Dr. Veselin Gerić, specialist in anesthesiology with resuscitation, treats pain at Atlas Hospital.
We all have the right to live without pain
The World Health Organization has given clear principles and protocols in the treatment of pain. Pain therapy- timely treatment and elimination of pain for doctors of all specialties is a very important and complex task.
” At Atlas General Hospital, we are dedicated to pain therapy, and pain can be acute or chronic ” says Dr. Veselin Gerić – specialist in anesthesiology and resuscitation.
We all know what acute pain is – what hurts you right away, like a myocardial infarction or appendicitis. There you have a period in which you have to call a doctor immediately, so that you do not have permanent consequences or a fatal outcome. We also distinguish between chronic pain, which is divided into benign and malignant chronic pain.
Pain is a warning that we should call a doctor, but in many cases we do not do that.
We are waiting for the pain to pass with time, and the pain can go from acute to chronic benign or malignant. For that reason, it is important to use that time of waiting and diagnose the cause of the pain.
Patients must contact a doctor immediately regardless of the type of pain they feel. You don’t have to suffer and take medicine on your own. Now almost all types of drugs are available: from non-steroidal antirheumatics and Paracetamol to coanalgesic drugs, even Tramadol. You definitely can’t take it without a prescription, but you always have a friend or family member who will lend you some medicine because it works well for him and can help you. This hides your clinical picture, practically masking the problem you have, which can have catastrophic consequences.
Types of pains
We have several type of pains:
- Musculoskeletal
- Visceral pain (lungs, intestines, liver ..)
- Neuropathic pain
- Headache – 132 types of headache
Pain treatment is a multidisciplinary procedure
There you really have to be well-versed in knowledge to make an accurate diagnosis and cause of pain. Recently, the Faculty of Medicine, within the specialization in anesthesia and resuscitation, introduced a subspecialization in pain therapy. Pain treatment is a multidisciplinary procedure and depending on the type of pain, you must undergo several examinations. If the patient has neuropathic pain, he must be examined by a neurologist, a neurosurgeon must do an magnetic resonance, maybe a scanner, a complete laboratory. Patients who have exhausted all these possibilities and the pain is still present usually turn to us for help.
The World Health Organization has given clear guidelines in the treatment of pain and you have a clearly defined scale:
- Paracetamol
- NSAIDs
- Coanalgesics
- Trodon
- Synthetic Morphines
- Morphine
- Intervention procedures
The pain in benign or malignant diseases cannot be covered with a single drug and expect the pain to stop, you must cover all neuropathic and visceral and bone receptors for this therapy to be effective!
Most clinics and institutions in this area deal exclusively with the oral approach in pain relief. So you get a medicine to drink, then a transdermal approach – something that you will stick to the skin or you get a remedy through a vein. You will not be able to solve the cancerous pain in the pancreas in this way.
At Atlas General Hospital, we are seriously committed to pain therapy. Pain is treated by doctors of various specialties, but it is the anesthesiologist who ultimately decides on the therapy. When you have a patient to whom you have solved a pain problem then he binds to you, whether he is a surgical, psychiatric or neurological patient.
When patients come to us, we have to assess what is the biggest benefit for them. Is it oral therapy or is an intervention procedure necessary that only we do here.
In addition to prescribing medications, patients are offered interventional procedures at Atlas Hospital that help patients resolve pain in 15 to 20 minutes.
Dr. Geric explains what intervention procedures are:
We perform various neurolysis:
- Plexus
- Nerves
- Therapeutic-diagnostic blockades with local anesthetics or corticosteroids
- Implantation of epidural and spinal stimulators
The advantage of an institution such as Atlas is that a large number of experts work with us, as well as Dr. Milenko Savić who helps us with these procedures. Thus, we closed that surgical part in the interventional procedures for analgesia of patients.
What does pain therapy look like in severe patients
Patients with pancreatic cancer are severe patients with severe pain. Dr. Veselin Gerić reminds us of the range of medicines that are given to these patients as standard, but which do not solve the problem for them or their families. You give such patients Paracetamol, Diclofen or any non-steroidal antirheumatic drug, Tramadol, transdermal Fentanyl – it is Morphine that is 100 times stronger in that dose than the classic Morphine, so if there is still pain, you also add Morphine. You have a patient who is tied to the bed and has pain, he is often unconscious of everything around him, but he suffers from pain.
At Atlas General Hospital there is a way to help the seriously ill, to make the pain go away and thus their quality of life becomes better.
As for pain in pancreatic cancer, the best therapy against pain is Celiac plexus neurolysis
How is the Celiac plexus neurolysis done?
It is a single plexus, a set of small neurons located at the level of the thoracic 12th and lumbar 1st vertebrae between the aorta of the largest blood vessel and the spinal cord. The patient lies on his stomach with a pillow under his stomach. In that region, we give a local anesthetic and with needles the size of 15 cm, we approach the plexus on the left and right side. We give a test dose to see if we are in the right place and then we give a neurolytic solution.
After that procedure, patients lie on their stomachs for half an hour in intensive care and then turn on their backs. They spend 24 hours in the hospital because there may be a slight drop in tension or a slight chest pain, which is normal with such procedures. 70% of patients no longer have any pain after this procedure.
In the other 30% of cases, we have patients who have been on Morphine for a long time, so we must not discontinue it abruptly. These patients remain on Duragesic or if they feel another breakthrough of pain on Morphine which we slowly discontinue we increase a little nonsteroidal antirheumatic drugs and Paracetamol. We have patients who still have the same pain.
For the most difficult patients, Atlas General Hospital has procedures that relieve these patients of pain, by implementing an epidural catheter.
What is an epidural catheter?
At the level of the thoracic 5th and 6th vertebrae, we pass a catheter through the skin and on the anterior abdominal wall there is one filter through which we give medication twice a day for 12 hours. We apply a solution of local anesthetic and Morphine, which is in a 100 times smaller dose than the patient would take orally or transdremally. The patient is mobile and has no pain.
Cancer pain is treatable and patients and their families need to know that.
Unfortunately, patients come to Atlas Hospital in the terminal phase of the basic disease, and one of the reasons is the doctors who treat patients with the patient’s basic disease. There are a lot of colleagues who will tell you that it must hurt you and that you are happy that it hurts you because you are alive as long as you feel pain. Many of my colleagues have no knowledge of intervention procedures, they are not ready to say that there may be solutions for all patients.
Patients in the terminal phase of the disease are left to fend for themselves. You do not have enough hospices, there are no places that will receive such patients, treat their pain and provide them with care.
Pain in the younger population
In addition to cancer pain, a large number of patients have benign chronic pain. This pain is most present in younger people who are between 30 and 50 years old.
This benign chronic pain is due to:
- Hard work
- Stress at work or at home
- Overtime stay at work
- Bad eating habits
- Improper posture
- Impossibility for regular rest
- Lack of physical activity
More and more young people are experiencing pain that lasts for more than three months. The primacy refers to: lumbo-sacral pain, pain due to sciatica, discopathy, facet joints and the entire spinal area, and it is treated with all these procedures that we have listed.
For the treatment of chronic benign pain, Atlas Hospital offers patients the following procedures: diagnostic and therapeutic blockades in painful places, epidural blockades, implementation of epidural and spinal catheters in spinal stenosis, postoperative problems and discs. It is common for pain to occur after a few months of disc surgery. That patient is not eligible for other surgical procedure and the pain must be removed and then all these procedures are effective.
Migraine headaches – migraine
There are 123 types of headaches.
Atlas Hospital also treats migraine headaches, which are benign chronic pains and are difficult to treat. There are several medications that can work. We also do diagnostic procedures that can help and delay the next migraine attacks for up to 8 months. The cause of the migraine must be known in advance, whether it is hypoglycemia, starvation or impaired vision. The patient feels a migraine attack and should take migraine medication at the beginning. You should definitely call an expert who will do everything to relieve the patient of pain.
Svaki čovek ima pravo na život bez bola. Terapija bola postoji i uspešno se primenjuje u Atlas bolnici od strane stručnjaka za anesteziologiju. Dođite na vreme i posle dijagnostikovanja uzroka problema bola, dobićete adekvatnu terapiju i rešićete se bola.
Everyone has the right to life without pain. Pain therapy exists and is successfully applied in Atlas Hospital by anesthesiologists. Come on time and after diagnosing the cause of the pain problem, you will receive adequate therapy and you will get rid of the pain.
