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Roussin A, Cissé Z, Rousseau V, Roche G, Lestrade C, Cauchie A, Delage N, Donnet A, Van Obberghen E, Wood C, Lapeyre-Mestre M, Cantagrel N. Discordance between pain specialists and patients on the perception of dependence on pain medication: A multi-centre cross-sectional study. Therapie 2024:S0040-5957(24)00043-X. [PMID: 38653623 DOI: 10.1016/j.therap.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 11/10/2023] [Accepted: 01/11/2024] [Indexed: 04/25/2024]
Abstract
AIM Patients with chronic non-cancer pain are referred to pain centres to improve their pain treatment. The discontinuation of pain medications in case of poor efficacy can be difficult to accept for patients, particularly opioid analgesics. Previous research has described that from the patients' perspective, the psychological relief of a negative effect of chronic pain and withdrawal symptoms of prescription opioids represent drivers of persistent use and first stage of opioid use disorder, despite insufficient pain relief. There is no validated tool to investigate this psychological dependence. This study aimed to assess discordance between patients and pain specialists in their perception of dependence on pain medication and investigate associations with characteristics of patients, type of pain and iatrogenic pharmacodependence. METHODS Self-administered questionnaires (patients and physicians) were administered in six pain centres in France. A question on perceived dependence on pain medications was addressed to the patient and the physician in a matched pair. Discordance between them was evaluated by the Cohen kappa coefficient. Demographics, pain, anxiety and depression, pain medication withdrawal symptoms, diverted use, and craving represented variables studied in a multivariate model as potentially associated with patient-physician discordance. RESULTS According to the 212 pairs of completed questionnaires, a perceived dependence was reported by the majority of patients (65.6%) and physicians (68.4%). However, the concordance was fair (kappa=0.38; CI [95%]: 0.25-0.51). Almost all patients (89.3%) were treated with an opioid analgesic. A higher likelihood of discordance was observed when patients suffered from nociplastic pain (odds ratio [OR]: 2.72, 95% [CI]: 1.29-5.84). CONCLUSION Medical shared-decision for changing pain treatment could be improved by taking into account the perception of patient dependence on medications for pain relief and or psychoactive effects, particularly in nociplastic pain for which the treatment is challenging.
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Affiliation(s)
- Anne Roussin
- Pharmacologie en population cohortes et biobanques, centre d'investigation clinique 1436, Toulouse University Hospital, 31059 Toulouse, France; Département de pharmacologie clinique et médicale, centre d'addictovigilance, Toulouse University Hospital, 31000 Toulouse, France.
| | - Zénab Cissé
- Pharmacologie en population cohortes et biobanques, centre d'investigation clinique 1436, Toulouse University Hospital, 31059 Toulouse, France
| | - Vanessa Rousseau
- Pharmacologie en population cohortes et biobanques, centre d'investigation clinique 1436, Toulouse University Hospital, 31059 Toulouse, France
| | - Guillaume Roche
- Département de pharmacologie clinique et médicale, centre d'addictovigilance, Toulouse University Hospital, 31000 Toulouse, France
| | - Cécile Lestrade
- Centre d'évaluation et de traitement de la douleur, Toulouse University Hospital, 31059 Toulouse, France
| | - Alexandre Cauchie
- Centre d'évaluation et de traitement de la douleur, pôle neurosciences cliniques, Bordeaux University Hospital, 33000 Bordeaux, France
| | - Noémie Delage
- Centre d'évaluation et de traitement de la douleur, Clermont-Ferrand University Hospital, 63000 Clermont-Ferrand, France
| | - Anne Donnet
- Centre d'évaluation et de traitement de la douleur, Timone Hospital, 13005 Marseille, France
| | - Elise Van Obberghen
- Pain Department, CHU de Nice, France - FHU InovPain, université Côte d'Azur, 06000 Nice, France; Department of Pharmacology and Toxicology, PharmacoVigilance Centre, University of Nice Medical Centre, 06000 Nice, France
| | - Chantal Wood
- Centre d'évaluation et de traitement de la douleur, Limoges University Hospital, 87042 Limoges, France
| | - Maryse Lapeyre-Mestre
- Pharmacologie en population cohortes et biobanques, centre d'investigation clinique 1436, Toulouse University Hospital, 31059 Toulouse, France; Département de pharmacologie clinique et médicale, centre d'addictovigilance, Toulouse University Hospital, 31000 Toulouse, France
| | - Nathalie Cantagrel
- Centre d'évaluation et de traitement de la douleur, Toulouse University Hospital, 31059 Toulouse, France
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Elyn A, Roussin A, Lestrade C, Franchitto N, Jullian B, Cantagrel N. Low-dose ketamine infusion to facilitate opioid tapering in chronic non-cancer pain with opioid-use disorder: a historical cohort study. Reg Anesth Pain Med 2024:rapm-2023-105035. [PMID: 38499357 DOI: 10.1136/rapm-2023-105035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 03/04/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Long-term opioid use is associated with pharmacological tolerance, a risk of misuse and hyperalgesia in patients with chronic pain (CP). Tapering is challenging in this context, particularly with comorbid opioid-use disorder (OUD). The antihyperalgesic effect of ketamine, through N-methyl-D-aspartate (NMDA) antagonism, could be useful. We aimed to describe the changes in the dose of opioids consumed over 1 year after a 5-day hospitalisation with ketamine infusion for CP patients with OUD. METHODS We performed a historical cohort study using a medical chart from 1 January 2014 to 31 December 2019. Patients were long-term opioid users with OUD and CP, followed by the Pain Center of the University Hospital of Toulouse, for which outpatient progressive tapering failed. Ketamine was administered at a low dose to initiate tapering during a 5-day hospitalisation. RESULTS 59 patients were included, with 64% of them female and a mean age of 48±10 years old. The most frequent CP aetiologies were back pain (53%) and fibromyalgia (17%). The baseline opioid daily dose was 207 mg (±128) morphine milligram equivalent (MME). It was lowered to 92±72 mg MME at discharge (p<0.001), 99±77 mg at 3 months (p<0.001) and 103±106 mg at 12 months. More than 50% tapering was achieved immediately for 40 patients (68%), with immediate cessation for seven patients (12%). 17 patients were lost to follow-up. CONCLUSIONS A 5-day hospitalisation with a low-dose ketamine infusion appeared useful to facilitate opioid tapering in long-term opioid users with CP and OUD. Ketamine was well tolerated, and patients did not present significant withdrawal symptoms. Prospective and comparative studies are needed to confirm our findings.
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Affiliation(s)
- Antoine Elyn
- Chronic Pain Center, University Hospital of Toulouse, Toulouse, France
- General and Family Medicine University Department, University of Toulouse III - Paul Sabatier, Toulouse, France
- RECaP F-CRIN - Réseau national de Recherche en Épidémiologie Clinique et en Santé Publique, Inserm, Toulouse, France
| | - Anne Roussin
- Clinical Pharmacology, University Hospital of Toulouse, Toulouse, France
- INSERM UMR1295, Pharmaco-épidémiologie, University of Toulouse III - Paul Sabatier, Toulouse, France
- University of Medicine, University of Toulouse III - Paul Sabatier, Toulouse, France
| | - Cécile Lestrade
- Chronic Pain Center, University Hospital of Toulouse, Toulouse, France
| | - Nicolas Franchitto
- University of Medicine, University of Toulouse III - Paul Sabatier, Toulouse, France
- Clinical Addictology Center, University Hospital of Toulouse, Toulouse, France
- INSERM UMR1295, EQUITY "Embodiment, social inequalities, lifecourse epidemiology, cancer and chronic diseases, interventions, methodology", University of Toulouse III - Paul Sabatier, Toulouse, France
| | - Bénédicte Jullian
- Clinical Addictology Center, University Hospital of Toulouse, Toulouse, France
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Kerckhove N, Delage N, Cambier S, Cantagrel N, Serra E, Marcaillou F, Maindet C, Picard P, Martiné G, Deleens R, Trouvin AP, Fourel L, Espagne-Dubreuilh G, Douay L, Foulon S, Dufraisse B, Gov C, Viel E, Jedryka F, Pouplin S, Lestrade C, Combe E, Perrot S, Perocheau D, De Brisson V, Vergne-Salle P, Mertens P, Pereira B, Djiberou Mahamadou AJ, Antoine V, Corteval A, Eschalier A, Dualé C, Attal N, Authier N. eDOL mHealth App and Web Platform for Self-monitoring and Medical Follow-up of Patients With Chronic Pain: Observational Feasibility Study. JMIR Form Res 2022; 6:e30052. [PMID: 35234654 PMCID: PMC8928045 DOI: 10.2196/30052] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/14/2021] [Accepted: 11/29/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Chronic pain affects approximately 30% of the general population, severely degrades quality of life (especially in older adults) and professional life (inability or reduction in the ability to work and loss of employment), and leads to billions in additional health care costs. Moreover, available painkillers are old, with limited efficacy and can cause significant adverse effects. Thus, there is a need for innovation in the management of chronic pain. Better characterization of patients could help to identify the predictors of successful treatments, and thus, guide physicians in the initial choice of treatment and in the follow-up of their patients. Nevertheless, current assessments of patients with chronic pain provide only fragmentary data on painful daily experiences. Real-life monitoring of subjective and objective markers of chronic pain using mobile health (mHealth) programs can address this issue. OBJECTIVE We hypothesized that regular patient self-monitoring using an mHealth app would lead physicians to obtain deeper understanding and new insight into patients with chronic pain and that, for patients, regular self-monitoring using an mHealth app would play a positive therapeutic role and improve adherence to treatment. We aimed to evaluate the feasibility and acceptability of a new mHealth app called eDOL. METHODS We conducted an observational study to assess the feasibility and acceptability of the eDOL tool. Patients completed several questionnaires using the tool over a period of 2 weeks and repeated assessments weekly over a period of 3 months. Physicians saw their patients at a follow-up visit that took place at least 3 months after the inclusion visit. A composite criterion of the acceptability and feasibility of the eDOL tool was calculated after the completion of study using satisfaction surveys from both patients and physicians. RESULTS Data from 105 patients (of 133 who were included) were analyzed. The rate of adherence was 61.9% (65/105) after 3 months. The median acceptability score was 7 (out of 10) for both patients and physicians. There was a high rate of completion of the baseline questionnaires and assessments (mean 89.3%), and a low rate of completion of the follow-up questionnaires and assessments (63.8% (67/105) and 61.9% (65/105) respectively). We were also able to characterize subgroups of patients and determine a profile of those who adhered to eDOL. We obtained 4 clusters that differ from each other in their biopsychosocial characteristics. Cluster 4 corresponds to patients with more disabling chronic pain (daily impact and comorbidities) and vice versa for cluster 1. CONCLUSIONS This work demonstrates that eDOL is highly feasible and acceptable for both patients with chronic pain and their physicians. It also shows that such a tool can integrate many parameters to ensure the detailed characterization of patients for future research works and pain management. TRIAL REGISTRATION ClinicalTrial.gov NCT03931694; http://clinicaltrials.gov/ct2/show/NCT03931694.
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Affiliation(s)
- Nicolas Kerckhove
- Service de Pharmacologie médicale, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Noémie Delage
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Sébastien Cambier
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Nathalie Cantagrel
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Eric Serra
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire d'Amiens, Amiens, France
| | - Fabienne Marcaillou
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Caroline Maindet
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | - Pascale Picard
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Gaelle Martiné
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - Rodrigue Deleens
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Rouen, Rouen, France
| | - Anne-Priscille Trouvin
- Centre d'évaluation et de traitement de la douleur, Assistance Publique-Hôpitaux de Paris Cochin, Paris, France
| | - Lauriane Fourel
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Régional de Bayeux, Bayeux, France
| | - Gaelle Espagne-Dubreuilh
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - Ludovic Douay
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire d'Amiens, Amiens, France
| | - Stéphane Foulon
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire d'Amiens, Amiens, France
| | - Bénédicte Dufraisse
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - Christian Gov
- Centre d'évaluation et de traitement de la douleur, Hospices Civils de Lyon Pierre Wertheimer, Lyon, France
| | - Eric Viel
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Nîmes, Nîmes, France
| | - François Jedryka
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Nîmes, Nîmes, France
| | - Sophie Pouplin
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Rouen, Rouen, France
| | - Cécile Lestrade
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Emmanuel Combe
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Serge Perrot
- Centre d'évaluation et de traitement de la douleur, Assistance Publique-Hôpitaux de Paris Cochin, Paris, France
| | - Dominique Perocheau
- Centre d'évaluation et de traitement de la douleur, Assistance Publique-Hôpitaux de Paris Cochin, Paris, France
| | - Valentine De Brisson
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Régional de Bayeux, Bayeux, France
| | - Pascale Vergne-Salle
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - Patrick Mertens
- Centre d'évaluation et de traitement de la douleur, Hospices Civils de Lyon Pierre Wertheimer, Lyon, France
| | - Bruno Pereira
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Violaine Antoine
- Laboratoire d'Informatique, de Modélisation et d'Optimisation des Systèmes, Université Clermont Auvergne, Aubière, France
| | | | | | - Christian Dualé
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Nadine Attal
- Institut National de la Santé et de la Recherche Médicale, Unité 987 - Centre d'évaluation et de traitement de la douleur, Assistance Publique-Hôpitaux de Paris Ambroise Paré, Paris, France
| | - Nicolas Authier
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
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Ingster-Moati I, Crochet M, Manchon E, Anquetil D, Lestrade C, Jacob A, Le Brun D, Albuisson E. Surveillance ophtalmologique des patients sous APS au long cours : analyse d’une population de 925 patients. J Fr Ophtalmol 2004; 27:367-73. [PMID: 15173643 DOI: 10.1016/s0181-5512(04)96142-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim of this 4-Year study was to analyze the population referred to our laboratory for the visual follow-up of hydroxychloroquine or chloroquine treatment. MATERIAL AND METHODS We received 925 patients: 78% female, 22% male. For each patient, a 13-item criteria was filled out and regular exams were performed. The pathologies were divided in to 4 groups: rheumatoid polyarthritis (P), lupus (L), sarcoidosis (S), others (O). RESULTS The pathologies were distributed as follows: 48% "P", 29% "L", 3% "S", 1% "P + L", 19% "O". Of these patients, 19% had less than 1 Year of treatment, 73% 1-10 Years and 8% more than 10 Years. The screening exposed no retinal intoxications but 3% presented pre-clinical intoxication (PCI) and 80% were allowed to continue their treatment. The most important statistical results were: 1) a significant relation between the PCI and the duration of the treatment (p<0.001); 2) a non-significant relation between the PCI and the daily dose (p=0.417); and 3) a significant relation between PCI and the cumulative dose (p=0.003). CONCLUSION The results shows the advantage of the ERG in screening to prevent anti-malarial retinal toxicity. This study confirms that the cumulative dose seems to be more important than the daily dose, but we agree with the international consensus to respect a daily dose under 6.5 mg/kg/d. The results also demonstrated that, with this large and diversified population, there is a need for prospective and multi-centric studies. With the above results, international standards should be established in order to obtain the most efficient screening for each category of patient.
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Affiliation(s)
- I Ingster-Moati
- Service de Biophysique, Hôpital Lariboisière, Université Paris 7, INSERM-U483, Paris.
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Suc A, Mariotti M, Lestrade C, Kern D, Izard P, Marmet T, Vignes M, Raynaud JP. [Children also die]. Arch Pediatr 2001; 8:751-3. [PMID: 11484460 DOI: 10.1016/s0929-693x(00)90311-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Palliative care has recently been developed in adults. However, children die as well and quite a few articles have been published on this special issue. The object of this article is to summarize the available literature in order to call for the development of clinical policies and minimum standards adapted to French pediatrics.
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Affiliation(s)
- A Suc
- Hôpital des Enfants, 330, avenue de Grande-Bretagne, BP 3119, 31026 Toulouse, France.
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Ingster-Moati I, Rigaudiere F, Choltus-De Petigny MC, Bremond-Gignac D, Lestrade C, Grall Y. [Functional visual explorations of Bardet-Biedl syndrome. A study of three cases]. J Fr Ophtalmol 2000; 23:802-8. [PMID: 11033503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Laurence-Moon syndrome, which is very rare, and Bardet-Biedl syndrome, which is more frequent are now well-recognized as two distinct entities in pediatric neurology. Bardet-Biedl syndrome includes a number of common clinical signs it shares with Laurence-Moon syndrome but also with other syndromes, particularly Alströme syndrome. These signs are retinitis pigmentosa, mental retardation, obesity, and hypogonadism. Ophthalmological and electrophysiological examinations are essential for confirmation and correct diagnosis of Bardet-Biedl syndrome. We present three case histories. Our third case illustrates the possibility of below normal yet discernable electroretinogram amplitudes which do not infirm the diagnosis of Bardet-Biedl syndrome.
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Affiliation(s)
- I Ingster-Moati
- Service Central de Biophysique et de Médecine Nucléaire, Explorations fonctionnelles visuelles, Hôpital Lariboisière, 2, rue A. Paré, 75010 Paris
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Lestrade C. [The war of the gasses: observations at witness of Dr. Voivenel during the conflict, 1914-1918]. Hist Sci Med 2000; 34:23-8. [PMID: 11625631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Dr Voivenel was an exceptional witness of the First World War in fact of his regular attendance on the battle front close to soldiers. Through his duty, he brought great contributions to psychiatry and fighting gas pathology. We are proposing to pick that second subject out of his book: La Guerre des Gaz", published in 1919, a true and present-day chemical war study.
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