Practical aspects of pain relief in palliative medicine

Abstract

Background. Treatment of chronic pain in adults and children is regulated by the national standard of Ukraine, which recommends adherence to the choice of painkillers in accordance with the WHO three-step protocol. But the treatment standard does not detail the use of painkillers according to nosological units. The aim of the work was to determine the need for different types of analgesia in palliative patients depending on the main palliative diagnosis. Materials and Methods. System analysis, aggregation and bibliosemantic methods were used. The list of palliative diagnoses was determined when studying the need and forecasting the need for palliative and hospice care according to the methodology of the Ukrainian Center for Social Data (2019), improved by us in 2021–2024. Results and Conclusions. The conducted research made it possible to determine the predominant types of pain, their possible intensity and corresponding groups of pharmaceutical drugs with an analgesic effect in the units from the list of palliative diseases proposed by us. Neuropathic pain is mainly present in diabetes (diabetic polyneuropathy) and phenylketonuria. Predominantly nociceptive pain is present in cardiovascular diseases of palliative stages, tuberculosis, rheumatoid arthritis, cystic fibrosis and chronic hepatitis in children. Predominantly mixed (nociceptive and neuropathic types of pain at the same time) characteristic of HIV/AIDS, epilepsy, dementia, multiple sclerosis, fibrosis and cirrhosis of the liver, chronic obstructive pulmonary disease, palliative stage kidney disease in adults, cerebral palsy, inflammatory diseases of the central nervous system and mucopolysaccharidoses in children. We proposed to clarify the national standard for treatment of chronic pain in adults and children, and to define the necessary non-steroidal anti-inflammatory drugs, non-narcotic analgesics, weak and strong opioids, anticonvulsants, antidepressants, and other adjuvants with an analgesic effect. The perspective of further studies is to detail the dosage of drugs with an analgesic effect and to calculate the need at the national level for reimbursement under the "Affordable Medicines" program. Keywords: neuropathic pain, nociceptive pain, analgesics, opioids, reimbursement.