The old saying goes that suffering ennobles. A patient who struggles with chronic pain will not agree with this statement. But the doctor is. Many of them are unwilling or unable to prescribe medications to alleviate unbearable ailments. The latest report of the Supreme Chamber of Control only confirms the terrible situation of Polish patients. The collected data show that one in five of us struggles with chronic pain and does not receive adequate help. Where does such anesthesia for the suffering of another person come from and what can be done to change the situation of patients who are refused palliative treatment?
Contrary to popular belief, chronic pain does not only affect people who fight cancer. Very severe pains accompany rheumatic diseases and sometimes remain after shingles treatment. It is these patients that pain medicine and palliative medicine should serve. Its primary goal is to care and treat a person suffering from chronic pain, a progressive and life-threatening disease, and the sick at the end of life. Palliative medicine teaches a holistic approach to patients and what to do to improve their quality of life.
Redundant tools?
While disease does not have to be synonymous with pain, the vast majority of physicians do not recognize it. – Pain and suffering must not be neglected by medical workers, especially doctors, nurses, physiotherapists, etc. Suffering, like any other symptom (dyspnea, constipation, edema, etc.) should be alleviated or eliminated by effective, safe and modern control methods pharmacological and non-pharmacological. Regardless of the patient’s age and disease. Chronic pain is unnecessary suffering and is a scandal if it is ignored – says Jadwiga Pyszkowska, MD, PhD, specialist in palliative medicine, provincial consultant in the field of palliative medicine.
So why, despite resources and possibilities, does the problem of chronic pain persist? The shortcomings start from the very beginning. In medical studies, pain management is neglected or completely ignored. There are also fears – including the patients themselves – of using opioids. A patient who reads in the leaflet that he is dealing with a narcotic drug is afraid to take it, fearing that he will become addicted. They don’t know that properly selected drugs and the right doses are the best and safest way to fight pain. With this method of treatment, there is no question of addiction and complications that arise with the use of non-steroidal anti-inflammatory drugs.
– The doctor is not a dealer. The doctor prescribes medications. Agents such as tramadol, dihydrocodeine, morphine, oxycodone, pentanthyl, buprenorphine, methadone – these are world-class painkillers, available in pharmacies in Poland, not all of them are reimbursed and not for every suffering patient. There is no reason to treat pain ineffectively or ignore suffering in a patient reporting chronic pain – adds the specialist.
Check what medications doctors prescribe for moderate to severe pain
But doctors are afraid of not only painkillers. Rarely will patients know that medications are just one option in the fight against chronic pain. – Pain neuromodulation uses magnetostimulation, laser stimulation, acupuncture, physical therapy, everything that helps relieve pain. But the most effective way to deal with chronic pain is to combine the two. Such therapy brings the best results – emphasizes the expert.
You have the right to
The World Health Organization has dealt with chronic pain a long time ago and has recommended for 30 years to follow certain rules (the so-called Analgesic Ladder), but in Poland they are ignored. The record prepared by WHO guarantees and the right to every patient to receive medications that will alleviate his ailments and help him – despite his illness – return to a relatively normal life. – On this basis, each patient who has been refused treatment and has not been given medication may and even has to assert his rights. Unfortunately, many patients either do not know about it or do not want to break into the orchards – says Dr. Pyszkowska.
Few people know that chronic pain medications should be offered and prescribed by their primary care physician. Unfortunately, this is not the case and patients are forced to seek help in specialized centers. We keep forgetting that such an approach to pain treatment that is in force in Poland serves no purpose and only generates additional costs. – A successfully treated patient may even return to work, he does not feel unnecessary, and this helps a lot to get patients on their feet and helps them fight the disease. Opioids are drugs that are administered orally, not intravenously, and the painkiller they contain is gradually released. Their use is much cheaper than condemning the patient to torment and constantly lying in bed – he adds.
But the problem isn’t just getting a prescription. Receiving it does not guarantee that the drug will be available for purchase at a pharmacy without major problems. – Many pharmacists still look askance at patients who come with opioid prescriptions. Many patients return to my office because the pharmacist has stated that the record is incorrect. Although these stigmatizing pink recipes have disappeared, the implementation is still difficult. Patients are perceived as drug addicts, and the prescription is viewed from all sides, because there is definitely something wrong with it – adds Dr. Pyszkowska.
Tilting at windmills?
It is not only Poles who have problems with access to strong painkillers. Patients from less developed countries face similar problems. Even though the situation in Poland has changed a lot over the course of several decades, there is still much to be done. Where to start? Education is the absolute basis.
– Weaving in the nineteenth century model of teaching does not bring anything good. The knowledge that is passed on to future doctors is usually limited to what to do to properly perform a given procedure or surgery and what to do to avoid complications, which is definitely not enough, because the treatment does not end in the operating room. Very often, these patients also need care after leaving the hospital – emphasizes the specialist. But modifying the education system is not enough. Changes in drug reimbursement are necessary. Access to them should be granted to everyone in need, regardless of the type of disease and health condition. It is absurd that a painkiller is reimbursed in the case of cancer, and not in the case of problems with joints. – The actual accounting for the work of doctors also requires changes. Effectiveness should be important, not the mere presence at work – says Dr. Pyszkowska.
Split in the group
Strange as it may seem, the pain – at least not for all – of doctors is a symptom that does not require their intervention. Those who decide to fight it and give the patient a strong painkiller are perceived poorly. They face harassment, some also lose their jobs because they try to relieve the sick.
Although we have something to treat the sick, in Poland, the issue of medical marijuana returns from time to time. Although the direction is right, according to Dr. Pyszkowska, local doctors should learn the basics of pain treatment and learn to help the sick, and only then reach for top-shelf drugs. The key is to understand that there is nothing noble about pain. Suffering only takes away joy and the will to live. And it does not have to be this way, because the means of fighting it are at hand.