals, whereas it is more challenging for public hospitals to achieve.
Additionally,The relative ease of mastering pain rehabilitation techniques is also an advantage for private hospitals in developing specialized pain departments.. The primary rehabilitation approaches for pain management include minimally invasive procedures and physical therapy; hospitals can relatively easily cultivate relevant personnel, with a short training cycle.
In terms of dissemination, Xiao Ling believes that the reputation of pain rehabilitation is easy to accumulate. The evaluation of pain treatment effects is simply whether it hurts or not, and results are relatively easy to achieve, which makes it easy to form a good reputation among patients, benefiting the hospital's brand building.
Therefore, it is easy for private rehabilitation hospitals to achieve noticeable results and economic benefits by developing specialized pain rehabilitation departments.
Bi Sheng pointed out that private hospitals exhibit greater flexibility in managing pain clinics by adopting an integrated approach combining traditional Chinese and Western medicine, with some private rehabilitation hospitals achieving significant development in their pain clinic services.Neck, shoulder, lower back, and leg pain have the highest incidence rate among the general population. Therefore, the market for pain rehabilitation is substantial, although market education remains in its early stages.。
However, the overall rehabilitation standards at private rehabilitation hospitals are somewhat weaker. These institutions must first enhance their physicians’ proficiency in pain management and, based on their specific circumstances, gradually establish “pain-free wards” by screening all patients for pain and striving to address it as effectively as possible.
Moreover, Bi Sheng stated that patients should avoid enduring pain whenever possible. Prolonged tolerance of pain can lead to central sensitization, creating a vicious cycle. Currently, Bi Sheng recommends that rehabilitation hospitals with the capacity should monitor inpatients closely to assess their pain status and address pain management during the rehabilitation process.
Talent is the most critical factor in developing any new field. Bi Sheng stated that cultivating professionals for pain rehabilitation currently presents a significant challenge. Pain rehabilitation departments are primarily staffed by physicians from anesthesiology, pain management, and rehabilitation medicine. However, China already faces a shortage of both anesthesiologists and rehabilitation physicians.
University-level rehabilitation education, particularly at the graduate level, primarily trains therapists, whereas the core personnel in pain rehabilitation departments are physicians. As a subspecialty within rehabilitation medicine, pain rehabilitation is typically pursued by physicians with many years of clinical experience, representing an advanced career path for either rehabilitation physicians or anesthesiologists.
Currently, the training of pain rehabilitation professionals is still conducted through workshops, advanced study programs, and conferences.. Bi Sheng believes that the most critical tool in pain rehabilitation currently is ultrasound-guided injection technology. From the perspective of talent development, the Pain Rehabilitation Committee organizes 4–6 training courses annually, which are divided into introductory and advanced levels to cater to two groups of pain rehabilitation physicians with differing levels of diagnostic and therapeutic expertise.
Mastering ultrasound-guided injections can resolve over 90% of pain-related issues; for the remaining complex cases, it is advisable to refer patients to other hospitals. Bi Sheng emphasized that while ultrasound-guided injections are effective in treating pain, they should not be solely relied upon. Given the multitude of causes underlying pain, it is sometimes necessary to address both the symptoms and the root cause.
Precisely because physicians in the Pain Rehabilitation Department are transferred from other specialties and possess a solid technical background, the training cycle is short, making it easier for them to acquire the necessary skills. This aligns well with the initial development needs of private hospitals, as it requires minimal effort in talent cultivation.
Bi Sheng has pointed out in his articles that, compared to rehabilitation therapists, rehabilitation physicians possess a relatively limited set of core technical skills, among which injection techniques are one. Prior to the advent of musculoskeletal ultrasound, injections were primarily performed via blind puncture guided by palpation, with their accuracy and efficacy largely dependent on the physician’s clinical experience. The primary reason musculoskeletal ultrasound has become a new tool for rehabilitation physicians is its ability to enhance injection accuracy, which is closely correlated with clinical outcomes. Compared with traditional injection methods, ultrasound-guided injections demonstrate significantly improved accuracy.
Because pain rehabilitation physicians need to master fewer core technologies, risk control can be effectively managed through proper personnel training.
Bi Sheng stated that pain rehabilitation interventions fall into two categories. The first is physical therapy, which carries a very low risk; adverse events such as scalds or burns occur only when procedures are performed improperly. The second is injection therapy, which entails certain risks and thus requires physicians to undergo repeated training and practice. Pain rehabilitation specialists must receive rigorous training in this technique and adhere strictly to operational protocols. In cases where confidence is lacking, physicians should refrain from performing the procedure themselves and instead refer patients to experienced experts.
It is precisely for the above reasons that it is relatively easier for private hospitals to establish a team of pain rehabilitation professionals.
VCBeat has learned that while rehabilitation hospitals have been developing rapidly in recent times, few have achieved quick profitability. The development of specialized pain rehabilitation departments may present a significant opportunity for private rehabilitation hospitals to achieve high-quality growth and overtake competitors.