Persistent Spinal Pain Syndrome Type 2 (PSPS-T2), a Social Pain? Advocacy for a Social Gradient of Health Approach to Chronic Pain.

The Social Gradient of Health (SGH), or position in the social hierarchy, is one of the major determinants of health. It influences the development and evolution of many chronic diseases. Chronic pain dramatically affects individual and social condition. Its medico-economic impact is significant and worldwide. Failed Back Surgery Syndrome or Persistent Spinal Pain Syndrome type 2 (PSPS-T2) represents one of its most fascinating and disabling conditions. However, the influence of SGH on PSPS-T2 has been poorly explored. We designed a prospective multicentric study (PREDIBACK study) to assess the SGH prevalence, and to examine its association with medical and psychological variables, in PSPS-T2 patients. This study included 200 patients to determine the SGH association with pain (NPRS), Quality of life (EQ-5D-5L), kinesiophobia (FABQ-Work), catastrophism (CSQ), and functional capacity (ODI). Around 85.3% of PSPS-T2 patients in our study had low SGH. Low SGH patients had a higher FABQ-Work and CSQ-Catastrophizing score than high SGH patients (p < 0.05). High SGH patients have a higher ODI score than low SGH patients (p < 0.10). Our results suggest that SGH is a relevant factor to guide prevention, research, and ultimately intervention in PSPS-T2 patients and could be more widely transposed to chronic pain.

[Modesty in hospital and in care]. / La pudeur à l'hôpital et dans les soins.

Modesty is the expression of the fear of being seen in a position which the individual considers as strictly private. It is turned towards others and if it is breached, the individual experiences a feeling of shame. The hospital is a place where it is challenged.

[Different old ages]. / Des vieillesses multiples.

There is no single form of ageing. Some people age in a sort of peaceful and happy continuity of their existence, while others are confronted with illness or bereavements which can weaken them considerably. Ageing therefore takes many different forms. Autonomy, social ties and quality of life are key factors in determining how someone ages.

[When pain cannot be expressed]. / Quand la douleur ne peut se dire.

How pain is felt is a personal and private fact which is almost impossible to measure, which eludes any attempt to grasp and describe it and any desire to convey to another person its intensity and its nature. The challenge is to understand the pain, to assess it and manage it.

[Reconstructing the face, an identity issue]. / Reconstruire le visage, enjeux d'identité.

The human being invests a physical body, a symbol of different significations and values. When this body is damaged, it is the individual's relationship with the world which is unsettled. The disfigured person is confronted with a loss of his or her identity and with a destabilising social relationship. A transplant is an option which leaves patients with an identity which they and others can find difficult to accept.

[The body and touch in nursing care]. / Le corps et le toucher en soins infirmiers.

The body is intimate, social and cultural. The care relationship is constructed through the body. The skin, a symbolic cover, exposes and protects. The touch between the patient and the caregiver expresses the story of a relationship between two bodies.

[Representation in life sciences (6). Cultural images of the body: Organism and flesh]. / Représentation en sciences du vivant (6). Images culturelles du corps : Entre organisme et chair.

In the social and historical plan, the « body ¼ is not still a datum of evidence. This formulation with a dualist connotation does not appear in all the human societies, certain do not distinguish the man from his flesh. The body is rather a question than an answer, a misleading evidence which reveals a multitude of different representations which assign to it a position determined within the general symbolism of the society, dependent on a social status, on a vision of the world, and inside this last one on a definition of the person. The body is a changeable reality from a society to an other one : the images which define it, the systems of knowledge which clarify its nature, the accomplished performances are strickingly diverse, contradictory. The body is a symbolic construction. It seems to be obvious, but nothing is more imperceptible.

[Pain and the care relationship]. / Douleur et relation de soins.

From one social and cultural condition to another, and depending on their personal history, people do not react in the same way to the same type of injury or disease. Each pain is unique. Making the patient a player in his/her treatment is an essential component of an effective care relationship.

[Risk-taking behaviours in adolescents]. / Les conduites à risque des jeunes.

Risk-taking behaviours often reflect ambivalent ways of calling for the help of one's close friends and family--those who count. In spite of the suffering it engenders, risk-taking nevertheless has a positive side, fostering independence in adolescents and a search for reference points; it leads to a better self-image and is a means of developing one's identity. It is nonetheless painful in terms of the repercussions it has through the injuries, death or addiction it incurs. But let us not forget that the suffering in upstream, perpetuated by a complex relation between a society, a family structure and a life history.

[Risk-taking behaviors among young people]. / Les conduites à risque des jeunes: des violences sur soi à celles sur les autres.

Risk-taking behaviors are often an ambivalent way of calling for help from close friends or family - those who count. It is an ultimate means of finding meaning and a system of values; it is a sign of an adolescent's active resistance and attempts to re-establish his or her place in the world. It contrasts with the far more incisive risk of depression and the radical collapse of meaning. In spite of the suffering it engenders, risk-taking nevertheless has a positive side, fostering independence in adolescents and a search for reference points. It leads to a better self-image and is a means of developing one's identity. It is nonetheless painful in terms of its repercussions in terms of injuries, death or addiction. The turbulence caused by risk-taking behaviors illustrates a determination to be rid of one's suffering and to fight on so that life can, at last, be lived.