Chronic pain is an extremely common and underestimated phenomenon. According to the Russian Association for the Study of Pain, the prevalence of chronic pain syndromes in Russia varies from 13.8% to 56.7%, averaging 34.3 cases per 100 people (Yakhno N.N. et al., 2008). A patient with chronic pain syndrome often stops paying attention to pain, begins to perceive it as something proper and inevitable, and continues to carry out his normal daily activities. In many cases, patients with chronic pain syndrome, on the contrary, become overly subordinate and dependent: they demand more attention to themselves, feel seriously ill, begin to rest more and relieve themselves of responsibility for performing certain duties. This interferes with the healing process and delays it. Additional characteristic features chronic pain syndrome: 1. his/her attention is constantly focused on pain; 2. he/she constantly complains of pain; 3. the patient dramatizes his pain and demonstrates with his entire appearance that he is sick (for example, grimaces, groans, groans, limps); 4. he/she uses a large number of different medications; 5. he/she begins to seek medical help more often and 6. his/her family relationships change for the worse. The spouse of a person with CHD also experiences anxiety, depression, and fear. Let's consider the basic principles of diagnosing chronic pain syndrome.
Diagnostics chronic pain syndrome includes several provisions. Exclusion of possible somatic (organic) factors causing pain. Thus, in the case of chronic pain in the left half of the chest, coronary heart disease is excluded. For pain in the pelvis, gynecological, urological and other causes of pain are excluded; in case of headaches - volumetric processes in the cranial cavity, anomalies of the craniovertebral junction, pathology cervical region spine, etc. In cases where organic pathology is excluded or its presence cannot explain the duration and nature of pain, diagnosis of chronic pain syndrome is carried out using the following criteria:
1. clarification of the temporal characteristics of pain: for 3 (three) months or more, the patient experiences pain that lasts most of the day and at least 15 days within 1 month;
2 . qualitative characteristics of pain: 2.1. pain of a monotonous nature, periodically intensifying until an attack; 2.2. the use of other terms to describe pain, for example, “stale”, “cotton” head, “stuffiness” in the left half of the chest, “heaviness” in the abdomen, “unpleasant tickling” in the lumbar region, etc.; 2.3. senestopathic coloring of pain: when questioned, patients report that they feel “difficulties in the passage of blood through the vessels”, “as if something is moving or flowing in the head” and other similar phenomena;
3 . localization of pain always much wider than the patient presents; Thus, patients with chronic lower back pain often have headaches, pain in the heart, stomach, etc.; upon palpation, such patients experience painful sensations much wider than in the initially presented area;
4 . pain behavior: depending on the location of the pain, it includes different behavioral patterns, for example, marking the “sick” organ - immobilizing it, constantly rubbing the skin in the heart area or restrictive behavior, for example, avoiding usual physical activity, strict diet to prevent abdominal pain, regular intake analgesics if they have no effect, call an ambulance, etc.);
5 . psychogenesis of pain: when studying the anamnesis of patients, it often turns out that in childhood one of the close relatives suffered from pain, more often in the same location as the patient; Often the patient himself experienced pain or observed it in emotionally charged situations, for example, the death of a parent from a myocardial infarction with severe pain or headaches leading to a stroke, etc.;
6 . beaten paths: debut or exacerbation of chronic pain after injuries, surgical interventions, infectious diseases; for example, chronic “post-traumatic” headaches for many years after a mild traumatic brain injury or chronic post-operative abdominalgia, usually occurring under the guise of an “adhesive” disease;
7 . syndromic environment includes psychovegetative and motivational disorders; with active and targeted questioning in these patients, it is possible to identify sleep disturbances, appetite disorders, changes in body weight, decreased libido, constant weakness and fatigue, breathing difficulties, palpitations and other symptoms that indicate a violation of the autonomic system that are not emphasized by the patient. nervous system.
To assess multifactorial pain syndrome Most often they use a specially developed McGill questionnaire. This questionnaire contains 20 groups of adjectives that describe pain. The patient is asked to underline one word from each group that most accurately reflects his/her pain sensations. The McGill scale measures the sensory, emotional and quantitative components of pain; The obtained data, although not expressed in absolute values (i.e., are not parametric), are nevertheless amenable to statistical interpretation. Difficulties in assessing the McGill questionnaire only arise when the patient is new to the language.
To assess the psychological component For chronic pain patients with chronic pain syndrome, the Minnesota Multiphasic Personalized Inventory (MMPI) is most often used. Patients with chronic pain syndrome have elevated scores in the following three categories of the MMPI scale: hypochondriasis, hysteria and depression. The combination of these pathological conditions, which is called the neurotic triad, quite well reflects the psychological status of patients with chronic pain syndrome.
On initial stages examinations of a patient with chronic pain syndrome sometimes assess the level of depression (using the Beck Depression Inventory and Scale) and anxiety (using the Spielberger Anxiety Questionnaire and Inventory). When examining patients with chronic pain syndrome, special attention is paid to such clinical signs as the individual's excessive attention to his physical condition, depressed mood and a helpless/hopeless outlook on life. Listed below are some specific pain characteristics that indicate poor psychological tolerance to nociceptive stimuli:
1
- pain does not allow a person to perform his daily duties, but nevertheless does not prevent him from going to bed peacefully;
2
- the patient vividly and vividly describes the pain experienced and demonstrates with all his behavior that he is sick;
3
- he/she experiences pain constantly, but the pain does not change;
4
- exercise stress increases pain and increased attention and care from others soften it.
Treatment A patient with chronic pain syndrome should be treated by specialists of various profiles, since chronic pain is polyetiological. If we take it at a minimum, the treatment and rehabilitation team should be represented by an anesthesiologist, psychologist, nursing staff and a social worker; In larger pain centers, the team also includes a neurologist, an orthopedist, a neurosurgeon, an acupuncturist, and an authorized vocational rehabilitation provider. If necessary, assistance from other specialists may be required.
© Laesus De Liro
Doctors at the Yusupov Hospital Neurology Clinic diagnose and treat all types of chronic pain syndrome: neurogenic, psychogenic, that appeared after courses of chemotherapy, radiation therapy, surgical interventions.
Specialists select individual therapy to relieve the patient of phantom pain after operations, joint pain, and asthenia after bedsores. In each case, a separate comprehensive program is developed, including drug therapy, palliative care, rehabilitation, after which the pain symptoms in patients significantly decrease or disappear altogether.
Our specialists
Prices for treatment of chronic pain syndrome *
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Treatment of chronic pain at the Yusupov Hospital
Pain is a symptom that signals that not everything is in order in the body and performs protective functions. But when the pain syndrome becomes chronic and painful, it does not have any meaning or benefit. In addition to suffering, it limits a person’s functional capabilities and interferes with full life, do work. In fact, this is an independent disease that needs to be fought.
Not so long ago, a special specialty appeared in global clinical practice - pain medicine.
At the Yusupov Hospital, neurologist Ekaterina Dmitrievna Abramtseva deals with this area. Together with other medical specialists, she identifies the cause of the patient’s pain and prescribes treatment in accordance with modern international recommendations. We use original drugs of the latest generations, physiotherapy, psychotherapy, kinesio taping, manual techniques, physical therapy and other modern methods.
Pain treatment at the Yusupov Hospital is aimed at achieving the following goals:
- Relieving the patient of pain.
- Improving general well-being and functionality.
- Normalization of psycho-emotional state.
- Return to a full, active life, if possible, restoration of performance.
- Ensuring maximum physical and psychological comfort.
Pain is a symptom of many diseases, and with the right approach it can be kept under control. Don't be patient. Contact a specialist at the Yusupov Hospital.
Principles of the Yusupov Hospital
Currently, the concept of chronic pain has been significantly revised. Modern doctors perceive it not just as certain unpleasant, painful sensations, but as a complex process in which changes occur in the functioning of the nervous, endocrine, cardiovascular systems, muscular system, and psychological sphere.
In order to effectively treat pain, specialists at our clinic follow some key principles:
- Chronic pain is an independent disease that needs to be treated. You cannot tell the patient: “we are treating the underlying disease, but you just need to endure the pain.” There is a symptom that makes a person suffer, reduces the quality of life, and this symptom must be dealt with correctly. In modern medicine there is even such a principle: “no pain.” The patient should not experience any discomfort associated with the disease or any procedures.
- There may be more than one reason. Often, in addition to the main condition causing pain, there are concomitant ones. They need to be detected and eliminated.
- Subjective perception of pain varies. Each person perceives pain in his own way, depending on the characteristics of his nervous system and psychology. We always take this into account when prescribing treatment.
- Multidisciplinary approach. Each patient is treated by a pain management specialist and a team of other specialized doctors, depending on the nature of the disease.
- Complex treatment. We use drug therapy, blockades, physical therapy, manual techniques, kinesio taping and other techniques. The doctor draws up an individual program for each patient.
- The pain cannot be tolerated. Therefore, at the Yusupov Hospital, the patient receives treatment in the required volume as soon as the need arises.
- Important psychological factors. At the Yusupov Hospital, all conditions have been created to ensure that patients feel as comfortable as possible. Comfortable rooms, respectful and caring attitude, a “homely” environment - all this helps to reduce the subjective feeling of pain.
Types of pain we treat
According to some data, pain syndrome is accompanied by up to 90% of all diseases. The nature of pain is also very different. At the Yusupov Hospital, a thorough diagnosis is carried out to understand the causes of the symptom, and each patient receives optimal treatment.
Pain in the neck, back, spine
This is one of the most common reasons for visiting doctors, temporary incapacity for work, and in severe cases, disability. Most often, pain in the spine is caused by intervertebral hernias and other pathologies in which pinched nerve roots occur.
In the early stages, these diseases can be treated conservatively with painkillers, muscle relaxants, physiotherapy, manual techniques, therapeutic exercises and a healthy lifestyle. For severe persistent pain, our doctors perform blockades: they inject medicine near the damaged nerve root. A rehabilitation course helps prevent exacerbations in the future.
Headache
Almost every adult has experienced this type of pain at least once in their life. If this happens occasionally, you can get by with a painkiller tablet. Chronic headaches require complex treatment. Doctors at the Yusupov Hospital treat migraines, tension headaches, cluster headaches, and rare varieties. We always conduct a thorough differential diagnosis, because the treatment regimen will depend on this.
Pain due to cancer
Excruciating chronic pain is a common symptom of advanced cancer. At the Yusupov Hospital, treatment is carried out in accordance with the three-step “pain ladder” recommended by the World Health Organization. If the drugs at one stage do not help, the doctor moves to the next stage:
- For mild pain, use drugs from the NSAID group (ibuprofen, diclofenac, etc.).
- For moderate pain, use NSAIDs in combination with weak narcotic analgesics.
- For severe pain, use powerful narcotic analgesics.
If necessary, the patient receives other medications. Antitumor and palliative treatment is being carried out.
Pain due to damage to nerve roots and peripheral nerves
Our doctors treat pain syndromes that occur when nerve fibers are damaged as a result of various diseases:
- Various types of polyneuropathy, neuritis, neuralgia;
- Diabetic polyneuropathy;
- Neuralgia of the trigeminal, occipital nerve;
- Tunnel syndromes;
- Intercostal neuralgia;
- Postherpetic neuralgia.
Some of these diseases are accompanied by disturbances in movement and sensitivity. Our doctors provide comprehensive treatment that helps restore these functions.
Pain after operations and injuries
After surgical interventions, especially extensive ones, patients often experience pain, so it is important to provide high-quality pain relief. The Yusupov Hospital has everything you need for this. We treat patients suffering from chronic pain syndrome after injuries to the spine and spinal cord, joints, and traumatic brain injuries.
Phantom pain
Chronic phantom pain occurs in a missing body part after amputation or loss due to injury. They are sharp, burning, reminiscent of a blow electric shock, often become unbearable. Currently, there are many effective ways to combat phantom pain, including medications, blockades, and biofeedback. The Yusupov Hospital uses the most modern techniques with proven effectiveness.
Vascular diseases of the brain
Headaches often bother patients after a stroke or with vascular pathologies. In a bedridden patient, degenerative changes occur in the muscles and joints, which can also lead to pain. Comprehensive treatment at the Yusupov Hospital helps get rid of excruciating pain, improve nervous functions, prevent complications and recurrent acute cerebrovascular accidents.
Treatment options for chronic pain in our clinic
Currently, there are many ways to combat chronic pain. The Yusupov Hospital uses all available opportunities:
- Medications: NSAIDs, glucocorticosteroids, muscle relaxants, antidepressants, anxiolytics, etc.
- Narcotic analgesics.
- Blockades, during which anesthetics and glucocorticosteroids are injected into the area of damaged roots or nerves.
- Various physical procedures.
- Therapeutic massage, manual therapy, osteopathy.
- Biofeedback method.
- Injections of botulinum toxin preparations help in the fight against headaches.
- Kinesio taping is a method of combating pain in the musculoskeletal system using adhesive tapes. They help relieve tense muscles, improve blood circulation, lymph outflow, and activate metabolic processes in tissues.
- In cancer patients, long-term pain relief can be provided through intravenous infusion port systems.
- For malignant tumors, we provide antitumor, palliative, symptomatic treatment - they can also be considered as part of complex therapy to combat pain.
- Electroneuromyostimulation.
- Psychotherapy.
- Complex rehabilitation therapy helps to consolidate the effect and prevent exacerbations in the future.
After discharge, the patient receives detailed recommendations from the doctor on how to keep pain under control, prevent exacerbations, and what to do if severe pain begins again.
Chronic pain is dangerous
Any pain signals that pathological processes are occurring in the body. Even if you “endure it,” the symptoms may return with greater force in the future. Many diseases accompanied by chronic pain progress over time and become increasingly difficult to combat. Complications develop that may require surgical intervention or emergency care.
Five steps to getting rid of chronic pain at the Yusupov Hospital:
- The doctor talks with you, evaluates your complaints, general condition, and determines how much pain you subjectively assess. If necessary, you will receive immediate emergency assistance.
- A thorough examination using modern methods diagnostics The doctor discovers the underlying condition and any underlying conditions that are causing your pain.
- You are prescribed a comprehensive treatment that is optimal for your individual case, in accordance with international recommendations. Your condition is constantly monitored, the doctor adjusts the prescriptions.
- A course of rehabilitation treatment is carried out, which helps to consolidate the results and return you to an active life.
- After discharge, you receive detailed recommendations from the doctor.
Don't wait and be patient. At the Yusupov Hospital there are professionals who will understand the causes of pain and take control of it. We know how to help and use every opportunity to do so. modern medicine. Contact us.
Bibliography
- ICD-10 ( International classification diseases)
- Yusupov Hospital
- Abuzarova G.R. Neuropathic pain syndrome in oncology: epidemiology, classification, features of neuropathic pain in malignant neoplasms // Russian Journal of Oncology. - 2010. - No. 5. - P. 50-55.
- Alekseev V.V. Basic principles of treatment of pain syndromes // Russian Medical Journal. - 2003. - T. 11. - No. 5. - P. 250-253.
- Pain syndromes in neurological practice / Ed. A.M. Veina. - 2001. - 368 p.
Chronic pain syndrome (CPS) is a condition in which a person feels physical suffering for a long time. Pain can be localized in different areas of the body and have real prerequisites in the form of chronic pathology of organs, joints, blood vessels and nerves. However, it happens that physiological reasons there is no such sensation; in this case, the provocateur of CHD is the human psyche. The ICD 10 code depends on the location, diagnosis, and nature of the sensations. Pain that cannot be assigned to any section is coded R52.
Possible causes of chronic pain
The etiology of chronic pain syndrome in each specific case is different:
- One of the most common prerequisites for the syndrome are diseases of the musculoskeletal system. Degenerative changes in the spine and joints lead to mechanical compression of nerve endings and blood vessels. In addition, local inflammation develops. This includes vertebrogenic (spine), anococcygeal (sacrum and coccyx, pelvic area) and patellofemoral (knee). Often this situation cannot be corrected by treatment, so the person is forced to constantly feel pain in the lower back, neck, head or knee. Diseases that cause CHD are osteochondrosis, arthrosis, various neuritis, arthritis, spondylitis and others.
- The culprit of the syndrome in its most severe form is. As the tumor grows rapidly, it puts pressure on organs, blood vessels, and nerves, which leads to pain that gets worse day after day. Suffering occurs due to the “corrosion” of healthy tissue by a cancerous tumor.
- No less often than diseases of the spine, the cause of CHD is psychological problems. In this case, a person prone to depression and neurosis continues to feel pain after being cured of the pathology. Sometimes in such patients the syndrome is an independent disease that does not have any physiological prerequisites. Sensations can be localized in the head, abdomen, limbs, and sometimes do not have a clear location. The pain is manifested by spasms, pressure, distension, tingling, numbness, burning sensation and coldness.
- Phantom syndrome occurs in patients who have lost a limb as a result of surgery. The amputated leg or arm is felt and painful. It is believed that the cause of this condition is changes in the vessels and nerves at the site of surgery, but the psychological side of this issue should not be completely dismissed. Since such a loss brings extreme stress to a person, it is possible that the nervous system projects feelings that are not accustomed to the absence of a limb.
- Neurogenic disorders are a malfunction in the functioning of local receptors, the spinal cord, the brain and the chain of connections between them. The reasons are different: trauma, tumor, spinal pathologies, circulatory disorders, consequences of infectious diseases. It is extremely difficult to detect such an anomaly.
These are just the main causes of CHD. Exists a large number of pathologies that are divided by location, for example, headaches, pelvic pain, back pain, chest pain, etc.
Unfortunately, it often happens that a patient visits all the specialists, but the cause of CHD is never identified. In such a situation, it makes sense to undergo examination by a psychotherapist. However, sometimes physiological prerequisites exist, but insufficient diagnostic measures do not allow the problem to be detected. Doctors advise noting any unusual symptoms that accompany pain, even if they seem unrelated to the person's condition.
Symptoms of chronic pain syndrome
The concept of CHD is very capacious, so it is impossible to talk about general specific manifestations. But there are signs that can help guide the diagnosis of the patient’s condition in the right direction.
Clear localization
The location of sensations allows you to find the cause. It is enough to examine the diseased area to get to the bottom of the diagnosis. But sometimes neurological CHD gives false symptoms. For example, osteochondrosis may manifest as chest pain, different parts heads, limbs.
Anococcygeus syndrome is negative sensations in the anus, rectum and tailbone. It remains to be seen whether the problem is at the end of the spine, or in the intestines.
The absence of a constant source of pain, when it aches, goes numb, pricks the whole body, or here and there, usually indicates the psychogenic nature of the syndrome.
When do symptoms intensify?
Most vertebrogenic diseases are characterized by a decrease in negative sensations when changing body position. As a rule, it is easier to lie down. worsens when a person is in a stationary position for a long time, or when turning his head sharply.
The psychogenic nature of CHD can be suspected if pain appears in a certain environment or life situation. This is often how sexual disorders occur when the patient experiences discomfort during (before, after) sexual intercourse, or even with a hint of intimacy. The reason may lie in trauma associated with sexual life or problems in relationships with a partner.
Loss of consciousness is often accompanied by various syndromes that have formed due to insufficient blood supply to the brain. This situation is typical for cervical osteochondrosis, atherosclerosis, and tumors in the skull.
Personality changes
The psychogenic cause of CHD is identified by the patient’s behavior. Relatives may notice that the person has become withdrawn, irritable, apathetic, touchy, or even aggressive. The problem is preceded by both negative stress in the form of job loss, death of a relative, or divorce, and a strong positive shock. In general, people who are vulnerable, emotional and indecisive are more susceptible to psycho-emotional disorders.
Attention! The defining feature is that depression develops first, and then pain appears, and not vice versa.
How to identify the cause of the syndrome?
Diagnosis starts with studying the medical history and interviewing the patient. The doctor can already guess the direction during the conversation. Further, general blood and urine tests and biochemistry are required. They first of all dismiss the presence of infection and inflammation in the body. Then, depending on the location and the suspected problem, an ultrasound, CT, MRI, or x-ray is prescribed.
If the examination does not reveal tumors, infectious process, degenerative changes in bone structures and other physiological disorders, the patient may be referred for an electroencephalogram of the brain. Based on the results, the specialist will detect a failure in the transmission of nerve impulses.
The absence of any serious diseases most likely indicates the psychogenic nature of the pain. Therefore, the last point will be a consultation with a psychotherapist.
Interesting fact! Sometimes the prescription of medications plays the role of diagnosis. If the drug does not work, then the diagnosis is false.
CHD treatment
Therapy will be different in each case. If pathology is detected internal organs To eliminate pain, they deal with getting rid of the cause. Once the disease is cured, negative feelings will leave the patient.
Treatment of osteochondrosis and other pathologies of the musculoskeletal system requires a lot of time and patience. This is a combination of anti-inflammatory drugs with physiotherapy, physical therapy, and sometimes surgery. It is not always possible to achieve complete recovery. Often, such patients are forced to take painkillers throughout their lives during exacerbation of the syndrome. Various analgesics are used for them.
Patients with phantom pain after amputation or other operations undergo comprehensive rehabilitation, during which they not only receive pain relief with painkillers, but also receive psychological assistance.
Cancer patients whose chronic disease is severe and the negative feelings are simply unbearable are prescribed narcotic drugs - opioids. These are codeine, tramadol, morphine, buprenorphine.
Treatment of depression in combination with chronic pain is carried out with antidepressants. For example, the instructions for amitriptyline indicate use for chronic heart disease. Taking medications must be combined with the work of a psychotherapist.
Attention! It is extremely difficult even for a specialist to select an antidepressant, dosage, regimen and duration of treatment, so it is not recommended to do this without a doctor.
Conclusion
Pain is a symptom; it is necessary to look for the underlying cause, be it osteochondrosis or depression. You shouldn’t give up if doctors don’t find anything and accuse you of malingering. It is necessary to carry out a thorough diagnosis and find a specialist who can help. Psycho-emotional disorders are not at all harmless and lead to personality changes, physiological diseases and suicide.
The purpose of this publication is to clearly outline the problems facing specialists in the treatment of chronic pain: what logistical and physical costs await health care administrators and practitioners, what are the economic and moral gains. We emphasize: we will talk about chronic pain syndrome, about pain as a disease, and not about acute pain as a symptom, which anesthesiologists and resuscitators are currently coping with quite successfully.
The needs of society and understanding of the importance of the problem of pain have contributed to the emergence in some developed countries specialized “pain clinics”, specialized departments in medical centers and university clinics.
The treatment of patients with chronic pain syndromes carried out in these clinics allows them to provide them with significantly more effective and well-structured specialized care, significantly increases the positive effect of treatment, and contributes to the rapid restoration of patients’ ability to work or their social adaptation.
Unfortunately, the problem of chronic pain is completely ignored by Russian insurance companies and healthcare as non-existent. We still do not have official statistics on this matter, although based on population proportions it is not at all difficult to calculate that in Russia millions of people suffer from various types of chronic or often recurrent pain. And given the current state of the state’s economy, apparently, in the foreseeable future we should not hope for any significant budget funding to solve this problem.
The multidisciplinary scientific center “Integrative Medicine” was created at the Russian Scientific Center for Surgery of the Russian Academy of Medical Sciences on the basis of the scientific advisory department (polyclinic) and the department of pain syndrome therapy in 1993. The purpose of creating the center is to provide an opportunity for patients suffering various types pain syndrome, concomitant pathology and functional disorders, receive specialized medical care, and medical workers quite legally have additional income.
Organizational and legal form of the new structural unit RNTSKH is a closed joint-stock company, where its sole founder is a government agency owning 51% of the shares. The remaining shares are distributed among RNCH employees and cannot be transferred (sold) to third-party individuals or legal entities. All financial and economic activities are controlled and determined by the general meeting. Profit from commercial activities mainly goes to the purchase of medicines, equipment and Supplies for research; Specific expense items are approved at the annual general meeting of shareholders.
The Center for Integrative Medicine is licensed for almost all types of medical activities(from the medical control commission and all types of diagnostic and treatment practice to testing and development of new medical equipment), which largely determines the success of financial and economic activities in the current economic conditions.
As a result of long scientific research problems of diagnosis and treatment of chronic pain and practical achievements in this area, the Center has formed the following composition of specialists working in the relevant laboratories:
- main specialists: anesthesiologists, neurologists, psychoneurologist, orthopedic traumatologist, physiotherapists, reflexologists, chiropractor, exercise therapy doctor, massage therapists, nurses and junior medical staff;
- consultants: neurosurgeon, microsurgeon, vascular, thoracic and other surgeons, therapists (cardiologist, gastroenterologist, etc.), urologist, gynecologist, ENT, ophthalmologist, endocrinologist, dermatologist, functional diagnostics specialists;
- diagnostic laboratories: express diagnostics, clinical, functional, immunology, radioisotope, ultrasound, endoscopic, X-ray diagnostics and computed tomography, thermal mapping, prevention and treatment of infections.
The center uses the latest diagnostic and treatment techniques (Tables 1 and 2). Of course, such a selection of specialists, with a wide range of diagnostic and therapeutic methods, is only possible for fairly large research centers and multidisciplinary clinical hospitals. In practical medicine, at first it is quite possible to get by with 25-33% of the specified list of specialists and methods, and as you acquire skills, work experience, appropriate equipment and equipment, you can expand the scope of assistance. The following composition of specialists should be considered minimally sufficient: two anesthesiologists (one of them must be trained in performing therapeutic blockades, and the second must know reflexology methods to the extent necessary for the treatment of pain, including elements of manual therapy), a psychoneurologist (or a neurologist and a psychiatrist) and a physiotherapist. These specialists ex consilio determine the strategy and tactics of treatment for each patient, as well as the need for additional research and consultations. More often you have to resort to consultations with specialists available in each clinic or hospital (surgeon, gynecologist, dentist, etc.).
| Specific | Computerized visual analogue pain scale A modernized Mc'Gill pain questionnaire in one modification or another. Assessment of the condition of trigger points. Determination of pain thresholds for electrical stimulation Computer heart rate monitoring Omura test Ryodorraky method Electropuncture auricular and corporal diagnostics, etc. |
| Generally accepted | Radiography and fluoroscopy Computed and NMR tomography Ultrasound diagnostics of blood vessels, heart, organs abdominal cavity and etc. Electromyography and electrocardiography Endoscopy Thermography, including computer thermal mapping, and other methods |
It should be specially noted that at present (orders of the Ministry of Health of the Russian Federation No. 364 and 365 of December 10, 1997) reflexology and manual therapy for the first time received the status of officially existing specialties in Russia. Nursing staff are involved as needed to perform specific work (massage, physiotherapy, manipulation, blockade, etc.). The medical recorder copes well with the function of a cashier.
Experience has shown that the organization of the work of the pain center is successfully undertaken by anesthesiologists, being the most proactive people, informed about the inpatient and outpatient activities of the hospital, who, as a rule, get along well with management, colleagues and staff. If your medical institution has all of the above prerequisites, then a group of like-minded people can take the initiative to organize a pain center in order to provide additional LEGAL income to ALL specialists of the hospital or clinic. Further organizational actions do not present any major problems. The management of the medical institution or the initiative group brings to the general meeting of employees the issue of creating a closed joint stock company(or another structure more convenient for the team), the charter is adopted and the new one is registered legal entity, an agreement is concluded under which the institution transfers the necessary space or workplaces and the necessary equipment to the pain center for use. One condition remains to be fulfilled - to introduce a single full-time position - an accountant, and also to purchase and register a cash register.
Currently, there are already regulations on the pricing of medical services. All employees whose advisory and therapeutic activities will be in demand among the population work in the center under a contract agreement in their free time from their main activities. Percentage of deductions from total applicants Money on wages, as well as for development, is determined by the general meeting of shareholders, taking into account taxes, etc.
| Non-drug | Classical corporal acupuncture Auricular acupuncture Microneedling and superficial acupuncture ECIWO and Su-Jok therapy Electroacupuncture and electropuncture Transcutaneous electrical nerve stimulation Resonance electropuncture analgesia and therapy Light, thermo, laser puncture EHF therapy and micromagnetotherapy Hirudo- and apitherapy Vacuum, acupressure and classic massage, vibration reflexology Exercise therapy and manual therapy in different versions Sound, aroma and music therapy Autotraining with biofeedback and other methods |
| Pharmacotherapeutic | Blockades various types(epidural, epipleural, conduction, etc.) Pharmacopuncture (mesopuncture) Pharmacotherapy with analgesics, sedatives, anti-inflammatory, relaxants and other drugs |
| Homeopathic, Phytotherapeutic And other non-standard methods |
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The pain center should build its work, focusing mainly on outpatients, which, however, does not exclude, if necessary, hospitalization for more detailed examination and treatment, as well as the possibility of serving enterprise teams on a contractual basis.
The scope of services depends on the level of professional skills of the staff. Based on the principle of minimum sufficiency, economic profitability can be achieved if the following items are included in the list of medical services:
- classical acupuncture;
- manual therapy;
- therapeutic blockades and pharmacopuncture;
- therapeutic massages: vacuum, segmental, acupressure;
- integrative methods of influence (TENS, EHF, etc.);
- combined reflexology with psychotropic drugs;
- physiotherapeutic procedures.
The given list of effects can be mastered and applied by any specialist in a pain center - these methods are taught in Russia today in many specialized institutions.
The group of patients with chronic pain of oncological origin stands somewhat apart, that is, patients who are within the competence of the palliative and hospice service of the oncology clinic. According to modern criteria, the methods listed above are equated to physiotherapeutic procedures, and therefore are not applicable in oncology, although there are results of studies conducted in many university clinics around the world showing the effectiveness of integrative medicine methods in relieving cancer pain. At the same time, in our opinion, any method that relieves pain in the terminal stage of cancer deserves the most careful attention and study.
Patients with various conditions and diseases come to the Center. Pain syndromes are presented in table. 3 in decreasing progression.
As mentioned above, we divide all methods of influence into invasive and non-invasive, pharmacotherapeutic and non-drug. The selection of optimal complex treatment methods and their integration were based on the use of more than 150 classical traditional and modern treatment techniques.
At each stage of treatment, the choice and sequence of application of techniques were determined individually, depending on the etiological and symptomatic manifestations of the pain syndrome and the severity of the accompanying functional disorders.
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Typically, patients came to us after undergoing treatment in many instances, but with previous complaints, so most often we had to begin treatment with pain relief using the following pharmacotherapeutic methods.
- For severe painful pain syndrome caused by malignant neoplasms of the abdominal and pelvic organs, phantom and causalgic pain, epidural analgesia was used. Puncture and catheterization of the epidural space were performed in accordance with generally accepted recommendations. Analgesia was carried out by administering the narcotic analgesic morphine (0.1 - 0.3 ml of a 1% solution in 10 ml of saline) once a day. The advantages of this methodological solution are that a good analgesic effect is achieved with minimal administration of the drug; there is no need for frequent repeated administrations, which reduces the risk of infection of the epidural space. The method was used both in inpatient and outpatient settings. No side effects such as hypotension, orthostatic collapse, or respiratory depression were observed.
- The method of regional analgesia has been used to treat almost all types of pain syndromes. Analgesia was carried out by administering 0.75-1% solutions of local anesthetics (bupivocaine, lidocaine). For the upper extremities, a Kulenkampff block, an axillary nerve block with a tourniquet was used; for the lower extremities - blockade of the femoral, sciatic, external cutaneous, obturator nerves. Treatment sessions were prescribed as needed, but not more than once every two days, both in inpatient and outpatient settings.
- The essence of the pharmacopuncture technique is the introduction of microdoses of modern pharmaceuticals into classical acupuncture points. The method was used to treat all types of pain syndromes, concomitant pathologies and functional disorders, such as bronchial asthma, impaired intestinal motility, urination disorders, skin itching, neuralgia, including herpetic, neuropathies, neuritis. Non-narcotic analgesics (tramal, butarphanol tartrate, analgin, baralgin) and local anesthetics were administered. In combination with them, depending on the cause of the pain syndrome, hormones and other anti-inflammatory drugs and antihistamines, B vitamins were prescribed. The drugs were injected into classic acupuncture points according to an individually selected prescription, based on the most painful (trigger) areas. It can be considered optimal to administer drugs using original sets of disposable syringes, which have two or three sequential containers in the tube containing a local anesthetic, B vitamins and hormonal agents. Drug administration is carried out through a single injection, which reduces trauma, increases the accuracy of administration and optimizes drug dosing. We also used a sequential attachment on one injection needle of two or three syringes containing drugs selected according to an individual prescription. Both methods can be performed according to the principle of polytopic administration of drugs.
The choice of integrative methods of reflexology for the treatment of patients with chronic pain syndrome is based on the severity of its manifestations, that is, intensity and duration, psycho-emotional exhaustion of patients associated with the low effectiveness of long-term use of traditional analgesics (narcotic and non-narcotic). We also proceeded from the fact that the traumatic nature of integrative methods of clinical reflexology should not exceed the severity of the manifestations of pain and should not be subjectively painful for the patient.
An objective characterization of the effectiveness of integrative reflexotherapy techniques based on the impact on biologically active points and zones was carried out based on an analysis of the results of computer thermal mapping and calculation of the consumed amount of analgesics before and during treatment. Good subjective tolerability of these techniques by patients is confirmed by the study of hemodynamic parameters and cyclic nucleotides before and after exposure. All reflexology methods we use reduce adrenergic stimulation, thereby eliminating arteriolospasm and improving tissue microcirculation.
The results of the introduction into the practice of pain clinics of integrative methods of clinical reflexology in the treatment of severe pain syndromes from traumatic surgical (destruction of the anterior lobe of the pituitary gland and frenotomy) and radiation methods indicate in favor of integrative reflexology.
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