At the end of the Second World War, the British social worker, nurse and doctor Cicely Saunders (1918-2005) became interested in providing care for the sick in their last days of life, especially those who were experiencing intense pain and were relegated from all care and medical attention. As a result of the antecedent of Saunders, a whole medical current was generated that ultimately became a specialization known as palliative medicine.
Given the importance of addressing the follow-up of patients who require palliative treatment, Dr. Alfredo Covarrubias Gómez, a surgeon specialized in Anesthesiology with a High Specialty in Pain Medicine and a postgraduate degree in Palliative Medicine for the Geriatric Patient and Interventionism, points out that a patient At the end of his life, he is prone to various medical problems that might be effectively resolved with some non-pharmacological intervention guided by ultrasound.
“In the case of herpetic neuritis, this type of patient requires the use of drugs that take between 90-120 days to take effect, and it is possible that the patient dies before observing pain relief due to this cause. Hence, the use of other innovative techniques that can support pain relief is necessary.
Figures from the World Health Organization indicate that annually 40 million people around the world require palliative care. Faced with this dramatic reality, Dr. Covarrubias Gómez, who is attached to the Department of Pain and Palliative Medicine of the “Salvador Zubirán” National Institute of Medical Sciences and Nutrition, warns that, worldwide, only 14% of people who require palliative care they receive.
“Mexico has an area of immense opportunity, since palliative care specialists are predominantly anesthesiologists, specialists in pain medicine. And this is very important because then we can create a school regarding invasive care for patients towards the end of life”, says Dr. Covarrubias Gómez, who will soon assume the presidency of the College of Anesthesiology of the state of Tlaxcala.
For Dr. Ale Ismael González Cazares, a surgeon with High Specialty in Palliative Medicine and High Specialty in Interventional Pain Management, palliative care also provides a support system that helps the family to adapt during the patient’s illness and in the followingmath. duel. It offers a space of comfort and respect, which allows effective communication where the needs of the patient and the family nucleus are identified, to prevent collateral damage following death. “Palliative care can reduce physical, psychosocial and spiritual problems of more than 90% of patients with advanced cancer,” says the doctor attached to the National Cancer Institute, INCAN.
Both specialists will participate next Tuesday, October 25, in the webinar “The role of interventionism in palliative medicine”, organized by Ocean Medic, a leading company in imaging equipment, and they agree that medical groups should focus more on disseminating the information that can help clinicians solve patient problems toward the end of life.
Covarrubias Gómez explains that, being anesthesiology the mother of pain medicine, it has undergone considerable evolution in recent decades. “About 15 years ago, blocks were performed only with paresthesia; then we began to use neurolocalizers to identify where the nerve structures that we were going to block were located. To date, ultrasound has helped us tremendously with the resolution of the pain of our patients, through the placement of blocks in peripheral nerves and in other types of structures”.
Likewise, Dr. González Cazares, certified by the World Institute of Pain WIP, highlights the technological progress of the equipment that offers the possibility of performing various procedures through fluoroscopic or ultrasonographic guidance that involve the application of medications, local anesthetics, anti-inflammatories, lytic agents. “In patients with metastasis or muscle invasion, ultrasound gives us the advantage of performing interfascial blocks, even in patients where venous cannulation is difficult, US helps us visualize the vessel and reduce multiple punctures.”
Palliative medicine in Mexico as a specialty
Unlike other countries, in Mexico the number of palliative care doctors is limited, due to the scarcity of university programs endorsed by the Secretaries of Health and Public Education. “Those of us who have done palliative care and palliative medicine have had to train in international institutions, many times without having all the Mexican medical endorsement. And that makes palliative care a great area of opportunity for the health sector and institutions,” says Dr. Covarrubias Gómez.
Given the need to best accompany patients towards the end of life, ultrasound-guided interventionism acquires great relevance because palliative care doctors can mitigate pain in the patient’s own bed, with all the measures of asepsis and antisepsis, to place a blockage, place a catheter that relieves or reduces the pain of the patient in their lifetime, or that reduces the consumption of opioids.
“It is very important to consider that ultrasound in qualified hands can be that ace up the sleeve to improve the quality of life of patients in their last days,” he concluded.
The webinar “Role of interventionism in palliative medicine” where also the palliative doctor, Nexahi Reyes Sampieri, and Dr. Miguel Esquer Guzmán, in charge of Palliative Care and Pain Medicine at the Personalized Oncology Center of Sinaloa will take place on Tuesday October 25 at 6:30 p.m., through the platform https://vinnomexico.mx/webinar/medicinapaliativa/
