Keywords
nociception
pharmacotherapy
narcotic analgesics
non-narcotic analgesics
How to Cite
Abstract
Availability and adequacy of analgesia is one of the factors that significantly influence the quality of life of palliative patients. At the current stage of development, the system of palliative and hospice care in Ukraine will not provide clear pain relief for the majority of patients. We conducted a study of PubMed and Google Scholar’s sources and legal acts of Ukraine at the list and content of pain management in palliative patients, which should be considered in their work by medical and social workers providing palliative care, as well as health care managers. We proposed to expand the scientific discussion about types of pain and their corresponding analgesia. The study of regulatory documentation on the palliative care in Ukraine and the protocol for the treatment of chronic pain in palliative patients revealed their compliance with modern protocols and rules of systems with developed systems of palliative care. However, we also found that the practical implementation of the existing rules varies significantly in the direction of their non-enforcement. We came to a conclusion about the need to expand the use of narcotic and non-narcotic pain relievers in Ukrainian palliative medicine, to strengthen the material and technical base of hospices and to eliminate their staff shortage. The article covers a number of issues of the pathophysiology of pain. We determined that both the causes of pain and its perception, which can be evaluated on several scales in points, are important in the issue of pain perception by palliative patients. We came to the conclusion that an adequate reaction of patients to pain simplifies the diagnosis and the appointment of adequate treatment, and an excessive and "stoic" reaction complicates them. We noted that the treatment of chronic pain involves the use of drug therapy, hypnosis, cognitive-behavioral therapy, physical exercises, and physiotherapeutic procedures.
Keywords: chronic pain, nociception, pharmacotherapy, narcotic analgesics, non-narcotic analgesics.
Archived: https://doi.org/10.5281/zenodo.14357707
References
Sepulveda C, Marlin A, Yoshida T, Ullrich A. Palliative Care: the World Health Organization's global perspective. J Pain Symptom Manage. 2002;24(2):91-6. DOI: 10.1016/s0885-3924(02)00440-2. PMID: 12231124.
Teoli D, Schoo C, Kalish VB. Palliative Care. 2023. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. PMID: 30725798.
The Procedure for providing palliative care. Approved by Order of the Ministry of Health of Ukraine No.1308 on 4 Jun 2020, in force on 20 Mar 2024. Available at: http://surl.li/umwut [in Ukrainian].
Shevchenko AS, Shevchenko VV, Brown GW. The preventive direction of modern theories of health and health-saving in public health and education. Inter Collegas. 2024;11(1):7p. In press. DOI: 10.35339/ic.11.1.ssb.
Shtefan LV, Shevchenko AS. Measured health indicators in valeological disciplines curriculum. Materials of the Scientific and practical conference dedicated to the 150th anniversary of the Department of Hygiene and Ecology No.1 of the Kharkiv National Medical University "Preventive medicine of Ukraine: problems and ways to solve them" (Ukraine, Kharkiv, KhNMU, 16 Oct 2023). P. 96-7. DOI: 10.5281/zenodo.10020035.
Heera HS, Najar SSH, Shevchenko АS, Lytvynenko OYu. Valeological relationship of physical workability with health indicators. Inter Collegas. 2023;10(1):33-6. DOI: 10.35339/ic.10.1.hns.
Order No.1308 on 4 Jun 2020 of the Ministry of Health of Ukraine "On improving the organization of palliative care in Ukraine", with changes and additions on 27 Dec 2023, in force on 20 Mar 2024. Verkhovna Rada of Ukraine. Legislation of Ukraine. Available at: https://zakon.rada.gov.ua/laws/show/z0609-20 [in Ukrainian].
National Classifier of Ukraine. Classifier of professions DK 003:2010. Approved by Order of the State Committee of Ukraine on Technical Regulation and Consumer Policy No.327 on 28 Jul 2010. In force on 20 Mar 2024. Verkhovna Rada of Ukraine. Legislation of Ukraine. Available at: https://zakon.rada.gov.ua/rada/show/va327609-10 [in Ukrainian].
Unified clinical protocol of palliative medical care for chronic pain syndrome. Approved by the Order of the Ministry of Health of Ukraine No.311 on 25 Apr 2012. Kyiv: State Expert Center of the Ministry of Health of Ukraine. 38 p. Available at: https://www.dec.gov.ua/wp-content/uploads/2019/11/dod_311_2ykpmd.pdf [in Ukrainian].
Laboratory of system analysis. Stages of system analysis according to Golubkov EP. DOI: 10.5281/zenodo.10645561.
Holovanova IA, Shevchenko AS. Determination of the main needs of palliative patients and ways of their provision in the healthcare system of Ukraine. Experimental and Clinical Medicine. 2021;90(3):88-94. DOI: 10.35339/ekm.2021.90.3.hos.
Nesterenko VG. On the procedure for providing palliative and hospice care in Ukraine. Medicine Today and Tomorrow. 2021;90(2):57-62. DOI: 10.35339/msz.2021.90.2.nes. [In Ukrainian].
Heiskanen T, Hamunen K, Hirvonen O. Kipu palliatiivisessa hoidossa [Management of pain in palliative care]. Duodecim. 2013;129(4):385-92. PMID: 23484355. [In Finnish].
Simone CB 2nd. Pain and quality of life in palliative care. Ann Palliat Med. 2015;4(4):E1-4. DOI: 10.3978/j.issn.2224-5820.2015.10.03. PMID: 26541405.
Dureja GP, Iyer RN, Das G, Ahdal J, Narang P. Evidence and consensus recommendations for the pharmacological management of pain in India. J Pain Res. 2017;10:709-36. DOI: 10.2147/JPR.S128655. PMID: 28435313.
Reville B, Foxwell AM. The global state of palliative care-progress and challenges in cancer care. Ann Palliat Med. 2014;3(3):129-38. DOI: 10.3978/j.issn.2224-5820.2014.07.03. PMID: 25841689.
Wongprom I, Chaithanasarn A. A survey of palliative care domains and the palliative care provision confidence of Thai family practitioners. BMC Palliat Care. 2023;22(1):147. DOI: 10.1186/s12904-023-01272-8. PMID: 37794416.
International Association for the Study of Pain. USA. Available at: https://www.iasp-pain.org
Treede RD, Rief W, Barke A, Aziz Q, Bennett MI, Benoliel R, et al. Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11). Pain. 2019;160(1):19-27. DOI: 10.1097/j.pain.0000000000001384. PMID: 30586067.
Nugraha B, Gutenbrunner C, Barke A, Karst M, Schiller J, Schäfer P, et al; IASP Taskforce for the Classification of Chronic Pain. The IASP classification of chronic pain for ICD-11: functioning properties of chronic pain. Pain. 2019;160(1):88-94. DOI: 10.1097/j.pain.0000000000001433. PMID: 30586076.
Smith BH, Fors EA, Korwisi B, Barke A, Cameron P, Colvin L, et al; IASP Taskforce for the Classification of Chronic Pain. The IASP classification of chronic pain for ICD-11: applicability in primary care. Pain. 2019 Jan;160(1):83-87. doi: 10.1097/j.pain.0000000000001360. PMID: 30586075.
Perrot S, Cohen M, Barke A, Korwisi B, Rief W, Treede RD; IASP Taskforce for the Classification of Chronic Pain. The IASP classification of chronic pain for ICD-11: chronic secondary musculoskeletal pain. Pain. 2019;160(1):77-82. DOI: 10.1097/j.pain.0000000000001389. PMID: 30586074.
Wyns A, Hendrix J, Lahousse A, De Bruyne E, Nijs J, Godderis L, Polli A. The Biology of Stress Intolerance in Patients with Chronic Pain-State of the Art and Future Directions. J Clin Med. 2023;12(6):2245. DOI: 10.3390/jcm12062245. PMID: 36983246.
Zimney K, Van Bogaert W, Louw A. The Biology of Chronic Pain and Its Implications for Pain Neuroscience Education: State of the Art. J Clin Med. 2023;12(13):4199. DOI: 10.3390/jcm12134199. PMID: 37445234.
Nijs J, Malfliet A, Roose E, Lahousse A, Van Bogaert W, Johansson E, et al. Personalized Multimodal Lifestyle Intervention as the Best-Evidenced Treatment for Chronic Pain: State-of-the-Art Clinical Perspective. J Clin Med. 2024;13(3):644. DOI: 10.3390/jcm13030644. PMID: 38337338.
Colloca L, Raghuraman N, Wang Y, Akintola T, Brawn-Cinani B, Colloca G, et al. Virtual reality: physiological and behavioral mechanisms to increase individual pain tolerance limits. Pain. 2020;161(9):2010-2021. DOI: 10.1097/j.pain.0000000000001900. PMID: 32345915.
Rogers ML, Duffy ME, Dougherty SP, Joiner TE. Interoception, Pain Tolerance, and Self-Injurious Behaviors: A Multidimensional Assessment. Behav Ther. 2021;52(5):1055-66. DOI: 10.1016/j.beth.2021.02.011. PMID: 34452661.
Lekhan VM. Impact of different types of pain on organizational decisions in palliative medicine. Medicine Today and Tomorrow. 2024;93(1):9p. In press. DOI: 10.35339/msz.2024.93.1.lvm.
Aziz Q, Giamberardino MA, Barke A, Korwisi B, Baranowski AP, Wesselmann U, al.; IASP Taskforce for the Classification of Chronic Pain. The IASP classification of chronic pain for ICD-11: chronic secondary visceral pain. Pain. 2019;160(1):69-76. DOI: 10.1097/j.pain.0000000000001362. PMID: 30586073.
Satghare P, Abdin EB, Hombali A, Lin Teh W, Samari E, Chua BY, et al. Chronic Pain: Among Tertiary Care Psychiatric Out-Patients in Singapore-Prevalence and Associations with Psychiatric Disorders. Pain Res Manag. 2022;2022:1825132. DOI: 10.1155/2022/1825132. PMID: 35463629.
Clark MR. Psychiatric issues in chronic pain. Curr Psychiatry Rep. 2009;11(3):243-50. DOI: 10.1007/s11920-009-0037-6. PMID: 19470287.
Baliki MN, Apkarian AV. Nociception, Pain, Negative Moods, and Behavior Selection. Neuron. 2015 Aug 5;87(3):474-91. DOI: 10.1016/j.neuron.2015.06.005. PMID: 26247858.
Seymour B. Pain: A Precision Signal for Reinforcement Learning and Control. Neuron. 2019;101(6):1029-41. DOI: 10.1016/j.neuron.2019.01.055. PMID: 30897355.
Blichfeldt-Eckhardt MR. From acute to chronic postsurgical pain: the significance of the acute pain response. Dan Med J. 2018;65(3):B5326. PMID: 29510808.
Orhurhu VJ, Roberts JS, Ly N, Cohen SP. Ketamine in Acute and Chronic Pain Management. 2023 Sep 4. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. PMID: 30969646.
Kleine-Borgmann J, Schmidt K, Scharmach K, Zunhammer M, Elsenbruch S, Bingel U, Forkmann K. Does pain modality play a role in the interruptive function of acute visceral compared with somatic pain? Pain. 2022 Apr 1;163(4):735-44. DOI: 10.1097/j.pain.0000000000002418. PMID: 34338242.
Fitzcharles MA, Cohen SP, Clauw DJ, Littlejohn G, Usui C, Häuser W. Nociplastic pain: towards an understanding of prevalent pain conditions. Lancet. 2021;397(10289):2098-110. DOI: 10.1016/S0140-6736(21)00392-5. PMID: 34062144.
Clauw DJ, Essex MN, Pitman V, Jones KD. Reframing chronic pain as a disease, not a symptom: rationale and implications for pain management. Postgrad Med. 2019;131(3):185-98. DOI: 10.1080/00325481.2019.1574403. PMID: 30700198.
Popkirov S, Enax-Krumova EK, Mainka T, Hoheisel M, Hausteiner-Wiehle C. Functional pain disorders – more than nociplastic pain. NeuroRehabilitation. 2020;47(3):343-53. DOI: 10.3233/NRE-208007. PMID: 32986624.
Yoo YM, Kim KH. Current understanding of nociplastic pain. Korean J Pain. 2024;37(2):107-18. DOI: 10.3344/kjp.23326. PMID: 38504389; PMCID.
Colloca L, Ludman T, Bouhassira D, Baron R, Dickenson AH, Yarnitsky D, et al. Neuropathic pain. Nat Rev Dis Primers. 2017;3:17002. DOI: 10.1038/nrdp.2017.2. PMID: 28205574.
Woolf CJ, Salter MW. Neuronal plasticity: increasing the gain in pain. Science. 2000;288(5472):1765-9. DOI: 10.1126/science.288.5472.1765. PMID: 10846153.
Melzack R. Pain and the neuromatrix in the brain. J Dent Educ. 2001;65(12):1378-82. PMID: 11780656.
Chen G, Zhang YQ, Qadri YJ, Serhan CN, Ji RR. Microglia in Pain: Detrimental and Protective Roles in Pathogenesis and Resolution of Pain. Neuron. 2018;100(6):1292-311. DOI: 10.1016/j.neuron.2018.11.009. PMID: 30571942.
Moseley GL. A pain neuromatrix approach to patients with chronic pain. Man Ther. 2003;8(3):130-40. DOI: 10.1016/s1356-689x(03)00051-1. PMID: 12909433.
Costigan M, Scholz J, Woolf CJ. Neuropathic pain: a maladaptive response of the nervous system to damage. Annu Rev Neurosci. 2009;32:1-32. DOI: 10.1146/annurev.neuro.051508.135531. PMID: 19400724.
Semkovych YaV, Dmytriiev DV. Visual analogue scale as a tool for assessing quality of life (PEDSQL™) and emotional stress in children after anterior abdominal wall surgery. Pain, Anaesthesia and Intensive Care. 2022;2(99):41-8. DOI: 10.25284/2519-2078.2(99).2022.265838. [In Ukrainian].
Abbey J, Piller N, De Bellis A, Esterman A, Parker D, Giles L, Lowcay B. The Abbey pain scale: a 1-minute numerical indicator for people with end-stage dementia. Int J Palliat Nurs. 2004;10(1):6-13. DOI: 10.12968/ijpn.2004.10.1.12013. PMID: 14966439.
Prazak KA, Lester PE, Fazzari M. Evaluation of physician assistant student knowledge and perception of competence in palliative symptom management. J Allied Health. 2014;43(4):e69-74. PMID: 25433191.
De Witt Jansen B, Brazil K, Passmore P, Buchanan H, Maxwell D, McIlfactrick SJ, et al. Nurses' experiences of pain management for people with advanced dementia approaching the end of life: a qualitative study. J Clin Nurs. 2017;26(9-10):1234-44. DOI: 10.1111/jocn.13442. PMID: 27324751.
Hooten WM. Chronic Pain and Mental Health Disorders: Shared Neural Mechanisms, Epidemiology, and Treatment. Mayo Clin Proc. 2016;91(7):955-70. DOI: 10.1016/j.mayocp.2016.04.029. PMID: 27344405.
Breivik H, Borchgrevink PC, Allen SM, Rosseland LA, Romundstad L, Hals EK, et al. Assessment of pain. Br J Anaesth. 2008;101(1):17-24. DOI: 10.1093/bja/aen103. PMID: 18487245.
LaFrance WC Jr. 'Hysteria' today and tomorrow. Front Neurol Neurosci. 2014;35:198-204. doi: 10.1159/000360064. Epub 2014 Jun 26. PMID: 25273501.
Carota A, Calabrese P. Hysteria around the world. Front Neurol Neurosci. 2014;35:169-80. DOI: 10.1159/000360062. PMID: 25273499.
Prabhu A, Abaid B, Sarai S, Sumner R, Lippmann S. Munchausen Syndrome. South Med J. 2020;113(4):198-200. DOI: 10.14423/SMJ.0000000000001079. PMID: 32239233.
Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken). 2011;63 Suppl 11:S240-52. DOI: 10.1002/acr.20543. PMID: 22588748.
Reed MD, Van Nostran W. Assessing pain intensity with the visual analog scale: a plea for uniformity. J Clin Pharmacol. 2014;54(3):241-4. DOI: 10.1002/jcph.250. PMID: 24374753.
He S, Renne A, Argandykov D, Convissar D, Lee J. Comparison of an Emoji-Based Visual Analog Scale with a Numeric Rating Scale for Pain Assessment. JAMA. 2022;328(2):208-09. DOI: 10.1001/jama.2022.7489. PMID: 35819433.
Merkel SI, Voepel-Lewis T, Shayevitz JR, Malviya S. The FLACC: a behavioral scale for scoring postoperative pain in young children. Pediatr Nurs. 1997;23(3):293-7. PMID: 9220806.
Riga OO, Gonchar MO, Konovalova NM, Orlova NV. Pain assessment using the r-FLACC scale in young children with paralytic syndromes. International Journal Rehabilitation and Palliative Medicine. 2017.l-2(5-6):69-73. 2017;1-2(5-6):69-73. Available at: http://surl.li/uqgbq [in Ukrainian].
Matsuishi Y, Hoshino H, Shimojo N, Enomoto Y, Kido T, Hoshino T, et al. Verifying the validity and reliability of the Japanese version of the Face, Legs, Activity, Cry, Consolability (FLACC) Behavioral Scale. PLoS One. 2018;13(3):e0194094. DOI: 10.1371/journal.pone.0194094. PMID: 29534083.
Elman I, Zubieta JK, Borsook D. The missing p in psychiatric training: why it is important to teach pain to psychiatrists. Arch Gen Psychiatry. 2011;68(1):12-20. DOI: 10.1001/archgenpsychiatry.2010.174. PMID: 21199962.
Ho PT, Li CF, Ng YK, Tsui SL, Ng KF. Prevalence of and factors associated with psychiatric morbidity in chronic pain patients. J Psychosom Res. 2011;70(6):541-7. DOI: 10.1016/j.jpsychores.2010.10.006. PMID: 21624577.
International Association for Hospice and Palliative Care. USA. Available at: https://hospicecare.com [accessed 20 Mar 2024].
Davydovych OV, Kopcha VS, Maslii KO. Pharmacotherapy of pain syndrome. Rational Pharmacotherapy. 2011;4(21):66-8. Available at: http://surl.li/urkbz [in Ukrainian].
Tiffany FR, Twycross R, Ventafridda VV, van Dam F, Gelber R, Stanley K, et al. Cancer pain relief. Geneva: WHO; 1986. 79 p. Available at: https://iris.who.int/bitstream/handle/10665/43944/9241561009_eng.pdf
Mejin M, Keowmani T, Rahman SA, Liew J, Lai J, Chua M, Wan IC. Prevalence of pain and treatment outcomes among cancer patients in a Malaysian palliative care unit. Pharm Pract (Granada). 2019;17(1):1397. DOI: 10.18549/PharmPract.2019.1.1397. PMID: 31015879.
Langlois P, Perrochon A, David R, Rainville P, Wood C, Vanhaudenhuyse A, et al. Hypnosis to manage musculoskeletal and neuropathic chronic pain: A systematic review and meta-analysis. Neurosci Biobehav Rev. 2022;135:104591. DOI: 10.1016/j.neubiorev.2022.104591. PMID: 35192910.
McKittrick ML, Connors EL, McKernan LC. Hypnosis for Chronic Neuropathic Pain: A Scoping Review. Pain Med. 2022;23(5):1015-26. DOI: 10.1093/pm/pnab320. PMID: 34718772.
Melf-Marzi A, Bohringer B, Wiehle M, Hausteiner-Wiehle C. Modern Principles of Diagnosis and Treatment in Complex Regional Pain Syndrome. Dtsch Arztebl Int. 2022;119(51-52):879-86. DOI: 10.3238/arztebl.m2022.0358. PMID: 36482756.
Bicego A, Rousseaux F, Faymonville ME, Nyssen AS, Vanhaudenhuyse A. Neurophysiology of hypnosis in chronic pain: A review of recent literature. Am J Clin Hypn. 2022;64(1):62-80. DOI: 10.1080/00029157.2020.1869517. PMID: 34748463.
Heera HS, Najar SSH. Prerequisites for Using the Reiki Method in Physical Therapy. JMBS. 2021;6(4):28–37. DOI: 10.26693/jmbs06.04.028 [in Ukrainian].
National Center for Complementary and Integrative Health. National Institute of Health. US Government. Official cite: https://www.nccih.nih.gov [accessed 20 Mar 2024].
National Institute of Health. US Government. Official cite: https://www.nih.gov [accessed 20 Mar 2024].
Mitlehner W. Non-Steroidal Anti-Inflammatory Drugs. Dtsch Arztebl Int. 2022;119(33-34):566. DOI: 10.3238/arztebl.m2022.0183. PMID: 36422873.
Dydyk AM, Sizemore DC, Haddad LM, Lindsay L, Porter BR. NP Safe Prescribing of Controlled Substances While Avoiding Drug Diversion. 2023. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. PMID: 33232099.
Iverson NR, Lau CY, Abe-Jones Y, Fang MC, Kangelaris KN, Prasad P, et al. Evaluation of a novel metric for personalized opioid prescribing after hospitalization. PLoS One. 2020;15(12):e0244735. DOI: 10.1371/journal.pone.0244735. PMID: 33382802.
Mitlehner W. Non-Steroidal Anti-Inflammatory Drugs. Dtsch Arztebl Int. 2022;119(33-34):566. DOI: 10.3238/arztebl.m2022.0183. PMID: 36422873.
Schmidt M, Fosbol EL, Torp-Pedersen C, Olsen AS, Christensen B, Gislason GH. [Cardiovascular risks of non-steroidal anti-inflammatory drugs treatment]. Ugeskr Laeger. 2016;178(52):V08160612. PMID: 28041549. [In Danish].
Tai FWD, McAlindon ME. Non-steroidal anti-inflammatory drugs and the gastrointestinal tract. Clin Med (Lond). 2021;21(2):131-4. DOI: 10.7861/clinmed.2021-0039. PMID: 33762373.
Obarzanek L, Wu W, Tutag-Lehr V. Opioid Management of Dyspnea at End of Life: A Systematic Review. J Palliat Med. 2023;26(5):711-26. DOI: 10.1089/jpm.2022.0311. PMID: 36453988.
Horn DB, Vu L, Porter BR, Sarantopoulos K. Responsible Controlled Substance and Opioid Prescribing. 2023. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. PMID: 34283451.
Preuss CV, Kalava A, King KC. Prescription of Controlled Substances: Benefits and Risks. 2023 Apr 29. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. PMID: 30726003.
Treillet E, Laurent S, Hadjiat Y. Practical management of opioid rotation and equianalgesia. J Pain Res. 2018;11:2587-601. DOI: 10.2147/JPR.S170269. PMID: 30464578.
Kiyatkin EA. Respiratory depression and brain hypoxia induced by opioid drugs: Morphine, oxycodone, heroin, and fentanyl. Neuropharmacology. 2019;151:219-26. DOI: 10.1016/j.neuropharm.2019.02.008. PMID: 30735692.
Shevchenko AS. Rehabilitation programs for drug addicts and HIV-infected patients in the USA and Ukraine. Materials of the 2nd Regional scientific and practical conference "Prevention and treatment of HIV/AIDS, sexually transmitted diseases and drug addiction in the Kharkov region" (Ukraine, Kharkov, 2002, December 21). 2002;2(2):20-3. DOI: 10.5281/zenodo.3594199.
Shevchenko AS. Social support in drug rehabilitation programs in the United States and Ukraine. Information Digest of the AIDS Foundation East-West "Harm Reduction Program for Drug Use". 2002;(9):54-61. DOI: 10.5281/zenodo.3339918.
Holovanova IA, Shevchenko AS. The issue of patient-oriented organization of palliative and hospice care in Ukraine. Experimental and Clinical Medicine. 2021;90(2):21-7. DOI: 10.35339/ekm.2021.90.2.hos.
Nesterenko VH, Peresypkina TV, Shevchenko OS, Sarkhadova II. Palliative and hospice care in the Kharkiv region in the first year of the war. Ukraine. Nation's Health. 2023;73(3):106-12. DOI: 10.32782/2077-6594/2023.3/18.
Riga O, Marston J, Khaustov M, Myasoedov V, Penkov A, Marabyan R. Aspects of the development of the program of palliative assistance for children of the Kharkiv Region throuth the challenges of the military conflict. Neonatology, Surgery and Perinatal Medicine. 2023;13(3(49):5-10. DOI: 10.24061/2413-4260.XIII.3.49.2023.1.
Wolf A. How Palliative and Hospice Care are Organized in Ukraine (Review). Clinical Social Work and Health Intervention. 2017;8(4):99-106. DOI: 10.22359/cswhi_8_4_14.
Lekhan VM. Retrospective analysis of the construction of the national system of hospice and palliative care in Great Britain. 2024;11(1):5p. In press. DOI: 10.35339/ic.11.1.lvm.
Volf O. Futuristic aspects in the sphere of social policy towards seriously ill persons in Ukraine, Great Britain and Australia in 2030–2040. Social and Human Sciences. Polish-Ukrainian scientific journal. 2019;04(24):3p. Available at: http://surl.li/ukspp
Rastvorov OA, Yasinskyi RM, Mironchuk YV (compl.) Organization of palliative and hospice care worldwide and in Ukraine: Handbook. Zaporizhzhia, 2023. 76 p. Available at: http://surl.li/ukson
Danyluk K. State management of palliative and hospital assistance in Ukraine: organizational mechanism. State administration. 2020;14(1-2):56-64. DOI: 10.46922/2306-6806-2020-1-2(14)-56-64.
Holovanova IA, Shevchenko AS. Evaluation of packaged funding programs for palliative and hospice care by the National Health Service of Ukraine. Experimental and Clinical Medicine. 2021;90(4):45-52. DOI: 10.35339/ekm.2021.90.4.hos.
Arthur JA, Reddy A, Smith U, Hui D, Park M, Liu D, et al. Practices and perceptions regarding intravenous opioid infusion and cancer pain management. Cancer. 2019;125(21):3882-9. DOI: 10.1002/cncr.32380. PMID: 31291011.
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