The controllability of pain in palliative medicine as a factor in the medical and social impact on the patients’ quality of life at the end-of-life

Abstract

Availability and adequacy of analgesia is one of the factors that significantly influence the quality of life of palliative patients. At the current stage of development, the system of palliative and hospice care in Ukraine will not provide clear pain relief for the majority of patients. We conducted a study of PubMed and Google Scholar’s sources and legal acts of Ukraine at the list and content of pain management in palliative patients, which should be considered in their work by medical and social workers providing palliative care, as well as health care managers. We proposed to expand the scientific discussion about types of pain and their corresponding analgesia. The study of regulatory documentation on the palliative care in Ukraine and the protocol for the treatment of chronic pain in palliative patients revealed their compliance with modern protocols and rules of systems with developed systems of palliative care. However, we also found that the practical implementation of the existing rules varies significantly in the direction of their non-enforcement. We came to a conclusion about the need to expand the use of narcotic and non-narcotic pain relievers in Ukrainian palliative medicine, to strengthen the material and technical base of hospices and to eliminate their staff shortage. The article covers a number of issues of the pathophysiology of pain. We determined that both the causes of pain and its perception, which can be evaluated on several scales in points, are important in the issue of pain perception by palliative patients. We came to the conclusion that an adequate reaction of patients to pain simplifies the diagnosis and the appointment of adequate treatment, and an excessive and "stoic" reaction complicates them. We noted that the treatment of chronic pain involves the use of drug therapy, hypnosis, cognitive-behavioral therapy, physical exercises, and physio­therapeutic procedures. Keywords: chronic pain, nociception, pharmacotherapy, narcotic analgesics, non-narcotic analgesics.