Pain management: what's the more efficient model?

OBJECTIVES: Conduct a literature review on the organization models for the chronic neuropathic pain management of spinal cord injury (SCI) patients. METHODS: Bibliographical research on Medline based on the following keywords: chronic neuropathic pain in spinal cord injury-comprehensive management-multidisciplinary approaches. RESULTS AND DISCUSSION: No data was found in the literature on this specific topic. We took the option to report the data from the French laws regarding chronic non-cancer pain management. Chronic pain in SCI patients needs a specific and rigorous approach, justifying the role of the physical medicine and rehabilitation (PM&R) physician within specialized pain management centers as a key referent physician and coordinator for this type of patient. Furthermore, SCI pain is a chronic pain and as such requires a global care management; engulfing its emotional, affective, cognitive and behavioral aspects. These particular aspects need to be evaluated within specialized centers dedicated to chronic pain that provide specific therapies such as behavioral and cognitive therapies. CONCLUSION: Specific pain management centers or hospital units remain the benchmark place for chronic pain in SCI patients. PM&R physicians play a key role in the care management of chronic SCI pain. The partnership PM&R-Pain management center aims to provide the most efficient and coordinated care for SCI patient.

[Relationship with the glaucomatous patient: how to announce glaucoma to the patient]. / Comment annoncer le glaucome à un patient ?

Announcement of a chronic disease, always, is a difficult task in the physician professional activity. For glaucoma, its possible impact on their vision and quality of life are a source of anxiety for most patients. The message should be simple and comprehensible, but accurate, to ensure long term compliance to follow-up and treatment. Announcement should be tailored to the patient personality and psychological profile. The clinician should know his own personality, but his patient's personality also, to guarantee successful information and communication and a good quality patient-clinician relationship. Simple rules to be applied are described.

[The physician-patient relationship in chronic disease management]. / La relation médecin-malade dans les maladies chroniques.

The relationship between patients and clinicians is a key element in the management of chronic diseases. With the objective of a more efficient communication, the clinician should know his own personality but also the patient personality. The organisation of the consultation, of the waiting room and of the secretary has to facilitate this relationship. The amelioration of this relationship is usefulness only for the clinician in particularly complicated cases but also for the patients suffering from chronic diseases.

[Pain asssessment methods in otolaryngology]. / Méthodes d'évaluation de la douleur en ORL.

Evaluation of pain in otolaryngology diseases is indispensable in treating patients. Parallel to the etiological diagnosis of otolaryngology disease, a clinical diagnosis of the pain must be made to determine the weighting of the three causes of pain involved in any acute or chronic condition: the component of nociceptive, neurogenic, and psychofunctional pain. This paper will discuss how pain can be quantified and qualified, and how to identify the status of the neurological system of perception and control of the pain process.

[Effect of music therapy among hospitalized patients with chronic low back pain: a controlled, randomized trial]. / Intérêt de la musicothérapie dans la prise en charge de la lombalgie chronique en milieu hospitalier (Etude contrôlée, randomisée sur 65 patients).

OBJECTIVE: To evaluate the influence of music therapy in hospitalized patients with chronic low back pain. METHODS: A controlled, randomized study (N = 65). During a stationary rehabilitation stay of 12 days, 65 patients with low back pain were randomized to receive on alternate months standardized physical therapy plus 4 music therapy sessions between day 1 and day 5 (intervention group; N = 33) or standardized physical therapy alone (control group; N =32). Scores for pain (as measured on a visual analogue scale [VAS]), disability (Oswestry index) and anxiety and depression (as measured on the hospital anxiety and depression scale [HAD]) were collected on day 1, 5 and 12. Pain intensity was also evaluated on a VAS just before and after music therapy sessions. RESULTS: Introduced music therapy sessions during a stationary rehabilitation stay in patients with chronic low back pain reduce pain (-2.0+/-2.7 vs -1.8+/-2.6) but not significantly. However, music therapy significantly (p < 0.01) reduced disability as measured on the Owestry index between day 1 and day 5 (-11.8+/-17.8 vs -2.5+/-9.4), anxiety (-3.5+/-3.7 vs -0.9+/-2.7) and depression (-2.1+/-3.0 vs 0.6+/-2.4). The immediate effect on pain intensity (VAS score) was confirmed (p < 0.001). CONCLUSION: Our results confirmed the effectiveness of music therapy for hospitalized patients with chronic low back pain. Music therapy can be a useful complementary treatment in chronic pain and associated anxiety-depression and behavioural consequences.

Fibromyalgia as a national issue: the French example.

Fibromyalgia has been known by French rheumatologists for more than 15 years. However, only recently have teaching and basic, clinical and epidemiological research been developed on this topic in France. Management of the fibromyalgia patient should benefit from this recent evolution, all the more so since the French government took action to facilitate the medical treatment of chronic pain and to support the development of algology in France.