The chronic pain

The chronic pain and in need of support

“I never feel well

Even when I have a little less evil, I know that the next day I’ll be very evil..

.. ” “When the pain I twist the skull stops an hour or two in the day, it is as if I was in heaven.

” These two testimonies, among others, collected by David Le Breton, a sociologist, in Take. Chronic pain and reinvention of self (Editions Métailié), illustrate the daily lives of 20 % of French people who live with chronic pain. Cancers, lumbago, osteoarthritis, migraines, fibromyalgia, endometriosis, inflammatory arthritis, irritable bowel syndrome. ..

.. The pain is the main symptom of a large number of diseases”, says professor Serge Perrot, president of the French Society of study and treatment of pain (SFETD). She poisons the lives of 12 million people.

And this impressive number will continue to increase. Because, as pointed out by Serge Perrot, “from the age of 70, half of the population has pain”.

However, real progress has been made in the assessment and management of pain since the implementation of the first plan pain, in 1995. Despite everything, even today, 70 % of the pain do not receive appropriate treatment and less than 3% of the patients are followed in specialized centers, warning the learned society in a white paper published last October. And the conclusion is alarming: half of the patients a quality of life altered. To such an extent that 30 % of the suffering patients have suicidal thoughts, said Dr.

. Emilie Olié, a psychiatrist at the university hospital of Montpellier, during the congress of the SFETD last November.

“Despite a clear trend, studies show that 40 % of cancer patients who should receive morphine have no” Pr Serge Perrot, Even in the pain related to cancer, the support remains very heterogeneous across the territory.

“Despite a clear trend, studies show that 40 % of cancer patients who should receive the morphine does not have one,” says professor Serge Perrot. Yet, in a way, a priori, paradoxical, prescriptions for analgesics strong opioids increased 74 % between 2005 and 2015. “The percentage is high, but in absolute value, this represents around 600,000 to 700,000 French who are going to have at least one prescription for analgesics strong opioids.

In addition, the prescription increases especially in pain not related to cancer,” explains professor Nicolas Authier, head of the pain centre at the CHU Clermont-Ferrand, france. Indeed, the strong opioids (fentanyl, oxycodone, and morphine) are increasingly prescribed in pains in the bones and joints when conventional treatments are no longer effective. “Besides, we practically have more analgesics tier 2.

. It is normal that we prescrivions more of strong opioids. Today, we need to relieve people with an arsenal that is reduced constantly,” said Anne-Marie Magnier, professor of general medicine at the university of Pierre-and-Marie-Curie in Paris. For example, she says, the nonsteroidal anti-inflammatory drugs, which have been widely used in rheumatology, are now to avoid the long course.

In addition to the risk of gastrointestinal bleeding, they have demonstrated a toxicity of kidney and cardio-vascular. “We also need to know that codeine is not supported by everyone,” she continued. “Today, what we lack are new molecules.

The treatments are old, and not sufficiently effective or poorly tolerated ” Pr Alain Eschalier In addition, painkillers do not relieve all pain.

In effect, pain of neuropathic, pain of herpes zoster or diabetes, or even the pain of fibromyalgia or the irritable bowel, tell nociplastiques or dysfunctional, do not respond or little in these molecules. For the pain, the drugs used belong to the class of anti-epileptic drugs or antidepressants.

“Today, what we lack are new molecules. The treatments are old, and not sufficiently effective or poorly tolerated. For example, we need of painkillers as effective as morphine but without the side effects”, analysis of Pr Alain Eschalier, president of the Institute Analgésia.

Molecules exploring new ways pharmacological are also being studies. But the real innovations are expected. In the meantime, doctors and patients need to do with the molecules at their disposal.

Not to mention the approaches non-drug. “Hypnosis, acupuncture, exercise may be as effective but are not reimbursed by the social Security system,” said professor Serge Perrot, who is campaigning with the SFETD for a recognition of these approaches. Drugs strong opioids under surveillanceMédiatisée by the death of the singer Prince, the epidemic of addiction to opioid drugs alarm the american authorities.

It must be said that, each day, nearly 150 Americans die from an overdose of drugs to combat the pain. This dramatic situation could emerge in France? The question arises.

For the first time, a study focused on the French data.

And the fact is there. While the prescription of opioid medications has increased greatly, hospitalization for overdoses, and deaths have also increased dramatically. The deaths (excluding suicide) by drugs, strong opioids have been multiplied by three in ten years, from 1. .3 to 3. .4 per 1 million inhabitants, reveals a study conducted by the French Observatory of analgesic drugs (Ofma). “In particular, we need to guard against the use of drugs present in the cabinet family self-medication” Pr Nicolas Authier, head of the pain centre of the Clermont-Ferrand university hospital Of overdose, and contrary to what one may imagine, are not addicted to drugs addicted to drugs. In fact, 40% of hospitalizations for overdose relate to women aged 62 years, without a diagnosis of cancer, no recent surgery and no history of addiction known.

“These data are a cause for concern but not yet alarming. We know that we have a problem of abuse and misuse, but no crisis”, says the Pr Nicolas Authier, head of the pain centre of the university hospital of Clermont-Ferrand. For this specialist, the first action to take is to inform the French about the risks of addiction that can cause these medicines. “In particular, we need to guard against the use of the medicine in the cabinet, family and self-medication. Or recall the factors that promote addiction such as anxiety, depression, addiction to other substances, including benzodiazepines”, he says. However, it is not a question of limiting the access of these drugs to patients painful but to monitor and accompany any misuse.

“We must not find ourselves in a problematic of crisis, as in the United States. It would be so difficult to get out of it.

. When the crisis is installed, this means that there is a significant reservoir of dependent patients. And these are not going to disappear just because you change the conditions for the prescription of medication,” says Nicolas Authier.

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