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Salmon M, Sibeoni J, Harf A, Moro MR, Ludot-Grégoire M. Systematic review on somatization in a transcultural context among teenagers and young adults: Focus on the nosography blur. Front Psychiatry 2022; 13:897002. [PMID: 35958663 PMCID: PMC9358691 DOI: 10.3389/fpsyt.2022.897002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/27/2022] [Indexed: 11/15/2022] Open
Abstract
Aims Somatic complaints are a frequent cause for consultation in primary care. In a transcultural context, somatic complaints are typically associated with psychological distress. A recent review about somatic symptom disorders in adolescence showed some nosographic heterogeneity and outlined various etiological hypotheses (traumatic, environmental, or neurologic), separate from the cross-cultural considerations. Migrants' children encounter specific problems involving cultural mixing-issues of filiation (familial transmission) and affiliation (belonging to a group). This paper aims to provide a systematic review of somatization in transcultural contexts among teenagers and young adults, aged 13 to 24, over the past decade. Methods This review adheres to the quality criteria set forth by the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Two authors queried three English databases (Medline, PsycInfo, WebOfScience) about somatization in transcultural contexts (migrant or non-Western population) among teenagers (13-18), young adults (19-24), or both. The methodological process comprised articles selection, data extraction, and then the analysis of emerging themes. Setting selection criteria to limit the transcultural field was difficult. Results The study analyzed 68 articles. We present a descriptive analysis of the results, centered on three main themes. First, the literature highlights a nosographic muddle reflected in the combination of anxious and depressive symptoms together with the highly variable symptomatology. Second, discrimination issues were prevalent among the migrant population. Lastly, the literature review points out possibilities for improving a care pathway and reducing the diagnostic delay induced by migrants' hesitancy about Western care and the recurrent use of inappropriate diagnostic criteria. Conclusion This review discusses the links between the nosographic muddle described here and the diagnostic delays these patients experience and raises concerns about rigid diagnostic compartmentalization. The work of the psychiatrist Frantz Fanon is here useful to understand externalized symptoms resulting from physical and psychological confinement. Discrimination issues raise questions about the cultural counter-transference health professionals experience in dealing with young migrants. Defining healthcare professionals' representations about somatic complaints in a transcultural context might be a fruitful path to explore in future research. Protocol PROSPERO registration number CRD42021294132. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021294132.
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Affiliation(s)
- Mathilde Salmon
- APHP, Hôpital Cochin, Maison de Solenn, Paris, France
- Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Jordan Sibeoni
- Service Universitaire de Psychiatrie de l'Adolescent, Centre Hospitalier d'Argenteuil, Argenteuil, France
- ECSTRRA Team, UMR-1153, Inserm, Université de Paris, Paris, France
| | - Aurélie Harf
- APHP, Hôpital Cochin, Maison de Solenn, Paris, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France
| | - Marie Rose Moro
- APHP, Hôpital Cochin, Maison de Solenn, Paris, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France
- Université de Paris, PCPP, Boulogne-Billancourt, France
| | - Maude Ludot-Grégoire
- APHP, Hôpital Cochin, Maison de Solenn, Paris, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France
- Université de Paris, PCPP, Boulogne-Billancourt, France
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Barrachina J, Margarit C, Muriel J, López-Gil S, López-Gil V, Vara-González A, Planelles B, Inda MDM, Morales D, Peiró AM. Oxycodone/naloxone versus tapentadol in real-world chronic non-cancer pain management: an observational and pharmacogenetic study. Sci Rep 2022; 12:10126. [PMID: 35710811 PMCID: PMC9203709 DOI: 10.1038/s41598-022-13085-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 05/20/2022] [Indexed: 12/25/2022] Open
Abstract
Tapentadol (TAP) and oxycodone/naloxone (OXN) potentially offer an improved opioid tolerability. However, real-world studies in chronic non-cancer pain (CNCP) remain scarce. Our aim was to compare effectiveness and security in daily pain practice, together with the influence of pharmacogenetic markers. An observational study was developed with ambulatory test cases under TAP (n = 194) or OXN (n = 175) prescription with controls (prescribed with other opioids (control), n = 216) CNCP patients. Pain intensity and relief, quality of life, morphine equivalent daily doses (MEDD), concomitant analgesic drugs, adverse events (AEs), hospital frequentation and genetic variants of OPRM1 (rs1799971, A118G) and COMT (rs4680, G472A) genes, were analysed. Test CNCP cases evidenced a significantly higher pain relief predictable due to pain intensity and quality of life (R2 = 0.3), in front of controls. Here, OXN achieved the greatest pain relief under a 28% higher MEDD, 8–13% higher use of pregabalin and duloxetine, and 23% more prescription change due to pain, compared to TAP. Whilst, TAP yielded a better tolerability due the lower number of 4 [0–6] AEs/patient, in front of OXN. Furthermore, OXN COMT-AA homozygotes evidenced higher rates of erythema and vomiting, especially in females. CNCP real-world patients achieved higher pain relief than other traditional opioids with a better tolerability for TAP. Further research is necessary to clarify the potential influence of COMT and sex on OXN side-effects.
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Affiliation(s)
- Jordi Barrachina
- Neuropharmacology on Pain (NED), Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain
| | - Cesar Margarit
- Neuropharmacology on Pain (NED), Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain.,Pain Unit, Department of Health of Alicante - General Hospital, Alicante, Spain
| | - Javier Muriel
- Neuropharmacology on Pain (NED), Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain.,Pain Unit, Department of Health of Alicante - General Hospital, Alicante, Spain
| | - Santiago López-Gil
- Occupational Observatory, Miguel Hernández University of Elche, Alicante, Spain
| | - Vicente López-Gil
- Occupational Observatory, Miguel Hernández University of Elche, Alicante, Spain
| | - Amaya Vara-González
- Occupational Observatory, Miguel Hernández University of Elche, Alicante, Spain
| | - Beatriz Planelles
- Neuropharmacology on Pain (NED), Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain.,Department of Pharmacology, Paediatrics and Organic Chemistry, Miguel Hernández University of Elche, Elche, Spain
| | - María-Del-Mar Inda
- Neuropharmacology on Pain (NED), Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain
| | - Domingo Morales
- Operations Research Centre, Miguel Hernández University of Elche, Elche, Spain
| | - Ana M Peiró
- Neuropharmacology on Pain (NED), Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain. .,Department of Pharmacology, Paediatrics and Organic Chemistry, Miguel Hernández University of Elche, Elche, Spain. .,Clinical Pharmacology Unit, Department of Health of Alicante - General Hospital, Alicante, Spain. .,Neuropharmacology on Pain (NED) Research Group, Hospital General Universitario de Alicante, C/Pintor Baeza, 12, 03010, Alicante, Spain.
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Cathébras P. Patient-Centered Medicine: A Necessary Condition for the Management of Functional Somatic Syndromes and Bodily Distress. Front Med (Lausanne) 2021; 8:585495. [PMID: 33987188 PMCID: PMC8110699 DOI: 10.3389/fmed.2021.585495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 03/10/2021] [Indexed: 12/02/2022] Open
Abstract
This paper argues that “functional,” “medically unexplained,” or “somatoform” symptoms and disorders necessarily require a patient-centered approach from the clinicians. In the first part, I address the multiple causes of the patients' suffering and I analyze the unease of the doctors faced with these disorders. I emphasize the iatrogenic role of medical investigations and the frequent failure in attempting to reassure the patients. I stress the difficulties in finding the right terms and concepts, despite overabundant nosological categories, to give a full account of psychosomatic complexity. Finally, I discuss the moral dimension attached to assigning a symptom, at times arbitrarily, to a psychogenic origin. The following part presents a brief reminder of the patient-centered approach (PCA) in medicine. In the last part, I aim to explain why and how patient-centered medicine should be applied in the context of functional disorders. First, because PCA focuses on the patients' experience of illness rather than the disease from the medical point of view, which is, indeed, absent. Second, because PCA is the only way to avoid sterile attribution conflicts. Last, because PCA allows doctors and patients to collaboratively create plausible and non-stigmatizing explanations for the symptoms, which paves the way toward effective management.
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Affiliation(s)
- Pascal Cathébras
- Department of Internal Medicine, Jean-Monnet University, Saint-Etienne, France
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Shahid AH, Singh M. Computational intelligence techniques for medical diagnosis and prognosis: Problems and current developments. Biocybern Biomed Eng 2019. [DOI: 10.1016/j.bbe.2019.05.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Pitron V, Ranque B, Vulser H, Rotgé JY, Limosin F, Lemogne C. [Functional somatic syndromes: A comprehensive cognitive model]. Rev Med Interne 2019; 40:466-473. [PMID: 31160125 DOI: 10.1016/j.revmed.2019.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 03/25/2019] [Accepted: 04/12/2019] [Indexed: 12/16/2022]
Abstract
Functional somatic syndromes are frequent in general and specialized medicine practices. Several treatments can be useful. However, the treatment program is often hampered by patients' reluctance to acknowledge the diagnosis because of erroneous lay representations. Recent advances in cognitive science offer a new understanding of the pathophysiology of functional somatic disorders, making this diagnosis more acceptable for patients and caregivers. Simply explained with practical examples, the Bayesian model in particular provides some insights into the underlying cognitive mechanisms of functional somatic syndromes and their treatments. Advantages of this approach are twofold: it is consistent with current scientific knowledge and it can facilitate the physician-patient relationship.
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Affiliation(s)
- V Pitron
- UMR 8129, ENS/EHESS/CNRS, IEC, PSL, Instit Jean-Nicod, 29, rue d'Ulm, 75005 Paris, France; Service de psychiatrie et d'addictologie de l'adulte et du sujet âgé, hôpitaux universitaires Paris Ouest, AP-HP, 20, rue Leblanc, 75015 Paris, France.
| | - B Ranque
- Service de médecine interne, hôpitaux universitaires Paris Ouest, AP-HP, 20, rue Leblanc, 75015 Paris, France; Faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, 12, rue de l'École de médecine, 75005 Paris, France
| | - H Vulser
- Service de psychiatrie et d'addictologie de l'adulte et du sujet âgé, hôpitaux universitaires Paris Ouest, AP-HP, 20, rue Leblanc, 75015 Paris, France; Faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, 12, rue de l'École de médecine, 75005 Paris, France
| | - J Y Rotgé
- Service de psychiatrie d'adultes, groupe hospitalier Pitié-Salpêtrière, AP-HP, 75013 Paris, France; Équipe neurosciences sociales et affectives, ICM CRICM, CNRS UMR 7225, Inserm S 1127, institut du cerveau et de la moelle épinière, 75013 Paris, France; Sorbonne université, 75006 Paris, France
| | - F Limosin
- Service de psychiatrie et d'addictologie de l'adulte et du sujet âgé, hôpitaux universitaires Paris Ouest, AP-HP, 20, rue Leblanc, 75015 Paris, France; Faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, 12, rue de l'École de médecine, 75005 Paris, France; Inserm U894, centre psychiatrie et neuroscience, 102-108, rue de la Santé, 75014 Paris, France
| | - C Lemogne
- Service de psychiatrie et d'addictologie de l'adulte et du sujet âgé, hôpitaux universitaires Paris Ouest, AP-HP, 20, rue Leblanc, 75015 Paris, France; Faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, 12, rue de l'École de médecine, 75005 Paris, France; Inserm U894, centre psychiatrie et neuroscience, 102-108, rue de la Santé, 75014 Paris, France
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Savall A, Dieudonné M, De Lazzari M, Hassam R, Cathébras P. [One or more functional somatic syndromes? Comparison of the health status of fibromyalgia and electro-hypersensitive people]. Rev Med Interne 2019; 40:645-653. [PMID: 30885414 DOI: 10.1016/j.revmed.2019.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/01/2019] [Accepted: 02/24/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Functional somatic syndromes, grouping somatic symptoms without an organic explanation, are defined either by their predominant symptoms or by an attribution to an, often hypothetical, cause. Due to many similarities, some authors consider that there is only one FSS due to a general phenomenon of "somatization". The objective of this work was to compare two functional somatic syndromes, one defined by its symptoms, fibromyalgia, and the other by a specific contested attribution, electro-hypersensitivity. METHOD Fibromyalgia or electro-hypersensitive participants (EHS) were recruited from September 2016 to April 2017 through associations of patients in Auvergne-Rhône-Alpes. Home interviews included the collection of medical, psychopathological, and symptom histories. The assessment of psychological distress, quality of life and the search for other functional somatic syndromes was performed through structured questionnaires, self-administrated scales, and clinical examination. RESULTS Sixteen fibromyalgia subjects and sixteen EHS subjects were included. There are differences in symptomatology, although many symptoms are common to both conditions. Lifetime history of psychiatric disorders and current psychological distress and psychopathology are frequent in both groups but more prevalent in fibromyalgia subjects. The experience of the symptoms, their interpretation, the diagnostic itineraries and the therapeutic behaviours differ radically according to the group, even if for all socio-professional impact is high and quality of life are altered. CONCLUSION The health status of fibromyalgia persons is overall worse than the health status of electro-hypersensitive individuals in this small sample. Despite the overlap in symptoms and a similar impact on daily functioning, this exploratory study suggests that heterogeneous mechanisms of "somatization" may be at stake in functional somatic syndromes.
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Affiliation(s)
- A Savall
- Faculté de médecine Jacques-Lisfranc, département de médecine générale de Saint-Étienne, université Jean-Monnet Saint-Etienne, 10, rue de la Marandière, 42270 Saint-Priest-en-Jarez, France.
| | | | - M De Lazzari
- Faculté de médecine Jacques-Lisfranc, département de médecine générale de Saint-Étienne, université Jean-Monnet Saint-Etienne, 10, rue de la Marandière, 42270 Saint-Priest-en-Jarez, France
| | - R Hassam
- Faculté de médecine Jacques-Lisfranc, département de médecine générale de Saint-Étienne, université Jean-Monnet Saint-Etienne, 10, rue de la Marandière, 42270 Saint-Priest-en-Jarez, France
| | - P Cathébras
- Service de médecine interne, CHU de Saint-Étienne, hôpital Nord, 42270 Saint-Priest-en-Jarez, France
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Forestier E, Gonnet F, Revil-Signorat A, Zipper AC. [Pathway to diagnosis and real-life experience of patients believing they are affected by "chronic Lyme disease"]. Rev Med Interne 2018; 39:912-917. [PMID: 29706237 DOI: 10.1016/j.revmed.2018.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 03/29/2018] [Accepted: 04/03/2018] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Chronic Lyme disease is a subject of scientific and social controversy in both Europe and the United States. The aim of our study was to analyze the pathway to diagnosis of patients believing they were affected by the disease, and to describe their real-life experience. METHOD A qualitative study was performed with 13 patients declaring themselves to be affected by chronic Lyme disease. Interviews were analyzed by 2 general medical practice interns, supervised by a general practitioner with a diploma in socio-anthropology and an infectious diseases specialist. RESULTS Internet and other media played a major role in informing the patients or their doctor about the existence and the characteristics of chronic Lyme disease. The diagnosis was confirmed by features considered objective (chronic infection by Borrelia, tick bite, positive serology, beneficial or worsening effects of antibiotics). The long medical diagnosis and treatment process of those interviewed was marked by a conflicted relationship with the medical profession, caused by a feeling of non-recognition and abandonment. They reported their experience as being very painful, both because of the physical pain and also the psychological consequences of their condition. CONCLUSION Improving the diagnosis and therapeutic management of patients believing themselves to be affected by chronic Lyme disease appears highly necessary both to limit their search for diagnosis and their experience of pain. It could be based on existing guidelines concerning medically unexplained symptoms to which the chronic Lyme disease issue appears quite similar on several points.
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Affiliation(s)
- E Forestier
- Service de maladies infectieuses, centre hospitalier métropole Savoie, BP 31125, 73011 Chambéry cedex, France.
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Cathébras P. La perspective de la médecine centrée sur la personne : une condition nécessaire pour apporter une réponse adéquate aux syndromes somatiques fonctionnels. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.03.340] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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