Search

Dolodoc is a mobile application aimed at improving autonomy and quality of life for individuals living with chronic pain. Designed as a virtual coach, it offers counseling according to 7 important dimensions of quality of life. Activities, pain and fulfillment of the 7 dimensions of quality of life can be recorded in the application. Moreover, a report can be exported to enhance patient monitoring during clinical interactions. Dolodoc was developed with a user-centered approach and is based on scientific evidence related to the self-management of chronic pain. Indeed, counseling by the coach is based on a multimodal strategy, incorporating elements of physical activity, pacing, positive psychology, and relaxation, among others. Overall, Dolodoc is an innovation that can be used in various clinical settings with an individualized approach., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article. Le développement de Dolodoc a été possible grâce au soutien de la Fondation des HUG.

Despite chronic primary pain being recognized as a disease in the 11th revision of the International Classification of Diseases (ICD-11), individuals suffering from it are still too frequently met with a certain skepticism. This skepticism can detrimentally affect their healthcare journey, social life, and economic stability. This article outlines part of the legal evolution regarding the recognition of chronic pain as well as the current insurance-related provisions in Switzerland. With a thorough understanding of this system, physicians can reduce frustration and disputes as well as promoting decision-making processes. The article concludes by highlighting the tools that physicians can use to navigate procedures related to disability insurance effectively., Competing Interests: Les auteur-ice-s n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Chronic pain is poorly explained by the pathological biomechanical model. Pain neuroscience education (PNE) aims to help patients reconceptualize their pain by understanding its physiology and dissociating it from the notion of threat. It must be combined with functional re-education. Catastrophism and kinesiophobia exacerbate the perception of pain and are an obstacle to movement. Gradual exposure to movement, whether virtual or real, is a tool for managing pain more effectively and regaining optimum functionality. According to the literature, PNE reduces pain intensity, catastrophizing, kinesiophobia, disability and improves functionality., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

The doctor-patient relationship is changing directions in current medical practice, towards greater involvement of the latter. Pain neuroscience education (PNE) must play an important role in the treatment of chronic pain. Despite the complexity of studies, the effectiveness of PNE is proven, especially when integrated into interdisciplinary programs. It is fundamental that all healthcare professionals use coherent explanations to reassure and actively involve patients in pain. The dissemination of the scientifically validated biopsychosocial model of chronic pain is essential to correct common misunderstandings. Although the implementation of PNE is often carried out in pain or rehabilitation centers, but can also be conducted in medical practices., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêt en relation avec cet article.

The management of chronic pain is based on a biopsychosocial approach including pharmacological and non-pharmacological therapies such as Transcutaneous Electrical Nerve Stimulation (TENS). The effectiveness of TENS has been debated for over 50 years. While it provides symptomatic pain relief through physiological neuromodulation mechanisms, irrespective of the type of pain, there is no solid proof that it has curative effects specific to a pathology. There are no robust predictors of response to TENS depending on the type of pain, but reinforcing self-management skills in patients who benefit from it through an educational measure is a guarantee of satisfaction and retention., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Anal pain can be acute (most commonly related to anal fissure, perianal abcess or fistula, perianal vein thrombosis) or chronic (functional or neuropathic) including levator ani syndrome, proctalgia fugax, pudendal nevralgia and coccygodynia. History and clinical examination are keys to diagnose acute causes. Diagnosis of chronic anal pain on the other hand is more challenging and based on thorough history and analysis of symptoms. The aim of this article is to discuss the main etiologies and treatments of acute and chronic anal pain, including an update on the management and treatment of hemorrhoidal disease and postoperative pain management., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

For several decades now, chronic spinal pain has been one of the most prevalent health problems in virtually every country in the world. Although most scientific research has focused on the intervertebral disc, this has unfortunately not yet led to truly effective treatments. Fortunately, other groups have resolutely tackled this challenge by adopting a complexity-based perspective, paving the way for the emergence of promising new therapeutic approaches., Competing Interests: L’auteur n’a déclaré aucun conflit d’intérêts en relation avec cet article.

Managing chronic pain in endometriosis requires multidisciplinary assessment and care. The aim is not complete disappearance of symptoms, but rehabilitation through medication, non-medication treatments and overall follow-up., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

There is a growing body of scientific understanding surrounding the topic of functional chronic pain. Numerous studies have highlighted a persistent low-grade inflammation within the fascial and central nervous systems, coupled with detrimental neuroplasticity involving substantial remodeling of pain pathways in the spinal cord and brain. These findings provide a more concrete basis for explaining functional chronic pain to adolescents, simplifying the establishment of trust and the justification of proposed treatments in the process., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Pelvic congestion syndrome is a debilitating condition that is often under-diagnosed and under-treated, defined by chronic pelvic pain in the presence of pelvic varicose veins in women or, more rarely, in men. The differential diagnosis of chronic abdominal pain is vast and often leads to lengthy and costly diagnostic procedures. Conservative treatment is often insufficient, and embolization of pelvic varices is the treatment of choice to improve symptoms. A multidisciplinary management algorithm is proposed to facilitate the clinical path for these patients., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Early psychological factors, including childhood traumas and personality, play a crucial role in the emergence and persistence of painful symptoms and appears to be frequent in patients with nociplastic pain. Patient care involves validating the reality of their pain and identifying various facets of their suffering, taking into account their individual history and context. A multimodal therapeutic approach, within a bio-psycho-social model, emphasizing psychotherapeutic care, is recommended., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Living with chronic, daily pain generates a variety of reactions for every individual. To provide the best possible support for sufferers, management strategies have diversified, becoming multimodal and encompassing pharmacological, non-pharmacological, psychological, physiotherapeutic and educational therapies. It is within this framework that therapeutic patient education, hypnoanalgesia and self-hypnosis have been deployed., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Chronic pain affects a large number of French people, and has a considerable impact on their quality of life. Spinal cord stimulation is a technique for managing and reducing this pain, which is often resistant to (poorly tolerated) medication. Between the consultation with the specialist and the operation, a specific procedure is imperative: the pre-implantation assessment. Numerous appointments and tests are required to verify the patient's eligibility. The pain resource nurse plays a key role in supporting the patient through this process: she is the guiding light in the care process., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Whether acute or chronic, pain leads to a reorganization of the subject's psychic functioning, and thus to a different interpretation of his or her own painful experience. To transform the experience, pain must be addressed in all its biopsychosocial components, and through the use of various therapeutic devices, with the hope of overcoming it., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

In recent years, numerous studies have highlighted the advances made possible by kinesitherapy treatments. These can be used to reduce the frequency, intensity and duration of pain, as well as the functional repercussions of chronic pain. The neurophysiological mechanism involved in primary chronic pain and the pathology producing secondary chronic pain must be taken into account in determining the nature of the treatments to be implemented. This article presents the main physiotherapy interventions recommended for the management of patients with chronic pain, according to the type of pain experienced (nociceptive, neuropathic or nociplastic)., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Mindfulness meditation is a mind-body approach that helps to cope with psychological or physical symptoms such as pain. To date, this approach is still not widely available to patients in our French-speaking somatic clinical settings, despite its scientific validation. This article describes three mindfulness meditation programs delivered at Lausanne University Hospital (CHUV) to people living with HIV, cancer or chronic pain. It highlights the issues related to the involvement of participants in these programs as well as those related to their implementation in a Swiss somatic, teaching French-speaking hospital., Competing Interests: L’institution de C. Courvoisier et D. Jackson-Perry a reçu un soutien pour sponsoring de prestations de Gilead, MSD et ViiV. Les autres auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

At last, chronic pain, with its consequences and impact for patients and society, is now considered as a disease in its own in the 11th revision of the international classification of diseases (ICD). We present here in the light of two clinical cases, why the diagnosis of chronic primary pain is useful and how to utilize these new codes. We hope to rapidly see the awaited impact on the healthcare system (from the patient care to insurance issues), as on research and teaching., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

The chronic pain complaint is still poorly accepted in the community and even sometimes in the health care system. It may trigger reactions of disbelief, suspicion or rejection. The legitimization and validation of the patient's suffering is a priority in order for him/her to feel believed and understood and improve his/her commitment to the treatment proposal. The social consequences of chronic pain include various limitations, a reduction of activities, of personal and professional ties leading to social exclusion amplifying the painful experience. Exploring his/her social context during the consultation often helps the patient to re-establish significant links. It leads to wider therapeutic approaches focusing on the strengthening of social support, with documented benefits on pain experience, mood and quality of life., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Doctors, when facing patients suffering from chronic pain, are driven to the limits of their clinical practice, which essentially is based on a diagnostic interpretation of the patient's signs and symptoms, leading to the appropriate therapeutic intervention. A doctor's awareness of his own experience of helpless distress facing these patients is bound to occur and to make him address the issues of transference between him and his patient. Listening to the patient's narrative is essential. This has a reassuring and therapeutic role for the patient in pain. Above all, it enables the doctor to evaluate the patient's intensity of distress and need for security and to recognize that he must let the patient express his feelings, without necessarily responding immediately., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

The majority of non-specific low back pain has a favourable evolution within a short period of time but in some cases the pain becomes persistent or recurrent. These chronic forms are responsible for most of the social and economic burden of low back pain. The crucial role of psycho-social factors in the chronicisation of low back pain justifies a thorough bio-psycho-social assessment. An active semi-intensive ambulatory multidisciplinary programme (Spine Unit Center) that complies with international and national recommendations (KCE and INAMI) has demonstrated its effectiveness in chronic low back pain in terms of algo-functional, physical and psycho-social components. In contrast to intensive programmes requiring hospitalisation, this outpatient treatment allows the patient to remain in his/her social and professional network. The active participation and motivation of the patient are essential for the success of the treatment. The multidisciplinary team will help the patient to define his/her functional objectives and to manage, via the psychologist, emotional aspects. The programme includes therapeutic education and physical reconditioning sessions including progressive aerobic training, group exercises, and individualised and progressive strengthening of the trunk muscles. The introduction of physical activity at home will be encouraged in order to sustain the changes in the patient's behaviour.

Pain is generally perceived as a sensory, emotional and cognitive aggression by the patient who suffers from it and as the enemy that must be defeated by the physician. It may become chronic, and the passage from the acute phase to the chronic phase cannot be explained in a single way. Indeed, multiple factors come into play: biological, psychological and socio-professional. The patient's quality of life then deteriorates and places him/her in a vicious cycle of pain. The assessment of the different components of pain (sensory, emotional, cognitive and behavioural) and its maintenance factors allow for the implementation of therapeutic strategies, both physical and psychological, adapted to every patient. Due to the complexity of chronic pain management, a multidisciplinary strategy is being developed, with a global approach according to the biopsychosocial perspective, including non-pharmacological approaches, with the objective of allowing the patient to be autonomous in the management of his/her symptoms.

It is recognized that multimodal management of chronic pain is necessary. This management requires the use of both drug and non-drug approaches. Acupuncture is a non-medicinal approach that has been shown to be effective in treating chronic musculoskeletal and arthritic pain. It has few side effects and contraindications. Its use should be developed in geriatrics as a complement to usual analgesics and other non-drug approaches., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

Self-management is a process in which the patient actively engages in the management of his or her disease, adapting to the resulting problems, and complying with behavioral changes. Its support will have beneficial effects, as well as an improvement in quality of life, and reasonable use of resources available for health. Exercise plays a central role in the self-management of a range of chronic diseases, including musculoskeletal conditions, one of the most prevalent conditions in Switzerland. However, physical activity and exercise are under-prescribed in chronic disease management. A combination of supervised strategies and digital devices in self-management coaching could maximize the effects of physical activity., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Chronic testicular pain represents up to 5% of urological consultations. A simple workup can help identify an organic etiology in 50 to 75% of cases, leading to a targeted treatment. If this is not the case, chronic idiopathic orchialgia is diagnosed and multidisciplinary management is necessary. Treatment is initially conservative but is only effective in 4 to 15% of patients. Spermatic block by infiltration of the cord confirms the testicular origin of the pain and provides temporary relief. Microsurgical denervation of the spermatic cord is the treatment of choice for responders. It provides significant pain relief in 77 to 100% of cases., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Chronic back pain is a very frequent and highly morbid disease. Among the different factors influencing chronicization are the intensity of the initial episode, lack of physical activity and psychological factors. This paper focuses on this last point, and more specifically on the so-called unhelpful beliefs. The aim is to review the degree of evidence for some of these beliefs frequently found in patients and health professionals., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Copyright of Douleur et Analgésie is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The biopsychosocial complexity of chronic pain requires a multimodal approach of which hypnosis is one. Its effectiveness is increasingly proven by studies using functional neuroimaging, as well as clinical studies in various etiologies of chronic pain. The goal of hypnosis is to restore the patient to an active role where, during the sessions, he will discover his creative capacities allowing him to temporarily modify or even significantly reduce painful sensations. Regular practice of self-hypnosis amplifies and anchors these changes. Gradually, hypnosis allows patients to regain both physical and mental mobility., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

The role of cryotherapy in the treatment of pain has been known since the Egyptians. For fifty years, techniques initially dedicated to the whole body have evolved into more specific approaches by targeting nerve structures. Several indications for the treatment of acute and chronic pain have emerged and are supported by scientific evidence. A reduction in pain for up to several months, a decrease of opioid consumption and an improvement in the physical activity are among the main results reported in the literature. Cryotherapy appears to be an efficient treatment in pain management correlated with a relatively few numbers of side effects., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

The entanglement between pain and emotions is increasingly recognized. Emotions can predispose to pain and contribute to its chronicisation but also to its relief. The placebo effect is a witness to the moderating influences of cognitions and emotions on pain. An awareness of these influences is of interest to patients as it can widen their therapeutic perspectives. Chronic refractory pain has often been linked to a history of abuse, neglect and psychological trauma whose neuropsychological and affective traces can predispose to painful complaints. The treatment approach requires strong commitment and empathy on the part of the therapist in order to help patients reconnect with their own history and their emotions., Competing Interests: Les auteures n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Decentration and cognitive restructuring are used in cognitive-behavioural therapy (CBT) with patients suffering from chronic pain and are reinforced by group work. They can also be useful to the general practitioner. Clinical vignettes summarize the role of group CBT in identifying realistic and meaningful activities. They stress decentration and cognitive restructuring as key therapeutic tools in group CBT. Using them with patients suffering from chronic pain is complex and challenging when it comes to allow the patients to overcome the impossibility to function 'as before' while figuring out how to cope 'as for now'., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Chronic idiopathic musculoskeletal pain is common in adolescence, and its impact is sometimes severe. The diagnostic process, which consists of eliminating other etiologies, can be long, complex, and at risk of medical nomadism. Specialists rely on many clinical elements to orient themselves. The care pathway and the subjective feeling of the professional are valuable diagnostic elements., (Copyright © 2021. Published by Elsevier Masson SAS.)

Chronic pain is a complex phenomenon that includes three dimensions : biological, socio-cultural and psychological. The psychological aspect plays an amplifying role in the perception of pain and therefore, adjuvant psychotherapies are an important tool in the multidimensional management of chronic pain. In this article, we present the main psychotherapeutic approaches and techniques applied in the field of chronic pain which act on the cognitive-emotional, traumatic, as well as on the sensory level. The personalization of psychotherapeutic treatment, as well as the involvement of patients in its choice, should allow psychotherapeutic approaches to achieve their goal in terms of improving the quality of life of patients., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Pediatric chronic pain is an increasingly recognized condition in children and adolescents. Current treatment is based on the bio-psycho-social model of chronic pain: an interprofessional and integrative team will help the young patient and his environment, in order to find a balance between physical, psychological and social impacts. This article focuses on different treatment approaches for pediatric chronic pain in the outpatient and inpatient setting., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Different international clinical guidelines from expert committees recommend acupuncture on equal terms with conventional pharmacological or interventional techniques for the management of chronic pain. Thus, this traditional Chinese medicine technique has won its place in a primary care chronic pain management plan. It should not be reserved as a last resort, when all other techniques have failed. Inspired by the concept of integrative medicine, this article proposes an overview of currently validated indications, and offers some tools for the primary care physician who wishes to orient a patient towards an acupuncture treatment., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Self-management of chronic pain should enable patients to regain an acceptable quality of life, autonomy, and reduce the number of consultations. These strategies are increasingly available on mobile applications, which have been evaluated for their content and effectiveness in several reviews. The vast majority of applications offer only one self-management strategy, few opportunities for interactions, and have not involved patients and healthcare professionals in their development. It is therefore still difficult to determine their effectiveness in the self-management of chronic pain. However, mobile applications should not be neglected. On the contrary, it is necessary to develop validated applications in French considering the five criteria classically recommended for self-management. Then such applications can be prescribed by health professionals as part of the multimodal management of chronic pain., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

The International Association for the Study of Pain (IASP) proposed the current diagnostic description of complex regional pain syndrome (CRPS) for the distinct and complex chronic pain condition in 1994. Since this classification, studies on the syndrome have led to a better understanding of the underlying pathophysiological mechanisms, epidemiology and therapeutic approaches. F. Luthi of SUVA Care reviewed CRPS in detail in 2014 and 2019 issues of the Revue médicale suisse. The purpose of this article is to provide an update of results on the neural mechanisms involved in this syndrome and how this helps management of CRPS, in particular bringing awareness to physicians of all specialties of the first symptoms with practical advice for investigations and treatment., Competing Interests: Les auteurs n’ont declare aucun conflit d’interets en relation avec cet article.

Caring for people with chronic pain is complex and multifaceted. At the Rothschild Hospital in Paris, the multi-professional team of the pain assessment and treatment service includes a music therapist. On medical orientation and according to the typology of the source pathology, this professional opens to the patients spaces of musical relaxation and awareness that a better well-being is possible., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Objective: The aim of this article was to describe the diagnostic and therapeutic value of transcranial stimulation in pelvic and perineal disorders., Methods: A literature review (Medline database and Google scholar) with no time limit was performed using keywords: "transcranial direct stimulation", "transcranial magnetic stimulation", "neurogenic bladder", "urinary incontinence", "Parkinson disease", "multiple sclerosis", "stroke", "muscle spasticity", "pelvic pain", "visceral pain"., Results: Twelve articles have been selected. Transcranial magnetic or electrical stimulation is a noninvasive neuromodulation technique widely used to establish brain maps to highlight causal relationships between brain and function. Regarding pelvic-perineal disorders, repeated transcranial stimulation has shown significant effects for the treatment of overactive bladder in Parkinson's disease (P<0.05) and multiple sclerosis, but also for the treatment of refractory chronic pelvic pain (P=0.026). Finally, therapeutic effects have also been demonstrated in irritable bowel syndrome. No evidence of efficacy was found on genito-sexual disorders., Conclusion: Data from the literature suggest that transcranial stimulation is a noninvasive treatment that may have a role in the management of pelvic and perineal disorders. Its promising field of action would require prospective and randomized studies on a larger scale., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Cognitive and behavioral techniques (CBT) are used in the approach of chronic pain, based on the assumption that pain and disability are not (only) influenced by somatic issues but also by psychosocial factors. CBT aim to improving quality of life while targeting disability. Psychoeducation, activity-centered and cognitive techniques are central, drawing on the identification of an activity that is not only important and meaningful for the patient but also realistic. This should allow the patient to overcome the impossibility to function « as before » while figuring out how to cope « as for now ». The ways to explore possible alternative options during the group therapy is presented and discussed., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Integrative medicine can usefully be applied to the care of patients suffering from chronic pain, when there is a good understanding of its framework. Integrative pain management relies on the following principles: considering globally all aspects of the person's life, creating a strong partnership with the patient, choosing treatments both from complementary and conventional medecine as long as they are relying on evidence and prioritizing therapeutic interventions that are the least invasive and costly for equal benefits. This article provides key elements to enhance a pain management plan through a holistic perspective. Amongst other practical tools, it offers a non exhaustive synthesis of validated therapeutic techniques based on recent reviews and clinical guidelines for different pain conditions., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Twenty-five to 65% of patients suffer from chronic pain after breast cancer. The treatment combines analgesic drugs and psychophysical techniques., Hypothesis: Osteopathy improves the control of pain and the quality of life of patients., Methods: This randomized prospective single center study allocated patients to the initiation of a standard analgesic treatment exclusively (arm A) or associated to osteopathy (arm B) between from 1 to 12months after surgery., Main Objective: Intensity of pain (VAS at three months [j90])., Secondary Objectives: Pain (VAS) at 6 and 12 months, analgesic consumption, anxiety/depression (HADS), and Quality of life (QLQ-C30). Eighty patients were planned to observe a 2-point difference in VAS (5% bilateral alpha, 90% power)., Results: Twenty-eight patients (A: 14; B: 14, median age 50 years) were included from April 2011 to February 2014; the study was stopped due to a too slow recruitment. No difference in the VAS pain score between arms was observed at j90 (P=0.258), nor at 6 and 12 months. At j90, the HADS depression score was reduced in arm B (P=0.049). Improvement in the overall score of quality of life (P=0.015), and reduced pain sub-score (P=0.021) were observed at j90 in arm B., Discussion: Patients are strongly seeking complementary therapies. Few studies exist. Our study has encountered major recruitment difficulties therefore limiting the interpretation of the results. Despite the absence of difference in the main objective, some other scores (QOL, depression) are noteworthy in favor of osteopathy. Further multicentric studies are needed., (Copyright © 2019 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)

The current treatment of migraine attacks is triptans and NSAIDs, but the calcitonin gene-related peptide (CGRP) has emerged as a key neuropeptide target for migraine therapy. Despite an off target class effect on liver enzymes, two CGRP receptor antagonists, ubrogepant and rimegepant, remain in development, together with a 5-HT 1F receptor agonist (lasmiditan), for which cardiovascular contraindications that limit the utility of triptans do not exist. Importantly, to avoid an excessive use of acute medication with the risk of medication overuse, prophylactic therapeutics are the best choice. To date, monoclonal antibodies which block CGRP actions are on the market all over the world but not yet in France. The research is very active in different directions and targets notably hypothalamic neuropeptides because the hypothalamus hosts many key neuropeptide systems that seem to play a role in migraine physiopathology. These neuropeptides include orexins, oxytocin, neuropeptide Y (NPY) and pituitary adenylate cyclase-activating polypeptide (PACAP). In addition, other promising drugs for the treatment of migraine are nitric oxide synthase inhibitors and acid-sensing ion channel (ASIC) blockers., (© Société de Biologie, 2019.)

In the framework of the management of patients receiving hyperbaric oxygen therapy, hypnoanalgesia is a complementary pain management tool, notably during the changing of dressings. Trained in this management of care-related pain, the teams of the hypebaric medicine centre in Lyon share their experience., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Transcranial Direct Current Stimulation (tDCS) is a cheap, easy to use, and relatively safe noninvasive brain stimulation technique. It is increasingly used in several indications in psychiatry and neurology, mainly for depression, chronic pain and cognitive decline due to degenerative brain diseases. Its efficacy is probable in depression and must still be confirmed in numerous other indications. Lowcost devices for the general public are easy to find on the internet and are frequently used for non-therapeutic indications, like the improvement of video gamers' performances. A non-medical use could represent a public health hazard, due to lack of control on stimulation parameters i.e. localization, duration and intensity.

A study explored the factors which can have an impact on the use of connected objects to improve patients' adherence to physical activity, when they suffer from chronic low back pain. The results can be used to adjust the development of an application aimed at patients with chronic low back pain., (Copyright © 2017. Publié par Elsevier Masson SAS.)

Dry eye symptoms are one of the leading complaints in ophthalmology. They include visual disturbance, various types of symptoms and variable intensity of pain and discomfort that may become chronic or permanent and thus affect significantly the quality of life of patients. Nevertheless, the pathophysiological mechanisms of ocular surface pain remain largely unknown. A better clinical characterization of chronic ocular pain and an understanding of the molecular and cellular mechanisms involved are crucial issues for developing effective management and therapeutic strategy to alleviate ocular pain. In this review, we first describe the nociceptive corneal nerve pathways and the classification of corneal sensitive receptors neurons. The second part of this review gives an update of the preclinical and clinical data related to the inflammatory processes linked to inflammatory ocular pain. The last section describes the various diagnostic tools used in the clinic to evaluate corneal sensitivity and corneal inflammation., (© 2017 médecine/sciences – Inserm.)

Complementary medicines are frequently used by chronic pain patients. It is a challenge for the primary care physician to provide objective information based on the scientific literature. Meta-analyses have shown favourable effects of acupuncture, therapeutic massage and osteopathy for patients with acute low back pain. Concerning chronic low back pain, meta-analyses have shown positive results with acupuncture, osteopathy, yoga and tai-chi. Other therapies have shown positive effects, but further trials are necessary to fully validate them. This article reviews the literature supporting the most studied complementary medicines., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

The treatment of chronic lumbar pain patients needs a global interdisciplinary approach when traditional conservative treatments do not fulfil their aims. One of the most efficient ways to proceed is using an interdisciplinary treatment program, including physiotherapeutic measures, occupational therapy and psychological support for 3 weeks. It is important that people in conflicts with insurances companies should be excluded from these treatments. It is also important that the reconditioning should continue over a long term to have a sustainable result., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.