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.

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.

[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.

[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.

[Empowering patients suffering from chronic pain]. / Rendre son pouvoir d'agir au patient souffrant de douleur chronique.

Living with chronic, daily pain generates a variety of reactions for every individual. To provide the best possible support for sufferers, management strategies have diversified, becoming multimodal and encompassing pharmacological, non-pharmacological, psychological, physiotherapeutic and educational therapies. It is within this framework that therapeutic patient education, hypnoanalgesia and self-hypnosis have been deployed.

[Physiotherapy treatments for the care of patients with chronic pain]. / Traitements kinésithérapiques pour la prise en soins des patients atteints de douleur chronique.

In recent years, numerous studies have highlighted the advances made possible by kinesitherapy treatments. These can be used to reduce the frequency, intensity and duration of pain, as well as the functional repercussions of chronic pain. The neurophysiological mechanism involved in primary chronic pain and the pathology producing secondary chronic pain must be taken into account in determining the nature of the treatments to be implemented. This article presents the main physiotherapy interventions recommended for the management of patients with chronic pain, according to the type of pain experienced (nociceptive, neuropathic or nociplastic).

[Development of pain resource nurses: towards a national cooperation protocol]. / Évolution des infirmiers ressource douleur : vers un protocole de coopération national.

Improving access to specialized pain management centers for the 20% of French people suffering from chronic pain is a major challenge for our healthcare system. Less than 3% of these people receive appropriate care in one of the Chronic Pain Centers (SDC) in France. The current care offer is therefore not sufficient despite the constant increase in the number of SDC. Recognition of the expertise of Pain Resource Nurses (IRD) working in these structures and the delegation of protocolized activities would be one possible response to improve access to care and the quality of care for chronic pain patients by freeing up medical time for the care of new patients.

Overall comorbidities in functional neurological disorder: A narrative review.

INTRODUCTION: The importance to assess and include the frequent comorbidities in the personalised care management plan of patients with functional neurological disorders (FND) has arisen through the years. FND patients are not only complaining from motor and/or sensory symptoms. They also report some non-specific symptoms that participate to the burden of FND. In this narrative review, we aim to better describe these comorbidities in terms of prevalence, clinical characteristics and their variability depending on the subtype of FND. METHODS: The literature was searched for on Medline and PubMed. The search was narrowed to articles between 2000 and 2022. RESULTS: Fatigue is the most common symptom reported in relation to FND (from 47 to 93%), followed by cognitive symptoms (from 80 to 85%). Psychiatric disorders are reported in 40 to 100% FND patients, depending on the FND subtype (functional motor disorder [FMD], functional dissociative seizures [FDS]…) but also on the type of psychiatric disorder (anxiety disorders being the most frequent, followed by mood disorders and neurodevelopmental disorders). Stress factors such as childhood trauma exposure (emotional neglect and physical abuse predominantly) have also been identified in up to 75% of FND patients, along with maladaptive coping strategies. Organic disorders are commonly reported in FND, such as neurological disorders (including epilepsy in FDS [20%] and FMD in Parkinson's Disease [7%]). Somatic symptom disorders including chronic pain syndromes are frequently associated to FND (about 50%). To be noted, recent data also suggest a high comorbidity between FND and hypermobile Ehlers Danlos Syndrome (about 55%). CONCLUSION: Put together, this narrative review highlights the high burden of FND patients, not only due to somatosensory alterations but also by considering the frequent comorbidities reported. Thus, such comorbidities must be taken into consideration when defining the FND personalised care management strategy for the patients.

Management of Chronic Pain by Occupational Therapist: A Description of Practice Profile.

Background. Current state of knowledge regarding occupational therapy's contribution to chronic pain (CP) management has evolved over the past decade. Yet, has this been transferred to clinical practice? Purpose. Describe the current state of practice of CP management-specific occupational therapy. Method. An online survey was sent to occupational therapists working with CP patients. Findings. Of the 90 respondents (11.9%), 42.2% worked in primary care and 52.2% in secondary care. They reported that their primary role aimed at enabling occupation and providing vocational rehabilitation. The Canadian Model of Occupational Performance and Engagement (CMOP-E) (87.8%), semi-structured interview (86.7%), and education on energy conservation (65.6%) and postural hygiene (60.0%) were the most frequently reported conceptual model, assessment, and intervention methods. Implications. Results illustrate the diversity of current occupational therapy practice in CP management and suggest opportunities for improvement to ensure best practices are adopted, by emphasizing an occupation-based vision of health and well-being.

[The experience of pain: cultural representations to give meaning]. / L'expérience de la douleur : les représentations culturelles pour donner du sens.

The pain center of the Armand-Trousseau hospital in Paris receives children and adolescents for a multidisciplinary management of their pain. From all cultural backgrounds, these young people have different representations of suffering. The aim here is not to highlight cultural differences in the sensory experience of pain, but to analyze the representations of the experience of chronic pain. To do this, we will use the clinical case of Kayla, aged 15.

A retrospective analysis of pain changes and opioid use patterns temporally associated with a course of chiropractic care at a publicly funded inner-city facility.

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.

Contexte: Conformément aux directives de pratique clinique, un traitement non pharmacologique, notamment des soins chiropratiques, à la place de prescriptions d'opioïdes est désormais recommandé dans le traitement initial de la douleur chronique à la colonne vertébrale. Les soins chiropratiques, qui comprennent habituellement la manipulation vertébrale, ont été liés de manière provisoire à une consommation réduite d'opioïdes sur ordonnance chez les vétérans souffrant de douleurs à la colonne vertébrale. Objectif: Déterminer si un traitement chiropratique, y compris la manipulation vertébrale, était lié à une diminution de la douleur ou de la consommation d'opioïdes chez les personnes défavorisées sur le plan financier utilisant des médicaments à base d'opioïdes et souffrant de problèmes musculosquelettiques. Méthodologie: Une analyse rétrospective des données sur l'assurance de la qualité provenant d'un établissement de soins de santé financé par l'État a été menée. Les mesures portaient sur des résultats numériques de la douleur à la colonne vertébrale et des extrémités des membres à trois moments différents, la consommation d'opioïdes, des données démographiques et les modes de soins. Résultats: La douleur et la consommation d'opioïdes ont sensiblement diminué dans le cadre de soins chiropratiques. Conclusions: Une diminution importante de la douleur et de la consommation d'opioïdes observée de façon statistique et clinique a coïncidé de manière provisoire avec des soins chiropratiques financés par l'État dans un groupe de personnes défavorisées sur le plan financier vivant au centre-ville.

[When pain becomes complex, feedback from a pain team]. / Quand la douleur devient complexe, retour d'expérience d'une équipe douleur.

The main advantage of a pain team is its multidisciplinary nature. The different perspectives and roles of the members of this team (doctor, nurse and psychologist) make it possible to offer more appropriate support to the patient in pain. This is the case of 13-year-old Élio, whose journey and the specificities of pain management have proven to be complex.

[Distress tolerance and experience of chronic pain]. / Tolérance à la détresse et expérience de la douleur chronique.

INTRODUCTION: Chronic pain is a highly prevalent condition that is associated with distressing somatic and emotional experiences. Consequently, an individual's distress tolerance, the perceived capacity to tolerate negative psychological and physical states, may influence their pain experience. This effect could be explained in part by a reduction in the catastrophic interpretation of pain which is associated with increased pain intensity and interference in everyday activities. AIMS: The first aim of this study was to explore the association between the components of the 5-factor model of distress tolerance and (1) pain intensity and (2) pain interference in everyday activities. The secondary aim was to assess the potential mediating effect of pain catastrophizing in the eventual association between components of distress tolerance and (1) pain intensity or (2) pain interference in everyday activities. METHOD: This is a cross-sectional study of adult (18 years or older) university students and staff with chronic pain (3 months). They were invited to complete the online questionnaire through an email invitation. Pain intensity and interference in everyday functioning were assessed with the corresponding subscales of the Brief Pain Inventory. The following instruments were used to assess the components of the 5-factor model of distress tolerance: Ambiguity Tolerance Scale (tolerance to ambiguity), Intolerance to Uncertainty Scale (reversed score: tolerance to uncertainty), Discomfort Intolerance Scale (reversed score: discomfort tolerance), Distress Tolerance Scale (tolerance to negative emotions), Frustration Discomfort Scale (tolerance to frustration). Participants also completed the Pain Catastrophizing Scale. RESULTS: Eighty participants were recruited (57 % women, mean age=33.09; standard deviation=12,87). Tolerance to negative emotions was the only component of distress tolerance that was associated with pain (ß=-0.04; 95% CI): -0.07--0.01; t (78)=-3.06, p<0.01) or pain interference in everyday functioning (ß=-0.07; 95% CI: -0.10--0.03; t (78)=-3.97, p<0.01), independently of the others. Combined with age, these factors explained 16.2 % of the variance in pain intensity and 19.4 % of the variance in pain interference. Pain catastrophizing partially mediated the association between tolerance to negative emotions and pain interference in everyday functioning, but it was not involved in the association between tolerance to negative emotions and pain intensity. CONCLUSION: Tolerance to negative emotions appears to be the most relevant aspect of distress tolerance in the context of chronic pain and is a potential clinical target that is independent and complementary from pain catastrophizing.

[Professional representation of chronic idiopathic musculoskeletal pain in adolescents]. / Représentation des professionnels face aux douleurs musculo-squelettiques chroniques idiopathiques de l'adolescent.

Chronic idiopathic musculoskeletal pain is common in adolescence, and its impact is sometimes severe. The diagnostic process, which consists of eliminating other etiologies, can be long, complex, and at risk of medical nomadism. Specialists rely on many clinical elements to orient themselves. The care pathway and the subjective feeling of the professional are valuable diagnostic elements.

[The Coupling of Pain, Anxiety, and Stress]. / Die Kopplung von Schmerz, Angst und Stress.

The Coupling of Pain, Anxiety, and Stress Abstract. There is considerable neurobiological, clinical and epidemiological evidence that the systemic phenomena of anxiety and pain closely interact. Both perceptions trigger stress activation processes and are in turn modulated by long-term stress. This overview illustrates the coupling of pain, anxiety and stress with some clinical examples. The relations shown here should help us to gain a holistic view of the individual patient and his/her psychosocial reality, in which nociceptive, affective and vegetative symptoms are often interdependent and mutually reinforcing each other.

Fibromyalgie en réeducation fonctionnelle à Cotonou: caractéristiques et vécu socio-professionnel des patients / NA

La fibromyalgie est une affection de douleur chronique, peu connue sous les tropiques. Elle pourrait altérer le vécu quotidien des patients. Objectif : Présenter les caractéristiques des cas de fibromyalgie suivis en Médecine Physique et de Réadaptation au CNHU-HKM de Cotonou, de même que le retentissement socio-professionnel noté chez ces patients. Méthode : Etude transversale de type descriptif ayant porté sur 60 patients diagnostiqués fibromyalgiques selon les critères de l'ACR 1990 et suivis en rééducation fonctionnelle du CNHU-HKM du 31 décembre 2009 au 30 Avril 2015. Ces patients ont été réévalués du 31 octobre 2014 au 30 Avril 2015 avec l'auto-questionnaire de Dallas pour apprécier le retentissement socio-professionnel de leur affection. Résultats : L'âge moyen des patients a été de 48,55 ans. Il s'agissait de 91,7% de femmes. La douleur était de type variable. Sa durée d'évolution était en moyenne de 89,38±74,77 mois. Elle était d'installation progressive (73,4%), intermittente (50%) et d'intensité au moins forte (88,4%). Des points douloureux spécifiques ont été identifiés dans notre série. La principale étiologie évoquée par les patients était la dépression et l'anxiété (95%). Un important retentissement des activités quotidiennes, professionnelles et des interactions sociales a été noté chez la majorité des patients. Conclusion : Les répercussions de la fibromyalgie sur les patients sont assez marquées. Il paraît judicieux d'associer à la rééducation un accompagnement psycho-social chez ces patients.

Moving towards Soul - an alchemical journey. Rehabilitation of women suffering from 'chronic pain' in a clinical and Jungian context.

The aim of this paper is to explore the connection between symptom and symbol in the body of women suffering from chronic pain, diagnosed as fibromyalgia. The working hypothesis has been that the symbol that emerges from the symptom in the body can bridge the gap to a deeper meaning of pain and suffering, thereby becoming the agent of change for healing of the bodymind and the experience of pain in the physical body. To explore this subject I will introduce some recent research from the field of fibromyalgia, and the concepts of agency and affect systems in the body, which are important cornerstones in my work. I will briefly present my clinical concept of 'Form and Freedom'. From this theoretical base I give some clinical examples of what I see as an alchemical journey towards soul, presented through vignettes, images and the words of three women - Maria, Riba and Ishtar. I conclude with how I see analytical psychology taking its rightful place alongside, informing or in conjunction with, as in my case, other psychotherapeutic modalities, working in creative ways that enhance healing in patients who suffer from chronic pain.

Le but de cet article est d'explorer le lien entre le symptôme et le symbole dans le corps de femmes souffrant de douleurs chroniques, diagnostiquées comme fibromyalgie. L'hypothèse de travail a été que le symbole qui émerge du symptôme dans le corps peut fournir une passerelle pour aller vers un sens plus profond de la douleur et de la souffrance, devenant ainsi l'élément du changement dans la guérison du corps-esprit et de l'expérience de la douleur dans le corps physique. Afin d'explorer ce sujet je présenterai des recherches récentes dans le champ de la fibromyalgie. Je présenterai aussi le concept des systèmes d'affect et d'éléments de changement dans le corps, qui sont des pierres angulaires dans mon travail. Je présenterai brièvement mon concept clinique « Forme and Liberté ¼. A partir de ce support théorique je donnerai quelques exemples cliniques de ce que je vois comme un voyage alchimique vers l'âme, ceci par des vignettes, images et paroles de trois femmes - Maria, Riba et Ishtar. Je conclue en évoquant comment je vois la psychologie analytique prendre sa place légitime parmi d'autres modalités psychothérapeutiques, informant celles-ci ou leur apportant simplement son concours, comme c'est le cas dans mon travail, travaillant de manière créative à soutenir la guérison chez des patientes souffrant de douleurs chroniques.

El objetivo de este trabajo es explorar la conexión entre síntoma y símbolo en el cuerpo de mujeres que padecen dolor crónico, diagnosticado como fibromialgia. La hipótesis de trabajo es que el símbolo que emerge desde el síntoma en el cuerpo puede tender un puente hacia un sentido más profundo del dolor y el sufrimiento, por lo tanto volviéndose un agente de cambio para la sanación del cuerpomente y la experiencia de dolor en el cuerpo físico. Para explorar este tema, voy a introducir algunas investigaciones recientes del campo de la fibromialgia, y los conceptos de sistemas de agencia y de emoción en el cuerpo, los cuales son piedras fundamentales en mi trabajo. Introduciré brevemente mi concepto clínico de 'Forma y Libertad'. A partir de esta base teórica, presento ejemplos clínicos de aquello que comprendo como un viaje alquímico hacia el alma, presentado a través de viñetas, imágenes y el trabajo de tres mujeres - María, Riba e Ishtar. Concluyo con mi percepción respecto a cómo la psicología analítica puede tomar su debido lugar, informando o en forma conjunta con, otras modalidades psicoterapéuticas, trabajando de maneras creativas para enaltecer la curación en pacientes que sufren de dolor crónico.