When talking about cancer, many people immediately think “pain”. This is far from the rule. As such, cancer is rarely painful, but pain can be caused by the invasion or compression of organs, vessels or nerves.
Numerous treatment possibilities exist, from aspirin to morphine (correctly used, it is an excellent medicine), through chemotherapy or palliative radiotherapy (intended to relieve the patient without seeking to cure it).
In order to be fully effective, these treatments must be administered under medical supervision and scrupulously monitored by the patient, for example by respecting the doses of prescribed pain medicines.
In general practice, improvements in pain management and end-of-life management have changed the practice of physicians and the experiences of patients. Let’s listen to the words of Dr. Michel Vanhalewyn, general practitioner in Brussels (Société Scientifique de Médecine générale), who has experienced this evolution of the treatment of pain closely.
What pain has taught us …
“It all started in the eighties with the emergence of palliative care in Belgium and opened the door to another practice of general medicine where we learned to better manage a double responsibility: that which results from the global care – Medical, psychological, social or spiritual – but also acute care for which hospitalization is no longer decided on an official basis, thanks to an interdisciplinary approach and work. “
An interdisciplinary approach
“Frankly, physicians in the 1980s were not trained to do that role. Many of us have followed the Ramp (Extra-Mural Palliative Medical Care Network) project, Three years of age, including pain, dyspnea (difficulty breathing), pressure ulcers, digestive problems, disorders of consciousness, biomedical, psychological, social and spiritual problems.
“We have discovered the importance of an interdisciplinary approach . Real collaborations with nurses specializing in palliative care with skills that were not ours, and did not need to be, were born from The rules of the game – that is, the role, responsibility and limitations of each person in relation to the patient and his / her family – have been defined. Local experts, pain specialists, oncologists specializing in chemotherapy and radiotherapy treatments and other caregivers, the concept of hospitalization at home of a person suffering from cancer has developed.
Medication? It must also be able to withdraw!
Over the years, the drug approach has been refined. “These drugs should be given wisely and sometimes removed, rather than added,” said Dr. Vanhalewyn, “Chronic pain is still difficult to overcome. The only biomedical optics has often demonstrated its impotence. Reason why the organic approach Psycho-social and behavioral therapies. It helps to break the vicious circle where the long-suffering person is likely to fall, creating a situation where pain is sustained and where the pain feeds disadvantage and / or depression.”
The end of the boundaries between acute and chronic
Since the 1980s, the control of acute pain has progressed tremendously from the therapeutic point of view. Patients now benefit from more curative and palliative care that allows them to live longer with a relatively “good” quality of life .
Dr Vanhalewyn: “The majority of these problems are now well controlled, but we have not completely defeated them, but the rule of 70% death in hospital and 30% at home corrects. The risk of an acute condition that is added to the chronic illness, and better still, as it is part of our prevention work. Pain, difficulty breathing or other acute conditions becoming uncontrollable, or providing for timely access to appropriate medications that, together with appropriate gestures, will help, for example, drying out a patient suffering from Cancer of the face, without emergency hospitalization. “
For fifteen years, palliative care training has been part of regular continuing education and basic training for future doctors. They also become criteria for the quality of nursing homes. For a generalist, the idea of getting out of isolation and working with a support team has come a long way. Listening to the patient, the time taken to hear his needs and expectations, without being interrupted by a doctor who lacks time or who feels that this or that point is irrelevant, have progressed … Pain care, Approach to the end of life have changed doctors.
Act and Surround
Palliative … the word comes from the Latin “pallium” and designates a mantle, the one that protects … When a person has a serious, progressive illness that can lead to a fatal or already terminal end, palliative care Take on their full meaning. They are meant to relieve physical pain and other symptoms while taking into account psychic, social and spiritual suffering . In this overall accompaniment of the patient and his entourage, the objective is to achieve the best possible quality of life while trying to preserve, as far as possible, the autonomy of the patient.