Report from Poltava region: How can palliative patients receive adequate pain relief?

– Woman, 93 years old, bedridden, seriously ill. According to relatives, he suffers from severe pain. Neighbors are already complaining about her constant screams. The doctor does not prescribe effective pain relief, acting adviser. Minister Victoria Loza writes down under dictation the information that came to the "hotline" of the Ministry of Health and "returned" back to Poltava for resolution.

After talking with relatives, the data increases: the family doctor prescribed ... "Ketanov" to an elderly woman with an incurable disease and constant pain. The same one that is sold in pharmacies without a prescription and that is usually prescribed for much milder cases of noticeable but short-term pain. It is clear that the patient did not feel any relief.

Next - a series of calls: to the head doctor of the Primary Care Center, to which the palliative patient is assigned, to the district doctor, again to relatives... It is possible to get an appointment for effective pain relief within a day.

... Such cases are rare, but they do happen. Why was an effective pain reliever not prescribed immediately? Perhaps the patient did not complain that the drug does not work? I thought that this is how it should be: a serious illness, pain, suffering? In fact, it is not so. And that's why it's worth talking about it again.

Prescribing adequate analgesia is the basis of palliative care, says Ludmila Samolelis, a specialist in palliative and hospice care at the Department of Health Care.

– If a person cannot be cured, it does not mean that doctors cannot help him. We should make it possible to leave life in such a way that they say "rested" and not "tired". Modern medicine provides such an opportunity. This is very important: to help the patient not to lose his human dignity in a difficult situation, when he knows that he cannot be cured, when he experiences chronic pain. Palliative care is about improving the quality of life of patients at the end of their days or when they are terminally ill.

Palliative as a requirement of time

7-10 years ago, says Lyudmila Samolelis, there was no such thing as palliative care in Ukraine. But now the state pays considerable attention to this direction.

- We currently have 192 palliative care beds in Poltava Oblast. Of these, 25 beds are for psychiatric palliative care on the territory of the regional psychiatric hospital, 6 beds are for HIV-infected patients, 20 beds are for patients with incurable, multi-resistant tuberculosis (in Hadiatsky district), 10 beds are for cancer patients (in Lubensky and Myrhorod districts). Last year, a 25-bed palliative ward was opened on the basis of City Hospital No. 2 in Kremenchuk. Today it is one of the best in Ukraine. Patients with various diseases, except for infectious ones, get there. And at the beginning of this year, a palliative department was opened in the district hospital in Kobelyaki. Such are the requirements of the time, Samolelis explains.

Of course, not all patients want to be in palliative care units. Mostly, there are lonely people or those who have led an antisocial lifestyle and, in fact, do not have a home. Or patients in a serious condition, who at a certain time stopped helping the pain medication prescribed by the doctor: sometimes medical observation is needed for a certain time to change the drug or dosage. Most of the patients want to stay in their native walls. There are no problems with this now, Samolelis is convinced: the family doctor and the district nurse are obliged to provide such a "hospital at home": with the necessary condition control and, of course, adequate anesthesia.

Despite all the urgency of the question, there are currently no accurate statistics - how many patients in Ukraine need palliative care:

- The World Health Organization proposes to calculate the number as follows: determine 80% of all those who died from chronic diseases during the year. Last year, 24,000 people died in Poltava Oblast, the specialist explains.

They are currently trying to solve the problem of lack of adequate statistics. At least in Poltava Oblast. The region took part in a pilot project in which data on palliative patients were collected: the ratio of men and women, residents of cities or villages, which drugs are taken... These data are currently being analyzed.

Analgesia: how it is prescribed and where to get it

– After establishing the patient's diagnosis and determining the degree of pain, the family doctor prescribes pain relief on a preferential basis, and the patient or his relatives receive drugs at the pharmacy for free. The doctor not only prescribes, but also supervises the treatment, - explains Svitlana Levchenko, chief physician of Poltava Primary Care Center No. 2.

– The approach to each patient should be exclusively individual. The doctor determines the level of pain both verbally and non-verbally: by facial expressions, various manifestations of discomfort, etc. A patient may have Alzheimer's disease, in which he cannot explain anything, but he still feels pain. Babies who can't speak yet feel pain too. There are a lot of situations - explains Lyudmila Samolelis.

And he emphasizes: it is important to understand that we are talking about constant, chronic pain. It is considered as such if it lasts more than six months. Unrelenting pain exhausts both the patient and his relatives. Therefore, effective pain relief is considered one of the foundations of palliative care.

The specialist explains: now Ukraine has developed the entire regulatory framework that allows providing adequate palliative care to patients. For Poltava doctors, training on this topic is regularly conducted, so they are sufficiently knowledgeable about appointment schemes and legislation on this topic.

– Any doctor can write a prescription for painkillers. Patients receive them free of charge. 37 communal pharmacies "Poltavafarm" in the region have the right to sell narcotic drugs, so we have no problems with this. The main thing is that the prescription is written correctly. Now you can also buy tablet morphine in different dosages in Ukraine by prescription. The prescription is issued for 10 days. However, the patient can adjust the frequency of administration himself. If he is in more pain, it is not necessary to wait until four hours have passed to take the pill. Then he will simply go back to the doctor for pain relief, says Samolelis.

Still, something prevents some doctors from prescribing the painkillers that the patient really needs. Lyudmila Samolelis thinks: maybe some people are still afraid. For a long time, the prescription of powerful painkillers was too regulated - regardless of the patient's condition, painkillers were prescribed exclusively within the strict limits of the instructions. And going beyond their limits could even threaten criminal liability. The memory of it turned out to be very persistent.

However, patients should know their rights and advocate for them.

According to Tribuna publication https://tribuna.pl.ua/news/paliativ/