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What is pain

One of the symptoms of many diseases is pain. Our knowledge and experience allow us to cope with it. But without your help, our efforts would be ineffective, so in this article we want to inform you about pain and methods of dealing with it.

There are two types of pain: acute and chronic.

Acute pain occurs suddenly. Its duration is usually limited.

Chronic pain continues for a long time. A person who has been in pain for a long time behaves differently than someone for whom pain is a new sensation. People who have been in pain for a long time may not moan or show motor restlessness, their pulse and breathing rates may be normal, but the patient’s restrained behavior does not mean that he is not experiencing pain.

The ways in which pain spreads and manifests are complex. Many components take part in the formation of the sensation of pain. Feeling pain and expecting it to intensify, a person experiences not only unpleasant physical sensations, but also suffers mentally. Suffering is a mental reaction to pain or a psychological component of pain, and this component can often dominate the true (physical) pain. When a person experiences chronic pain, he is forced to constantly limit himself in some way. Some of his usual actions become difficult or inaccessible.

It is not always possible to get rid of severe pain completely, but you can learn to reduce it to a tolerable level.

When regulating pain, you should strive to bring it within reasonable limits and avoid emergency situations when it becomes unbearable.

Indeed, many diseases at different stages are accompanied by pain. But pain is not an obligatory companion to the disease. Many people do not experience pain. Remember this!

In most cases, the cause of chronic pain in patients is space-occupying formations that change the structure and function of the organs and tissues involved in the disease process.

But pain can also be caused by other reasons. For example, abdominal discomfort may be a consequence of prolonged stool retention, exacerbation of chronic gastritis or gastric ulcer; joint pain caused by chronic arthritis; pain behind the sternum - be a manifestation of heart disease, etc. In other words, the patient “has the right” to exacerbation of his chronic diseases and “acquisition” of new diseases, one of the symptoms of which may be pain.

Often pain is a consequence of previous radiation therapy or surgical treatment. This is due to traumatization of nerve fibers, their involvement in the inflammatory or scarring process, pressure due to developed lymphostasis of the limb, etc.

From the above, it follows that patients may have several types of pain with different localizations, and our specialists strive to identify the cause of each and take the necessary measures.

Treatment of chronic pain

Treatment of chronic pain will always be successful if you adhere to several mandatory rules:

If a doctor prescribes painkillers for chronic pain, they should be used according to the recommended regimen, under the supervision of hospice specialists.

Chronic pain requires regular, hourly use of analgesics. Taking medications should “stay ahead” of the increase in pain.

The dose of the painkiller and the intervals between doses are selected in such a way as to maintain a stable concentration in the blood and avoid increased pain during these intervals.

Nighttime pain relief is a priority because a bad night inevitably leads to a “bad” day. During 7-8 hours of sleep at night, one should strive to maintain a concentration of analgesic in the patient’s blood sufficient to block pain receptors. If necessary, this can be achieved by taking a slightly larger dose of an anesthetic drug immediately before bedtime and/or combining it with a drug that has a sedative effect, which will enhance and prolong the effect of the analgesic. If necessary, you can take an extra dose of pain medication at night.

If pain appears and the time for the next dose of the drug has not yet arrived, you must urgently take an extraordinary dose of painkiller, and at the appointed time take the medicine according to the schedule and then stick to it. If cases of “breakthrough” pain recur, the pain relief regimen is adjusted by the doctor.

There is no need to wake up the patient if it is time to take pain medication and he is sleeping. The missed dose is given immediately upon waking; the diagram may shift somewhat. If the patient is unconscious, medication hours are not skipped.

A number of drugs in the first days from the start of use can cause increased general weakness and drowsiness. During the first 4-5 days from the start of taking potent drugs, hallucinations, some confusion, and nausea may develop. All these symptoms are short-term and can be corrected with medication. If side effects do not disappear, the doctor may replace the analgesic with another from the same group, recalculating the equivalent dose.

Conclusions about the effectiveness of the pain relief regimen are made no earlier than 1-2 days from the start of its use. To facilitate the analysis of the effectiveness of pain relief, it is advisable for the patient or you to regularly keep diary entries according to the scheme, where it is necessary to note the date and time of taking the drug, the effectiveness of the drug taken. Such recordings help to correct the pain relief regimen.

Sometimes patients tell us: “Taking painkillers does not treat the cause of pain, but only brings relief.” This is true, but it is not the whole truth. If pain takes over the entire territory of life, preventing you from eating and sleeping, thinking and acting, then the body is deprived of the strength to fight the disease on its own. More precisely, we can deprive him of this opportunity by neglecting pain relief.

An adequate pain relief regimen is achieved by using an analgesic of one or another group or a combination of drugs from different groups.

During visits, the doctor asks the patient questions about the pain he or she is experiencing. The intensity of pain is determined by the patient himself, and not by anyone around him, because each person has his own pain sensitivity threshold. It is very important that the patient speaks openly about his pain. Some patients tend to downplay the degree of pain in their stories.

There is no need to fear that a patient experiencing severe pain will become dependent on narcotic drugs used for a long time. After all, here he takes the medicine for the purpose of pain relief, and not to cause new sensations. The opiates used are used by the body primarily in the area of ​​pain receptors, which means that the patient does not become dependent on them even with long-term use.

The need to increase the dose of drugs may arise due to increased pain as the disease progresses. Depending on the severity of the pain syndrome, the doctor prescribes as the main drug one of the three steps of the pain management ladder developed by the World Health Organization, supplementing it, if necessary, with drugs from the previous step and/or co-analgesics - drugs that enhance the effect of the main analgesics. Unless otherwise indicated by your doctor, you should take tableted painkillers after meals to minimize their irritating effect on the gastric mucosa. If your loved one is used to having breakfast late, there is no need to delay taking analgesics because of this. Offer him something to snack on and give him some medicine. The same should always be done if the prescribed time for taking painkillers does not coincide with main meals. “Put something in your mouth before taking the medicine” should be the rule, because in the treatment of chronic pain syndrome, drugs taken on an empty stomach can be counted on one hand, and the doctor will tell you specifically about them.

We try to cause the least discomfort to patients, so injections of drugs are used only if oral administration is impossible due to nausea, vomiting, swallowing disorders, and through the rectum - due to exacerbation of rectal diseases or the patient’s refusal of this route of administration .

In the case of parenteral (in the form of injections) administration of analgesics, the principle of “hourly” use naturally remains the same.

In the case of rectal administration, it is necessary to especially carefully monitor the regularity of stool, since the presence of feces in the rectum makes it difficult to absorb medications.

Non-drug ways to relieve pain

Non-drug methods of pain relief that can and should be used along with drug pain relief. These include:

massage of arms and legs, whole body, gentle stroking over the epicenter of pain; This can include “little” family members and visitors who want to help and who can be entrusted with massage;

cold or dry heat to the painful area, which, along with massage, helps reduce pain impulses in the spinal cord;

Maximum physical activity, supported by self-care tools and a comfortable home space for interesting activities and work. It prevents the “stiffening” of muscles, which causes pain, and connects the brain to activities that distract it from analyzing pain;

communication with pets, who give us examples of serenity and give us unconditional love;

Regularly performing exercises aimed at relaxing muscles.

Regarding the last method, I would like to say in more detail.

The reaction to almost any pain is muscle spasms - like striated muscles, the work of which we can largely regulate consciously, because. it makes up the muscles of our body and smooth muscles, which are contained in the structure of all internal organs, as well as blood and lymphatic vessels.

Muscle spasms make the pain worse. All techniques that promote muscle relaxation thus reduce any pain or may even eliminate some types of pain completely, making it available to the body's own pain management systems. Some of the simplest relaxation techniques that can be done without the help of a therapist include progressive relaxation, breathing exercises, and the method of “forgiveness and letting go” of pain.

When performing progressive relaxation, you first tense certain muscle groups and then relax them. This sequence allows you to relax more deeply. In Peter Lehndorff's book it is written as follows: “Sit comfortably in a quiet room in a chair or in bed and begin to breathe slowly and deeply. Focus on your breathing, and begin to work one by one with different muscle groups. Start with your hands. Clench your fists as tightly as possible and hold this position for 10 seconds. If you find it tedious, start with less and gradually build up the time. After 10 seconds, relax your hands and arms, mentally repeating the words: “RELAX AND RELEASE.” Feel the tension flowing out of your fingertips. Now turn your attention to your forearms and shoulders. Tighten their muscles as hard as possible for 10 seconds, then relax, repeating mentally: “RELAX AND RELEASE.” Then do this through your toes, calves, thighs, buttocks, stomach, back, chest, neck, face and forehead. Just “RELAX AND FREE.” Feel the tension flowing out of your body and the warmth spreading.”

It is quite possible to carry out these exercises without preliminary muscle tension if this is difficult for some reason.

Breathing exercises when working with pain are as follows. Having performed muscle relaxation as described, with your eyes closed, you begin to imagine that the air you exhale can pass through the pain. After a few attempts, you easily begin to “exhale” through the pain - at the same time, it seems to begin to dissipate in space.

You can use this method as an ambulance in case of any unpleasant sensations of the soul and body, sitting comfortably, with your eyes closed, kindly focusing your inner attention on the area of ​​​​unpleasant sensations and starting to “exhale” through them.

You should be confident that with a thoughtful and attentive approach, the family and patient, who have information about the principles of treating chronic pain and are in constant contact with the doctor, will take control of the situation within a matter of days and even hours whenever the situation changes. You must be confident in this, just as specialists working in this field of medicine know about it from their daily practice.

Anyone who has encountered pain - their own or someone else's - should know three simple things:

Quality of life is possible with any diagnosis.

You can live without pain and you can die without pain.

If a person cannot be cured, this does not mean that medicine is powerless to help him.

This is an axiom that has long been known abroad. Unfortunately, in our country the words “illness” and “pain” are not just the same root, they are perceived by many as equivalent. “If you are sick, then you must be sick.” That's what doctors think. This is what the patients themselves think. If you think so, read carefully and remember your legal rights and options.

What every patient needs to know about pain treatment

The effectiveness and quality of pain (analgesic) therapy (therapy of pain syndromes) largely depends on its proper organization. At the same time, the choice of necessary medications is within the competence of the doctor, but the timeliness of seeing a doctor depends on the patient, who must understand where he should first go with complaints of pain.

If pain occurs (intensifies), the patient must go to the clinic at his place of residence, where, simultaneously with a primary examination that excludes acute pathology (requiring immediate intervention), he must be prescribed effective analgesic therapy. All additional stages of examination (if necessary) should be carried out against the background of adequate treatment of pain syndromes.

The local (family) doctor is authorized to prescribe all necessary medicinal analgesics, even those that were previously prescribed only after additional consultations with an oncologist or other specialist.
no prior consultation with an oncologist is required ( Order of the Ministry of Health of Russia dated December 20, 2012 No. 1175n“On approval of the procedure for prescribing and prescribing medications, as well as forms of prescription forms for medications, the procedure for completing these forms, their recording and storage”).

In this way, not only the problems of timely prescription of painkillers are solved, but also the problems of drug supply - control of the availability of necessary painkillers is entrusted to the medical institution located at the patient’s place of residence.

The quality of pain therapy largely depends on the patient’s compliance with several basic rules for the treatment of chronic pain:

• Medicinal analgesics should be taken hourly, in pain prevention mode. The next dose is taken until the previous dose expires.
• Analgesics are prescribed “ascending” - if weaker drugs are ineffective, stronger ones are prescribed. If analgesic therapy is insufficiently effective, the patient must inform the doctor at the clinic at the place of residence.
• The basis of effective pain therapy are non-invasive (non-injection) dosage forms of analgesics (tablets, capsules, suppositories, special patches or transdermal systems). Injectable dosage forms of analgesics should be used in exceptional cases.

It should be understood that the quality of analgesic therapy largely depends on the coordination of the actions of the local (family) doctor, the patient himself and his relatives, and in cases of any pain management problems, the patient can always solve these problems by contacting the administration of the medical institution at the place of residence.

Memo for patients and their relatives on the treatment of chronic pain

Where to go if a patient with cancer has severe pain?

Treatment of chronic pain in patients suffering from both cancer and non-cancer diseases is carried out by a doctor at the place of his actual residence.

For patients for whom pain relief is indicated at this stage of treatment, full assistance in treatment is provided by a local therapist, neurologist, rheumatologist, oncologist or palliative care doctor at their place of residence. These doctors have the right to issue prescriptions for all groups of painkillers.

You must contact the district clinic at your place of actual residence, where you should be prescribed the necessary medications for adequate pain relief.

If you continue to have pain, or have problems with prescribing and prescribing pain medications, you can call the mobile palliative care service of City Clinical Hospital No. 30 of the Moskovsky district of Nizhny Novgorod by phone - 274-01-98 from 08.00 to 15.00.

How to get medicine?

1. The patient or a proxy goes to the clinic at the place of actual residence and provides the doctor with all medical documents (certificates, results of studies and treatment performed).
2. A medical professional examines the patient (including at home) and writes a prescription. When prescribing a narcotic analgesic for the first time, the signature of the head of the medical organization or other authorized person is placed on the prescription. When re-writing a prescription, a second signature is not required. In all cases, the usual stamp “for prescriptions” is placed on the prescription.
3. The patient or his authorized representative receives the medicine at the pharmacy (with a prescription). The patient's relative can obtain a narcotic analgesic by providing the pharmacist with a power of attorney written in any form and certified by his signature.

In the event of an unexpected increase in pain, pain relief is provided by a visiting emergency medical team (as part of providing emergency medical care in an emergency).

The patient should always remember that pain treatment should be based on the principles of the World Health Organization (WHO):

Purpose of the NON-INVASIVE form of the drug:(i.e. no injections - avoid injections)

BY HOUR: analgesics (painkillers) are taken by the hour, in anticipatory pain mode

ASCENDING: analgesics are prescribed, starting from weak to strong analgesic

INDIVIDUALLY: taking into account the patient’s individual response to the drug;

WITH ATTENTION TO DETAIL: you need to monitor the effectiveness of the analgesic and its side effects, carefully read the instructions and strictly follow all the doctor’s recommendations. It is not allowed to increase the dose of narcotic analgesic on your own!!!

In order for the doctor to select the optimal tactics for pain relief, the patient (his relatives) must always be ready to provide the doctor with detailed information about the drugs taken (name, dose, frequency and duration of use) and the effect of these drugs.

What is the patient's right to?

Pain can be treated for any diagnosis. Pain cannot be tolerated: pain takes away strength and does not provide an opportunity to relieve other symptoms of the disease.

The right to pain relief is guaranteed by law. Paragraph 5 of Article 19 of the Federal Law of November 21, 2011 No. 323-FZ “On the fundamentals of protecting the health of citizens in the Russian Federation” determines that the patient has the right to “relief of pain associated with a disease and (or) medical intervention, available methods and medications "

The attending physician, as well as the midwife and paramedic, if they have the authority of the attending physician, have the right to prescribe painkillers, without the consent of the medical commission (see paragraph 2 of the order of the Ministry of Health of Russia dated December 20, 2012 N 1175n (as amended on April 21, 2016)).

The doctor and patient should rate pain on a scale of 10, and the doctor should prescribe the drug according to the scale, not his or her opinion of the level of pain.

If after prescribing pain relief and taking medications the pain does not go away, it means the wrong drug was prescribed or in the wrong quantity. Demand to change the assignment!

The doctor is obliged to write a repeat prescription to the patient without requiring the return of used packaging.

The patient has the right to receive free narcotic painkillers even without an established disability, simply based on the diagnosis. Moreover, if there are no free drugs in the pharmacy, the patient has the right to receive a prescription for a paid drug.

Doctors in hospitals and clinics should note the presence of pain in the patient in the chart and in the extract.

If the patient’s diagnosis is confirmed and there is chronic pain syndrome, pain relief can be obtained from emergency doctors, including strong narcotic drugs, which are equipped with all teams.

Upon discharge from the hospital, the patient is given a five-day supply of medications or a prescription to receive them at the pharmacy to which the patient is assigned. If the institution does not have a license to work with narcotic substances, doctors are required to report a patient with pain syndrome to the clinic at the patient’s place of residence for registration. It is prohibited to discharge patients with severe pain from the hospital on the eve of weekends and long holidays if the person is not provided with a supply of painkillers for these days.

Remember: any diagnosis involves providing care to the patient and his family. If doctors cannot offer you radical treatment, they are obliged to transfer you to palliative care specialists!

Hospices and palliative care units should provide care primarily in the home rather than in the hospital. The patient and his relatives have the right to demand that doctors come to the patient’s home when the patient needs it.

Palliative care includes not only medical support, but also psychological support. If you feel that you or your family are having difficulty coping with stress, seek help from a psychologist.

If you do not receive proper support or pain relief, please contact the mobile service of City Clinical Hospital No. 30 of the Moskovsky District of Nizhny Novgorod and the hotline of the Ministry of Health of the Nizhny Novgorod Region for help:

Mobile visiting palliative care service City Clinical Hospital No. 30, Moskovsky District, Nizhny Novgorod

274-01-98

Hotline for pain management issues
Ministry of Health of the Nizhny Novgorod Region:
435-32-12

Patient School: a joint project of the portal “Mercy.ru” and the Regional Patient Organization “Cancer is Treated” (St. Petersburg).

Venue: St. Petersburg Clinical Scientific and Practical Center for Specialized Types of Medical Care (Oncology).

Participants: patients with various cancer diagnoses.

Issue topic: radiation therapy

Patient questions answered in this issue Alexander Vladimirovich Kirillov, radiologist of the highest category, head of the day hospital of the radiology department.

Is this the same radiation as in Hiroshima?

A. V. Kirillov, radiologist, head of the day hospital of the radiology department

- Tell me, doctor, is the radiation we are being exposed to is the same dangerous radiation that killed many in Hiroshima and Chernobyl? Or other radiation? Useful?

— We have gathered today to talk about radiation therapy. Because when they say “surgery,” people more or less understand what it is. And in the case of chemotherapy, there is some understanding. And people are usually afraid of us, radiologists, frightened by stories about world disasters. And sometimes they even try to avoid radiation therapy. And therefore I would like to start with the simplest, what our method includes, why it is needed and whether it is as dangerous as it seems at first glance.

For example, we are often asked when they find out that someone’s course is five weeks, someone’s six: “Doctor, why can’t it be done at one time?” And then we just remember about Chernobyl and explain that “at one time” this will be a disaster on a local scale.

— Is it necessary to drink red wine to remove radiation? And should you only drink dry red wine?

— Red wine should only be drunk at the movies and while playing dominoes. Just kidding, just kidding. But I know that a lot is written about wine on the Internet. In general, there is no need to specifically try to combat radiation. Let me clarify once again, you are not sources of radiation, you don’t need to get something out of yourself, because nothing is being injected into you. You only accumulate the effect of our treatment. This means that you can drink red wine solely for pleasure and when there is a reason. And only for a good mood.

— Or maybe everyone doesn’t need radiation therapy?

— It is absolutely certain that about 80-90% of cancer patients need radiation therapy to one degree or another. And that is why our method is quite widespread.

And the first and only thing you need to understand right away, to make it easier for both you and the doctors who will work with you, is that radiation therapy, which is carried out at medical facilities, is not dangerous. It does not turn you into a source of radiation. It works with tumor cells. The main thing is that you need to understand that you are absolutely safe for yourself and for others during the period when you are taking the course. And this is precisely the stumbling block for many. They begin to worry: “What about the relatives, what about the little children who are nearby.” Sometimes it gets to the point of absurdity. We have patients who burned the clothes they wore when they came to our Center for treatment.

You can't do without our method. And radiation therapy, although it causes some harm to the body, certainly does not make you outcasts, dangerous to society.

"Skin Burnt"

- So it becomes clear that this is dangerous, even by the way the body reacts. Burns appear, it’s hard to swallow, everything in the throat seems to be burned, although the chest is being irradiated.

— Yes, they are often afraid of burns. Burns happen. There are predictable complications. There are things that happen spontaneously that we cannot predict. There are acute reactions and there are delayed ones. As a rule, we try to talk through all these points.

Why are there burns on the skin? Because the skin is the first thing that encounters ionizing radiation, it is the first barrier that suffers first. A reaction occurs, but no more than the reaction that occurs with sunburn. This means that it is possible to fight it.

There are also unpleasant moments from the gastrointestinal tract in the form of changes in stool. There are also painful sensations.

Our method (external beam radiation therapy using a linear electron accelerator) is based on the fact that we act on rapidly dividing cells. And in the human body, rapidly dividing cells are usually found either in the epithelium, or they are tumor cells. And here we remember again that this is why the skin suffers during treatment, because it is an epithelium, the mucous membrane suffers, this is also an epithelium. And those unpleasant situations arise that accompany our treatment.

But all this is quite individual, and you must understand that there is no standard approach to complications. For Ivanov, Sidorov and Petrov everything will be different than for you.

And there are patients who have no reactions at all. There is no need to program yourself in advance for the worst.

- And my skin, doctor, really burned. You gave me twenty-five sessions, and after seventeen sessions my skin felt like it had been scalded by boiling water. Is this an isolated incident? And it seems to me that this is the case for the majority. So what should we do?

— Skin characteristics are individual. Blue-eyed blonds are most often affected. But there are exceptions. And we come back to the words that everything will be different for each of you. If there is skin discomfort during radiation therapy, you should first inform your doctor, and the doctor will prescribe treatment. There is no need to self-medicate.

There are ointments, creams, foams. But not all time periods can be used. And as a rule, we use non-greasy creams. Because the greasy film distorts the beam path and, accordingly, additional electron radiation from this film appears and the burn only gets worse. That is, you can harm yourself with fatty creams if you prescribe yourself creams that “once helped someone.”

“The day after irradiation, I blow my nose and my nose bleeds.

- This is quite natural. This is what we were talking about. In your situation, the skin and the nasal mucosa underneath, which are young, rapidly dividing cells, are irradiated; they also suffer. That's why the blood vessels burst there. As a rule, after two to three weeks these negative reactions go away, and you will forget about it forever. This is a natural complication, we expect such complications.

— My relative is being treated in her small town, they have one doctor per department and he has no time to answer questions. Tell me, what should I smear myself with? Well, at least the safest product for the skin?

— Relieves skin reactions, as a rule, Panthenol foam. Foam, or sometimes called spray, is what is sold in a can. She's not fat. And after radiation therapy, that is, when the course has already been completed and there are changes on the skin, you can use Bepanten, this is a children's ointment. And it’s just oily, it thickly covers the skin. But I repeat, fatty products can be used after completing the entire course, when there is no longer radiation exposure.

Baby fatty cream also does a good job of relieving all the unpleasant effects after treatment. As a rule, after radiation therapy, skin reactions go away within about a week, two, three. Again, depending on the characteristics of the skin.

Intracavitary radiation therapy – what is it?

— My friend was treated in Kazakhstan in Almaty. She was locked in the department for the entire duration of treatment. And she just gave birth. And her little daughter was shown to her through the glass of the department door. And she spent the entire period of treatment in the clinic, because the doctors just said that it was dangerous and that she should not be with a small child.

— There is external beam radiation therapy, which is what we do, and there is radiation therapy, when a radiation drug is injected into the human body. At such moments, yes, the patient is dangerous. Although also not throughout the entire course. But in our Center we do not have such a technique and do not carry out such procedures.

— Do you have weaker radiation therapy than in Almaty?

- No, there is simply external beam radiation therapy, there is intracavitary radiation therapy, interstitial radiation therapy. Radiation therapy is also possible, when a radioactive substance is injected into the blood and it is distributed throughout the body through the bloodstream. Thus, for example, bone changes are treated with the help of strontium. Strontium, already in the bones, continues to decay and emit. And at such moments, patients are truly dangerous. But this happens for a short period of time. (Our clinic does not have a cyclotron and there are no such patients.)

I am treated differently than my friend

— I have uterine cancer. My friend was treated for cancer in another city. She was injected with radiation using some kind of device. Is it better when they treat from the inside? Will they do this to me too? What to prepare for?

- One complements the other. There are different diseases and different methods. So again we return to the words that you should not try to project something that is happening to others, that it will happen to you too. You are all completely different, everyone has different diseases, even if it sounds the same, the histological variants will be different and the approaches to each patient will be different.

Some people need combined radiation therapy, when both remote and intracavitary therapy is used. Some people will only need a remote one. For others, contact is when skin lesions are treated. In this situation it is impossible to say - better or worse. There is only “right or wrong in a particular case.”

Why do they draw marks?

— Why do they draw lines before treatment? Do you remember that you once looked for points on me through a computer and then marked them directly on my body. Isn’t it just me who is being lined up? We compared drawings, many had them.

- Not just you. Although sometimes there are diseases when we do not need such preparation with the help of computed tomography, as was done with you. And in your case it was necessary. And using a computer tomogram, we made a 3D model of your body, and based on this 3D model, the physical department, physicists, made treatment calculations.

— Is it possible to wash these tags? And then one nurse said that it was possible, the second that in no case. Who should I listen to?

- No, you cannot erase marks from the body. And if they wear off during bathing, then we paint them on. Because this is important markup. It would probably be easier if it were a tattoo, but I think that not all patients will agree to get such a tattoo for a long memory. And so, some people have oily skin, others have dry skin. And that’s why some people’s drawings hold up well, but others don’t.

After treatment: what to eat and can I go to the bathhouse?

— I have prostate adenoma. I prepared questions before the meeting. Here I have it written down. Nutrition? Tan? Bathhouse? State of health, tone? Medicines? What vitamins should you take?

- Let's start with nutrition. During treatment, it is better to eat heavily. And this applies to everyone. Whatever treatment you receive, surgical, chemotherapy or radiation, you need to receive fats, proteins and carbohydrates in excess. Try not to even fast.

To the doctor? Be sure to constantly go to the doctor. As a rule, leaving our hospital, many believe that the disease has been cured and “I’m off and running.” So, if you fall out of the dynamic observation of an oncologist at your place of residence or with us here, then troubles will immediately begin. And all relapses that are detected in the early period are also subject to treatment.

About the bathhouse. The bath is a physiotherapeutic effect, so it obviously increases the risk of recurrence of the disease that we are trying to fight together. And it is better to avoid sunbathing.

— Do families need separate dishes and cutlery?

“I repeat that for yourself and for those around you, you are absolutely safe people who do not require isolation. You are no different from the rest. It’s just that at this moment you need treatment.

Surgery or radiation?

— And when the doctor says that you can choose either surgery and radiation therapy, or without surgery, but more intense radiation. Which is better to choose? And how can the patient understand what is best?

— Yes, there are diseases when radiation therapy and surgery are equivalent and equally replaceable. And if for some reason it is impossible to perform surgical intervention due to the general condition of the patient, then we go for radiation therapy.

Sometimes there are situations when, on the contrary, radiation therapy cannot be carried out for reasons of the patient’s general condition, and we are forced to perform surgery. Everything is individual. There is no such thing as just a strict standard approach. We always weigh the benefits and harms of treatment on the scales. If the harm is greater, then we will carry out, for example, chemotherapy to delay the radiation intervention and then carry out radiation a little later.

— Can the same organ be irradiated a second time? What if there was a relapse in him?

- Sometimes yes. But this is very individual. This is quite a risky undertaking.

Irradiation and examinations – can they be combined?

- Tell me, doctor, if I am undergoing radiation therapy, can I undergo a CT scan, ultrasound, MRI or bone check at the same time? Or does it interfere with one another?

— You just named completely different examination methods. MRI can be done despite radiation therapy. Computed tomography, if the area is small, can be combined with sessions. And if you need to examine two or more areas, then it is better to skip the CT scan, because the radiation dose will be too high.

In the case of bone scintigraphy, bone testing, you will be injected with a radiopharmaceutical, and for some time you are unsafe for others, so it is better to wait so as not to expose others to the influence, and yourself to additional exposure.

Therefore, when you have any examinations planned or you want to carry them out while undergoing radiation treatment, you must agree with your doctor.

— So it’s just because it’s unsafe? But the examination results will not be distorted due to radiation?

- Not always. Both CT and MRI may show incorrect results, for example due to tissue swelling.

In the hospital or at home? In Russia or abroad?

— What is the difference between inpatient and outpatient treatment?

- In my understanding, it is better to undergo treatment on an outpatient basis, because hospital walls have not yet cured anyone. But there are different life situations when it is difficult to get to the clinic, when it is financially expensive to get there every day.

It’s rare, but it does happen when a person feels psychologically more protected while constantly in the hospital. But it is still better to undergo treatment on an outpatient basis, because with radiation therapy, patients feel quite normal and physically active.

— Do we have good equipment in the clinic? And in the country in general?

- Everything is learned by comparison. Of course, there are better devices in the world, more modern ones. But what we have allows us to provide assistance to all patients who come to us.

- This is not the answer. Well, let's talk honestly. Tell me, are the devices abroad better? Now we don’t want to pretend and say “oh how good everything is in our country.” We want to live. And each of us at least once thought, “maybe we should sell everything and go to another country for treatment?”

— In terms of the quality of the treatment itself, one way or another, everything depends on the doctors, and not just on the technology. Improvement of equipment leads to a reduction in possible negative side effects. But the result itself is still the same everywhere. That is, the treatment programs and protocols that we use (at least in our hospital) are the same as in Europe, in America, and throughout the world.

A.V.Kirillov with patients

Well, we have what we have. And they don’t buy us any other equipment. And abroad there may be better technology in terms of minimizing the risk of complications.

— I get very tired after each radiation course. Is it just me? Why?

- The fact that you feel very tired means that the overall effect is accumulating. Cells are destroyed, cells release toxins and, accordingly, fatigue accumulates and drowsiness occurs. Over time, the body recovers.

Ask your question!

You can ask a question for the next issue of the Patient School. In the next seven days, readers of Miloserdiya.ru can ask any questions about chemotherapy procedures. About what worries those who are currently undergoing treatment. Those who are about to undergo chemotherapy in any clinic in Russia and the world. Those who support their family and friends in this fight.

And on March 29, as part of a joint project of the charity portal “Mercy.ru” and the regional patient organization “Cancer is Treated” with the support of the St. Petersburg Clinical Scientific and Practical Center for Specialized Types of Medical Care (Oncology), a School for Cancer Patients and Their Relatives will be held.

Natalya Valerievna Levchenko, candidate of medical sciences, chemotherapist with twenty years of experience, head of the department (o), will answer your questions.

Send questions by email: [email protected]

Or leave a comment on the announcement of the event in the group

Kursk State Medical University
Department of Polyclinic Therapy and General Medical Practice
PATIENT EDUCATION
WITH CHRONIC
NON-INFECTIOUS
DISEASES IN
OUTPATIENT PRACTICE
Lecture
Head department, professor
N.K. Gorshunova

According to WHO, 80% of diseases
population have chronic
flow.
For most of them
proven and
evidence-based therapeutic
measures to slow down
progression of diseases and
prevent their exacerbations.
However, the prescribed treatment
less than 50% used correctly
patients.

Relevance of patient education
Patients do not own
necessary knowledge for
everyday
"management" of one's
illness and do not realize
responsibility for
state of your health.
Application of modern
treatment methods required
deep understanding
mechanism of their action, because
they are quite complex and
sometimes dangerous.

Relevance of training
patients
Patient education is an integral part
arsenal of therapy for many chronic
diseases: arterial
hypertension, diabetes mellitus, CHF,
obesity, etc.
Treatment results directly depend
from the patient's behavior: he should
follow the doctor's instructions, have
necessary knowledge and skills
for making independent
medical decisions,
be motivated.

Learning Objectives

developing skills in patients
self-government regarding their
chronic disease with
aiming to turn it into
active participant in treatment
process,
preparing the patient for everyday life
use of new effective
technologies for treating chronic
diseases.

raising awareness
patients about the disease and its
risk factors;
increased responsibility
patients for maintaining their
health;
formation of rational and
patient's active attitude towards
illness, motivation to
health improvement, commitment to
treatment and implementation
doctor's recommendations.

MAIN OBJECTIVES OF TRAINING PATIENTS WITH CHRONIC NON-COMMUNICABLE DISEASES

formation of patients' skills and
self-monitoring skills
health, first aid
assistance in cases of exacerbations and crises;
developing skills in patients
self-correction of behavioral factors
risk (nutrition, physical activity,
stress management, avoidance of harmful
habits);
formation of practical
skills in drawing up an individual plan
recovery.

Conditions for effective implementation of patient education

Development of training programs for
various chronic
diseases or specific forms
their currents.
Preparation of methodological
software and demonstration
teaching aids.
Training of training personnel
(doctors, nurses).

arterial hypertension -

Health school for patients with
arterial hypertension is included in the industry classifier
(OK) "Complex and complex
medical services" (SKMU)
91500.09.0002-2001 (order of the Ministry of Health of the Russian Federation No. 268 dated
07/16/2001 "Standardization system in
healthcare of the Russian Federation") and
has code 04.015.01 (04 - medical
prevention services; 015 cardiology; 01 - School for patients with
AG as a type of service).

Health school for patients with
arterial hypertension - organizational
form of preventive group and
individual counseling.

arterial hypertension - medical
preventive service (i.e. has
independent complete meaning and
certain cost).
Health school for patients with
arterial hypertension - aimed at
prevention of disease complications,
timely treatment, recovery.

School AG - new information and motivational technologies

Target
promote
increase
patient adherence to treatment,
create motivation to preserve and
increasing responsibility for health
as for personal property, what
will ensure the quality of preventive
help
to the population
V
process
implementation
preventive
orientation in the work of GPs (GPs)

Necessary structural elements for organizing an AG school

qualified personnel in

performing complex and


for educational activities
patient education;
providing conditions for
effective functioning
schools (rooms, methodological
and educational materials,
tonometers).

Forms of training:

individual conversations with a doctor,
group cycle classes,
conducting review lectures,
study by patients
popular literature
for arterial hypertension,
showing videos, etc.

significant increase in the frequency of achievement
target blood pressure level,

obesity,
significant reduction in the number of patients with
moderate and pronounced
hypercholesterolemia,
significant reduction in the number of smokers.

Criteria for the effectiveness of patient education in school

significant reduction in the number of patients,
those who abuse fatty, carbohydrate and
salty food.
significant reduction in the number of patients with
hypochondriacal and depressive
manifestations, with high levels of stress

taking antihypertensive drugs,


downgrading of the dispensary observation group
patient.

Essential to keeping patients' knowledge and skills up to date

Recommended frequency of exercises – 1–2 times
per week in outpatient clinic
institution or 3–5 times a week in
day hospital,
Recommended number of patients per
group – 10–12 people.
Recommended repetition rate
training – 2 times a year.
Keeping a control diary is mandatory
main functional indicators.

Registration and reporting documentation of the patient's schools

Patient registration log,
students at the School of Health.
Registration of patients studying at the School of Health,
carried out in a separate journal for each
type of School (indicating the patient’s name, age,
contact phone number, dates of classes,
presence marks).
Outpatient medical record
making entries about the beginning of training at the School
health, dates and topics of each lesson,
certified by a medical professional,
who conducted the lesson.
Mark on the front side of the medical card
completion of the training cycle

Health school option for patients with hypertension

The full cycle consists of 5 lessons of 90 minutes,
dedicated to the main most important
problems of hypertension control.
Lesson 1. Arterial hypertension: how to recognize it?
Lesson 2. Arterial hypertension: what contributes to it
development?
Arterial hypertension: how to do it correctly
measure your blood pressure level?
Lesson 3.
Lesson 4. Methods of preventing arterial
hypertension.
Lesson 5. Arterial hypertension: when and to whom
should medications help?

Lesson 1. “Arterial hypertension: how to recognize it?”

explain that arterial
hypertension – chronic
progressive disease (main
the symptoms of which are headache,
nosebleeds, fatigue,
decreased performance as
result of high blood pressure), and the task
learn to control the patient
its course in order to prevent
occurrence of crises.
Target:

Lesson 2. “Arterial hypertension: what contributes to its development?”

Purpose: to give a concept
about risk factors
development of hypertension and create
patient motivation
to overcome them.

Lesson 3. “Arterial hypertension: how to correctly measure blood pressure levels?”

Goal: teach the rules
and methodology
measurements
arterial
pressure.

Features of blood pressure measurement in the elderly

With age, thickening and
compaction of the wall of the brachial artery.
palpable even when exceeded
cuff pressure above
intra-arterial.
To achieve rigid compression
arteries require higher
cuff pressure level, in
resulting in false
overestimation of blood pressure
("pseudohypertension, Osler's symptom).
To recognize this error, you should
determine blood pressure by palpation
forearm.
If there is a difference between systolic blood pressure,
determined by palpation and
auscultation more than 15 mm Hg. Art., for
calculating the patient's true blood pressure
necessary from the measured value
subtract 10-30 mHg. Art.

Lesson 4. “Methods of preventing arterial hypertension.”

Goal: teach patients how to
non-drug treatment and
compliance with recommendations for
healthy lifestyle (refusal
sedentary lifestyle increased physical
activity - and bad habits,
dietary food)

Lesson 5. “Arterial hypertension: when and to whom should medications come to the rescue?”

Goal: to teach patients
take correctly
antihypertensive drugs
with consultation at
necessary with the attending physician
doctor.

The goal of "ASTMA-SCHOOL"

Providing assistance to the sick
bronchial asthma based
new principles of organization
treatment and observation.
To the medical complex of patients
asthma introduces a learning factor,
which will allow the patient
actively participate in your own
treatment and control the course
diseases.

Conditions for organizing a bronchial asthma school

qualified personnel in
compliance with the requirements for
performing complex and
comprehensive medical services;
presence of a license in the institution
for educational
training activities
patients;
providing conditions for
effective
functioning of the school
(room, methodological
materials and asthma kits).

Asthma - set

includes the necessary
accessories
For
control
patient's condition:
spacer to ensure effective and
peak flow meter to monitor your condition
nebulizer for emergency
safe use of dosed
aerosol inhalers,
and assessment of pulmonary function as under
under the guidance of a doctor and independently
at home,
treatment of exacerbations of bronchial asthma.

OBJECTIVES OF ASTHMA SCHOOL

Achievement and establishment
control of disease symptoms.
Prevention of exacerbations and
complications of the disease.
Maintaining quality of life
sick.
Preventing Side Effects
from drugs used for
treatment, as well as irreversible
complications of the disease itself
reducing morbidity,
mortality and disability.

Factors influencing the effectiveness of education in asthma schools

trusting relationship between
healthcare workers and patients
(mutual understanding and empathy, ability
convince and explain, etc.);
simplicity and accessibility of recommendations and their
realistic for specific patients,
availability of written instructions and reminders,
patient diary, forms and methods
training, premises, environment and
equipping the room where the
training, etc.).

Forms of training:
individual conversations with
doctor,
group cycle classes,
conducting review lectures,
study by patients
popular literature
for bronchial asthma,
showing videos, etc.

Asthma-schools program

Keeping a “Self-Control Diary”.
Learning the correct technique
medications.
Learning how to use
inhaler
Peak flowmetry training.
Training for orientation during asthma
/zonal rating: green, yellow,
red/.
Training in proper nutrition.
Physical rehabilitation: therapeutic
gymnastics, breathing exercises,
measured walking, exercises
exercise machines, massage, hardening.

“Asthma school” option

The number of patients in the group is 10-12 people
Cycle – 5 lessons of 1-1.5 hours
2 times a week

"What's happened
bronchial asthma?"
First lesson:
Purpose: explain that the bronchial
asthma is a chronic disease,
and the patient’s task is to learn
control its flow,
to prevent
the occurrence of exacerbations.

Second lesson:
“Peak flowmetry. Asthma and allergies"
Goal: teach patients to use
individual peak flow meter, conduct
daily and weekly diaries; give
block of available information about
allergies, methods of diagnosing them with
active participation of the patient,
prevention and treatment of allergies.

Third lesson:
"Treatment
chronic inflammation
for bronchial
asthma"
Goal: to teach patients
Right
use
anti-inflammatory
ny drugs.

Fourth lesson:
"Non-drug methods
corrections"
Goal: to create in patients
motivation to workout
respiratory muscles,
teach them the tricks
correct breathing.

Fifth lesson:
"Self-help during exacerbation
bronchial asthma"
Goal: to teach patients to recognize
exacerbation of bronchial asthma,
stop asthma attacks
of varying severity.

SYSTEM OF COLOR ZONES FOR PATIENTS WITH BRONCHIAL ASTHMA

“Everything is fine” - the disease is good
controlled, PEF – 80-100% of
the best/proper indicator for the patient,
daily deviation<20%. Ни ночных, ни
As a rule, there are no daytime asthma attacks.
Maintenance therapy is indicated.
“Warning” - “alarm zone” symptoms of asthma (cyclic or acyclic),
night attacks of coughing or suffocation. PEF – 6080%, daily deviation 20 -30%. Therapy
should be strengthened.
"Anxiety!" - sharp deterioration! – symptoms
asthma at rest, frequent attacks of prolonged
character, the interictal period remains.
PEF<60%. Немедленно обратиться к врачу!

Criteria for the effectiveness of training in school for a patient with asthma

significant reduction in the number of exacerbations
and nocturnal asthma attacks
increase in the number of patients regularly
controlling individual PSV with
keeping peak flow diaries and
symptoms,
reduction in the number of cases of temporary
disability and hospitalization,
downgrading of the dispensary group
patient observations.

School for CHF Patients

Organization
lesson process
schools and
her relationship
participants are being built
according to the principle of a single
teams, and in the center
attention - patient.
Classes are held in
clinic and
home.

Patients with CHF and their relatives need

competent information and
training including
recommendations for correction
diet, lifestyle,
physical activity, regimen
drug therapy,
acquisition of necessary
self-control skills for
heart symptoms
failure with management
diary.

Medical recommendations
it is advisable to give it in a non-directive manner
form of the need for hard
restrictions on habits and image
the patient's life, and in the form
joint search for ways
achieving greater independence
from illness and preservation
quality of life.

School for CHF Patients

Patients do not drop out
familiar surroundings that
allows them to use
acquired knowledge and skills in
everyday life.
Training in conditions
clinics are designed for
patients with class II CHF.

School for CHF Patients

To conduct schools with
patients with III-IV FC CHF
should be connected
specially trained
nurses.
Their task is to provide
psychological support and
necessary assistance for
compliance with medical
recommendations received at
inpatient stage of treatment.

Alternative
form of submission
patient with CHF
necessary information and
execution control
prescribed
recommendations for distance learning with
using
information
newsletters, booklets,
videos and
videos, participation in
work of webinars on
Internet sites.

One of the important elements
organizing school activities
CHF that determines success
its implementation, - a meeting of the doctor with
relatives of patients,
who need to be told
about all the problems with CHF.

Monitoring the clinical condition of patients trained at the CHF school

carried out by two
ways:
directly - inspection
patient's doctor or
reception nurse or
at home;
remotely - during
phone calls
(communications via email
email, Skype).

Specially held
studies have found that
use of telephone
(electronic) reminders
doctor about the need
fulfillment of prescribed
recommendations for the first time
months after discharge
patients from the hospital
significantly reduced the frequency
readmissions
compared to the group
patients with
traditional approach to
treatment.

Conclusion

Patient education
schools, successfully
carried out on
outpatient stage –
efficient technology
flow control
diseases and improvements
quality of life of patients
and their relatives.