Keywords
somatic pain
visceral pain
neuropathic pain
narcotic analgesics
non-narcotic analgesics
How to Cite
Abstract
This short scientific report reveals important aspects of palliative medicine use of narcotic and non-narcotic analgesics, antidepressants, and anticonvulsants. Specific indications and restrictions on their use, routes of drug administration (oral, intravenous, intramuscular, subcutaneous, transdermal, intrarectal) are defined. The issues of monitoring the dosage of narcotic painkillers by medical personnel and patients themselves, the administration of bolus doses, and the medical equipment necessary for this were discussed. Special attention is paid to such pharmaceuticals as morphine, oxycodone, buprenorphine, butorphanol, morphine. The study of pathogenesis, clinical manifestations, diagnostic methods and the arsenal of therapeutic agents for overcoming acute and chronic pain in palliative patients is important for the organization of hospice and palliative care (HPC). Different types of pain are described depending on the nosological forms, individual sensitivity to pain, sensitization to pain, ways of transmitting the pain signal from the peripheral to the central part of the nervous system, humoral mechanisms of increasing and decreasing the sensation of pain, pain assessment on the Visual Analogue Scale. The need for organizational solutions to improve the situation with analgesia in Ukrainian palliative and hospice institutions, in particular to increase the availability of effective analgesia for palliative patients, was identified. Improving the situation with pain relief corresponds to the national strategy of Ukraine for the development of the HPC system. The report makes a comparison with the development of such a system in Great Britain on the way to one of the best systems of medical care for palliative patients, and on the basis of the futuristic development models described in the literature, it is assumed that Ukraine is on a similar path.
Keywords: nociception, somatic pain, visceral pain, neuropathic pain, narcotic analgesics, non-narcotic analgesics.
Archived: https://doi.org/10.5281/zenodo.13736102
References
Holovanova IA, Shevchenko AS. Determination of the main needs of palliative patients and ways of their provision in the healthcare system of Ukraine. Experimental and Clinical Medicine. 2021;90(3):88-94. DOI: 10.35339/ekm.2021.90.3.hos.
Nesterenko VG. On the procedure for providing palliative and hospice care in Ukraine. Medicine Today and Tomorrow. 2021;90(2):57-62. DOI: 10.35339/msz.2021.90.2.nes. [In Ukrainian].
Nesterenko VG. Peculiarities of using the SF-36 questionnaire in palliative neurological patients. Medicine Today and Tomorrow. 2023;92(2):62-72. DOI: 10.35339/msz.2023.92.2.nes. [in Ukrainian].
Nesterenko VG. Peculiarities of using the SF-36 questionnaire in palliative oncological patients. Experimental and Clinical Medicine. 2023;92(3):73-85. DOI: 10.35339/ekm.2023.92.3.nes. [In Ukrainian].
Reville B, Foxwell AM. The global state of palliative care-progress and challenges in cancer care. Ann Palliat Med. 2014;3(3):129-38. DOI: 10.3978/j.issn.2224-5820.2014.07.03. PMID: 25841689.
Wyns A, Hendrix J, Lahousse A, De Bruyne E, Nijs J, Godderis L, Polli A. The Biology of Stress Intolerance in Patients with Chronic Pain-State of the Art and Future Directions. J Clin Med. 2023;12(6):2245. DOI: 10.3390/jcm12062245. PMID: 36983246.
Bonanno M, Papa D, Cerasa A, Maggio MG, Calabro RS. Psycho-Neuroendocrinology in the Rehabilitation Field: Focus on the Complex Interplay between Stress and Pain. Medicina (Kaunas). 2024;60(2):285. DOI: 10.3390/medicina60020285. PMID: 38399572.
Malfliet A, Kregel J, Meeus M, Roussel N, Danneels L, Cagnie B, et al. Blended-Learning Pain Neuroscience Education for People with Chronic Spinal Pain: Randomized Controlled Multicenter Trial. Phys Ther. 2018;98(5):357-68. DOI: 10.1093/ptj/pzx092. PMID: 29669079.
Watson JC. Overview of Pain. USA: Merck & Co., Inc; 2022 (last rev.). [Internet]. Available at: http://surl.li/uijwh [accessed 20 Mar 2024].
Orhurhu VJ, Roberts JS, Ly N, Cohen SP. Ketamine in Acute and Chronic Pain Management. 2023 Sep 4. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. PMID: 30969646.
Fenton BW, Shih E, Zolton J. The neurobiology of pain perception in normal and persistent pain. Pain Manag. 2015;5(4):297-317. DOI: 10.2217/pmt.15.27. PMID: 26088531.
Baliki MN, Apkarian AV. Nociception, Pain, Negative Moods, and Behavior Selection. Neuron. 2015;87(3):474-91. DOI: 10.1016/j.neuron.2015.06.005. PMID: 26247858.
Seymour B. Pain: A Precision Signal for Reinforcement Learning and Control. Neuron. 2019;101(6):1029-41. DOI: 10.1016/j.neuron.2019.01.055. PMID: 30897355.
Kleine-Borgmann J, Schmidt K, Scharmach K, Zunhammer M, Elsenbruch S, Bingel U, Forkmann K. Does pain modality play a role in the interruptive function of acute visceral compared with somatic pain? Pain. 2022;163(4):735-44. DOI: 10.1097/j.pain.0000000000002418. PMID: 34338242.
Colloca L, Ludman T, Bouhassira D, Baron R, Dickenson AH, Yarnitsky D, et al. Neuropathic pain. Nat Rev Dis Primers. 2017;3:17002. DOI: 10.1038/nrdp.2017.2. PMID: 28205574.
Yoo YM, Kim KH. Current understanding of nociplastic pain. Korean J Pain. 2024;37(2):107-18. DOI: 10.3344/kjp.23326. PMID: 38504389; PMCID.
Popkirov S, Enax-Krumova EK, Mainka T, Hoheisel M, Hausteiner-Wiehle C. Functional pain disorders – more than nociplastic pain. NeuroRehabilitation. 2020;47(3):343-53. DOI: 10.3233/NRE-208007. PMID: 32986624.
Clauw DJ, Essex MN, Pitman V, Jones KD. Reframing chronic pain as a disease, not a symptom: rationale and implications for pain management. Postgrad Med. 2019;131(3):185-98. DOI: 10.1080/00325481.2019.1574403. PMID: 30700198.
Fitzcharles MA, Cohen SP, Clauw DJ, Littlejohn G, Usui C, Häuser W. Nociplastic pain: towards an understanding of prevalent pain conditions. Lancet. 2021;397(10289):2098-110. DOI: 10.1016/S0140-6736(21)00392-5. PMID: 34062144.
Carota A, Calabrese P. Hysteria around the world. Front Neurol Neurosci. 2014;35:169-80. DOI: 10.1159/000360062. PMID: 25273499.
LaFrance WC Jr. 'Hysteria' today and tomorrow. Front Neurol Neurosci. 2014;35:198-204. DOI: 10.1159/000360064. PMID: 25273501.
Hooten WM. Chronic Pain and Mental Health Disorders: Shared Neural Mechanisms, Epidemiology, and Treatment. Mayo Clin Proc. 2016;91(7):955-70. DOI: 10.1016/j.mayocp.2016.04.029. PMID: 27344405.
Breivik H, Borchgrevink PC, Allen SM, Rosseland LA, Romundstad L, Hals EK, et al. Assessment of pain. Br J Anaesth. 2008;101(1):17-24. DOI: 10.1093/bja/aen103. PMID: 18487245.
Prabhu A, Abaid B, Sarai S, Sumner R, Lippmann S. Munchausen Syndrome. South Med J. 2020;113(4):198-200. DOI: 10.14423/SMJ.0000000000001079. PMID: 32239233.
He S, Renne A, Argandykov D, Convissar D, Lee J. Comparison of an Emoji-Based Visual Analog Scale with a Numeric Rating Scale for Pain Assessment. JAMA. 2022;328(2):208-09. DOI: 10.1001/jama.2022.7489. PMID: 35819433.
Sung YT, Wu JS. The Visual Analogue Scale for Rating, Ranking and Paired-Comparison (VAS-RRP): A new technique for psychological measurement. Behav Res Methods. 2018;50(4):1694-715. DOI: 10.3758/s13428-018-1041-8. PMID: 29667082.
Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken). 2011;63 Suppl 11:S240-52. DOI: 10.1002/acr.20543. PMID: 22588748.
Prommer E. Review article: dexmedetomidine: does it have potential in palliative medicine? Am J Hosp Palliat Care. 2011;28(4):276-83. DOI: 10.1177/1049909110389804. PMID: 21131636.
Kongsgaard U, Kaasa S, Dale O, Ottesen S, Nordoy T, Hessling SE, et al. Palliative Treatment of Cancer-Related Pain [Internet]. Oslo, Norway: Knowledge Centre for the Health Services at The Norwegian Institute of Public Health (NIPH); 2005. Report from Norwegian Knowledge Centre for the Health Services (NOKC) No. 09-2005. PMID: 29320015.
Langlois P, Perrochon A, David R, Rainville P, Wood C, Vanhaudenhuyse A, et al. Hypnosis to manage musculoskeletal and neuropathic chronic pain: A systematic review and meta-analysis. Neurosci Biobehav Rev. 2022;135:104591. DOI: 10.1016/j.neubiorev.2022.104591. PMID: 35192910.
Bicego A, Rousseaux F, Faymonville ME, Nyssen AS, Vanhaudenhuyse A. Neurophysiology of hypnosis in chronic pain: A review of recent literature. Am J Clin Hypn. 2022;64(1):62-80. DOI: 10.1080/00029157.2020.1869517. PMID: 34748463.
Ruan QZ, Chen GH. Hypnosis As A Therapy for Chronic Lower Back Pain. Curr Pain Headache Rep. 2022;26(1):65-71. DOI: 10.1007/s11916-022-01004-2. PMID: 35076877.
Mercadante S, Prestia G, Ranieri M, Giarratano A, Casuccio A. Opioid use and effectiveness of its prescription at discharge in an acute pain relief and palliative care unit. Support Care Cancer. 2013;21(7):1853-9. DOI: 10.1007/s00520-013-1740-8. PMID: 23400316.
Mitlehner W. Non-Steroidal Anti-Inflammatory Drugs. Dtsch Arztebl Int. 2022;119(33-34):566. DOI: 10.3238/arztebl.m2022.0183. PMID: 36422873.
Ungprasert P, Cheungpasitporn W, Crowson CS, Matteson EL. Individual non-steroidal anti-inflammatory drugs and risk of acute kidney injury: A systematic review and meta-analysis of observational studies. Eur J Intern Med. 2015;26(4):285-91. DOI: 10.1016/j.ejim.2015.03.008. PMID: 25862494.
Tai FWD, McAlindon ME. Non-steroidal anti-inflammatory drugs and the gastrointestinal tract. Clin Med (Lond). 2021;21(2):131-4. DOI: 10.7861/clinmed.2021-0039. PMID: 33762373.
Bacchi S, Palumbo P, Sponta A, Coppolino MF. Clinical pharmacology of non-steroidal anti-inflammatory drugs: a review. Antiinflamm Antiallergy Agents Med Chem. 2012;11(1):52-64. DOI: 10.2174/187152312803476255. PMID: 22934743.
Treillet E, Laurent S, Hadjiat Y. Practical management of opioid rotation and equianalgesia. J Pain Res. 2018;11:2587-601. DOI: 10.2147/JPR.S170269. PMID: 30464578.
Preuss CV, Kalava A, King KC. Prescription of Controlled Substances: Benefits and Risks. 2023 Apr 29. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. PMID: 30726003.
Pergolizzi J, Boger RH, Budd K, Dahan A, Erdine S, Hans G, et al. Opioids and the management of chronic severe pain in the elderly: consensus statement of an International Expert Panel with focus on the six clinically most often used World Health Organization Step III opioids (buprenorphine, fentanyl, hydromorphone, methadone, morphine, oxycodone). Pain Pract. 2008;8(4):287-313. DOI: 10.1111/j.1533-2500.2008.00204.x. PMID: 18503626.
Inturrisi CE. Clinical pharmacology of opioids for pain. Clin J Pain. 2002;18(4 Suppl):S3-13. DOI: 10.1097/00002508-200207001-00002. PMID: 12479250.
Kiyatkin EA. Respiratory depression and brain hypoxia induced by opioid drugs: Morphine, oxycodone, heroin, and fentanyl. Neuropharmacology. 2019;151:219-26. DOI: 10.1016/j.neuropharm.2019.02.008. PMID: 30735692.
Holovanova IA, Shevchenko AS. The issue of patient-oriented organization of palliative and hospice care in Ukraine. Experimental and Clinical Medicine. 2021;90(2):21-7. DOI: 10.35339/ekm.2021.90.2.hos.
Wolf A. How Palliative and Hospice Care are Organized in Ukraine (Review). Clinical Social Work and Health Intervention. 2017;8(4):99-106. DOI: 10.22359/cswhi_8_4_14.
Nesterenko VH, Peresypkina TV, Shevchenko OS, Sarkhadova II. Palliative and hospice care in the Kharkiv region in the first year of the war. Ukraine. Nation's Health. 2023;73(3):106-12. DOI: 10.32782/2077-6594/2023.3/18.
Riga O, Marston J, Khaustov M, Myasoedov V, Penkov A, Marabyan R. Aspects of the development of the program of palliative assistance for children of the Kharkiv Region throuth the challenges of the military conflict. Neonatology, Surgery and Perinatal Medicine. 2023;13(3(49):5-10. DOI: 10.24061/2413-4260.XIII.3.49.2023.1.
Lekhan VM. Retrospective analysis of the construction of the national system of hospice and palliative care in Great Britain. 2024;11(1):5p. In press. DOI: 10.35339/ic.11.1.lvm.
Volf O. Futuristic aspects in the sphere of social policy towards seriously ill persons in Ukraine, Great Britain and Australia in 2030–2040. Social and Human Sciences. Polish-Ukrainian scientific journal. 2019;04(24):3p. Available at: http://surl.li/ukspp
Arthur JA, Reddy A, Smith U, Hui D, Park M, Liu D, et al. Practices and perceptions regarding intravenous opioid infusion and cancer pain management. Cancer. 2019;125(21):3882-9. DOI: 10.1002/cncr.32380. PMID: 31291011.
Holovanova IA, Shevchenko AS. Evaluation of packaged funding programs for palliative and hospice care by the National Health Service of Ukraine. Experimental and Clinical Medicine. 2021;90(4):45-52. DOI: 10.35339/ekm.2021.90.4.hos.
Danyluk K. State management of palliative and hospital assistance in Ukraine: organizational mechanism. State administration. 2020;14(1-2):56-64. DOI: 10.46922/2306-6806-2020-1-2(14)-56-64.
Riga O, Marston J, Khaustov M, Myasoedov V, Penkov A, Marabyan R. Aspects of the development of the program of palliative assistance for children of the Kharkiv Region throuth the challenges of the military conflict. Neonatology surgery and perinatal medicine. 2023;8(3(49)):5-10. DOI: 10.24061/2413-4260.XIII.3.49.2023.1.
Rastvorov OA, Yasinskyi RM, Mironchuk YV (compl.) Organization of palliative and hospice care worldwide and in Ukraine: Handbook. Zaporizhzhia, 2023. 76 p. Available at: http://surl.li/ukson
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