La Revue du praticien
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The chronic pain management structures were identified by the French health authorities regarding two levels: consultation (with a pluri-professional organization and proximity missions) and the center (with a multidisciplinary organization and expertise). Access to these structures is facilitated by guidelines published in 2008 by the Haute Autorité de santé.
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The major development of experimental and clinical pain research over the last two decades should result in the development of new treatment strategies. In the future, the management of chronic pain should rely both on new molecules targetting specific pathophysiological mechanisms and new non pharmacological approaches, such as non invasive transcranial magnetic stimulation, acting on endogenous pain modulatory systems. The variety of new treatment options should allow a more efficacious management of chronic pain, taylored to each patient's profile.
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La Revue du praticien · Jun 2013
Review[Pharmacological treatment of neuropathic pain in primary care].
Neuropathic pain is difficult to treat. First line treatment includes tricyclic antidepressants (notably amitriptyline), mixed serotonin and norepinephrine reuptake inhibitors (duloxetine for diabetic peripheral neuropathic pain), antiepileptics (gabapentin and pregabalin) and topical agents (lidocaine plasters for postherpetic neuralgia). These drugs can be subsequently associated in case of partial response to monotherapy. Opioids and tramadol are only considered second/third line, alone or in combination with first line drugs.
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La Revue du praticien · Jun 2013
Review[Pathophysiology of chronic pain. Classification of three subtypes of pain].
Pain is a physiological sensation which aim is to alert for an upcoming danger that may threaten the individual. This system includes peripheral nociceptors that initiate the nociceptive message. Then, the information is conveyed to the brain through the spinothalamic tract that projects to the thalamus, insula, SII and other areas. ⋯ This is the neuropathic pain. Case 3: between the two former cases, there is no evidence for a lesion in the nociceptive system, and there are no evidences for lesion at the peripheral level, but there are evidences of dysregulation(s). These are the cases of dysfunctional pain.