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Video: The Main Thing Is That The Patient Knows: He Did Not Deserve This Pain
The main thing is that the patient knows: he did not deserve this pain
Over the past two years, the authorities have issued a record number of documents facilitating the prescription of narcotic analgesics. And now, as the Ministry of Health assures, there are no difficulties in obtaining painkillers. In fact, if the breakthrough of pain occurs "unplanned", there is a wall between the patient and the life-saving ampoule of morphine. The problems of non-cancer patients suffering from pain are not solved at all.
Over the past two years, the authorities have issued a record number of documents facilitating the prescription of narcotic analgesics. And now, as the Ministry of Health assures, there are no difficulties in obtaining painkillers. In fact, if a pain breakthrough happens "unplanned", and even worse - on a weekend, there is a wall between the patient and the life-saving ampoule of morphine. The problems of non-cancer patients suffering from severe pain are not solved at all.
“Yesterday was hell. All attempts to get help ended in nothing … We manage with burdens, baralgin, sedatives, which we constantly pin up. Maybe we are doing something wrong. But in our glorious city for almost two days, we did not find medical assistance. Only an ambulance with baralgin”, - this was written on her Facebook page by film director Lyubov Arkus, whose mother, who was in the terminal stage of illness, began to experience terrible pains from Saturday evening. And such stories, unfortunately, are not uncommon.
About why, despite all the efforts of recent years, such stories still happen and how to avoid them, MedNovosti talks with Olga Goldman, director of the Yasnoye Ustro charitable cancer service
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Clumsy system
Olga Emilievna, it turns out that all the assurances of officials that the problem of the availability of pain relief has been resolved is an empty phrase?
- No, it’s not. You see, formally everything that was required has already been done: all the necessary laws have been adopted, orders have been issued. The validity of the prescription for a narcotic drug has been extended from five days to 15, and any local doctor can prescribe it. The dosage of drugs has been doubled. Upon discharge from the hospital, the doctor may give a patient with chronic pain a supply of painkillers for five days. The ambulance received the right to use drugs to relieve pain in palliative patients. And palliative care itself is developing very quickly.
But in fact it doesn't work
- The problem is that our routing system in medicine is very lame. The patient finds himself face to face with these problems - he has to rush around the Internet, through funds, to look for information that he should receive in his clinic at the place of residence. When a loved one leaves, this is the hardest thing that can be. And if this is still accompanied by hellish pain, relatives are often in a state of shock and cannot act adequately. Therefore, the attending physician must go half a step ahead: not wait until the situation becomes critical, but warn relatives that such a development of events is possible, and everything must be foreseen in advance.
At a minimum, a patient in the terminal stage should be registered with a palliative service and his relatives should be informed about the opportunities that are available in their city. What opportunities this family will take advantage of, whether it is paid or free, is no longer important. But the system must work in such a way that the initiative comes from the attending physician and before the crisis develops. And to establish such a system is the task of health care organizers in each region.
The rescue of drowning people is the work of the drowning themselves
It seems that it will take a very long time to wait until it is adjusted
- Of course, sluggishness, slowness, which is inherent in any government organization, is not good for a person with pain. Therefore, you need to understand what the risks are and try to minimize them. Of course, it is impossible to spread straw everywhere, but this is still not an emergency situation when you need to work in an emergency mode. For example, now a prescription for pain relief can be obtained within half an hour, but only if this is not the first time you receive this prescription, when you have to fill out the documentation and complete other formalities. And even more so, not on the weekend. Therefore, if a person becomes worse, it is necessary, without waiting for the development of pain syndrome, to register, to attach to a hospice or mobile palliative service.
Many people are not ready to send their loved ones to hospice
- Unfortunately, there are many prejudices associated with hospice care. Often people think that if they send their relative to hospice, they will betray him. But a hospice is just a medical institution where the patient is given a dose of pain reliever, his relatives are taught to care, that is, his quality of life is improved. And from where you can always take him home. But it is still important to face the truth and understand that if you reach the end, it will be very painful for everyone.
Is it possible to avoid the breakthrough of pain altogether?
Breakthrough of pain (increased pain syndrome) does not occur spontaneously, but when there is already chronic persistent pain. When a person takes various types of pain medications, but at some point they are no longer enough. And this means that you need to change the dose or form of the medicine, for example, switch from injections to plasters or vice versa. The problem is that if a person constantly suffers pain, it is more difficult to remove it: his body, his brain gets used to this painful background, changes begin to occur in the brain. Therefore, it is so important that the patient does not experience pain. The physician must assess how severe the pain syndrome is and decide on pain relief - this is a medical decision.
“We do not have a culture of trust in the patient”
It is not only cancer patients that experience severe, persistent pain
- This is a very big problem. There are a lot of such patients, in addition, in Russia there are a huge number of problems with bedridden patients that can never be cured. And unlike cancer patients who face this at the end of their lives, they may need palliative care for many years. For non-cancer patients who have been living on painkillers for years, it is very important to choose the right medicine so that the quality of life does not suffer, but at the same time so that there are no side effects and addiction. This is a separate, very highly specialized issue.
According to world statistics, 80% of people who use palliative care are not cancer patients. We have a system for helping people with chronic pain, if it is not oncological, is practically absent. Russian hospices now serve only cancer patients. But in some places there are geriatric centers, palliative departments, the so-called social beds in hospitals. And relatives should also be informed about this, for whom it is very difficult in such a situation.
How can such patients get powerful pain relievers?
- According to the law, any patient with pain syndrome can receive painkillers - if necessary, he should be prescribed a drug, regardless of the diagnosis and whether he is being treated in a hospital, or at home or in a hospice. to your local doctor, who should monitor this pain. Unfortunately, we lack a culture of patient trust. But, nevertheless, if a person is dismissed, stating, "you do not hurt", you should not stop, you must insist on your own.
The doctor should measure this pain on a scale, make an entry in the medical record, and if the condition worsens, send the patient to a pain office, which should be available at the place of residence. Pain specialists must be able to manage pain and adjust pain relief for each disease and patient. And these will not necessarily be drugs, perhaps even a combination of drugs with some kind of procedures.
The most important thing is for the patient to know: pain cannot be tolerated, he did not deserve this pain, it is just a disease. It is impossible to allow a breakthrough of pain, so you need to take the pain relievers prescribed for him on time and clearly.
And if a person is still in a critical situation, where to go?
- In no case should you leave him unopened. To solve problems associated with obtaining medicines, there is an anesthesia hotline in Roszdravnadzor. 8 (800) 500-18-35. Roszdravnadzor works very effectively - in half an hour they can solve the issue of pain relief in another region. The problem is that during working hours consultants pick up the phone there, and outside of working hours you can only leave information on the answering machine (although this option should not be neglected).
Hot lines are open around the clock only in NGOs. The telephone number of the helpline for help for terminally ill people of the Vera Hospice Fund is 8 (800) 700-84-36. The hotline telephone of our Service "Clear Morning": 8 (800) 100-01-91.
And, finally, do not hesitate to call the ambulance - according to the law, its employees are obliged to provide the palliative patient with pain relief in case of pain breakthrough in order to “hold out” him until the time when it will be possible to go to the clinic and get a prescription.
