1. PECULLIARITIES OF CHRONIC PAIN ASSESSMENT AND MANAGEMENT
Authors
Nanuli Ninashvili1,2, M. Shavdia2,3
1. National Center for Disease Control and Public Health
2.Tbilisi State Medical University
3. Universal Medical Center, Palliative Clinic
INTRODUCTION
METHODS
Although Chronic pain presents one of the priorities of public health, its assessment and management remains problematic worldwide creating serious obstacles in the prevention. We aimed to study chronic pain assessment and management in Georgia.
Descriptive study (survey) was conducted in on 232 randomly selected patients in palliative care clinic and 304 physicians in primary health care institutions. Pain assessment tools such as Visual Analog Scale (VAS) and numeric pain rating scale along with questionnaires, composed of 20 (for patients) and 40 (for physicians) open and closed questions were employed. Study results were processed in SPSS software.
Table 1. Symptom frequency in 232 oncoincurable patients by ECOG-WHO
(%)
Picture 1. Knowledge level of primary health care physicians
Knowledge of:
WHO_pain Ladder – 50.1%
pain assessment – VAS - 0%
Dosing opioids – 4.1%
Titration of opioids – 8.2%
Side effects of opioids – 46,9%
RESULTS
Response rates were 83% for patients and 87% for physicians. 65% of patients were unaware of their diagnoses, only 20% new the reason of their suffering only at the incurable stage of the illnesses. 15% attributed pain to inflammatory conditions. Perception and expression of pain by majority of patients (85%) didn’t correspond to the pain intensity, measured with tools (t=3.4). Pain prevalence ranged between 75.8% %and correlated with ECOG stage (r=0.8)/.
50,0% of physicians were unaware of WHO pain leadder, 90% of them didn’t employ tools for evaluating pain intensity. 89,8% - prescribed opioids without prior determination of causes and risk factors. None of the enrolled physicians new preventive principles of chronic pain, resulted in unawareness of patients towards self-management and preventive potential of chronic pain.
CONCLUSIONS
RECOMMENDATIONS
Renewal of national legislation and guidelines;
2. Creation of appropriate educational base for students;
3. Training and certification of primary health care physician in chronic pain management;
4. Active advocacy of chronic pain self-management and prevention medical personal and general public via mass-media.
According to IASP definition, pain is “an unpleasant sensory and emotional experience”; therefore perception and expression of pain is largely dependent upon a person experiencing it. Cultural patterns play a significant role not only in pain assessment, but also in management and prevention. Our study results showed that irrespective of national legislation, existing stigma in physicians were reflected in nondisclosure of diagnoses to the vast majority of patients. Low knowledge level of physicians in chronic pain as a disease of its own Right, and neglecting pain causality and componential psycho-social factors along with cultural patterns of pain perception and expression in 95% of cases presented reasons of inadequate chronic pain control, management and prevention.