Doc. Tomáš Gabrhelík: Pain treatment should be seriously addressed by all fields, especially in seniors
Chronic pain is often underestimated, especially in older and polymorbid patients. On the other hand, during self-treatment, many patients use inappropriate medication for a long time. The treatment of prolonged and more intense pain should be managed by an algologist, and other specialists should not forget to monitor the patient's documentation to avoid medication duplication and other risks arising from inappropriate prescription. We discuss the pitfalls and benefits of analgesic treatment with doc. MUDr. Tomáš Gabrhelík, Ph.D., from the pain treatment clinic at the Department of Anesthesiology, Resuscitation, and Intensive Medicine at the Faculty of Medicine, Palacký University and University Hospital Olomouc.
What proportion of patients address chronic pain problems through self-treatment?
It's hard to estimate. We don't have data on this, but it is certainly a significant part of the population. Especially with episodic pain, such as vertebrogenic, many people reach for available anti-inflammatory drugs. Only in the case of long-lasting problems do they turn to specialists.
Can a person behave rationally if suffering from long-term pain?
Yes, but often they do not have enough relevant information. Many times they follow what a friend recommended or something they read somewhere. If they suffer from more significant chronic pain, such as cancer pain, then the impact on the psyche appears and they may experience altered perception and behavior.
How frequent is the problem of overuse of analgesics and possible addiction?
With treatment not led by a specialist, overuse is more common, and many analgesics do indeed have addictive potential. However, with guided algological treatment, this risk is minimized.
Do doctors also contribute to the overuse or inappropriate choice of analgesics?
Certainly. This often results from a lack of information, but organizational reasons also contribute significantly. Doctors often do not monitor what another specialist has prescribed for the patient, so one prescribes something for rheumatology, another for orthopedics… one analgesic for back pain, another for headache. It is crucial to realize that an analgesic works on the whole body. And to monitor the patient's electronic documentation.
Is pain often underestimated as well?
Undoubtedly. All fields should seriously address pain treatment. This is especially true in the treatment of seniors. Subdosing can also be an issue. Many doctors avoid prescribing opioids, but these can significantly improve the quality of life in many cases. In addition, non-pharmacological interventions are also available.
Which analgesics are most popular among patients?
Generally, those they have tried and tested, or those recommended by someone they trust. Very often, these are non-steroidal anti-inflammatory drugs. However, these are a double-edged sword. They are excellent medications for young people for a short period, but not suitable for long-term use in older and polymorbid patients. For this group, it is better to choose a drug from the class of weak opioids, which have the best balance of efficacy and risk.
Metamizole is one of the oldest analgesics still in use. What is its current status?
Metamizole shows similar efficacy to paracetamol for mild to moderate pain. Additionally, it has a spasmolytic effect and can be well combined with other classes of analgesics. Regarding the mentioned dependencies, it is safe in this regard.
What is the significance of the NNT value in practice, and to what extent does it influence a doctor's decision in choosing an analgesic?
We algologists are well acquainted with the potency of known analgesics and their groups. However, I believe that other specialists choose treatment based more on empirical experience and general knowledge about the strength of the analgesics.
MUDr. Andrea Skálová
editorial team proLékaře.cz
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