["Zero heavy restraint" objective]. / Objectif "zéro contention forte".

When caring for a patient with an intellectual disability, restraint is often an ambush. At the Institut Jérôme Lejeune, the nursing team has put in place a series of measures designed to help both patient and caregiver, whether in managing the pain induced by care or the apprehension it provokes. After a year's implementation, the number of heavy restraints has fallen significantly.

[Pain assessment for children and adolescents with autism spectrum disorders (ASD): A systematic review]. / Évaluation de la douleur des enfants et adolescents avec troubles du spectre de l'autisme : une revue systématique.

OBJECTIVE: Pain in children and adolescents with autism spectrum disorders remains underdiagnosed due to their inherent communication difficulties. The goal of this review is to identify the most suitable methods for assessing pain in this population and for evaluating the specific perceptions of, or behavioural reactions to, pain whilst considering disorder severity and specifiers (with or without accompanying intellectual impairment, with or without accompanying language impairment). METHOD: A systematic review and analysis of the international literature was conducted. RESULTS: Fourteen studies were selected. No difference was found in pain-related behaviours based on the age or gender of children or adolescents with autism. Three studies showed pain-related behaviours in autism spectrum disorders to be similar to control groups. Other studies showed specific behavioural responses in autism spectrum disorders with a longer physiological and behavioural recovery time associated with an episode of acute pain in this population. Similarly, the three studies that focused on sensory perceptions of pain all showed differences in the autism spectrum disorders population compared to control groups. In hospital or daily life contexts, studies essentially showed idiosyncratic expressions, hypervigilance, motor agitation, negative emotional reactions, or vocalizations. Regarding the association of autism severity with hyposensitivity to pain, the results remain unclear even when language disorders or intellectual disabilities are also present (in conjunction with autism). The Non-Communicative Children Pain Checklist and its translation into French and Italian showed good internal validity and was used by almost half of the studies in hetero-assessment, mostly by parents. Studies recommend the inclusion of parents in the assessment in order to optimise the evaluation process. Similarly, analysis of parent/child/caregiver interviews from the studies highlights the importance of personalizing pain assessment of children and adolescents, taking into account subject-specific characteristics, pathology, and context. CONCLUSION: An integrative and personalized approach to pain assessment appears to be the most appropriate for enhancing the understanding and detection of pain in individuals with autism spectrum disorders. This approach aligns well with a care setting where a nominated professional with a good expertise in autism is responsible for pain assessment. Given the complexity of identifying pain in individuals with autism, further qualitative studies, in conjunction with new pain exploration technologies, are considered necessary as well as a more extensive categorization of the population studies.

Poor sleep quality is predictive for higher pain levels in patients with chronic scrotal pain, regardless of body perception, biological rhythm, anxiety, and depression.

OBJECTIVES: To investigate the association between pain and sleep quality, anxiety, depression, body perception, and biological rhythm in chronic scrotal pain (CSP). MATERIAL AND METHODS: This cross-sectional study of 140 CSP patients was conducted between January and October 2023. The patients were separated into groups according to the Visual Analogue Scale (VAS) score as group 1 (score<3, n=27), group 2 (score: 3-6, n=84), and group 3 (score>6, n=29). In addition to demographic data, the points were recorded from the Body Image Scale (BIS), Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN), Hospital Anxiety and Depression Scale (HADS), and the Pittsburgh Sleep Quality Index (PSQI). RESULTS: The median (IQR) age of patients was 33 (20) years and the median (IQR) duration of pain was 5 (9) months. Group 3 patients had more anxiety (24.1% vs. group 1: 22.2%; group 2: 8.3%; P=0.03) and depression (55.2% vs. group 1: 40.7%; group 2: 29.8%; P=0.04) symptoms. No statistical differences were determined between the groups according to the BIS (P=0.54). The median (IQR) total BRIAN score was higher in group 3 than group 1 [37 (11) vs. 33 (13), P=0.03]. Higher rates of poor sleep quality were determined in group 3 patients according to the PSQI (75.9% vs. group 1: 48.1%; group 2: 51.2%; P=0.04). The VAS score was found to be positively associated with pain duration, total BRIAN score and PSQI score (r=0.31, P<0.001; r=0.17, P=0.04; r=0.23, P=0.006, respectively). The PSQI score was found to be an independent predictor for a higher VAS score (HR: 1.14, P=0.01). CONCLUSION: The results of this study suggest that poor sleep quality may influence the perceived intensity of pain. LEVEL OF EVIDENCE: II.

Coronary atherosclerosis among symptomatic patients with zero coronary artery calcium score in computed tomography coronary angiography.

BACKGROUND: Computed tomographic coronary angiography has been recognized as a reliable imaging modality with excellent negative predictive value and a good negative likelihood ratio to exclude coronary artery disease in stable, symptomatic patients with intermediate or high risk. 1) Coronary calcium scoring has been extensively shown to be an invaluable tool to exclude the presence of coronary artery disease in low-risk patients. 2) Our aim was to identify the presence and extent of coronary atherosclerosis in computed tomographic coronary angiography in stable symptomatic patients with a zero Coronary Calcium score. RESULTS: Three hundred and eighty-three (383) consecutive patients aged ≥ 18 years fulfilling the criteria were enrolled as of January 1, 2021; 165 (43.1%) were male and 218 (56.9%) were female, with a mean age of 57.8 ± 4.9 years and a zero coronary artery calcium score. Two hundred and twenty-six (226) (59.0%) were hypertensive, followed by 125 (32.6%) who were smokers, and 117 (30.5%) who were diabetic. The frequency of atherosclerotic plaque in coronary arteries was 34 (8.9%), with 16 (47.1%) being male and 18 (52.9%) being female. The mean age of patients with atherosclerosis was 54.9 ± 3.3 years; among them, 13 (38.2%) were between the ages of 45 and 54, and 10 (29.4%) were between the ages of 55 and 64. Nineteen (19) (55.9%) were hypertensive, followed by 10 (29.4%) with dyslipidemia. Twenty-three (23) (67.6%) had non-obstructive plaque, and 11 (32.3%) had obstructive plaque. In the subgroup of patients with non-obstructive plaque, 13 (56.5%) were hypertensive, 8 (34.8%) were diabetic, and 16 (69.6%) had single vessel disease, while among patients with obstructive plaque, 6 (54.5%) were hypertensive, 5 (45.5%) were smokers, and all of them had single vessel disease. The most affected artery was the left anterior descending artery. CONCLUSION: As the frequency of atherosclerotic plaque in patients with a zero coronary calcium score is relatively high, computed tomographic coronary angiography is indicated in stable, symptomatic patients with a lower likelihood of coronary artery disease.

[IPA's clinical expertise in the identification and assessment of somatic pain in schizophrenic patients]. / Expertise clinique de l'IPA PSM dans le repérage et l'évaluation de la douleur somatique chez les personnes schizophrènes.

Identifying and assessing somatic pain in people with schizophrenia remains a major public health issue for this vulnerable population. In France, Advanced Practice Nursing is developing, based on a practice built around clinical expertise. How can the clinical expertise of psychiatric and mental health APNs improve the identification and assessment of somatic pain in these patients, and thus help to improve their somatic health?

[Understanding endometriosis]. / Mieux comprendre l'endométriose.

Endometriosis is a chronic disease defined by the presence of endometrial cells outside the uterus. Research is ongoing to better understand its etiologies, the anatomopathological forms it takes and the associated symptoms, which often have pain in common.

[Endometriosis and pain]. / Endométriose et douleur.

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.

[Towards an ideal environment in neonatology]. / Vers un environnement idéal en néonatalogie.

The establishment of sensory systems occurs gradually along a transnatal continuum. During premature birth, hospitalization in neonatology, through its atypical sensory stimulations, can disrupt the development of the baby's still immature brain. To promote harmonious development in children, caregivers and parents must learn to take into account their sensory expectations in order to create the most suitable environment possible for their development.

Catastrophizing and rumination mediate the link between functional disabilities and anxiety/depression in fibromyalgia. A double-mediation model.

Fibromyalgia can be considered to be a model of chronic pain resulting from dysregulation of pain processing. From a psychological point of view, it is possible to consider transdiagnostic processes that would participate in both the dysregulation of pain and associated emotions. OBJECTIVE: The aim of this study was to test the links that exist between the tendency to Repetitive Negative Thinking (RNT) and the anxious-depressive manifestations in fibromyalgia. More specifically, we wanted to test a double mediation model where RNT would mediate the link between pain and depression/anxiety via catastrophizing. METHOD: Eighty-two patients with fibromyalgia completed a series of questionnaires evaluating their level of depression, anxiety, disability related to pain, catastrophizing as well as various measures of Repetitive Thoughts. RESULTS: The results showed strong correlations between RNT levels, pain, and anxious-depressive manifestations in this population. Moreover, the links between pain and depression/anxiety were mediated by catastrophizing and RNT in serial. CONCLUSION: Results support the interest of studying RNT as a transdiagnostic process in fibromyalgia pain. Considering RNT in fibromyalgia allows a better understanding of tthe links that exist between pain and emotional disorders in this population and thus to better understand the psychopathological comorbidity of fibromyalgia.

The Experience of Pregnancy-Related Lumbopelvic Pain: A Qualitative Evidence Synthesis.

Background. Pregnancy-related lumbopelvic pain is common and can impact quality of life. Purpose. To synthesize existing qualitative research on people's experiences of pregnancy-related lumbopelvic pain in pregnancy and during the postpartum period. Method. A keyword search of four electronic databases between 2000 and 2022 was completed. Included studies were appraised and synthesized using a meta-ethnographic approach. Findings. Twenty-three studies were included. Analysis identified four core themes: (1) uncertainties about pregnancy-related lumbopelvic pain, (2) struggles to attain achieve treatment and pain management, (3) profound activity consequences, and (4) emotional wellbeing, relationship, and identity impacts of pregnancy-related lumbopelvic pain. Implications. The occupational therapy role with this population has not to our knowledge yet been described. Given the centrality of occupational disruption to the experience of this population we argue that developing and evaluating occupational therapy interventions to address functional, work, parenting and wellbeing outcomes for this population is warranted and should be prioritized.

[HOSPITAL FREQUENCY AND FACTORS ASSOCIATED WITH INFLAMMATORY RHEUMATIC DISEASES IN CHILDREN AT THE CNHU-HKM IN COTONOU]. / Fréquence hospitalière et facteurs associés aux maladies rhumatismales inflammatoires de l'enfant au CNHU-HKM de Cotonou.

Introduction: Les maladies rhumatismales inflammatoires (MRI) longtemps méconnues en Afrique subsaharienne sont très souvent confondues à la drépanocytose ou au rhumatisme articulaire aigu. Ce travail permet d'étudier la fréquence hospitalière et les facteurs associés aux MRI de l'enfant. Méthodes: Etude transversale et analytique de 2017 à 2022 ayant inclus les patients de 0-18ans avec un diagnostic de MRI depuis au moins trois mois. Les données épidémio-cliniques, thérapeutiques, évolutives ont été recueillies. Résultats: Parmi les 4418 consultations 254 enfants ont été reçus et le diagnostic de MRI posé chez 166 soit une fréquence hospitalière de 3,75% des consultations et 65% des maladies rhumatismales de l'enfant. Etaient inclus 105 enfants avec une sex-ratio de 0,75. L'âge moyen était 13,97 ± 3,04 ans. Le motif principal de consultation était la douleur (94,29%) qui siégeait aux membres pelviens dans 84,8% (n= 89) et était asymétrique dans 57,1%(n=60). Les manifestations extra articulaires étaient absentes chez 50,5%. L'anticorps anti-CCP (67%)était le bilan immunologique majoritairement prescrit. Les AJI étaient la MRI la plus retrouvée (79,99%). Le traitement administré était dominé par les AINS (n=98) et la rémission obtenue dans 73,33%. Les facteurs associés à une mauvaise évolution étaient l'âge supérieur à 12ans(p=0,0014), la non-scolarisation (p= 0,0048), l'absence de couverture sanitaire(p=0,0018) et la longue durée d'évolution supérieure à 18 mois(p=0,0029).Les MRI sont relativement fréquentes chez l'enfant dans notre pratique pédiatrique. Il faudrait y penser devant des douleurs chroniques et mieux organiser leur suivi.

[Ketamine in chronic pain]. / Intérêt de la kétamine dans le traitement des douleurs chroniques.

Ketamine is now frequently used in the management of chronic pain refractory to conventional treatments. However, its efficacy and adverse effects appear variable in the literature in line with heterogeneous methodologies and modes of administration, leading to controversy regarding the actual interest of ketamine for chronic pain treatment. A need for clinical trials on larger cohorts of well selected patients but also real-life studies to more accurately quantify its efficacy, refine its prescription dosages and better understand its long-term adverse effects is highlighted in the literature. Progress in this direction has been achieved in recent years with improved recommendations for use, taking into account different trajectories of analgesia with ketamine, depending on the etiology of the pain, and the psycho-affective profile of patients. A holistic approach is clearly needed with consideration of pain and depression comorbidities to optimize pain management.

Title: Intérêt de la kétamine dans le traitement des douleurs chroniques. Abstract: La kétamine est aujourd'hui fréquemment utilisée dans la prise en charge de la douleur chronique réfractaire aux traitements classiques. Selon les études, l'efficacité et les effets indésirables de la kétamine apparaissent variables, en lien avec des méthodologies et des modes d'administration hétérogènes, conduisant à des controverses sur son utilisation en clinique. Un besoin d'essais sur des cohortes plus nombreuses de patients mieux sélectionnés mais aussi d'études en « vraie vie ¼ pour mieux quantifier son efficacité, raffiner les posologies de prescription et mieux comprendre ses effets indésirables à long terme, est régulièrement souligné dans la littérature. Toutefois, au cours des dernières années, plusieurs travaux ont permis d'avancer sur les recommandations d'utilisation. Ils soulignent en particulier la nécessité de prendre en compte à la fois les trajectoires diverses d'antalgie avec la kétamine, selon l'étiologie de la douleur, et les comorbidités, en particulier la dépression, afin d'optimiser la prise en charge des patients douloureux.

The psychopathological repercussions on patients faced with pain: A focus on endometriosis.

OBJECTIVES: Endometriosis is a chronic and progressive gynecological disease that affects 1 to 2 out of 10 women of childbearing age in France. The objective of this research was to understand the factors determining the quality of life of the patients who experience significant pain symptoms (75%), distinguished by the extent and depth of the lesions. The second objective was to evaluate the psychological repercussions of this pain. We will therefore assess the various psychological processes involved in explaining quality of life. METHOD: In total, 1039 women aged 18-55 years completed a self-administered questionnaire, assessing different types of pain and intensity, body image (BIS), self-esteem (Rosenberg), anxiety-depressive symptomatology (HAD), and quality of life (SF-36). Socio-biographical and medical characteristics of the patients were also assessed. RESULTS: Analyses of variance showed that patients with chronic pain had lower self-esteem and body image, more anxiety-depressive symptoms, and a poorer quality of life than women with cyclic pain and those without pain. Regression analyses showed that the determinants of physical and mental quality of life differed significantly according to the type of pain experienced. CONCLUSION: The consequences of the pain associated with endometriosis reveal multiple problems that can be considered from a new perspective. Although psychological disorders can be a response to pain phenomena they can also contribute to their increase. This is where the challenge lies in providing comprehensive care.

[Benefits and drawbacks of CT scan as a triple rule-out exam in acute chest pain to exclude acute coronary syndrome, pulmonary embolism and aortic dissection]. / Le scanner thoracique injecté « triple-rule-out ¼ a-t-il un intérêt dans le bilan des douleurs thoraciques aiguës pour éliminer le syndrome coronaire aigu, l'embolie pulmonaire et la dissection aortique ?

Chest pain is one of the major causes for admission in the Emergency Room in most countries and one of the principal reasons for urgent consultation with a cardiologist or a general practitioner. After clinical examination and initial biological measurements, substantial patients require further explorations. CT scan allows the search for pulmonary embolism in the early stage of pulmonary arteries iodine contrast exploration. During the same exam at the systemic arterial phase, the search for aortic dissection or coronary artery disease is possible while exploring the later contrast in the aortic artery. This triple rule-out exam allows correct diagnosis in case of acute chest pain with suspected pulmonary embolism, aortic dissection and other acute aortic syndromes or acute coronary syndrome. But X-rays are substantially increased as well as iodine contrast agent quantity while exam quality is globally decreased. Artificial intelligence may play an important role in the development of this protocol.

[Pain management in 2023]. / La prise en charge de la douleur en 2023.

Pain is a frequent symptom for healthcare professionals in the community and in hospital. Appropriate management of pain begins with a precise and comprehensive assessment, whether acute or chronic. The available therapies are summarized below, so that they can be used as closely as possible to the pathophysiology of pain. Available drug analgesics are reinforced by non-drug interventions, which are increasingly present in the algology care offering. In 2023, the authorities have announced a new ten-year national plan for pain and palliative care. Proof that this public health issue, at the heart of caregivers' concerns, is also a priority for political leaders.

[Nursing consultations in pain assessment and treatment facilities]. / La consultation infirmière en structure d'évaluation et de traitement de la douleur.

The concept of nursing consultation takes on its full meaning with people suffering from chronic pain. The Société française d'étude et de traitement de la douleur (French Society for the Study and Treatment of Pain), and more specifically its professional nursing commission, has drawn up a reference framework of consultation activities on which pain resource nurses (PRNs) can draw. This describes the various stages in the management of chronic pain patients. In view of the needs and expectations expressed by the population in terms of care, the PRN function is likely to evolve towards that of advanced practice nurse.

[The role of the private practice nurse in pain management at home]. / Rôle de l'infirmière libérale dans la prise en charge de la douleur à domicile.

Optimizing the management of chronic pain in outpatient clinics remains an ongoing challenge. Liberal nurses are local healthcare players, helping to establish links with other healthcare professionals. The experiment carried out by a team of liberal clinical nurses opens up the field of possibilities and enables us to diversify the range of care we offer.