Overcoming the pain. What to do when medications don't help?

They're looking in the wrong place

“For such patients there are special pain clinics, where treatment is individually selected,” says Emil Isagulyan, a neurosurgeon-algologist at the Institute of Neurosurgery named after. N. N. Burdenko, Ph.D. “They deal only with pain and consider pain as an independent disease.
Unfortunately, we have few such clinics, and doctors are aimed at eliminating the cause of pain. They often perform multiple operations, looking for formations that can put pressure on the nerve and cause pain - scars, adhesions, hernias, fragments of intervertebral discs, consequences of injuries. This anatomical cause is eliminated, but the pain remains. For such patients there is even a special diagnosis - “operated spine syndrome.” In such cases, the matter is not in anatomy, not in eliminating the cause of nerve compression, but in physiology - in the improper functioning of the nervous system. The body's anti-pain system, which normally works well, is depleted, and the pain system is activated. We don’t know why this happens, but we know how to help.” An article on the topic of exercise therapy and the gym. Pain syndromes can be treated without pills. How not to bring things to such agony? The cause may be the painkillers themselves. After watching enough advertising, we ourselves treat headaches without a doctor and get hooked on pills. As a result, the so-called Overuse headache - it is caused by medications. You cannot treat migraines and other pain that appear periodically on your own. This increases the risk of developing severe pain syndrome. “Advertised” medications can be taken for moderate and rare pain. All others should be treated by a doctor.

“If he can’t help either,” continues Emil Isagulyan, “you need to go to a pain clinic. Over the past year they were opened at the Institute. Sklifosovsky and at the First Moscow State Medical University. They are mainly treated with therapeutic methods. We are engaged in pain surgery; people come to us who cannot be helped there. The main method of treatment is electrical stimulation. We implant a special device under the skin with electrodes that are connected to the nerves, spinal cord or brain. Using the remote control, we turn on the stimulator, which sends signals that modulate the functioning of the nerves. As a result, the pain weakens or disappears. First, we install a test stimulator to check whether it helps a particular patient. If all is well, we install a permanent one. The operation is simple, and the device does not limit life.

What to do if symptoms are present

If a woman has pain in her lower abdomen for a long time, she should consult a doctor. He will examine the patient, study all the features of the body, and palpate the stomach with his fingers.

If a man comes to the appointment, then usually his testicles and penis are examined, if a woman, then the doctor examines the pelvic area. This allows you to understand whether the lower abdomen hurts due to the uterus, ovaries, and fallopian tubes.

When to see a doctor

You should visit a specialist if the following symptoms appear:

• the duration of pain is more than 6 hours without a break, high intensity;
• in case of sharp pain in the lower abdomen on the right;
• if your stomach hurts after eating;
• if the pain is very strong, appetite disappears;
• when experiencing pain, a person vomits several times in a row;
• if pain in the lower abdomen occurs in pregnant women;
• in case of increased pain when changing body position;
• when the stomach hurts at the navel, then movement occurs. If pain is felt in the lower right quadrant, this may indicate appendicitis;
• if sleep is interrupted due to pain;
• pain ends in bleeding (in pregnant women);
• if in addition to pain there is a high temperature;
• if it is painful for a person to release gases, as well as during bowel movements and urination;
• if there is any kind of pain in the abdomen on the right, which differs from the usual discomfort in the stomach area.

It is best to visit a doctor if your stomach hurts for a week. Then you can avoid serious consequences.

When urgent medical attention is needed

You should call an ambulance as soon as possible in the following situations:

• if your stomach hurts badly and this leads to loss of consciousness and inability to breathe. This is typical for diseases such as liver failure, acute pancreatitis, abdominal bleeding;
• if the stomach hurts badly, a fever appears and the person is unable to move;
• painful sensations in the abdominal area lead to vomiting for several hours or vomiting blood;
• if the intestines do not work for several days due to acute pain. This may indicate obstruction of the digestive tract;
• if bleeding has started from the rectum. If the pain in the lower abdomen is acute, then a person may develop hemorrhagic gastropathy and intestinal ischemia. In the case of a chronic disease, abdominal pain with simultaneous bleeding indicates cancer;
• a person may have pain in the abdomen, chest, but he is not entirely sure of its placement. In such cases, heart disease often occurs;
• Men have stomach pain (groin area). This may indicate testicular torsion. If left untreated, tissue necrosis is possible.

Treatment of abdominal pain

If your stomach hurts, doctors can use two treatment methods - surgery or a conservative method. Sometimes it is necessary to undergo surgery (appendicitis, intestinal obstruction) to save a life. At JSC "Medicine" (clinic of Academician Roitberg), you can undergo effective treatment in a hospital; for this, visit the page.

The most important thing is to visit a specialist on time. He will study the whole picture and prescribe the necessary treatment. If it hurts in the front of the abdomen, tests are taken and all the research is done. Based on this, a diagnosis is already made.

Abdominal pain during pregnancy

If the symptoms listed above are absent, then heaviness in the abdomen and pain may indicate other causes. Pain in the lower abdomen may occur during pregnancy in women who are in the first trimester. This happens as the uterus grows and blood circulation increases. If a woman is pregnant, but the term is later, then abdominal pain may be associated with the fact that the baby’s weight has increased. Such sensations inside the abdomen can also occur as a result of stretching of the pelvic floor muscles, pressure on the rectum and bladder from the side of the uterus.

However, if your stomach hurts with nagging pain, you feel heaviness, but you also have vaginal discharge, spasms, pain, then you should definitely go to a specialist. Such symptoms can prevent premature birth, ectopic pregnancy, and miscarriage.

During pregnancy, your stomach may hurt due to diastasis. The growing uterus puts pressure and causes the abdominal muscles to separate. In most cases there is no pain, but sometimes there is pain in the back and navel. You don't need a doctor's help here. Almost always everything returns to normal after childbirth is over.

Treatment at home

Everything is quite simple here; you can use some methods when there is pain in the lower abdomen:

• eat prunes if you have pain in your lower abdomen. You can also take any product that contains a lot of dietary fiber (broccoli, bran). Prunes are especially useful in such situations because they contain sorbitol (a laxative of natural origin);
• Drink tea made from ginger, chamomile or peppermint. Such herbs reduce nausea and help with abdominal pain. With the help of ginger you can normalize digestion, chamomile and mint will help relieve muscle spasms;
• Use baking soda and prepare an aqueous solution. Baking soda is found in most antacid medications. It is worth taking 1 tbsp. baking soda and dilute with warm water (1 cup);
• Get a massage if your stomach hurts during your period. Spasms may occur inside due to the muscles being too tense. You will need a light massage, you need to focus on the place where it hurts the most;
• take a bath with hot water. Water will relax muscles, improve blood circulation, and relieve pain. You need to lie down for about 20 minutes. If a woman has a stomach ache, you can throw Epsom salts into the bath.

Case histories

Question answer

In what cases should patients be given pain medication? “For 12 years I was tormented by pain in my hip, in the last 2 years it has intensified, nothing helped, I could hardly walk,” says a man in his sixties, walking along the corridor of the department. — The Ministry of Health gave me a referral to the Research Institute of Neurosurgery. First they put in a temporary neurostimulator, and I immediately felt better. The pressure dropped to normal, before it was 180/120. The pain has eased significantly. Now the stimulator is constant, I turn it on when necessary. I take medications much less often.”

In addition to pain, the method can also help with delicate problems. “Three years ago I was diagnosed with an overactive bladder,” says the young woman. — Every 30-40 minutes I had to go to the toilet. I couldn’t leave home for a long time, I couldn’t go to the movies, and riding public transport was a problem. I tried everything - medications, homeopathy, acupuncture, psychotherapy - nothing helped. A year ago they installed a stimulator and life got better.”

What to do when regular painkillers stop helping?

Palliative care specialist* Andrei Ivanov answered questions from TV viewers about pain syndrome in seriously ill patients.

— What to do if a previously prescribed painkiller does not help, and the person is in pain?

— The regulatory framework states that any attending physician, including a local therapist, can prescribe narcotic painkillers without restrictions if persistent pain occurs. The therapist can do this even without any consultation with an oncologist or other specialist. This is now provided for by law.

Unfortunately, our therapists very often play it safe and try to send the patient to the oncology clinic so that they can write there what additional drugs can be prescribed. We take this calmly, we write recommendations, but according to the law, therapists must do this themselves without any restrictions or delays.

That is, if the patient’s pain intensifies, then the therapist must immediately either increase the dosage, or the shorter duration of taking the drug, or prescribe a stronger drug.

— Where to complain if medications are no longer effective, but they refuse to prescribe a stronger drug to a cancer patient?

- We need to complain to higher authorities. If your therapist refuses to help, then complain to the head of the clinic. Contact the chief physician, the chief freelance specialist, or the regional ministry of health.

Remember: if the drug does not help, the therapist must change it!

— When are potent drugs prescribed?

-. If the pain is severe and prevents a person from sleeping, actively participating in life, or caring for himself, then it is necessary to prescribe narcotic analgesics.

And if a person was previously helped by non-steroidal anti-inflammatory drugs or antispasmodics, but recently they have not helped even in maximum doses, then one must switch to narcotic drugs.

There are weak drugs and stronger ones. There are drugs in the form of tablets, patches, injections. The doctor can select the minimum dose of narcotic analgesics that will not even cause addiction. In this case, the person will be completely anesthetized.

But if, for example, a person says that he wakes up from pain once or twice, and during the day he experiences discomfort with some movements, then in this case narcotic drugs should not be prescribed yet. First you need to try regular painkillers, non-steroidal anti-inflammatory drugs, antispasmodics. Perhaps a person will be able to do without drugs for a long time.

* Andrey Ivanov – head of the palliative care department of the Novgorod Regional Oncology Center, chief specialist in palliative care in the Novgorod region.

More questions and answers - in the NT program “Tell me, Doctor” (host Svetlana Sterligova):
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Prevention

These rules should be followed by all people who experience pain in the left lower abdomen:

• control your stress and its level. To do this, you should meditate and do stretching exercises. Very often, stomach problems arise due to stress. Stretching, meditation will relax the body, mind, reduce pain in the left abdomen;
• Exercise regularly if your stomach hurts on the lower right side. Thanks to constant exercise, constipation is prevented and metabolism is accelerated. In addition, sport helps strengthen the digestive tract, cleanse the intestines, and ensure efficient functioning of the stomach;
• fill out a food diary. Write down all the dishes you ate throughout the day there. This will help you understand why your stomach hurts. You can prescribe your diet for a week, and it is important to indicate even the amount of food consumed. You should also write down your feelings during abdominal pain in your diary (the nature of the pain, their duration);
• watch your weight. Just because you're overweight and not much of it, doesn't mean you can forget about heartburn. Scientists say that the layer of fat puts pressure on the stomach, causing gastric juice to rise into the esophagus, and this guarantees heartburn;
• drink more water if your stomach hurts (about 2.2 liters). To have regular bowel movements and digest food, you need to drink enough liquid. Otherwise, hemorrhoids, polyps, and painful constipation are possible;
• get plenty of rest. If there is a stomach virus in the body, then you should be at peace and have strength. In the case of acid reflux, lack of adequate sleep can lead to serious consequences.