Over the past two years authorities have released a record number of documents, simplifying the discharge of narcotic analgesics. And now, as assure of the Ministry of health, difficulties with receiving painkillers not. In fact, if breakthrough pain can sometimes be “unplanned”, and even worse on weekends, between patients and life-saving vial of morphine is wall. Problems suffering from severe pain of non-oncological patients are not solved at all.
“Yesterday was hell. All attempts to get help ended in nothing… We don noshpu, baralgin, sedatives, constantly teasing. Maybe we are doing something wrong. But in our glorious city for almost two days of medical care we have found. Only soon with the baralgin”, — it wrote on its Facebook page filmmaker Lyubov Arkus, whose are in the terminal phase of illness, the mother began to experience terrible pains on Saturday evening. And these stories, unfortunately, are not uncommon.
On why, despite all the efforts of recent years, continue to occur with such stories and how to avoid them, Mednovosti talk with the Director of charitable Services to cancer patients “Clear morning” Olga Goldman.
Olga Goldman. Photo: svoboda.org
Olga emilevna, it appears that all the assurances of officials that the problem of availability of pain relief has been resolved — an empty phrase?
— No, it is not. See, technically all that was required is already done: taken all the necessary laws, issued orders. The validity of a prescription for a narcotic drug is extended from five days to 15, to write it can any local doctor. Dose of delivery of drugs doubled. At discharge from the hospital doctor can issue the patient with chronic pain supply of painkillers for five days. “Ambulance” has the right to use drugs to relieve pain in palliative patients. And she is palliative care included in the MHI and is developing very fast.
But it is not working.
The problem is that we have a very very lame the routing system within the medicine. The patient is left alone with these problems — he has to rush to the Internet, for the funds to seek out information that needs to obtain in his clinic in the residence. When you lose a loved one, this is the most difficult that can be. And if it is also accompanied by a hellish pain, the relatives are often in a state of shock and unable to act adequately. So your doctor needs to go half a step ahead: do not wait until the situation becomes critical, and to warn relatives about what development is possible, and everything must be foreseen.
As a minimum, a patient in the terminal stage should be put on record in palliative service and to inform his relatives about the opportunities that exist in their city. What opportunities will take advantage of this family, is it free or paid — this is not essential. But the system should work so that the initiative came from the attending physician and to the development of the crisis. But to establish such a system — the task of health care managers in each region.
The rescue of drowning the handiwork of drowning
Wait until it will adjust come, it seems, a very long time.
— Of course, clumsiness, slowness, which is inherent in any government organization, not for the benefit of the person with pain. So you need to understand what are the risks and trying to minimize them. Of course, everywhere straw podstelit impossible, but it’s still not an emergency when it is necessary to work in emergency mode. For example, now a prescription for pain relief you can obtain for half an hour, but only if you get this the recipe is not the first time it is necessary to complete the documentation and fulfill other formalities. And especially not on the weekend. Therefore, if a person is getting worse, we must not wait for the development of pain, to register, to attach to the hospice or palliative mobile service.
Many people are not ready to give to your loved ones in the hospice.
— Unfortunately, there are many prejudices associated with hospice care. Often people think that if you give your family member in hospice, you will be betraying him. But hospice is the only medical institution where the patient to select the dose of anesthetic, taught his relatives care, that is, increase the quality of life. And where it can always be taken home. But it is important still to look truth in the eye and understand that if you endure to the end, it will be very painful for everyone.
And you can do to avoid breakthrough pain?
Breakthrough pain (increased pain syndrome) happens not spontaneously, but when there is chronic constant pain. When a person takes pain medication different type, but at some point they no longer enough. And so, we need to change the dose or form of medication, for example, to switch from injections to the patch or Vice versa. The problem is that if a person is constantly in pain, to take her harder, his body, his brain gets used to this painful background, things start to change already in the brain. Therefore, it is important that the patient did not experience pain. The doctor needs to assess how serious pain and make the decision to anesthesia is a medical decision.
“We have no culture of trust the patient”
A strong continuous pain is experienced not only cancer patients.
Is a very big problem. These patients very much, in addition, in Russia a huge number of problems with immobile patients, which can not be cured ever. And unlike cancer patients, who face this at the end of life, they may need palliative care for many years. For non-cancer patients who live for years on painkillers, it is important to find a cure, so that not hurt the quality of life, but at the same time to avoid any side effects habituation. Is a very specialized question.
According to world statistics, 80% of people who use palliative help, it’s not cancer patients. We have a system of helping people with chronic pain, if it is not cancer, is virtually absent. Russian hospices now serve only cancer patients. But in some places there are geriatric centers, palliative care Department, the so-called social beds in hospitals. It is also important to inform relatives, which is very difficult in such a situation.
And how such patients can obtain potent pain-killers ?
— According to the law to take painkillers any patient with pain syndrome — if necessary he should prescribe the drug regardless of the diagnosis and undergoing treatment in hospital, either at home or in a hospice.The first thing to do is to tell about the pain the local doctor, who have for this pain to watch. Sorry, we have no culture of trust the patient. But, nevertheless, if the man shrugs, saying, “doesn’t hurt”, do not stop, we must insist on.
Fractalian to measure the pain on a scale, to make entry in medical records, and the degradation to direct the patient into the office in pain, which needs to be established in each district hospital. Experts in pain syndromes need to be able to stop pain and choose the pain management for each disease and for each patient. And it’s not necessarily drugs, maybe even a combination of medication with some procedures.
Most importantly, the patient knew the pain can not be tolerated, he didn’t deserve this pain, it’s just a disease. To prevent breakthrough pain is impossible, so you need time and clearly take prescribed him pain medication.
And if people still got into a critical situation where to turn?
— Leave it unanesthetized in any case impossible. To solve problems associated with obtaining medication, there is a hot line of pain management in healthcare. 8 (800) 500-18-35. The Ministry works very efficiently for half an hour there can solve the issue with anesthesia in another region. The problem is that during working hours there pick up the phone consultants and outside office hours you can only leave information on the answering machine (although this opportunity need not be neglected).
Working around the clock hotlines only in NGOs. Telephone helpline for terminally ill people hospice charity Fund “Vera”: 8(800) 700-84-36. The telephone hotline of our Service, “bright morning”: 8(800) 100-01-91.
And finally, don’t hesitate to call an Ambulance — by law, its employees are required at the break to provide palliative pain patient’s pain to “snap” it to the time when you can go to the clinic and get a prescription.
Reminder pain therapy