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Adverse drug events (ADE) are a major public health issue, with drug-drug interactions (DDI) being one of well-recognized causes of ADE that could be preventable by the use of DDI screening software. We compared the ability of four programs to detect clinically important DDI. We tested 62 drug pairs with and 12 drug pairs without clinically important DDI. Lexi-Interact and Epocrates were the most sensitive (95%) compared to the Compendium and Theriaque (80 and 73%, respectively). The Compendium and Theriaque also showed the lowest negative predictive value. All programs showed high specificity and positive predictive value. The qualitative assessment showed the best performances for Compendium and Lexi-Interact. The last one seems to be the best screening program, but the Compendium is in French and is freely available.

Le point de vue des patients – en particulier leurs représentations de ce qui leur arrive et leurs attentes par rapport au traitement – ainsi que l'importance d'indicateurs de réussite du traitement centrés sur le patient sont largement reconnus. L'influence des attentes sur les résultats du traitement fait l'objet de beaucoup d'attention. Les attentes constituent l'un des principaux mécanismes de l'effet placebo qu'elles modulent et auquel elles peuvent servir d'intermédiaire. La chirurgie soulève ici des questions intéressantes dans la mesure où le processus chirurgical, qui nécessite une hospitalisation, s'accompagne d'éléments tels qu'un cérémonial lié à la préparation de l'acte chirurgical, le recours à des techniques sophistiquées, mais aussi une reconnaissance de l'atteinte corporelle du fait de la nécessité d'une opération.

Objectif: évaluer l'impact du cycle menstruel sur le seuil de la douleur en réponse a un stimulus électrique chez 23 volontaires sains de sexe féminin avec et sans contraception orale. Méthode: nous avons suivi et comparé l'évolution longitudinale (3x/semaine durant un cycle menstruel complet) du réflexe nociceptif RIII, et du seuil subjectif de la douleur chez 23 volontaires, 13 avec et 10 sans contraception orale. Résultats: les volontaires sans contraception orale tendent a avoir des seuils nociceptif moyens plus bas que les volontaires sous contraception orale lors des phases menstruelle, folliculaire et lutéale. Lors de l'ovulation, cette différence s'accentue encore et devient significative (32.53 [41.03-24.04] vs 25,99 [33.97-18.02] mAmp, p = 0.04). Les données de l'évaluation subjective évoluent dans le même sens, sans être toutefois statistiquement significatives et sans nadir pendant l'ovulation. Conclusions: A l'instar des travaux expérimentaux parus sur la question, notre étude conforte l'idée d'un impact du cycle menstruel sur le seuil de la douleur. Bien qu'incomplète cette étude soulève le voile d'une influence des variations hormonales d'une part sur la transmission du message nociceptif au niveau central et d'autre part sur son intégration subjective qui pourrait être dissociée.

Cancer pain can be effectively controlled in most patients by classical pharmacological treatment. We retrospectively studied the characteristics and factors associated with non responsive pain. Between 1989 and 1996, 1767 patients were referred to our pain center; 831 (47%) had cancer pain and from 787 evaluable cases 118 (15%) experienced non-controlled pain whereas good pain control was achieved within a few days in 669 (85%) patients. Gender, age, cancer type, metastasis, initial pain intensity, nociceptive or neuropathic components and administration of adjuvant therapies were similar in both groups. On the other hand, diffuse pain, abdominal pain, terminal care, near death and doses of strong opioids were significantly different. Factors associated with therapeutic failure were conflicts, life and complications and breakthrough pain. In the presence of refractory cancer pain the factors predictive of therapeutic failure should be identified in order to optimize individual pain treatment.

Factors relating to working status, i.e. whether the subject is still at work or on workmen's compensation, have been studied in chronic pain patients. Sociodemographic and pain variables were not correlated with absence from work, nor was diagnosis. However, beliefs and attitudes concerning pain differed between patients still working and those on workmen's compensation. In chronic pain patients medical attention should focus not only on description of symptoms but also on the "illness behaviour" dimension.

This retrospective study considers the influence of chronological age on the perception and consequential effects of chronic non-cancer pain in 203 patients referred to an ambulatory pain clinic. One patient in four (50) was 65 years or older. Pain had existed for more than a year in 66%. It was referred to an "unbearable" by 54% of elderly adults vs 44% (NS) of the younger adult population, and as "intense" by 61% vs 44% (p < 0.05). A higher proportion of neurogenic pain (54% vs 26%, p < 0.05) could explain this significant difference. Cognitive factors could also have amplified the painful syndrome since 59% (vs 54%) of the elderly considered they had received insufficient information on the potential consequences of their painful condition. However, despite a higher occurrence of other severe illnesses in the elderly (52% vs 35%, p < 0.05), they appear to worry less about their health problems (58% vs 78%, p < 0.01). Finally, in spite of increased severity of pain in the elderly, depression scores and consequential effects are similar in the two populations. In conclusion, the intensity of chronic pain appears to be more severe in the elderly, perhaps due to its more frequent neuropathic origin. Nonetheless, its repercussions on daily life activity seem no worse than for younger adults, and could reflect better coping strategies towards chronic pain.

The aim of this retrospective study was to examine factors related to symptomatic pain treatment in 992 hospitalized patients referred to the pain clinic. These patients accounted for 1440 different pains (1.5 pains/patient), of nociceptive (59%), or neuropathic (24%) origin, a combination of both (16%) and of unidentified (1%) origin. Patients resistant to therapy did not differ from nonresistant patients (62%) in terms of age, sex, or number of pains. Although recommended pharmacological treatments were pursued, the neuropathic origin of pain was a factor in resistance to treatment. Among the neuropathic pains resistant to treatment (42%) a central nervous origin is more frequently found. Resistance to pain was more frequently encountered after strokes, primitive tumor of the central nervous system or traumatic plexopathy, whereas peripheral lesions of the nervous system were more easily controlled by symptomatic treatment. This study shows that central neuropathic pain is more frequently associated with resistance to recommended pharmacological symptomatic treatments. This observation underlines the limits of conventional medical therapy.