PALLIATIVE CARE FOR RHEUMATOLOGYСAL PATIENTS WITH CO-MORBIDITY

As a result of the analysis, it was established that demographic trends and a shift towards the aging of the population contribute to the increase in the prevalence of degenerative diseases of the joints (osteoarthrosis) and spine (spondyloarthrosis, osteochondrosis) in society. The problem of po stmenopausal and senile osteoporosis remains relevant as a cause of fracture of the femoral neck, vertebrae, and the lower third of the forearm. A significant part of these people need professional palliative care in specialized departments of oncology and multidisciplinary hospitals, separate hospices and boarding homes for the elderly or at home, in the family, with the participation of professional visiting teams of doctors, nurses and psychologists, as is done in many Western countries. Palliative patients and their family members need adequate pain relief and symptomatic treatment, professional care, moral, psychological and spiritual support, and sometimes just human compassion and attention. According to the actual state of the organization of palliative medicine in Ukraine, it is appropriate to consider that hospice medicine deals with a complex of issues related to the assistance of palliative patients in the terminal period of life in special medical and social institutions – hospices or palliative and hospice care departments of medical institutions. The introduction of palliative care should be at an early stage. Support should be administered after diagnosis. Elderly people with comorbid pathology suffer from pain more than representatives of other age groups. Pain can be aggravated by a sedentary lifestyle, which causes muscle stiffness, deterioration of joint mobility, and increased osteoporosis. Elderly people experience a combination of musculoskeletal pain, constipation, infections, neuropathy of peripheral nerves, emotional disturbances, major and minor injuries, etc. Analgesic therapy should be started at the first signs of pain. Analgesics are prescribed at equal intervals of time, without waiting for the recovery of pain, in order to ensure constant analgesia. Adjuvant and symptomatic drugs must be prescribed strictly according to indications. Constant monitoring of patients is established, especially at the beginning of treatment. Careful monitoring is also required in the future to correct treatment and prevent possible complications. In palliative medicine, there are medicinal (pharmacological) and non-pharmacological conservative (used mainly for mild or moderate pain) and aggressive (neurosurgical, used for severe and unbearable pain) methods of controlling chronic pain syndrome. According to WHO recommendations, there are three main levels of analgesia for chronic pain syndrome in palliative patients. In rheumatological patients, pain is caused by pathological changes in peripheral structures (skin, muscles, tendons, ligaments, synovial membrane, joint capsule, cartilage, bones). When assessing the features of the pain syndrome, one should take into account anamnestic data, comorbid conditions, results of clinical and laboratory examination methods and individual characteristics of the patient. Only such a comprehensive approach makes it possible to develop an effective plan of treatment and rehabilitation measures. NSAIDs are the most popular tool of analgesic therapy in medical practice due to the combination of efficiency, safety, availability and ease of use. Opioids are used for moderate or severe chronic pain in a patient with an incurable form of the disease. That is, medicine is able to save the patient from painful suffering and give him the opportunity to walk his last path with dignity. It is important for a palliative patient to formulate a clear plan of action with their doctor. A timely visit to your family doctor will help you cope with this.