Prime. Mag. Marija Cesar Komar, Dr. with anesthetist, has long been involved in pain relief.
She uses various methods, including acupuncture, which she studied at the Academy of Traditional Chinese Medicine in Beijing. She is now involved in pain management and acupuncture and, of course, still stunners her.
Yesterday I learned a new word: algologist. Are you an algologist?
Yes, of course, these are doctor specialists who treat pain management. Algology is a science of infertility.
Is this still a relatively young science?
Of course, anaesthesiologists have always taken care of pain treatment, because this is a kind of continuation of our work. Only the term is used relatively short, say the last two decades. When we guarantee good conditions for surgery, we take care of virginity, and we have to do it in the postoperative period.
Most people anesthesiologist like a person sleeping with you in surgery, and later you have no problems with you anymore.
This is a very wrong opinion. Anesthesiologist is a very important specialist who has to master the physiology and disease of a normal person affected by various causes and diseases, he must master various anesthesiological methods, a number of drugs, anesthetics, stimulants, interactions (interactions) of different drugs and their pharmacology. In clinics for the treatment of pain, we are primarily focused on the treatment of chronic pain. Anesthesiologists who do not have special skills in the treatment of chronic pain management for the treatment of acute pain, such as birth, postoperative and damaged pain.
Anyone who knows pain chooses to act – what should he do first?
First, she goes to her personal doctor after referring to an outpatient clinic.
And how many are these in Slovenia?
About the nineteenth century. Of course this is not enough. They have public hospitals, the Clinic Center has a large outpatient clinic for treatment of pain, and UKC Maribor also has a rehabilitation center in Soča, but there are also some smaller clinics in some spas, some of which are private. Some are concessionary, others are self-paid.
If the patient can not afford a self-pay clinic, what are the waiting times?
Different, depending on the reference – if it says "urgent" it must be in 24 hours, with "very fast", this is a new category, a fourteen day wait, "normal" is three months …
But if a person hurts, three months is very long.
Of course, the family supervisor must evaluate how it is necessary if he can prescribe simple analgesics and if they are sufficient to cover the pain. Our position is that opioids, intended for severe pain, should not be prescribed for the first time by family doctors, as this is a very dangerous drug. In the continuation of therapy and after consultation with the algologist, it can control the patient further. If the pain is very severe, the family doctor can contact the painter's specialist, which happens quite often.
You have already talked many times about the 2007 survey that 23 percent of Slovenian suffer from chronic pain. Is this information still valid?
Of course it is true. We would need someone who would help us to co-finance the repeat of this study (which costs a lot) to make sure that is the case. These 23% are many, we are fourth in Europe together with Belgium, but I think that in the past ten years many doctors have received training on pain management, they have also been informed by patients, why this percentage may be lower. But we can not assert this with certainty.
This is a high proportion, is Slovenian more sensitive?
Yes. I do not think we are so high. In the ranking, if you look at the classification, a more detailed study shows that in long-term pain – one lasting more than five years – below the European average, which is 19 percent.
You once said that chronic pain most affected women over thirty. Why?
This is evident from our research. However, when administered controlled studies of susceptibility to the same painful stimuli in men and women, men showed higher sensitivity. I do not know, maybe women are still more "oppressed" if I say that – as you know that pain sometimes also flows from everyday to something else. If we can not handle daily stress, daily stress, hacking at work or in the family, family relationships are not regulated, it's also one of the causes of pain.
How many visits to an algologist are required (on average) for the pain to disappear?
Depending on the pain. If the patient responds well to the therapy, the controls are rarely needed. However, if the patient is on opioids, they need more often, for example, one week until a dose that is appropriately detected. The problem can also be opioid hypersensitivity, which is the phenomenon when the pain stops responding to opioids at high doses. Then another type of medicine will be chosen.
How about acupuncture?
There we have a first review where we make a plan. First, we make a story, then follow the principles of traditional Chinese medicine to investigate the patient and decide which points to use in the treatment. Then the patient must take acupuncture treatment ten times a day, every other day and in very serious pain every day. Then we take a break, for acupuncture works for another month to one month after the end of treatment. After ten sessions, we take control, then we assess the situation and evaluate success.
You mean to start hurt again after a month?
Do not do it! The effects of therapy are still aggregated, but then we get the final state, let's say we've improved pain by 50 percent, the consumption of analgesics has fallen by 30-80 percent, and some can also eradicate all problems. But they do not have to, they can come back on time. We always say that patients must treat their own pain themselves if there is a chronic pain of the known cause – for example, for pain in the musculoskeletal system, exercise is very important, it should be performed regularly every day. Analgesics, which we find useful to give them, can also be measured by themselves. Of course, they must keep records of pain and analgesics consumed.
Have you ever had a patient you could not help?
Yes, but very rarely. There are also very persistent pains. Then we arrange with the hospital department to hospitalize it, and then the therapy is performed either by intravenous infusion or by blockages.
What can the patient do for himself when he is waiting for treatment? You have already answered in part, you mentioned gymnastics.
But gymnastics just for the pain, it's by no means to exaggerate. Just so much that the muscles work. We need healthy, strong muscles that can carry the body and keep us in the right position. The cause of their pain should be identified, therefore, they must visit appropriate specialists and perform certain diagnostic procedures to determine the cause of the pain.
"Pain is a very complicated phenomenon, not just physical pain, it is also a psychosocial phenomenon. Because of pain you also move away from your friends, from your family, you isolate yourself socially. Chronic pain often leads to depression so that is sometimes necessary to include a psychologist or psychiatrist and anitidopressive drug in the treatment of pain. Pain should be considered interdisciplinary – include a family doctor, a pain doctor, an algologist, psychologist or psychiatrist. We already have such centers to deal with pain, but there are too few. "
But specialists also have waiting times.
There are waiting times everywhere, this is a vicious circle, but in any case, the cause of pain must be identified. Movement and exercise are important but positive thinking. They can take analgesics alone, and they should not "feed" them with tablets of course not too much. Which paracetamol or pharmacodynamics are a very useful tablet, but not in large amounts. Three milligrams are the maximum daily dose, otherwise organs, kidneys, etc. may be impaired. Not to mention opioids, they have other types of side effects – addiction, decreased cognitive function, itching, water closure, slow bowel function …
Pain is a very individual thing, but you have enough pain – how much is it reliable if the patient self-assesses?
Pain is really very individual. The first rule of our algologists is that we think every patient is injured. We must believe him. For pain lenses, however, it is a visual analog scale (VAS) ranging from zero to ten or from zero to ten to one hundred. We explain to the patient that nothing means pain, the extent to which pain increases and that 9 or 10 is an unbearable pain, one that can not be transmitted. Everyone says first, I'm injured for ten. It's not true. I tell them I do not think they hurt 9 or 10, since then they could not even talk to me normally. It would be a pain as if you break your arm or leg legally. Then there's only somewhere on this scale and write down this number. Tracking the number of VAS tells us the success or failure of our treatment.
This means that the most important thing is not what the original number is, but how it decreases.
Of course, it's important – if VAS is high, you choose other types of drugs, like in low. The trend is also falling or rising.
Do you think that in addition to acupuncture, do you need to offer another type of alternative treatment? What do you think of homeopathy?
I do not really know about homeopathy. Research has shown that about 60% of them also decide on alternative therapies. However, there is no control over homeopathy, and the doctor has failed to introduce it. Homeopath may be someone, whether you have medical education or not, and this can be dangerous because some dangerous diseases can be overlooked and may delay the time for quick treatment. There are other methods and people use them, but they would not recommend them as a doctor. Also in acupuncture, people must know what education they have. In our field, a large number of Chinese doctors appear with non-doctors, even less acupuncturers.
But how can a layman check that?
Very hard. It is best to ask what kind of degree she has or what kind of education in acupuncture. This is unusual, but this is the only way. If he is a Chinese acupuncture practitioner who does not know Slovenian, and if a translator is a Slovenian who is not an acupuncturist, during the translation, when the Chinese are taking a story, fines that are important to the acupuncture can be lost, which helps him diagnose and then determine right healing.
So he can have a real diploma, but he is still not okay.
In the Slovenian Association for Acupuncture within the framework of the Slovenian Medical Association, we strive to ensure that everyone who performs acupuncture knows Slovenian. In the Slovenian Association for Acupuncture, we are preparing a register – not yet complete – Slovenian acupuncture. In all, there will be good education, good schools and the right number of hours of education. Next year will definitely be published.
The last question is, when something hurts, how do you help?
First, I have to know what and why it hurts. When I feel the cause, I take a mild analgesic, says paracetamol. When I had surgery, I knew it was a postoperative pain, I took the right pill for this type and pain, then I did acupuncture treatment with the needles, as this is a natural way to treat pain without any negative impact on the organism. I was gymnast and moved. This is my way.
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Zarja nr. 47
Zarja nr. 47