Twelve million French people are affected by chronic pain. In 70% of cases, these people do not receive appropriate treatment.
“I never feel good. Even when I have a little less pain, I know that the next day I will be very badly … “” When the pain that kills my skull stops an hour or two during the day, it’s like I’m at home. These two testimonies, among others, collected by David Le Breton, sociologist, in Hold. Chronic pain and self-reinvention (Éditions Métailié) illustrate the daily life of the 20% of French people living with chronic pain . Cancers, low back pain, osteoarthritis, migraines, fibromyalgia, endometriosis, inflammatory rheumatism, irritable bowel syndrome … “Pain is the main symptom of a large number of diseases,” recalls Professor Serge Perrot, President of the French Society of Study and Pain Treatment (SFETD). It poisons the lives of 12 million people. And this impressive number will continue to increase. Because, as Serge Perrot reminds us, “from the age of 70, half of the population has pain”.
However, real progress has been made in the evaluation and management of painsince the implementation of the first pain plan in 1995. Even so, even today, 70% of pain do not receive treatment. appropriate and less than 3% of patients are followed in specialized centers, alerts the learned society in a white paper published last October. And the report is alarming: half of the patients have a quality of life very impaired. So much so that 30% of suffering patients have suicidal thoughts, recalled Dr. Émilie Olié, a psychiatrist at the University Hospital of Montpellier, at the SFETD congress last November.
There are objects that make you fall backwards
Even in the pain related to cancer, the care remains very heterogeneous in the territory. “Despite a clear evolution, studies show that 40% of cancer patients who should receive morphine do not have,” says Professor Serge Perrot. However, in a paradoxical way, the prescription of strong opioid analgesics increased by 74% between 2005 and 2015. “The percentage is high, but in absolute value, that represents 600,000 to 700,000 French who will have at least one prescription of strong opioid analgesics. Moreover, the prescription increases especially in non-cancer pain, “says Professor Nicolas Authier, head of the pain center at Clermont-Ferrand University Hospital. Indeed, strong opioids (fentanyl,
“On the other hand, we have practically no stage 2 analgesics. It is normal that we prescribe more strong opioids. Today, we must relieve people with an arsenal that is constantly shrinking, “said Anne-Marie Magnier, professor of general medicine at the Pierre and Marie Curie University in Paris. For example, she recalls, nonsteroidal anti-inflammatory drugs, which have been widely used in rheumatology, are now to be avoided in the long run. In addition to the risk of gastrointestinal bleeding, they demonstrated renal and cardiovascular toxicity. “You also have to know that codeine is not supported by everyone,” she says.
In addition, analgesics do not relieve all pain. Indeed, neuropathic-type pains, such as shingles or diabetes pain or fibromyalgia or irritable bowel, so-called nociplastic or dysfunctional, do not respond or little to these molecules. For these pains, the drugs used belong to the class of antiepileptics or antidepressants.
“Today, what we are missing are new molecules. The treatments are old, not effective enough or poorly tolerated. For example, we need analgesics that are as effective as morphine but without any undesirable effects , “says Professor Alain Eschalier, president of the Analgesia Institute. Molecules exploring new pharmacological pathways are also being studied. But the real innovations are long overdue.
In the meantime, doctors and patients have to do with the molecules at their disposal. Not to mention non-drug approaches. “Hypnosis, acupuncture, physical exercise can be as effective but not reimbursed by Social Security,” says Professor Serge Perrot, who is working with the SFETD for recognition of these approaches.
Strong opioid drugs under surveillance
Mediated by the death of singer Prince, the epidemic of opioid drug dependence alarms US authorities. It must be said that every day, nearly 150 Americans die from an overdose of pain medication. Could this dramatic situation emerge in France? The question is valid.
For the first time, a study looked at French data. And the report is there. While the prescription of opioid medications has risen sharply, hospitalizations for overdose and death have also made a spectacular leap. Deaths (excluding suicides) by strong opioid drugs have been multiplied by three in ten years, from 1.3 to 3.4 per 1 million inhabitants, reveals a study conducted by the French Observatory of analgesic drugs (Ofma ).
Overdoses that, contrary to what one can imagine, do not strike young addicts addicted to drugs. In fact, 40% of overdose hospitalizations involve women aged 62, without a diagnosis of cancer, without recent surgery and with no known history of addiction. “These data are worrying but not yet alarming. We know that we have a problem of abuse and misuse but no crisis, “tempers Professor Nicolas Authier, head of the pain center of the University Hospital of Clermont-Ferrand.
For this specialist, the first action is to inform the French on the risks of addiction that can cause these drugs. “In particular, we must warn against the use of medicines in the family medicine cabinet for self-medication. Or recall factors that promote addiction such as anxiety, depression, addiction to other substances including benzodiazepines, “he says.
However, this is not to limit the access of these drugs to painful patients but to monitor and accompany any misuse. “We must avoid finding ourselves in a problem of crisis, as in the United States. It would be difficult to get by. When the crisis is established, it means that there is a large reservoir of dependent patients. And these will not disappear under the pretext that you change the prescription conditions of drugs, “said Nicolas Authier.