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Introduction: There is a dearth of research on the incidence and treatment of cancer pain in Africa. Yet Africa, with other developing countries, accounts for more than half of all cancer diagnoses, and it is estimated that cancer incidence in Africa will double by 2030., Objectives: This research protocol outlines an approach to investigate cancer pain in French-speaking African countries. The protocol intends to determine and describe the treatment and management of cancer pain in these countries. Barriers to treating cancer pain will be explored and the results will be collated to make a series of recommendations on policy positions, regulatory frameworks and protocols., Methods: A mixed-methods, co-creation methodology has been selected to ensure the societal impact of the research outcomes. This research will use both qualitative and quantitative data collection methods and analyses. The research will begin with a review of the policies and legislation that exist in relation to cancer pain management and the use of analgesics, in each French-speaking African country. An Experts Steering Committee will then be created to provide guidance on the protocol and research design and access to participants, as well as to execute on the administration of surveys to local structures and international experts. A series of semi-structured, qualitative interviews with experts and clinicians in the field of screening and management of cancer pain and access to treatment will follow. Purposive and snowball sampling will be used to select the respondent experts. The semi-structured interviews will be conducted to determine the main trends and barriers to the treatment of cancer pain in French-speaking African countries. From this qualitative research, two surveys will be developed and then administered: one to validate the policy and regulatory context, and the other to determine experts and healthcare professionals experience and perceptions of cancer pain., Results/conclusions: The results will be analyzed using quantitative and qualitative methods to determine themes and perceptions of cancer pain and treatment, from the policy level to the healthcare professional level. Evaluation of the results will lead to recommendations for a comprehensive framework for cancer pain treatment in French-speaking Africa., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Hadjiat and Perrot.)

Chronic postsurgical neuropathic pain (CPSNP) is frequent. While prevalence varies considerably according to type of operation and means of evaluation, it can reach 37% following breast surgery. Identification of risk factors related to the procedure and to the patient and taking into account the development of new, minimally invasive surgical techniques is increasingly nerve-sparing and reduces the likelihood of injury. CPSNP diagnosis in daily practice is facilitated by simple and quickly usable tools such as the NP4 4-question test. Management is based on pharmacological (analgesics, antiepileptics, antidepressants, local anesthetics) and non-pharmacological (kinesitherapy, neurostimulation, psychotherapy) approaches. In light of the present review of the literature, the authors, who constitute an expert group specialized in pain management, anesthesia and surgery, express their support for topical treatments (lidocaine, capsaicin) in treatment of localized postsurgical neuropathic pain in adults., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Objectives: Prescription opioid use disorder (POUD) is an established public health crisis in many countries, and current evidence indicates it is a growing problem in Europe. Many specialists play a role, including pain and addiction medicine specialists, in the diagnosis and management of POUD, but neither group can fully address these patients' needs alone. The purpose of this consensus process was to bring together experts from pain and addiction medicine to examine the positions of both specialties., Methods: In all, 13 international pain medicine, addiction medicine, and addiction psychiatry experts convened a meeting to formulate a set of consensus statements on the diagnosis and management of POUD. The statements were further refined by a wider group of 22 European expert clinicians. At a second meeting of all 35 participants, a set of controversy statements was also developed to recognize some of the key areas of divergent opinion., Results/conclusions: There was a high level of agreement between pain and addiction specialists. Key themes that emerged were the need to strengthen interdisciplinary communication, a desire for greater education and training for clinicians in both specialties, and mutual acknowledgment of the importance of multidisciplinary management of POUD. The blurred line between poorly managed pain and POUD was also a subject of much discussion, reflecting the difficulties in defining and diagnosing this complex condition.

Introduction: In 2016, the orally administered fixed-dose combination of dexketoprofen 25 mg and tramadol 75 mg (DKP/TRAM FDC) was approved in Europe for short-term treatment of moderate-to-severe acute pain, an indication that encompasses a wide range of post-operative and non-surgical painful conditions. This has suggested the necessity to have a clearer indication on its clinical use, with the support of expert pain clinicians, working in different medical specialities, and reinforced by the data present in the literature., Methods: With the aim of assisting clinicians in the use of DKP/TRAM FDC in daily practice, two rounds of a modified Delphi process were conducted. In the first round, a board of nine experts developed a series of consensus statements based on available evidence, and their clinical experience, with DKP/TRAM FDC. In the second round, 75 clinicians with extensive experience in pain management expressed individually their agreement with the statements, using a dedicated online platform. Consensus was defined as at least 70% agreement., Results: Twenty-eight statements were developed. Of these, 19 reached the defined level of consensus., Conclusion: The agreed consensus statements may assist clinicians in applying the results of clinical studies and clinical experience to routine care settings, providing guidance for use of this new analgesic combination in moderate-to-severe post-operative and non-surgical acute pain., Funding: Menarini Group.

Fibromyalgia represents a condition still controversial in its entity, pathophysiology, diagnosis and management (Figure ). In a world where everybody is connected, and everybody is sharing their own image, fibromyalgia (FM) represents the emblematic pathology of misconnection and lack of specific biomarker. FM is an invisible experience with all normal tests and analyses, without any visible biomarker to exhibit to healthcare professionals, colleagues and relatives. In this context, we propose to consider FM as a disease of misconnection at different levels: misconnection with society, misconnection with healthcare professionals, misconnection with pathophysiological concepts, misconnection between brain and body. The concept of misconnection defines FM in a different and holistic view and proposes different views of assessment, management and representation: FM pathophysiology: the desynchronization of brain and body FM recognition: the broken link between patients and physicians FM assessment: merging the body and mind for an optimal diagnosis and management FM treatment: re-establishing the good connections at different levels We hope to reconnect FM patients with all healthcare providers, help FM patients reconnect with their painful body and integrate FM into regular medical practice. SIGNIFICANCE: The concept of misconnection defines FM in a different and holistic view, and propose different views of assessment, management and representation., (© 2019 European Pain Federation - EFIC®.)

Background: Complex regional pain syndrome is a painful and disabling post-traumatic primary pain disorder. Acute and chronic complex regional pain syndrome (CRPS) are major clinical challenges. In Europe, progress is hampered by significant heterogeneity in clinical practice. We sought to establish standards for the diagnosis and management of CRPS., Methods: The European Pain Federation established a pan-European task force of experts in CRPS who followed a four-stage consensus challenge process to produce mandatory quality standards worded as grammatically imperative (must-do) statements., Results: We developed 17 standards in 8 areas of care. There are 2 standards in diagnosis, 1 in multidisciplinary care, 1 in assessment, 3 for care pathways, 1 in information and education, 4 in pain management, 3 in physical rehabilitation and 2 on distress management. The standards are presented and summarized, and their generation and consequences were discussed. Also presented are domains of practice for which no agreement on a standard could be reached. Areas of research needed to improve the validity and uptake of these standards are discussed., Conclusion: The European Pain Federation task force present 17 standards of the diagnosis and management of CRPS for use in Europe. These are considered achievable for most countries and aspirational for a minority of countries depending on their healthcare resource and structures., Significance: This position statement summarizes expert opinion on acceptable standards for CRPS care in Europe., (© 2019 European Pain Federation - EFIC®.)

This article describes a proposal for the new diagnosis of chronic primary pain (CPP) in ICD-11. Chronic primary pain is chosen when pain has persisted for more than 3 months and is associated with significant emotional distress and/or functional disability, and the pain is not better accounted for by another condition. As with all pain, the article assumes a biopsychosocial framework for understanding CPP, which means all subtypes of the diagnosis are considered to be multifactorial in nature, with biological, psychological, and social factors contributing to each. Unlike the perspectives found in DSM-5 and ICD-10, the diagnosis of CPP is considered to be appropriate independently of identified biological or psychological contributors, unless another diagnosis would better account for the presenting symptoms. Such other diagnoses are called "chronic secondary pain" where pain may at least initially be conceived as a symptom secondary to an underlying disease. The goal here is to create a classification that is useful in both primary care and specialized pain management settings for the development of individualized management plans, and to assist both clinicians and researchers by providing a more accurate description of each diagnostic category.

Pain is an ubiquitous symptom in osteoarticular diseases, occurring much more commonly than stiffness or disability. OA of the knee, hand, or hip affects around 20% of adults in various populations and is dramatically increasing in many countries, mostly related to age and obesity, leading to an increased number of people having OA pain, and creating a huge burden related to disability and health care costs. OA-related pain, has been classically considered to be a nociceptive pain condition. Clinicians have considered pain to be an alarm signal, correlated to the intensity of joint degradation. In OA, most authors have focused their studies on joint architecture and local degradation, considering pain as only a symptom, a consequence of joint damage. However, OA-related pain is a specific disease, with a complex pathophysiology, including neuropathic peripheral and central abnormalities, together with local inflammation involving all joint structures. Clinical findings emphasize that it is not a stable and linear condition, that pain experience is independent of structural modifications, and that the quality of pain in OA is important to consider, aside from its intensity. OA-related pain is modulated by many factors, including the individual patient's psychological and genetic factors, as well as the theoretical role of meteorological influences. Recent neuroimaging findings have improved our knowledge about central mechanisms of OA pain, especially in persistent cases., (Copyright © 2017 Société française de rhumatologie. Published by Elsevier Masson SAS. All rights reserved.)

Background: Pain centers manage only selected patients, and have long waiting lists. Some patients spontaneously send letters, before the visit, and these letters represent the first contact between the patients and the pain centers. We report a study of the content and format of these letters, for a patient perspective analysis., Methods: During a 3 month-period, all newly referred patients to a tertiary pain center were considered. If a patient letter was provided, it was collected for analysis. Qualitative analyses including semantic and content analyses were performed to identify themes and categories., Results: Among 138 newly referred patients, 44 had sent a letter before consultation. Content analysis of 42 letters disclosed four themes: I) pain experience; II) impact of the pain problem; III) patient history; and IV) expectations. These themes could be distributed along four pain dimensions: (1) physical; (2) psycho-affective; (3) social; and (4) temporal. This first study on patient letters reveals that a bio-psychosocial model. Patients contribute actively to their trajectory, not only as healthcare seekers but also by constructing their narrative identity., Conclusions: Patient letters constitute narrative material to be integrated into clinical analysis, alongside patient interviews, especially in pain management. Pain specialists should take account of this narrative approach to better understand the unvoiced and sometimes silent experience of pain. This may increase quality of medical care by including patient-centered data in an original method. Further studies may be valuable to analyze the possible contributions of such letters to patient management., Significance: Patients' letters constitute original narrative material to be integrated into clinical analysis, especially for pain management. Patients' letters analyses may improve the patient physician relationship, by understanding patient's perspectives, beliefs and expectations., (© 2017 European Pain Federation - EFIC®.)

Rationale, Aims and Objectives: The objective was to compare the extent of pain interference and pain medication among persons who were classified as obese [body mass index (BMI)≥ 30 kg m(-2) ] and normal weighted (BMI  ≤ 25 kg m(-2) ), before a hip or knee replacement surgery., Methods: Patients candidate for an orthopaedic surgery were successively enrolled, over a 6-month period, and classified in either the normal weight (BMI  ≤ 25 kg m(-2) ) or the obese (BMI ≥ 30 kg m(-2) ) categories. Data were collected using self-administered questionnaires with items concerning pain characteristics, pain medication and pain interference. Two standardized questionnaires were associated: the Brief Pain Inventory (BPI) and the Hospital Anxiety and Depression scale (HAD)., Results: Fifty-two obese patients (candidates for 24 hip replacements and 28 knee replacements) and 51 non-obese (23 hip replacements and 28 knee replacements) were enrolled. Obese patients suffered from a higher rate of acute pain episodes than non-obese patients (65 versus 44%, P<0.05). Pain interference on walking distance, sleep and relations with others was higher in obese patients. HAD score showed no significant difference between groups. The use of strong opioids and of non-steroidal anti-inflammatory drugs (NSAIDs) was significantly more important in obese patients (13 versus 0% and 31 versus 14%)., Conclusions: Obese patients suffer more significantly of unrelieved chronic pain, which lowers considerably their quality of life. Pain relief is more difficult to obtain, as it requires stronger pain medication and NSAIDs., (© 2014 John Wiley & Sons, Ltd.)

Patient-reported outcome measures are being developed for more relevant assessments of pain management. The patient acceptable symptom state (PASS) ("feeling well") and the minimal clinically important improvement (MCII) ("feeling better") have been determined in clinical trials, but not in daily pain management. We carried out a national multicenter cohort study of patients over the age of 50years with painful knee osteoarthritis (KOA) or hip osteoarthritis (HOA) who had visited their general practitioner and required treatment for more than 7days. Overall, 2414 patients (50.2% men, mean age 67.3years, body mass index 27.9kg/m(2), 33.5% with HOA) were enrolled by 1116 general practitioners. After 7days of treatment, PASS was estimated on a numerical rating scale as 4 at rest and 5 on movement, for both HOA and KOA, above the PASS threshold in clinical trials. In KOA, PASS was more frequently reached in men and younger people with less pain at rest and on movement, and in patients specifically seeking an improvement during sport activities. In HOA, PASS was most frequently reached in patients with low levels of pain at risk and in nonobese patients. MCII was -1 numerical rating scale point after 7days of usual treatment. This improvement is smaller than that recorded in randomized controlled trials, and was the same for both sites, both at rest and on movement. In conclusion, patient-reported outcome values in daily practice differ from those in clinical trials, and their determinant factors may depend on the site of osteoarthritis. Assessments of the treatment of painful osteoarthritis should be adapted to the characteristics and daily life of the patient, to personalize patient management., (Copyright © 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.)

Drug addicts often seek medical help for pain. Numerous fears and beliefs may hinder the recognition, evaluation, and management of pain in addicts. Nevertheless, the same fundamental principles apply to these patients as to other patients in terms of pain evaluation, analgesic selection, and dosage adjustment. Clarity of the medical prescription is crucial. Specific points that require attention in addicts include the effects of the abused drugs on the nociceptive system, the nature and amount of abused drugs, concomitant nondrug addictions, co-morbidities, and the nature of the pain symptoms. Also crucial is differentiating current abusers from former abusers and from abusers taking replacement therapy, as different management strategies are required in these three situations. Detailed information on the history of drug abuse is necessary to avoid unwanted events (e.g., overdosing or withdrawal syndrome) or an exacerbation of the addictive behaviors. In practice, hospital admission should be avoided to the extent possible. The use of strong opioids should be kept to a minimum (although this important rule may be difficult to follow, for instance in surgical emergencies). The best route of administration and galenic formulation vary with each individual situation but, in general, intravenous administration of strong opioids is highly undesirable. A treatment contract established with the patient is crucial and must indicate the nature of the drug or replacement agent used and the treatments given for pain control., (Copyright © 2012. Published by Elsevier SAS.)

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.)

Background: Despite the development of multimodal analgesia for postoperative pain management, opioids are still required for effective pain relief after knee arthroplasty. We aimed to identify the determinants of post-operative pain intensity and post-operative opioid requirement in this context.Methods: In this observational prospective study, we recorded patient characteristics, pre-operative pain intensity, anxiety and depression levels, sensitivity and pain thresholds in response to an electrical stimulus, and mu-opioid receptor (OPRM1) and catechol-O-methyltransferase (COMT) single-nucleotide polymorphisms. Multivariate linear regression models were used to identify predictors of post-operative pain at rest and opioid requirement.Results: We included 109 patients. Pre-operative pain at rest (p = 0.047), anxiety level (p = 0.001) and neuropathic pain symptoms (p = 0.030) were independently and positively associated with mean post-operative pain intensity adjusted for mean post-operative morphine equivalent dose (MED). Mean post-operative pain intensity at rest was lower (p = 0.006) in patients receiving celecoxib and pregabalin in the post-operative period, with all other variables constant. Mean post-operative MED over 5 days was low, but highly variable (78.2 ± 32.1 mg, from 9.9 to 170 mg). Following adjustment for mean post-operative pain intensity, it was independently negatively correlated with age (p = 0.004), and positively correlated with associated paracetamol treatment (p = 0.031). No genetic effect was detected in our sample.Conclusions: Our findings suggest that clinicians could use the pre-operative pain profile, in terms of anxiety levels, neuropathic pain symptoms, and chronic pre-operative pain intensity, to improve the efficacy of pain management after knee surgery. [ABSTRACT FROM AUTHOR]

An increasing number of obese patients are undergoing surgery, particularly bariatric and orthopaedic surgery. The physiological differences between obese and normal-weight subjects may modify not only anaesthetic requirements during surgery but also post-operative analgesic management, raising a number of challenges in a critical period. In this review, we analyse studies of post-operative pain management with opioids in obese subjects. We discuss the genetic factors common to pain and obesity and the factors potentially modifying opioid pharmacokinetics and pharmacodynamics in obese patients, and we analyse the overall efficacy and safety of opioids for pain management during the post-operative period in obese patients. Both modifications to surgical methods and additional analgesic treatments to decrease the requirement for opioids may improve early rehabilitation and quality of care and reduce adverse effects in obese patients. [ABSTRACT FROM AUTHOR]

Copyright of EMC-Rhumatologie--Orthopedie is the property of Elsevier B.V. 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.)