Series VI: Medical Sciences – SUPPLEMENT ... - Krongres

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Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 Series 6: Medical Sciences Supplement – Proceeding of The IV th Balkan Congress of History of Medicine DOCTOR-PATIENT RELATIONSHIP IN NEUROPATHIC PAIN: A COMPARATIVE STUDY BETWEEN URBAN AND RURAL ZONE L. TARTAU 1 , R. V. LUPUSORU 2 , C. E. LUPUSORU 1 , C. ANDRITOIU 1 , O. DUMA 3 Abstract: A descriptive study, regarding some ethical issues within the physician-patient relationship in the management of neuropathic pain. Method: This study was performed on a sample of 278 patients with neuropathic pain, in a comparison between urban and rural area medical centers, from Iasi County. This investigation was based on medical records and anonymous questionnaire; the informal consent was required. Results: The doctor-patient relationship in rural medical centers is better than in urban, patients being more satisfied with the medical consultation and more likely to comply with the treatment than patients in urban area. Opioids, antidepressants and anticonvulsants were recommended especially in urban medical center, but in a small number of patients. Conclusion: Even though there are some differences and meanings of the interactions between the physicians and sick peoples in urban and rural medical care centers, the study shows that in both cases, neuropathic pain is often undertreated, due to insufficient acquainted of the literature data, regarding the new modern therapeutic strategies in this type of pain. Key words: neurophatic pain, ethic, doctor-patient relationship. Aim: The paper represents a descriptive study, concerning in a comparison between urban and rural area from Iasi county, one of the most representative in the region of Moldova, regarding the physician-patient relationship in the management of neuropathic pain. General data The family physician plays a key role, being the first contact person for the patient. Addressability to medical services takes a central position in patient-physician communication and relationship. [9] The 1 Pharmacology, Algesiology Department, „Gr.T. Popa”, UMF, Ia�i, Romania 2 Pathophysiology Department, UMF, Ia�i, Romania 3 Public Health and Sanitary Management Department, UMF, Ia�i, Romania establishment of an optimal rapport between the physician and patient is essential to both parties, a successful collaboration depending on the physician’s ability to manage unhealthy person expectations. [1, 7, 18] This relationship concerns the foundation of contemporary medical ethics, and implies the existence of the physician, who offers specialized and responsible services first, and, on the other hand, the existence of the patient, who needs medical assistance. [22] These both parties can openly discuss the risks of
54 Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 • Series VI patient during medical procedures, and choices regarding the possibilities to improve his quality of life. [3, 15, 21] In terms of bioethics, patient-physician interrelation comprises patient’s right to the confidentiality of his medical problem, his consent to treatment, but also the right to health and to not be at pains. Physician’s vocation implies all activities targeted to preserve population health status, to prevent illnesses, to improve the patient healthy living conditions. [1, 13, 15] The major requirements of this complex physician-patient relationship are based on friendship, effective communication, respect, and mutually trust. Patient health outcomes can be improved with good physician-patient communication. [14, 25] Working together, the potential exists to pursue interventions that can significantly improve the patient's quality of life and health status. [13, 17, 20] Pain plays a central role in the health care system, and is one of the most frequent reasons for consulting a doctor. Primary care is the most frequent care provider for pain. [11] Neuropathic pain is a complex, chronic pain state that usually is accompanied by tissue injury. Within neuropathic pain, the nerve fibers themselves may be damaged, dysfunctional or injured. Major pathophysiological mechanisms include peripheral sensitization, sympathetic activetion, disinhibition, and central sensitization. [4, 16] Neuropathic pain is associated with many diseases, including diabetic peripheral neuropathy, postherpetic neuralgia, human immunodeficiency virus – related disorders, and chronic radiculopathy. [5, 6, 10] Neuropathic pain is described as burning, electric, tingling and shooting in nature. [4, 10] Numerous therapeutic options are available, including systemic medications, physical rehabilitation, behavioural modification, and invasive procedures. [5, 8] Unfortunately, most neuropathic syndromes respond poorly to nonsteroidal antiinflamatory drugs and opioid analgesics. First-line agents for modern treatment of neuropathic include tricyclic antidepressants, pregabaline, gabapentin, topical lidocaine, tramadol, and opioids. [12, 19, 23, 24] Method This exploratory study was performed, during six months (September 2008 - February 2009) on a sample of 278 patients with neuropathic pain, aged 25-70 years, from urban (157 cases) and rural medical centers (121 cases) in county of Iasi. This investigation was based on both medical records and anonymous questionnnaire, to obtain detailed information, regarding intensity of pain, associated diseases, and the treatment of neuropathic pain. The purpose of this study was to describe the socio-demographic patterns, consultations, pathology and the treatment of attendants at general practitioners at these two primary health care centers. The questionnaires involved epidemiologic characteristics and also, patient-reported relevance and performance of the consultation aspects. It was also identified the impact that physician-patient interpersonal interactions have had upon the satisfaction of primary medical services. The authors designed the questionnaire according to those presented in the literature. The study was performed with the support of the family physicians, for data collection. All questionnaires were distributed and collected, trying to maintain the confidentiality of the recorded data. All patients were informed about the aim and purpose of the investigation and how to fill in the questionnaire. Once they had given their consent, patients were asked to complete the self-administered questionnaire. Incomplete questionnaires were excluded. Data were scored and
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