Pain Management Options in Lithuania

The causes of pain can vary widely, from mechanical issues resulting from injuries to non-specific causes that even top specialists struggle to diagnose. But what drives doctors to choose the challenging specialty of pain management? What qualities are necessary to stay motivated while working with people in constant pain, and when do people typically start seeking help?

Our pain management specialist, Dr. Aida Kinderytė, shares her experiences and insights.

Why did you choose the specialty of pain management?

I found this field by accident. I hadn’t planned to work in it, and I hadn’t even considered it. During my residency, we had a cycle on pain management, but at the time, I didn’t find it appealing. I thought it was a rather dull specialty, and I always felt best in extreme situations, so I chose to work in intensive care. That work was full of excitement and challenges. However, after my residency, due to a shortage of pain specialists, I was directed into this field. I realized I needed to delve deeply into it since my knowledge from that single cycle was very superficial. Pain management was completely new to me.

I had to put aside my preconceived notion that it would be boring. I started tirelessly studying the specifics of pain management, building my knowledge, and getting to know the patients better. I gradually understood that my job involved not only treating physical pain but also examining many psychological, internal, and external factors that help people heal or, conversely, hinder positive health changes. I believe that psychological support for the patient is one of the most important aspects of pain management. Now, I can’t imagine myself working in any other field.

What was the state of pain management as a medical specialty in Lithuania at that time?

At that time, pain management was an unexplored field in Lithuania. There was little knowledge and few specialists who could share their experience, and resources were limited. In Lithuania, pain had long been disregarded because no one dies from it. However, in Europe, this treatment has been officially practiced for about 20-30 years. Initially, we received little attention and funding from the Lithuanian Ministry of Health or clinic administrators, so the possibilities were very limited. Fortunately, when I started working in the pain clinic, I was the only doctor in this field in Kaunas for an entire year. Some colleagues went to work in other clinics, while others left for abroad. I had to take on the full workload, but I received strong support from my supervisor, which allowed me to lay a solid foundation for future work over that year. It was a huge victory that gradually led to positive, effective changes. Patient numbers increased, knowledge about this treatment spread, and colleagues learned more about it. Moreover, I gained valuable experience from internships, learning and working alongside top pain management specialists in Austria, Sweden, the Netherlands, and the United States.

Based on current treatment methods, can we say that Lithuania is on par with other countries?

In basic areas, we are not lagging, but there are procedures we cannot offer our patients because they are not funded by the state. For example, we cannot perform the currently popular spinal cord neurostimulation procedure in Europe. We can’t provide this to our patients due to its high cost. Yet, some patients really need this procedure, and it’s hard for us not to be able to help due to limited resources.

As for other procedures, we have excellent options. Having visited many modern foreign clinics during internships, I can say that the standard in Lithuania is high, sometimes even exceeding it in certain areas. Additionally, our practice is often better. Now we truly have both the experience and knowledge to share equally with colleagues from other countries. In the Netherlands, for example, I taught a colleague how to use a radiofrequency electrode, as they didn’t have one yet and were only planning to acquire it. In the U.S., not all facilities perform blocks under ultrasound guidance, which we successfully do.

What principles guide you when working with patients?

The treatment is highly individualized. I won’t deny that I’ve gone through various stages and changed my approach to patients and work principles. Now I can say only one thing – it’s an absolutely individualized understanding. Some people just need support without any lectures, while others need a strict word to get them to take action. Such patients often express the most gratitude for receiving that stern word, realizing they can’t keep living as before. Patients lack knowledge and need an explanation of why they feel pain and what they can do about it. I don’t try to console stubborn patients; I emphasize that I have knowledge and experience to offer guidance, but everything else depends on the patient. The key is to understand each patient and determine whether to approach them through support, strict words, or by providing information.

Do you encounter patients with preconceived negative opinions, especially given the large amount of information available online?

People are quick to accept information that suits them and reluctant to accept information that is uncomfortable or contradicts their beliefs. When you provide information face-to-face, it’s received differently. However, today’s internet is filled with vast amounts of information, much of it incorrect. Patients tend to pick out the information that is “suitable” or “convenient” and reject what is “unsuitable.” This often leads us to waste valuable time on education and correcting misconceptions rather than treatment.

What are the most common patient complaints?

Back pain is the most common complaint, but it can be caused by many factors, not just nerves or the spinal cord. It can also stem from muscles, joints, and ligaments. A herniated disc, for example, is a relatively rare cause of back pain. The most common cause is spinal joints wearing out. Additionally, the longer the pain lasts, the more it spreads and affects more structures. If initially there was only one issue, it can spread, and sometimes it’s challenging to identify the primary problem.

Who typically seeks help at the pain clinic?

Most pain clinic patients are people aged 60 and older. I have conducted research and found that most patients seeking help are over 50. The problem, in my opinion, is generational. It’s hard for this generation to understand that lifestyle significantly affects their pain. Previously, there was little talk of self-care or a healthy lifestyle. The focus was on work and earning money, with self-care being a low priority. When we suggest that lifestyle changes and exercise could make a big difference, it’s often met with skepticism. Younger people, born in a free Lithuania or at the end of the Soviet Union, whose attitudes haven’t been shaped by the past system, are less likely to seek help at a pain clinic and typically do so only after trying other treatment methods. Older patients, unfortunately, often immediately request invasive procedures or decide to live in pain without changing their lifestyle.

Around the world, more women than men seek help at pain clinics . Why might that be? Various hypotheses exist: women may be more sensitive, or perhaps men are reluctant to seek help as it feels “unmanly.” Scientifically, women have a higher number of nociceptors (pain receptors) in their skin, which makes them more sensitive to pain than men. Studies show that women have 34 receptors per square centimeter of skin, while men have only 17.

Chronic pain, especially, isn’t just a physical issue; it’s closely tied to mental and emotional well-being. Women’s emotions tend to be more active, which may cause them to experience pain more intensely due to the additional emotional burden.

Moreover, traditionally, caring for children is considered a woman’s role. So, there comes a time when women start taking care of themselves because of their children, realizing that if they don’t look after themselves, they can’t care for others.

It’s also worth noting that men generally have a stronger physique. Women aren’t anatomically suited for heavy physical labor, and previously, women were often encouraged to work the same jobs as men, such as in construction or factories. In the past, occupational safety and health were not given as much attention as they are today.

Iš tikrųjų labai mėgstu moterų paklausti, ką jos veikė visą gyvenimą. Dažnai jos atsako, kad ir namus statė, ir plytas, cemento maišus nešiojo, gyvulius prižiūrėjo. Tai yra labai sunkūs fiziniai darbai. Šiais laikais dėl darbo saugos, ergonomikos reikalavimų, žmogus nepatiria tiek fizinio krūvio. Taip pat dažnai klausiu, kas pasikeitė jų gyvenime, kad atsirado nugaros skausmas. Neretai pacientai gali tiksliai įvardinti skausmo atsiradimo momentą, pasakoja apie įvairias artimųjų netektis, darbo netekimą, įvairius emocinius išgyvenimus, gyvenimo permainas. Kaip matote, emocinė, psichologinė žmogaus būklė turi labai daug įtakos skausmo paaštrėjimui.

Dažnai tenka išgirsti, kad išėjus į pensiją, ar po ilgesnių atostogų, kada kūnas atsipalaiduoja, žmonėms pradeda „išlysti“ įvairios sveikatos problemos

Taip, kai žmogus sustoja, pradeda „lįsti“ problemos. Prieš tai galbūt žmogus ir neleido sau jausti skausmo, būdavo per daug užimtas, susikoncentravęs į darbą, šeimą. Kitas variantas – kai į pensiją išeina ypatingai aktyviai dirbę žmonės, atsiranda emocinės, psichologinės problemos, jas lengviausia įvardinti kaip skausmą. Vyrams daug dažniau sunku pripažinti, kad skausmas gali būti emocinis, psichologinis.

Dėl ko dažniausiai skundžiasi žmonės iki 50 metų? Kokios dažniausios jų kreipimosi priežastys?

Priežastys būna labai įvairios. Dažniausiai tokiame amžiuje pasitaiko skausmas po įvairių traumų ar avarijų. Moterims dažnai pasitaiko galvos skausmai, kurie yra susiję su nugaros raumenų įtampa.

Šiame technologijų amžiuje žmonės daug laiko praleidžia prie kompiuterio, o jei su tuo susijęs ir darbas, tai visą dieną žmogus sėdi palenkęs galvą. Jei gyvenimo būdas yra sėslus, stebimas labai mažas raumenų tonusas. Todėl, visų pirma beveik kiekvienam pacientui pirmiausia skausmo specialistai siūlo greta skausmo gydymo procedūrų kreiptis ir į kineziterapeutą, mankštintis, įvairiais būdais stiprinti raumenyną.

Do patients easily find pain management? Can you say awareness has increased over the past five years?

Yes, awareness of pain management has grown and continues to grow. However, we still encounter the issue that family doctors don’t always inform patients about these services, and some even refuse to refer patients to a pain specialist. They usually refer them to a neurologist or neurosurgeon. Many patients report that family doctors or other specialists have outdated, incorrect views that invasive procedures at pain clinics can lead to disability or severe complications. In my 10-year career, neither I nor my colleagues have had a patient become disabled or paralyzed, nor has any experienced severe health complications. Each year, pain specialists hold conferences to inform other doctors about pain management, but unfortunately, the situation hasn’t improved.

What treatment methods do you typically use?

If we’re talking about physical procedures, it’s invasive treatment. Most patients come to us having already tried various painkillers, so medication alone isn’t helpful. For cancer patients, we use drug combinations, but non-cancer patients often need invasive procedures to reduce pain, allowing them to start listening to advice. While a patient is in significant pain, they might not absorb the information provided. One of the most common and safe invasive procedures is trigger point block. People often ask, "Did you perform a block?" We don’t actually block anything; the term “block” is jargon for a range of invasive procedures, all vastly different in execution and complication risks.

The only procedure close to a “block” is injections into trigger points. You could say we "block" the trigger point. Trigger points are often in muscles that, due to spasm or tension, generate pain in a specific area. We inject medication to reduce inflammation and relax the muscle. Procedures that truly block nerves are rare and highly specific. We can also use cryotherapy or radiofrequency therapy, which block impulse transmission through nerves. These procedures don’t involve medication but rather equipment.

What complications can arise from pain treatment?

Complications can be universal or specific. Universal complications include infection at the injection site or hitting a blood vessel. Specific complications might involve nerve damage or tearing of the nerve sheath. Everything depends heavily on the location of the complication.

While the risk is very low, it remains because, like in any field of medicine, we’re dealing with human work.

How can patients prepare for a consultation with a pain specialist?

If possible, patients should bring an MRI scan to their appointment. The more information a patient provides about their condition, the better the treatment outcome. Sometimes an ultrasound, or consultation with a traumatologist or neurosurgeon, is needed. The more thoroughly the painful area is examined, the smoother the consultation and treatment.

Kiek maždaug gali trukti skausmo gydymas?

Yra daug žmonių, kurie įsivaizduoja, kad skausmo klinika yra stebuklų kliniką. Tačiau vieną kartą ateiti neužtenka. Kuo ilgiau trunka skausmas, tuo ilgiau trunka jo gydymas. Žinoma, visas gydymo procesas yra labai individualus, kiek pats pacientas įdeda pastangų, kiek klauso ir kaip laikosi gydytojo rekomendacijų.

Su kuriais specialistais dažniausiai tenka bendradarbiauti gydant pacientą?

Svarbus yra komandinis darbas. Gydant pacientą dažnai dalyvauja ne tik skausmo gydytojas, bet ir neurologas, kineziterapeutas, psichologas. Dar kartą pabrėšiu, kad labai svarbus atviras ir sąmoningas bendravimas tarp specialistų ir paciento, tik tada bus pasiekti geriausi rezultatai.

Kas darbe Jus motyvuoja?

The most motivating aspect is when, in the flow of patients, a few genuinely change their lifestyle and perception of pain and its treatment. It’s wonderful when people thank me, say they’ve changed their way of life, their philosophy, and discovered something new within themselves. That is the best motivation for me and keeps me going. It takes a lot of positivity to celebrate these small victories, but without it, working in this field would be impossible.

Pacientams reikia ir psichologinės pagalbos. Pagalbos suprasti, kad pagrindinis asmuo gydymo procese yra pats pacientas. Ne gydytojas, ne procedūros, o pirmiausia paciento požiūris ir gyvenimo būdas. Kai pavyksta tuo įtikinti pacientą, jaučiu, kad mano darbas išties įgyja prasmę.