living with chronic pain

2023-04-03 15:56:04

The suffering never left her. Hit by a car in September 2020, Cyrielle Dubois underwent operations to repair the fracture in her spine. «The pain, present day and night, has a considerable impact on my daily life, my sleep, my concentration and my movements”explains this 29-year-old architect, on sick leave since the accident.

“The contact with water in the shower is extremely painful for me. I had to cut my hair, the friction on my skin was unbearable, as were certain textures of clothing. The pains take the form of hypersensitivity, tingling, electric shock sensations and lacerations”details the young woman, author of Living with chronic pain. An invisible roommate (Mango), valuable guide for those concerned (1).

An invisible evil

According to the French Society for the Study and Treatment of Pain (SFETD), nearly 12 million French people, or 20% of the population, are affected by chronic pain, permanent or recurrent, of moderate to severe intensity. “The pain becomes chronic when it has lasted for at least three months andimpacts the quality of life with consequences on social, professional or school activitiesexplains Professor Éric Serra, Vice-President of the SFETD. The longer the pain lasts, the greater the risk that the systems that control it will fail, exacerbating it. »

Unlike acute pain which serves as a warning signal, chronic pain serves no purpose. While the media have made the suffering that accompanies fibromyalgia and endometriosis more visible, 40% of patients in pain consultations suffer from the spine (lumbago, sciatica, etc.) and 10 to 20% from headaches or migraines. “Iatrogenic pain follows, that is to say pain created by medicine, surgery in particular, complete Eric Serra. 10 to 15% of patients continue to suffer three months after the procedure. »

Acute low back pain concerns more disadvantaged social categories, says Nicolas Naïditch, sociologist of pain: “The most affected patients generally have a difficult professional activity. Patients with a low health gradient in postoperative pain are also overrepresented, in particular due to a lack of cultural capital to judge the benefit-risk ratio. »

Centers for the study and treatment of pain (CETD), as here in Nantes, allow coordination between caregivers for better pain management. / AMELIE-BENOIST/BSIP via AFP

If the feeling varies from one patient to another, all have in common to suffer from an invisible evil which it is not well perceived to talk about. “For lack of information, they often let her settle in, which makes her more resistant to treatmentobserves Nathalie Deparis, president of the French-speaking Association to overcome pain (AFVD). The complaint annoys and alienates the entourage. It is not rare that after having prescribed several drugs that have remained ineffective, a doctor concludes that “it’s in the head”. A psychological follow-up then makes it possible to have a neutral place where to express one’s pain, one’s anger and one’s suffering. »

Relief with or without medication

According to Nicolas Naïditch, gender also comes into play: “The pain of women is much less heard than that of men who are under-screened and under-treated for their psychological suffering. » To evoke her pain, Cyrielle Dubois used the classic scale of 1 to 10, but also her own more explicit drawings, shared on her Instagram account and in her book, and now taken up by her readers in order to be better understood. .

“The evaluation of chronic pain also involves that of its impact on activities”, emphasizes Eric Serra. Drug treatment begins with paracetamol and, if necessary, tramadol, an opiate. “Morphine, which symbolizes these pain treatments, is only effective in certain cases (following a surgical operation, infectious diseases, neuropathic lesions, etc.)”specifies the vice-president of the SFETD, who also points out the analgesic properties of certain antidepressants and antiepileptics.

Without forgetting non-drug treatments: physiotherapy, adapted physical activity (it is essential to keep moving despite the pain), acupuncture, psycho-corporal techniques (meditation, yoga, hypnosis, etc.) and psycho-behavioral approaches . These treatments can be prescribed by a general practitioner or specialist, but are more frequently prescribed in chronic pain structures (SDC), whether in consultations or pain study and treatment centers (CETD).

An uneven territorial network

After medication that caused significant side effects (intense fatigue, feeling of detachment) without reducing pain, Cyrielle Dubois had access to transcutaneous electrical neurostimulation (TENS) and the implantation of a neurostimulator under -cutaneous in a CETD. “That’s what brings me the most peace of mind, she testifies. Living in Île-de-France allows me to be taken care of by several pain centers which do not all have the same specialties. »

These structures offer multidisciplinarity, coordination between caregivers and full financial coverage of care. But less than 3% of chronic pain patients are followed there. The median waiting time is three months, but can reach over a year. Finally, the coverage of the territory by 245 pain structures remains unequal: the Grand Est and Centre-Val de Loire regions are the worst off.

And the situation should not improve according to the SFETD, whose survey reveals that 30% of SDCs could disappear in the coming years due to lack of means and the retirement of many doctors.

Algology, “a complementary training very little valued”

How to respond to demand in this context? “One of the axes that I support in the pain structures of the Nouvelle-Aquitaine region is the delegation of tasks to pain referent nurses so that the doctors’ time is optimized”develops Martine Vivier-Darrigol, medical advisor for the care offer at the Regional Health Agency (ARS) of New Aquitaine.

“The algology (the study of pain and its effects on the body, Editor’s note) is not recognized as a specialty, but as a very undervalued complementary training, which partly explains the shortage of algologist doctors”, regrets Nathalie Deparis. Another problem: “In the SDCs where the care is said to be biopsychosocial, there is no social worker, while patients of working age, who suffer in particular from chronic pain of musculoskeletal origin, are almost all deprived of activity. professional “raises Nicolas Naïditch.

To overcome these difficulties, the High Authority for Health (HAS) published in January 2023 a new health course aimed at improving treatment times. “It is based on three levels: city medicine, consultations and CETD, and specialty hospital services, explains Albert Scemama, doctor and project manager at HAS. This course proposes the creation of new services by the local CETD for doctors in the area, including a hotline and teleconsultations. »

City professionals will also benefit from new tools: evaluation grid for chronic pain patients in primary care, self-questionnaire, etc. Ensuring the continuity of support is essential. “My care will certainly be spread over years, anticipates Cyrielle Dubois, worried about the future. Dependence on a system whose future is fragile worries me. »

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Insufficient support

Pioneer in the improvement of pain management, France dedicated three successive plans to it between 1998 and 2017. The fourth has not yet seen the light of day.

Pain is the first reason for consultation in emergency departments and general practitioners.

It affects all socio-professional categories and all ages of life. A source of disability, inactivity, social isolation and psychological suffering, it is increasing in the population, under the combined effect of aging and increased life expectancy.

More than 70% of chronic pain patients are not receiving appropriate treatment for their pain.

Over the six years of graduate medical studies, less than twenty hours of lessons are devoted to pain. It is even less in nurse training institutes.