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Introduction. Dans plusieurs provinces et territoires du Canada, on remarque que, souvent, les personnes qui décèdent d'une intoxication aiguë liée à une substance souffraient aussi de douleur chronique. Cette étude traite de la prévalence de la douleur chronique et des caractéristiques des personnes qui en sont atteintes en utilisant les données d'une étude nationale sur les décès par intoxication aiguë accidentelle. Méthodologie. Nous avons réalisé une analyse transversale des décès par intoxication aiguë accidentelle liée à une substance qui ont eu lieu au Canada entre le 1er janvier 2016 et le 31 décembre 2017. Nous avons synthétisé, sous forme d'effectifs et de pourcentages, la prévalence de la douleur ainsi que des problèmes de santé liés à la douleur à partir de l'échantillon global. Nous avons effectué des comparaisons entre les personnes avec antécédents documentés de douleur chronique et les personnes sans antécédents documentés de douleur chronique, sur la base de différentes caractéristiques sociodémographiques, des antécédents médicaux, de facteurs contextuels et des substances consommées. Résultats. Au sein de l'échantillon global (N = 7 902), 1 056 (13 %) personnes avaient des antécédents documentés de douleur chronique et 6 366 (81 %) n'en avaient pas. En général, les personnes souffrant de douleur chronique étaient plus âgées (40 ans et plus), n'avaient pas d'emploi et étaient à la retraite ou recevaient des prestations d'invalidité au moment de leur décès. Des antécédents de problèmes de santé mentale, de traumatisme et de chirurgie ou de blessure étaient beaucoup plus fréquents chez les personnes atteintes de douleur chronique. Parmi les substances le plus couramment en cause dans les décès, les opioïdes habituellement prescrits pour soulager la douleur (hydromorphone et oxycodone) ont été détectés plus souvent dans les analyses toxicologiques des personnes avec douleur chronique que dans les analyses des personnes sans douleur chronique. Conclusion. Les résultats font ressortir le rôle transversal que jouent la présence concomitante de problèmes de santé et la douleur non traitée, cette dernière risquant d'accroître le risque de décès par intoxication aiguë. Continuer à prioriser la réduction des méfaits et mettre à contribution régulière des patients pour l'évaluation des besoins courants font partie des pistes d'intervention. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Occupational Therapy is the property of Sage Publications Inc. 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.)

These proposed recommendations have been issued as part of an innovative approach based on an individualised, structured and coordinated patient pathway to engage patients in specific implanted neurostimulation (NSI) management for pain relief in the context of certain chronic pain conditions. This pathway necessarily involves chronic pain structures (SDC) and implantation centres (CI). This work takes the form of recommendations at several levels. We will distinguish between what is required, what is expected and what is desired in terms of good practice, depending on local and regional resources, in order to ensure optimal quality of care. [ABSTRACT FROM AUTHOR]

The article presents the discussion on Invalidation, as a mechanism, involves questioning lived experiences, and literature identifies five distinct forms. Topics include phenomenon is commonly experienced by individuals with chronic pain, particularly in the absence of a clearly identifiable cause, and can intensify the overall painful experience; and pain will only manifest if the threatening nature of the situation is confirmed through a mental equation that integrates personal history.

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Copyright of Management international / International Management / Gestiòn Internacional is the property of Management International 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.)

Chronic pelvic pain is difficult to manage. It calls for careful semiological analysis and a pragmatic therapeutic approach. This is often simple to apply in practice. [ABSTRACT FROM AUTHOR]

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A case of anteromedial leg pain diagnosed and treated for 10 years as "shin splints" (medial tibial stress syndrome) is described. A history and examination was performed focused on anatomy, biomechanics, and peripheral nerves. Detailed sensory testing was performed in the painful area, and imaging was obtained to confirm the diagnosis. The clinical investigation was consistent with dynamic stenosis of the left L4-5 intervertebral foramen, causing a mixed partial mononeuropathy of the L4 spinal nerve that presented as pain and hypersensitivity in the anteromedial shin. Manual therapy maneuvers intended to open the intervertebral foramen led to resolution of the pain and sensory deficits. After three additional treatments performed within a month, resolution was maintained for >3 years. This case highlights how concepts from preclinical studies, coupled with basic anatomical, neurological, and biomechanical investigations, can be critical for accurate diagnosis and treatment for a case previously considered unresponsive to care. [ABSTRACT FROM AUTHOR]

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The chronicity of pain is rooted in a singular life history, and it has been established that various mechanisms can sustain this painful process. The richness of this case study lies in the co-construction of a timeline of a life course which reveals the breeding ground for chronic pain. This work carried out here allows the identification of chronicization factors by the subject and leads to a certain psychic movement. This study opens a reflection around the notion of counter-transference from the body's point of view. [ABSTRACT FROM AUTHOR]

Dans les rhumatismes inflammatoires, des douleurs chroniques peuvent persister malgré un traitement adapté selon les recommandations actuelles. La première étape repose sur l'optimisation du contrôle de l'activité de la maladie et de l'inflammation à bas bruit. Cependant, il peut exister des douleurs nociplastiques liées à un dysfonctionnement de la nociception. Les recommandations pour la prise en charge de la fibromyalgie, qui est un modèle de douleur nociplastique, insistent en première intention sur les techniques non médicamenteuses. Plusieurs revues de la littérature sur l'évaluation de certains traitements non médicamenteux comme les thérapies cognitives et comportementales, le Yoga, les interventions de Mindfulness, le Taichi, l'acupuncture, la neurostimulation transcutanée, essentiellement dans la polyarthrite rhumatoïde? montrent des résultats intéressants. Malgré un niveau de preuve souvent faible, ces interventions non pharmacologiques sont reprises dans les recommandations EULAR sur la prise en charge de la douleur dans les RIC et plus récemment sur la prise en charge des polyarthrites rhumatoïdes difficiles à traiter. Pain in inflammatory rheumatic diseases (IRD) may persist even though they have been treated according to the current recommendations. The initial crucial step in managing IRD pain is controlling disease activity and low inflammation. However, there is nociplastic pain that arises from altered nociception. The main treatments proposed for fibromyalgia, which is the nociplastic pain model, are non-pharmacological interventions. Several literature reviews on the evaluation of non-drug treatments such as cognitive behavioral therapy, yoga, mindfulness interventions, Taichi, acupuncture, transcutaneous nerve stimulation, mainly in rheumatoid arthritis, show interesting results. Despite an often low level of evidence, non-pharmagological interventions are in the EULAR recommendations for the management of pain in rheumatic diseases et recently for management of difficult-to-treat rheumatoid arthritis. [ABSTRACT FROM AUTHOR]

The present study aims to determine the effect of self-efficacy on the way of enduring adopted by a patient suffering from chronic pain. The goal is to understand the predictive cognitive mediation that takes place in this context. On one hand, it allows the patient to controlhis illness, and on the hand, to manage his physical and psychological suffering. The ultimate goal is to better understand the factors that make it possible to achieve a multifactorial symbiosis to improve the patient's experience of chronic illness and the suffering that results from it. [ABSTRACT FROM AUTHOR]

La thérapie de désensibilisation et de retraitement par les mouvements oculaires (EMDR) est considérée comme un traitement fondé sur des données probantes pour le traitement du trouble stress post-traumatique (TSPT) chez l'adulte, mais il y a des différences dans la façon dont les diverses directives internationales de traitement jugent la solidité de cette base de preuves. En outre, dans des domaines autres que le TSPT de l'adulte, les principales lignes directrices diffèrent encore davantage quant à la solidité de ces preuves et quant au moment où on utilisera l'EMDR. En 2019 a été lancée la Commission de chercheurs sur l'avenir de la thérapie EMDR (Council of Scholars : The Future of EMDR Therapy Project). Plusieurs groupes de travail ont été créés dans cette commission, l'un d'entre eux étant centré sur la recherche. Le présent article a été produit par ce groupe de travail. Le groupe a tout d'abord conclu qu'il y avait cinq domaines pour lesquels il existait une certaine base factuelle indiquant que l'EMDR était efficace, mais que davantage de données étaient nécessaires pour augmenter la probabilité qu'elle soit prise en compte dans les futures directives internationales de traitement. Ces domaines couvraient le TSPT chez les enfants et les adolescents, les interventions EMDR précoces, les TSPT liés aux conflits armés, la dépression unipolaire et la douleur chronique. Les recherches portant sur le rapport coût-efficacité de la thérapie EMDR ont été en outre identifiées comme l'une des priorités à aborder. Nous avons employé un système de hiérarchisation pour classer et évaluer les preuves dans les différents domaines abordés. Après avoir évalué les 120 études de résultats relatives à ces domaines, nous concluons ici que pour deux d'entre eux (le TSPT chez l'enfant et l'adolescent, et les recherches portant sur les interventions EMDR précoces), la force des preuves est évaluée au niveau le plus élevé, tandis que les autres domaines obtiennent le deuxième niveau le plus élevé. Nous formulons également quelques recommandations générales pour améliorer la qualité des futures recherches sur l'efficacité de la thérapie EMDR. [ABSTRACT FROM AUTHOR]

Shame can be an emotion made of an impression of inferiority, of unworthiness, of lowering oneself in the opinion of others. It is then likely to be associated with a feeling of dishonor, humiliation, embarrassment felt by scruples of conscience, and fear of ridicule. This notion is not unlike that of guilt. If guilt and shame both concern a perceived or real moral transgression (regardless of any intention), guilt is externalized and focused on behavior, whereas shame concerns the internalization of this transgression. In chronic pain, shame and guilt can manifest themselves at the level of the disease, the person affected, and the loss of belonging to the social group, through the questioning of the person suffering from chronic pain, who is often challenged in his or her status and role(s). If ignored or not welcomed, these emotions can have a detrimental effect on the psychotherapeutic work. Shame should be welcomed and validated before going into a decentration process, among other things, by carrying out activities that are chosen for their potential to be a source of pleasure. It is then possible to "soothe" shame by abandoning a task that is too burdensome or by reorganizing its steps. The psychotherapeutic process tries to make it possible to accept a shorter, lighter activity aiming at behavioral (re)activation, and thus to decrease the feelings of failure and helplessness and to move out of the confinement of the complaint. This is the objective of cognitive-behavioral psychotherapeutic group work with patients suffering from chronic pain. [ABSTRACT FROM AUTHOR]

Context: Chronic Pain Structures (CPSs) provide care for patients with the most complex and refractory chronic pain in France. In 2018, 245 CPSs were accredited by the Regional Health Agencies (ARS). Despite this significant territorial coverage, the CPSs are now under threat. Objective: The aim of this study is to obtain a snapshot of the care offered by the CPSs, by specifying both the characteristics of the CPSs and the demographics of the professionals practicing there. Methodology: The survey was conducted under the aegis of the SFETD (Société française d'étude et de traitement de la douleur) among all the CPSs accredited by the ARS. CPS managers were asked to complete an online questionnaire on the characteristics of the CPS and the demographics of the medical and nonmedical staff. Results: Of the 245 CPSs, 223 (91%) responded. Although the territorial coverage of the CPSs is respected, with a median of 0.59 pain doctors per 100,000 inhabitants in France, there is great heterogeneity in the distribution of full-time equivalents (FTEs) from one region to another, with a variation of a factor of 2.8 for doctors and a factor of 5 for psychologists and nurses. The least endowed regions are the Centre-Val de Loire region and the Grand Est region. Fifty-four percent of CPSs offer consultations for both cancer pain and chronic non-cancer pain. Only 6% of CPSs are dedicated to children's pain. The median waiting time is three months, with extremes of up to a year. A total of 835 physicians, representing 388 FTEs, work in the CPSs. Only 58% of the physicians are tenured; 18% work full-time and 43% work less than 0.2 FTE. The retirement of 177 physicians is expected within five years, representing 91 FTEs, or 24% of total medical FTEs. Conclusion: The sustainability of CPS in France is threatened in the next five years. It is urgent to act. Concrete measures are proposed by the SFETD to anticipate the announced disaster. [ABSTRACT FROM AUTHOR]

Chronic calcifying pancreatitis is a chronic inflammatory disease of the pancreas which leads to the development of parenchymal and ductal fibrosis. The main cause is chronic alcoholism. From its lesions arise symptoms, acute and chronic complications which will tag the evolution of this disease which takes place over 15 to 20 years. In addition to the clinical and paraclinical check-ups necessary for acute complications, the GI specialist must ensure the long-term follow-up. It will rely on several practitioners from different specialties reflecting the multidisciplinary nature of this disease. At the clinical level, a six-monthly consultation will address the problem of chronic pain (type, evolution, treatment, opiate medications, dependence), nutritional status, alcohol and tobacco consumption, signs of pancreatic exocrine insufficiency (weight, diarrhea) and diabetes, as well as complications related to chronic alcohol and tobacco consumptions. Biologically, exocrine insufficiency is detected by measuring fecal elastase (annually), and diabetes by measuring glycated hemoglobin every six months. It is also necessary to monitor the serum albumin level, the hydroelectrolytic, renal and hepatic parameters and the vitamin D level. Imaging (cholangiopancreatography MRI and/or CT scan) is necessary in case of complications or new symptoms and systematically over the long term to detect the occurrence of pancreatic adenocarcinoma, particularly in cases of hereditary chronic pancreatitis (imaging every year or two depending on the cause of the pancreatitis). If there is any doubt, an endoscopic ultrasound with biopsy will complete this assessment. It will therefore be necessary to adapt the treatment with analgesics, pancreatic extracts, oral antidiabetics or insulin, or even to discuss in certain cases a therapeutic endoscopy in an expert center. The multidisciplinary approach will involve the general practitioner, diabetologist, psychiatrist, addictologist, algologist, biliary and pancreatic endoscopist and sometimes even the pancreas surgeon. [ABSTRACT FROM AUTHOR]

Copyright of Nouveau Praticien Vétérinaire Canine & Féline is the property of EDP Sciences 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.)

Public health research involves an interdisciplinary approach to developing strategies that promote health, prevent disease, prolong life, and improve its quality. The APEMAC public health laboratory (Adaptation, Measurement, and Evaluation in Health. Interdisciplinary Approaches--UR 4360) proposes an interdisciplinary project based on four cross-cutting themes (concepts and methods for perceived health measurements and for the development of complex health interventions, lifestyle and social inequalities in health, chronic diseases, and understanding prevention behaviors and care strategies), which have been developed and are studied jointly by the two research groups: the MICS group "Measurement and Complex Interventions in Health" and the EPSAM group "Adaptation, Health Behaviours and Psychological Care. With over 12 million people suffering from chronic pain in France, in addition to their family and friends, public health awareness is necessary for the prevention, management, and control of the disease. Therefore, the laboratory has chosen to develop two research axes, which are addressed in this article: the influence of adverse childhood experiences (ACEs) on pain and, in particular, the concept of resilience in the face of pain, as well as the relationship between traumatization and the chronicity of pain. These two areas hold great promise for the development of models for managing the complexities of pain. [ABSTRACT FROM AUTHOR]

Binge eating disorder (BED) is the most common eating disorder. It is characterized by an uncontrolled intake of high-calorie foods, such as fat and/or sugar. Clinical and preclinical research on this disorder show the development of an inflammatory response induced by diets high in fat and/or sugar. This inflammatory response spreads to the central nervous system, in particular to brain structures involved in reward and food intake circuits, via the gut--brain axis. Neuroinflammatory mechanisms are associated with a modulation of the endocannabinoid system, among others. The latter is also involved in the regulation of food intake, reward, and pain control. The comorbidities associated with BED not only favor obesity but also include mood disorders like anxiety or depression. Binge eating could also be a major risk factor for the development of chronic pain, underpinned by neuroinflammatory mechanisms. Future research in this field will allow the development of treatment strategies for this pathology, taking into account these comorbidities. [ABSTRACT FROM AUTHOR]

Chronic pain is defined as a pain lasting for more than 3 months and affects between 20% and 45% of the population worldwide. To date, medication remains poorly effective. Some antidepressants, but also antiepileptic drugs, are recommended as first-line treatment. In the absence of analgesic effect, opiate-based treatments are then considered. Opiates act on mu (μ) opioid receptors, which are responsible for both analgesic and unwanted side effects. In this context, there is a great need for new effective opioid analgesics devoid of side effects. Interestingly, the delta (δ) opioid receptor is widely distributed in the pain circuit, but δ agonists have low analgesic potency in humans. However, δ receptors can associate with others to form a new entity called heteromer whose functional properties have attracted attention. Here, we will evaluate their role in the context of acute and chronic pain. [ABSTRACT FROM AUTHOR]

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Background: Non-pharmacologic treatment, including chiropractic care, is now recommended instead of opioid prescriptions as the initial management of chronic spine pain by clinical practice guidelines. Chiropractic care, commonly including spinal manipulation, has been temporally associated with reduced opioid prescription in veterans with spine pain. Purpose: To determine if chiropractic management including spinal manipulation was associated with decreased pain or opioid usage in financially disadvantaged individuals utilizing opioid medications and diagnosed with musculoskeletal conditions. Methods: A retrospective analysis of quality assurance data from a publicly funded healthcare facility was conducted. Measures included numeric pain scores of spine and extremity regions across three time points, opioid utilization, demographics, and care modalities. Results: Pain and opioid use significantly decreased concomitant with a course of chiropractic care. Conclusions: A publicly funded course of chiropractic care temporally coincided with statistically and clinically significant decreases in pain and opioid usage in a financially disadvantaged inner-city population. [ABSTRACT FROM AUTHOR]

Copyright of Physiotherapy Canada is the property of University of Toronto Press 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.)

Pain, a sign of warning and danger, is difficult to conciliate with sleep onset. Phasic pain only disrupts sleep in 30% of cases in a transitory way, without leaving any memory on morning awaking. The factors that favour the interruption of sleep seem to involve the transient reappearance of an effective cerebral connectivity and a high-level cerebral processing. In chronic pain, top-down mechanisms allow 25% of patients to sleep properly, while vulnerability factors prevent these mechanisms in the others. [ABSTRACT FROM AUTHOR]

Neuropathic pain is frequent in the general population, with 7% to 10% of adults presenting with chronic neuropathic pain. To date, the gold standard to evaluate treatments is based on randomized controlled trials. Nonetheless, such design is running on a limited sample and for a limited period. Moreover, many treatments will never be compared directly in sufficiently large and representative populations. A way to overcome several of these limitations is to use real-world data. Indeed, the International Association for the Study of Pain (IASP) includes a special interest group focusing on pain registries and promoting the use of such approaches. In this short narrative review, several of the main chronic pain registries are presented. The strengths and weaknesses of this approach are presented. Indication bias is frequent in observational studies because the choice of treatment is generally influenced by the patients' characteristics. However, a propensity score can be computed to adjust for these differences. The use of propensity score is briefly explained. Some data specific to neuropathic pain are discussed. [ABSTRACT FROM AUTHOR]

The last two decades have seen a definitive revolution in the pathophysiological conception of fibromyalgia. This frequent pathology is today a centerpiece among the Central Sensitization Syndromes. In addition, a number of abnormal characteristics of the patients' sleep were specified: excessive sleep fragmentation, circadian disorders, reduction of spindles, and increased alpha waves on the sleep electroencephalogram; increased periodic limb movements on sleep electromyography. Specific sleep pathologies such as restless legs syndrome and obstructive sleep apnea syndrome are observed more frequently in fibromyalgia than in the general population. These elements, as well as the particular bidirectional relationship between pain and sleep, can and should guide and improve the treatment of fibromyalgia. [ABSTRACT FROM AUTHOR]

La pratique clinique auprès de patients douloureux chroniques, ébranlée par la réorganisation du champ sanitaire, a nécessité de repenser la prise en charge psychologique de la douleur. Afin de poursuivre l'accompagnement psychologique des patients, des consultations individuelles ou des ateliers de groupes à distance se sont développés. Un groupe d'échange de pratiques rassemblant des psychologues et psychothérapeutes a partagé ses expériences cliniques et son vécu de la crise. Les objectifs de cette étude sont d'explorer l'adaptation des pratiques cliniques pour les sujets douloureux chroniques, le vécu des professionnels, et de proposer des recommandations issues des réflexions collectives. La méthodologie de recherche clinique a suivi celle d'un focus group. Trois réunions en visioconférence de deux heures ont eu lieu de septembre 2020 à mai 2021. Une analyse thématique des retranscriptions a été réalisée avec le logiciel d'analyse qualitative NVivo. Au total, 9 psychologues et psychothérapeutes ont participé au focus group. L'analyse thématique a révélé trois grands thèmes, à savoir : (1) impact de la crise sanitaire liée à la COVID-19 ; (2) adaptation des pratiques ; (3) processus de changement des pratiques cliniques. Les professionnels rapportent que l'usage des outils numériques a permis de limiter l'impact psychologique de la crise sanitaire sur les patients et de maintenir le lien. Des recommandations issues des réflexions collectives suggèrent de maintenir les soins en distanciel et de s'appuyer sur le soutien des équipes, de la hiérarchie, et des groupes d'échanges entre pairs. Clinical practice with chronic pain patients, shaken by the reorganization of the health care field, has required a rethinking of pain management. In order to continue the psychological support of patients, individual consultations or distance group workshops have been developed. A practice analysis group bringing together psychologists and psychotherapists shared their clinical experiences and experiences of the crisis. The objectives of this study are to explore the adaptation of clinical practices for chronic pain subjects; the experience of professionals; and to propose recommendations resulting from the collective reflections. The clinical research methodology was that of a focus group. Three two-hour videoconference meetings were held from September 2020 to May 2021. A thematic analysis of the transcripts was carried out with the NVivo qualitative analysis software. In all, 9 psychologists and psychotherapists participated in the focus group. The thematic analysis revealed three main themes, namely: (1) impact of the health crisis related to COVID-19; (2) adaptation of practices; (3) process of changing clinical practices. Professionals report that the use of digital tools has limited the psychopathological impact of the health crisis on patients. The recommendations resulting from the collective reflections suggest maintaining remote care and relying on the support of the teams, the hierarchy, and peer exchange groups. [ABSTRACT FROM AUTHOR]

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Post-traumatic stress disorder (PTSD) is a psychiatric disorder that occurs after exposure to a traumatic event. Chronic pain is one of the most frequent comorbidities for patients with PTSD and higher levels of the proinflammatory cytokine tumor necrosis factor a (TNF-a) have been detected in these patients. In a recent study, Dib et al (2021) used the single prolonged stress (SPS) animal model of PTSD and blocked TNF-a with either thalidomide or anti-TNF-a antibody. This way, the authors prevented mechanical allodynia and thermal hyperalgesia in SPS-rats. [ABSTRACT FROM AUTHOR]

Les antidépresseurs ont été initialement conçus et commercialisés pour traiter la dépression et les troubles anxieux, mais ils constituent également une option hors AMM qui devrait être envisagée par les cliniciens dans des spécialités autres que la psychiatrie, en particulier pour le traitement de la douleur chronique. Les premiers antidépresseurs à avoir été utilisés dans cette indication sont les antidépresseurs tricycliques. Ils restent des produits de référence, même si des antidépresseurs plus récents, tels que les inhibiteurs de la recapture de la sérotonine et de la noradrénaline, la venlafaxine, le milnacipran et la duloxétine, ou d'autres antidépresseurs atypiques comme le bupropion, sont de plus en plus utilisés, en partie en raison de leur meilleure tolérance. Les inhibiteurs sélectifs de la recapture de la sérotonine par contre, semblent dépourvus d'effets antalgiques. L'utilisation d'antidépresseurs offre une option thérapeutique alternative et d'appoint pour les patients souffrant de douleurs chroniques de diverses modalités. D'autres études sont nécessaires pour établir de meilleurs profils de sécurité et l'efficacité de l'utilisation d'antidépresseurs dans la douleur chronique. Antidepressants were originally designed and marketed to treat depression and anxiety disorders, but they are also an off-label option that should be considered by clinicians in specialties other than psychiatry, particularly for the treatment of chronic pain. Chronic pain is considered one of the most costly and disabling medical conditions. There are many different treatment options available for patients that suffer from chronic pain, ranging from pharmacological therapy to surgical interventions. Antidepressants are used to treat a variety of chronic pain conditions including peripheral neuropathy, headache, and more recently, fibromyalgia. In this regard, recent studies have proven their effectiveness, and given further understanding of their mechanisms, drug-drug interactions, and adverse effects. The first antidepressants to have been used in this indication are the tricyclic antidepressants. They remain benchmark products, even though newer antidepressants, such as serotonin and norepinephrine reuptake inhibitors, venlafaxine, milnacipran and duloxetine, or other atypical antidepressants, such as bupropion, are increasingly used, in part because of their better tolerability. Selective serotonin reuptake inhibitors, on the other hand, appear to have no analgesic effects. Prescription of antidepressants offers an alternative and adjunct therapeutic option for patients with chronic pain of various modalities. It is also hoped that treating chronic pain with antidepressants could lead to a decrease in the use of opioid analgesics and also improve many of the concurrent psychiatric conditions associated with chronic pain. Further evidence-based research is still needed to establish better safety profiles and efficacy of antidepressant use in patients with chronic pain. [ABSTRACT FROM AUTHOR]

Introduction: An innovative therapeutic education tool, Kit-KAD® was created to support the development of sessions in a chronic pain TPE program. Objectives: The objective of this study is evaluating the relevance and appropriation of this educational tool by the health care teams. Methodology: A questionnaire was designed to collect feedback from health care teams who had implemented and/or modified the sessions proposed in Kit-KAD®. The analysis of data and verbatims allowed the main results to be extracted and made sense of them. Results: From the teams' responses Kit-KAD® is a clear, relevant and easily used tool for healthcare workers trained in TPE and chronic pain monitoring. Discussion: Appropriation of the content by teams allows them to adapt the sessions of the initial guide to the care context and to modify certain elements. Conclusion: A relevant, adapted, co-constructed, tested and evaluated tool, Kit-KAD® is a transversal therapeutic education device focused on pain, targeting the public for which it was developed. [ABSTRACT FROM AUTHOR]

Copyright of Therapeutic Patient Education / Éducation Thérapeutique du Patient is the property of EDP Sciences 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.)

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Copyright of Physiotherapy Canada is the property of University of Toronto Press 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.)

Repetitive transcranial magnetic stimulation (rTMS) is a non-pharmacological therapeutic option in chronic pain management treatment. Tangible evidence of rTMS interest in fibromyalgia (FM) management led to a grade B recommendation. However, there are no predictive factors of response to rTMS in FM. This study has two objectives: first, to carry out a retrospective analysis of the interest of rTMS on the primary motor cortex (M1) in patients with FM treated in routine care at the CHU de Montpellier; and second, to seek potential predictive factors of rTMS response. Thirty-one patients benefited from a complete rTMS acute phase, there is a significant analgesic benefit for 19 patients (61.3%), and out of fourteen patients who benefited from a complete rTMS maintenance phase, this benefit is sustained for ten patients (71.4%). Pain intensity decreases on average by 2.18 points (-32%) at the end of the acute phase and by 2.54 points (-42%) at the end of the maintenance phase. The pain severity of the BPI decreases by 1.7 points (-27%) at the end of the acute phase. The quality of life appears to be improved at the end of the acute phase with a drop in the scores of the FIQ and the interference of pain with the BPI, respectively, by 15.5 points (-21%) and 1.9 points (-30%). These results seem to be maintained with time. Regarding the potential predictive factors of the response to rTMS, it seems that maintaining a professional activity is associated with a better response. Opioid use and males are associated with less benefit. rTMS in FM care has positive results on pain and quality of life with few side effects. This study confirms the interest of rTMS in FM routine care. There's a need to define the type of patients who can be rTMS responders and the place of rTMS in the therapeutic sequence as a challenge of improving FM management. [ABSTRACT FROM AUTHOR]

• La sensibilisation centrale repose sur une interaction bidirectionnelle entre le système nerveux et le système immunitaire représenté par la microglie. • L'activation de la microglie ou microgliose et celle des astrocytes entraînent une hypersensibilité et une plasticité neuronale dans le système nerveux central. • Les facteurs de croissance (BDNF), les cytokines (IL-1, TNF, IL-6) et chémokines jouent un rôle majeur dans le développement de cette neuroinflammation. • La microgliose peut s'étendre dans certaines structures supraspinales intervenant dans la modulation et les aspects émotionnels et cognitifs de la douleur. La douleur chronique, en rhumatologie, s'installe le plus souvent au décours d'une lésion de l'appareil musculo-squelettique. Sa persistance n'est pas toujours liée à l'évolutivité de la lésion initiale, mais dans certains cas elle repose sur l'apparition d'une sensibilisation centrale. De nombreuses données scientifiques laissent penser que cette sensibilisation centrale est la conséquence des interactions multiples et complexes entre système nerveux et système immunitaire. Les fibres nerveuses afférentes spécialisées dans la douleur sont le siège d'une sensibilisation périphérique en partie liée aux molécules de l'inflammation. Ces fibres afférentes libèrent des neurotransmetteurs au niveau du ganglion de la racine dorsale et de la corne postérieure de la moelle, capables d'activer les cellules immunitaires locales, la microglie. La microglie à l'état d'activation va produire des cytokines pro-inflammatoires, des chémokines, des neuropeptides capables d'interagir avec le neurone secondaire, mais aussi les neurones inhibiteurs segmentaires et descendants. On parle de neuroinflammation, phénomène qui va amplifier l'hypersensibilité du neurone secondaire, autrement dénommée sensibilisation centrale. Cette neuroinflammation va pouvoir gagner les structures cérébrales supérieures, impliquées notamment dans la modulation de la douleur et dans ses aspects émotionnels et cognitifs. Cette mise au point a pour objectif d'aborder la physiopathologie de la douleur chronique en y intégrant les données scientifiques les plus récentes sur la neuroplasticité et la neuroinflammation. [ABSTRACT FROM AUTHOR]

Since 2014, telemedicine and more broadly, digital health technologies (electronic medical record or EMR, Connected Paths, etc.) have benefited from substantial progress in France with the establishment of standards that define and promote its use in routine care (tele-expertise, teleconsultation, tele-care), supported by a government strategy to transform the health organization and the deployment of digital in health. The current pandemic has been an astonishing acceleration factor in the use of the latter in the field of routine care in order to limit disruptions in access to care and patient follow-up. In this update, we wish to carry out a summary review of the main works published in the literature in recent years (strongly driven by the pandemic) with regard to the management of chronic pain, but above all, to put into perspective that technology with these limits should not be the end but the tool at the service of a more fluid organization and better sharing of patient journeys by experimenting with new uses in a redesigned city-hospital cooperation. [ABSTRACT FROM AUTHOR]

This state of the art synthesizes studies to assess the use and impact of e-health in patients with chronic pain. We evaluated text-message, electronic diaries, and mobile applications. Finally, the limitations and future challenges of integrating e-health in chronic pain management are discussed. In conclusion, the integration of e-health is promising for patient management, but there is a need for rigorous studies to validate the real benefit. [ABSTRACT FROM AUTHOR]

Every year, pain affects more and more patients, impacting their personal and professional lives. The treatment of pain remains complex, and the use of traditional pharmacology is not without risks of overdoses and addiction. For more than 20 years, the health sector and the European Union have been working together to develop what is now known as digital therapy (DTx). A real challenge for our current healthcare system, these innovative therapies can be used alone (stand-alone) or combined with a drug, a medical device or a therapy in order to maximize the effects of medical care. This article proposes a non-exhaustive review of the use of virtual reality, its origin and its functioning. Significant results have been obtained on its analgesic and short-term distraction action on various physiological events such as burns, cardiac surgery, stress, musculoskeletal and neuropathic pain. However, this field of study remains vast and requires further studies on chronic and acute pain and the interaction between an individual and a machine. [ABSTRACT FROM AUTHOR]

Opioids such as morphine are frequently used for chronic pain management despite their many adverse effects. Ongoing research aims at either finding new treatments to replace opioids or reducing its heavy adverse effects due to long-term use: opioid-induced hyperalgesia and antinociceptive tolerance. In a recent study, Doyle et al. (2020) demonstrate that the activation of sphingosine-1-phosphate receptor subtype 1 (S1PR1) in the central nervous system contributes to morphine-induced hyperalgesia and antinociceptive tolerance in a rodent model of chronic pain. By targeting S1PR1 with molecules with functional antagonistic properties (some of which are FDA-approved for multiple sclerosis treatment), hyperalgesia and tolerance were significantly reduced without modifying morphine pharmacokinetics or efficacy. [ABSTRACT FROM AUTHOR]

As part of specific consultations for patients suffering from "chronic pain", we are regularly called upon to meet children (generally from the age of 7) and adolescents, most often referred by pediatric orthopedic surgeons for the management of algoneurodystrophies (or Complex Regional Pain Syndrome 1) resistant to conventional analgesic treatments. We describe our experience with these patients with the need to pay as much attention to the veracity of their painful experience as to their life story, their personality and the relationships with those around them. The success of meeting these patients, their acceptance of our help depends on the quality of our listening and the multidisciplinary nature of the care: that of the doctor and the psychologist in consultation, that of other professionals and relay teams. [ABSTRACT FROM AUTHOR]

Context: Treating chronic functional musculoskeletal pain in adolescents is often deemed difficult by patients, families and even medical professionals themselves. Objectives: Exploring the experience of health professionals in diagnosis and treatment of chronic idiopathic musculoskeletal pain unexplained in adolescents and young adults (11-19 years old). Method: A qualitative observational study was conducted in three university reference centers in rheumatology of adolescents and young adults with a phenomenological approach. Participants: 25 medical (rheumatologists, pediatricians, pain doctors, psychiatrists, orthopedic surgeons), and paramedical (physical therapist, chiropractor, ergotherapist psychologist) professionals were interviewed in semi directive interviews. Results: chronic functional musculoskeletal pain is not a nosological entity which makes it difficult to affirm. Mutual suspicion among practitioners, patients and families is a limit to constructing a good quality therapeutical alliance, as is the need to build a multidisciplinary approach. Its treatments requires ressources and skills which are difficult to access. Conclusion: The holist approach seems the most constructive to treat chronic idiopathic musculoskeletal pain in adolescents. Research in physiopathology of central sensitization is promising and could be applied to chronic functional musculoskeletal pain in adolescents. [ABSTRACT FROM AUTHOR]

This article aims to describe, on a historical basis, the evolution of the concept of "health care pathway" for chronic patients in France, and to explore new possible horizons in the context of the recent public policies. [ABSTRACT FROM AUTHOR]

This article focuses on the relationship between sickle cell disease, a chronic genetic condition characterised by severe pain, and chronic pain, which is defined as ongoing or recurrent pain, in adolescent patients. We shall consider our two different clinical backgrounds – one in an adolescent treatment unit in a hospital setting and the other in a unit dealing with both physical and psychiatric treatment within a healthcare and education programme – in order to examine how these subjects experience pain and the way in which this interferes with the subjectivation process specific to this age. [ABSTRACT FROM AUTHOR]

Chronic pain in children is a complex sensory and emotional experience intertwined with individual and family elements, life events, frequently entailing the encounter between a somatic event and a life story. The official recommendations take this into account, advocating the biopsychosocial model for pain consultations. But how to put this into practice? How should the consultation be organised and conducted and how should emotional elements be addressed while also taking into account the clinical and more somatic elements of the case? How can an individual care plan be offered? This article describes the experience of the setting up of a centre for the treatment of chronic pain in children within a children's hospital, the art of medical practice and the way in which the views of the medical and the psychological team may be combined within a complex situation. It presents a model of teamwork, of frequent consultations with the doctor and the psychologist, in this way linking fields between which a distinction is often drawn in current medicine, but which must be brought together in order to address the issue of chronic pain. It discusses possible care plans and the links with the professional and personal environment of the child in pain. [ABSTRACT FROM AUTHOR]

Persistent or recurrent pain has an impact on all areas of a child's or adolescent's life, affecting the child's ability to function both physically and in his or her relationship with others, whether this be within the family or in a social setting. It is often associated with sleep disorders, anxiety and depression or with generated or related psychopathological signs which may reinforce the pain experience. In these situations, but also in those cases where the pain does not respond to the usual treatments, the vicious circle of chronic pain is reinforced. Thus an overall assessment of the situation, according to the biopsychosocial model, is essential in order to offer a personalised and appropriate therapeutic programme. When the impact of this persistent, recurrent or treatment-resistant pain is too great the child must be referred to a Chronic Pain Unit in order to be treated by a multi professional and multidisciplinary team that will liaise with local health professionals (the family doctor or paediatrician, psychologist, physiotherapist, school health service, etc.). After a review of the main features in the literature dealing with chronic pain in children, we will look at how the treatment of chronic pain in children in France has developed since the 1990s and how it is currently managed. [ABSTRACT FROM AUTHOR]