Prof. Yuriy Kobelyatskyy

Transcription

1 UKRAINE HISTORIC BACKGROUND AND PRESENT CHALLENGES IN ESTABLISHMENT OF PAIN MEDICINE SPECIALTY Prof. Yuriy Kobelyatskyy Dnepropetrovsk State Medical Academy Department Anaesthesiology & Intensive Care International Simposium «PAIN MEDICINE: PRESENT AND FUTURE» May,27-29,2010, Kiyv, UKRAINE

2 Humanity will not disappear until there is only one who is able to treat and there is only one who wants to recover Hyppocratus

3 Valentin Feliksovich Voyno-Yasenetskyy (May,9, 1877 June, 11, 1961) «Father» of regional anaesthesia in Russia (1915)

4 Approach to n.ischiadicus

5 Dr. Babitskyy Proposed infraclavicular approach to p.brachialis in 1917, during First World War

6 Prof. J.J.Bonica anesthetist and founder Pain Management in the world One of the most world famous anesthetists In he was President of WFSA Former ASA President

7 Prof.А.І. Trishchynsky and pain management 1955 y. defended thesis Neurological syndromes by lesion of T bend nerves Invasive management trigeminal neuralgia Spinal opioids in cancer pain

8 Prof A.Yu.Pashchuk (Charkov) Renewed interest to regional anaesthesia in former USSA Published book «Regional anaesthesia» 1987 Under his 49 dissertations on different aspects of regional anaesthesia were defended (M.N.Gilyova, V.S.Fesenko, U.A.Fesenko)

9 Prof.V.V.Suslov (Donetsk-Kiev) 1970 inspired of Prof. Bonica ideas started epidural anaesthesia/ analgesia in urology. Under his guidance first thesis on EA was defended by A.S.Karpenko Spinal opioid analgesia

10 Prof. I.P.Shlapak 1995 г. defended thesis DMedSc «Combined spinal anaesthesia/analgesia and its estimation as method of nociceptive defend» Regional anaesthesia (I.P.Shlapak, M.V.Bondar, I.I.Lesnoy) Management of pain syndromes (A.I.Tryshchinskiy, G.O.Vasiliev, S.N.Basmanov, A.I.Galushko) «Treatment of chronic pain syndrome in oncologic practice», Ukraine and Poland

11 V.A.Bersenev and pain management Head Institute of Pain Problems, PhD, neurologist. Created new direction in medicine based on principals of human body innervations peculiarities. His priority was confirmed with 15 patents. Institute of Pain Problems is in close connection with leading hospitals in Switzerland and other counties

12 V.B.Gasin (Prof. D.Niv, Israel) Dr.Gasin V.MD. F.I.P.P, F.I.S.A. F.I.P.A. Center of Pain Medicine named after Prof. D.Niv 25 years experience, Member of Interventional Pain Practice Section World Institute of Pain, USA, European Federation of IASP. Education

13 Theoretic backgroud for pain management Prof. Yuri Limansky, Dr med Head of Department of Brain Stem Physiology Bogomoletz Inst of Physiology Specialty: NEUS-Neuroscience (Neurophysiology) Author of classic books including «Physiology of pain» and others.

14 Organisational structures for acute and chronic pain management 1. Survice for acute postoperative pain management in Dniepropetrovsk Regional Hospital named after I.I.Mechnikov (lhead prof. Yuriy Yu. Kobelyatskyy) medical director prof. Pavlov V.A. order 109 April. 19, Pain service for oncologic patients Zhitomir Regional Oncologic Hospital (founder Lesnoy I.I., chief Radchuk I.P.) founded in 1998.

15 Predisposition for creation Pain Medicine in Ukrane 1.Highly motivated physicians. 2.Big demand in pain specialists. 3.Modern pharmacological drugs and technologies for patients in Ukrainian market. 4.Modern sets for making invasive techniques of analgesia. 5. First attempts of creation of acute and chronic pain treatment facilities.

16 Main problems on our way to Pain Management establishment 1. Lack of educational programs on pain. 2. Lack of evidence-based clinical protocols on management of pain syndromes 3. Lack of the mutual efforts of different specialists in management of patients with pain. 4. Not strong enough law principals as for opiods treatment. 5. Lack of special journal devoted to pain problems. 6. Ukraine is not involved in international pain process and does not take part in any of international professional pain associations.

17 Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine ACUTE PAIN MANAGEMENT: SCIENTIFIC EVIDENCE SECOND EDITION UPDATES Last update: DECEMBER 2007

18 Core curriculum for professional education in pain. 3-rd edition. Task Force on Pofessional Education. Editor: J. Edmond Charlton (2005) I. General (anatomy, physiology, pharmacology pain transmission and modulation, development of pain system, evidence-based medicine in pain, animals models, ethics in experimental and clinical settings). II. Assessment and psychology of pain (pain management in humans, placebo, clinical nerve function studies and imaging, epidemiology, epidemiology, psychosocial and cultural aspects of pain, sex and gender issues) III. Treatment of pain (pharmacology and other methods: cognitive-bihavioral interventions, psychiatric treatment, stimulation-produced analgesia, interventional pain management including nerves block and lesioning, surgical pain management, physical medicine and rehabilitation, work rehabilitation, complementary therapies).

19 Core curriculum for professional education in pain. 3-rd edition. Task Force on Pofessional Education. Editor: J. Edmond Charlton (2005) IV. Clinical states A Taxonomy B. Tissue pain (acute and postoperaive, cancer, cervical radicular, pain, lumbar radicular, lumbar radicular, low back, musculoskeletal, muscle and miofacial). C. Visceral pain (visceral, chronic urogenital, pain in pregnancy and labor) D. Headache and facial pain (headache and orofacial) E. Nerve damage (neuropathic,crps) F. Special cases (in infants children and adolescents, in older adults, in individuals with limited ability to communicate due to cognitive impairments, in substance abusers, in areas of deprivation and conflict).

20 Who is responsible for pain management in Ukraine? 1. Anaesthetists (acute pain) 2. Neurologists (neuropathic pain, CRPS) 3. Neirosurgeons (nerves lesion and compression) 4. Orthopedics (arthrosis, arthrites, fracturesmultiple trauma) 5. Vascular surgery (ischemic pain) 6. Oncologists (cancer pain) 7. General sugeons (abdominal and thoraccic) 8. Reumatologists (uvenoile arthrites, reumatoid, arthrites) 9. Gastroenterologists (irritable bowl synrdome and others) 10. Gynecologists (chronic pelvic pain, endometrioses) 11. Urologists (acute and chronic pelvic pain) 12. Physical therapeutics. 13. Psychotheraputists

21 Interdisciplinary approach in chronic pain management (main idea) Very often we do not use Separated efforts different specialists are not effective

22 Prof J.J.Bonica and «Management of Pain» «Management of pain» (1 st edition 1953), became «Bible» for all pain specialists. 2 nd and 3rd edition were in 1990 and 2001 yy. It is actual till now.

23 Publications on pain in USSA and Ukraine 1. Kalyuzhniy «Physiologic mechanisms of pain sensitivity regulation» 2. Kassil G.N. «Science of pain» 3. Kryzhanovskyy G.N. 4. Ignatov Yu.P. Adrenergic analgesia 5. Ignatov Yu.P. Pain syndrome 6. Melzak R. «Puzzle of pain»

24 Prof. J.J.Bonica and IASP In 1973 organized I World Congress on Pain (Florence, Italy), created IASP (International Association for the Study of Pain.). During long time he was President, Honorary President and Member of the Board of IASP.

25 13 IASP members from Ukraine ( , Kiley N. Thornton, Program Coordinator) Anesthesiology 1. Dmytro Dmytriiev, MD, PhD 2. Yevhen P. Yevstratov, Sr., MD 3. Yuriy Y. Kobelyatskyy, MD, PhD, DMedSc 4. Iurii L. Kuchyn, MD, PhD 5. Ivan I. Lisnyy, MD, PhD 6. Igor Petrovich Radchuk, MD Neurology 1. Olga Morozova, MD, PhD, DMedSc Neuroscience 1. Yuri P Limansky, Dr med 2. Oksana L. Tondiy, MD PhD 3. Igor V. Romanenko, MD, PhD 4. Volodymyr I. Romanenko 5. Inga Fedotova, PhD 6. Kayode K.Mike Agboola, I, Undergraduate

26 What are we waiting from Kiev Simposium? 1. Increasing interest to pain problem. 2. Changing view on pain as a symptom. 3. Establish institutional policies and procedures or appropriate pain management in every hospital. 4. Measurement of pain on constant bases. 5. Formation different kind of pain statistics 6. Integration into the international pain movement.

27