What is pain therapy, a new right of Romanian patients. Doctor: “Pain itself becomes a disease”

Pain therapy will be included in the category of rights of Romanian patients, if a legislative project is approved by the Parliament. At the moment, only a part of the patients benefit from this therapy, and in most cases it is only done privately.

Pain therapy, a right of patients – Photo Archive

The Health Committee of the Senate favorably approved the project to amend and supplement Law no. 95/2006 by which pain therapy is included in the category of patients' rights. Thus, the right to pain therapy will be included in the rights of the insured in social health insurance, alongside the rights to treatment, prevention and recovery.

The project is important because it represents a fundamental change in the approach to medicine in Romania: the emphasis is no longer only on the part of effective treatment for healing or improving the patient's condition, but also on the elimination or at least the drastic reduction of suffering. If we remove the pain, through medication and specific medical procedures, we improve the lives of the sick and we can help them get through some really difficult moments in their lives more easily. Medical technology and our knowledge have evolved enough that, in almost every case, we can do concrete things in the hospital system to reduce the suffering of those dealing with almost any type of condition.“, said Nicoleta Pauliuc, one of the initiators of the project.

The law stipulates that the Ministry of Health, other ministries and institutions with their own health network, together with the Ministry of Education, will develop strategies for the professional training of specialists in pain management and for the education of patients in the prevention and therapy of pain.

“In addition to introducing the right to pain-free therapy, the law we initiated provides that people should be informed about what it means that they can have access to specific treatments in this regard. A patient must know that he can go to any type of consultation or medical intervention and that he will not suffer physically from the procedures to which he is subjected. This can also guarantee a better psychological state. We also need medical personnel who are specially trained for this specialty and who, over time, will develop this important field for the well-being of patients. In the developed countries of the West, they have been working in this direction for decades, out of the desire to reduce the suffering of their fellows tried by the disease”added Pauliuc.

Pain therapy in our country

Even though in 2018 the World Health Organization recognized chronic pain as a distinct medical condition in its classification and many European countries have developed specialized centers for the treatment of this condition, pain therapy remains almost non-existent in Romania for patients whose pain they do not life danger.

Experts in the field say that this specialization is as well known in Western Europe as cardiology, oncology, or others for more than half a century. To treat pain, a multidisciplinary approach is needed that can include drugs, minimally invasive procedures, non-drug therapies (physical therapy, acupuncture, therapeutic massage), but also patient education. More specifically, they can be taught pain management, relaxation techniques or exercises that they can then practice on their own. Therefore, there is a need for doctors from various specialties to collaborate to ensure holistic and personalized patient care.

Is the Romanian system ready to treat pain?

The health system in Romania does not provide us with the necessary medication to treat the disease itself. In the emergency departments, they don't have heparin, they don't have painkillers, they don't have adrenaline. So what are we talking about? In Romania, until a functional health system is made, we make laws for nothing. Laws that are not enforced. So we don't believe anything anymore“, says Cezar Irimia, president of the Federation of Associations of Cancer Patients.

He adds that there are a lot of laws that have no enforcement rules. “We still had the personalized treatments, legislated, and they have no rules of application. There are about 6-8 laws in the Ministry of Health, without application rules“, he also shows.

On the other hand, Vasile Barbu, the president of the National Association for Patient Protection, is more optimistic, and explained that part of it has to do with “pain therapy” it is already done in state hospitals.

We find it in other medical protocols, on various pathological categories, in which pain is also referred to. Even for cancer, although it was not transferred to palliative care, it was done in an outpatient setting. In 2010, I tell you, we had only three doctors specializing in pain therapy and specializing outside the country. The term didn't really resonate with us. But later, also in Romania, there are curricula, in certain categories of specialties pain therapy is taught“, said Vasile Barbu.

However, experts in the field believe that there is still a long way to go before this field develops like in the West. Marius Sîntean, Doctor of Medical Sciences, ATI primary doctor, specialized in the USA, believes that “it's a long way, anyway, even if you want to, it's still there. Certain educational centers can be created, if there is such a desire. We are some professionals who can provide these services“.

In Romania, there are several specialties that deal with the treatment of pain, in principle, although not all of them delve into the subject. Anesthesiologists-intensive care doctors deal, not only and perhaps because they treat acute pain, postoperative pain. And doctors who practice palliative care, clearly, because it's one of the main goals. And there are others. But multidisciplinarity is needed, especially since pain is the most frequent and bothersome symptom for which patients seek medical advice“, added doctor Vladimir Poroch, certified Palliative Care primary physician, specializing in chronic pain management.

When pain becomes illness

Pain is a natural phenomenon, as long as this acute pain is within normal parameters it helps you heal. When it exceeds the normal duration of healing a trauma, an injury, we are talking about subacute pain or chronic pain which is already a separate pathology, I called it pathological pain. This is why there is pain management and pain medicine, which are fighting an anomaly. Pathological pain is much harder and more difficult to treat as time goes by, it is harder and harder to turn back time and redo it. Pain medicine, especially in chronic pathology, involves more than an accurate diagnosis, getting to know the mechanisms of that pain so that you can effectively treat that pain. The pain itself ends up being a disease, sometimes it is not even related to the injury that triggered it. The approach is most often polymodal in both diagnosis and therapy”Dr. Marius Sîntean explained for “Adevărul”.

Medical specialists emphasize that the emphasis must be on multidisciplinarity.

Multidisciplinarity is needed, especially pain is the most frequent and disturbing symptom for which patients seek medical advice. It is certain that chronic pain is still undertreated in Romania for various reasons. There is still a suboptimal diagnosis and treatment of chronic pain, especially in the case of patients with non-oncological chronic pain”adds doctor Vladimir Poroch.

Quality of life should be at the heart of the medical system, which should not only treat diseases.

Practically, it is a complementary discipline and aims to treat pain, which is a very important symptom in terms of the quality of life, the mental state of the patient, his integration into the family or reintegration into society. They collaborate with psychologists, they collaborate with physiotherapists. So it's a more complex approach that ultimately focuses on the man, his quality of life and to give him the opportunity to reintegrate into the family, into society, into the workplace. These are all finesse things and certain things cannot be achieved overnight. There should also be some national programs to facilitate. There are all kinds of devices that can improve the quality of life, but which patients cannot benefit from without state support, because they are very expensive, adds the doctor. Not only patients, but also colleagues, i.e. the medical world is not completely aware of the fact that they can offer extra treatment, extra value, certain collaborations can be made between doctors. We are a complementary discipline. We help other disciplines to treat the pain, to remove the suffering, the patient to return as much as possible to the life before. In acute situations, pain has a great impact on the immediate evolution of diseases or in chronic ones, patients end up with other problems, depression and so on, if this aspect is neglected“, concludes doctor Marius Sîntean.

According to the motivation of the legislative act, 70% of the Romanian population had at least one episode of chronic pain or acute pain.