Chronic pain is considered a “disease” in its own right that requires long-term treatment because it is invasive and disabling, morally and physically.

The management of chronic pain is complex because many factors are involved. It necessarily begins with a consultation with the attending physician (general practitioner) or a specialist, who directs if necessary towards a specialized consultation in a Pain Assessment and Treatment Center (CETD). As these centers are in high demand, a waiting period of 6 to 12 months is expected.

Pain treatment combines medications with physical methods (physiotherapy, etc.) and/or psycho-corporeal methods (relaxation, hypnosis, sophrology, etc.).

Pain, what is it for? It’s what ?

Pain is part of the body’s defense and protection system. When the body detects an illness, an injury or an anomaly, it triggers a signal which can become pain in order to make us react, for example removing our hand from the fire, not walking with a sprain, etc.

Pain is a complex sensation, which results in 4 inseparable components:

A physical sensation, localized in one place of the body or diffuse, more or less intense, and evolving (“it stings”, “it burns”, “it hurts very much”, “it increases”…);

An emotion (“it’s unpleasant”, “it’s worrying”, “it’s unbearable”);

A reaction behavior to pain via the body or speech (position, grimace, avoidance, crying, screams, complaint);

A mental reaction, which corresponds to our way of interpreting pain, of trying to forget it or live with it, and of anticipating it too.

The detection of a painful stimulus is done using the nervous system, in particular the nerves which are connected to receptors sensitive to pain, the nociceptors. We then speak of nociceptive pain.

However, sometimes the nervous system is damaged and no longer functions normally. It can then trigger so-called neuropathic pain, which presents a permanent background of pain and/or sudden attacks. This type of pain can become chronic.

Acute pain does not last over time: it disappears in a few hours or weeks, depending on the time needed for healing of what caused it. It is due to a specific cause, known or not: an injury, a medical examination or treatment, the side effect of a treatment, etc.

Some chronic pain is due to acute pain that is poorly relieved, others to after-effects that cannot be repaired, and still others to long-term illnesses. Among the most common chronic pains are migraine, osteoarthritis, and rheumatoid arthritis.

Chronic pain does not or no longer acts as an alarm signal. These are illnesses in their own right that require long-term treatment because they have significant consequences on quality of life: sleep, depression, disability, isolation, professional and/or family difficulties, etc.

The person who is in pain is best able to define their pain and talk about it. To measure the intensity of pain, the patient can therefore be asked to give a numerical value on a scale of 0 to 10, or to indicate it on a ruler: this is the principle of self-assessment.

When the patient cannot express himself because of his state of health or his age, for example, the caregiver evaluates the intensity of the pain with a scale that analyzes behavior: this is heteroevaluation.

There are several types of pain assessment tools: questionnaires, diagrams to complete, scales, rulers, etc. Each of them has a specific objective: to assess the intensity of the pain, to help find words to describe it, to locate the pain, to assess its consequences on daily life. These tools are very useful when you suffer from chronic pain, which is difficult to assess and therefore to treat, with the exception of intensity scales which are only useful for assessing acute pain.

Whatever the pain, only reporting it to a healthcare professional allows it to be taken care of. The first recourse is the attending physician or any other regular liberal health professional such as a nurse or pharmacist.

For the management of chronic pain, there are specialized structures within health establishments: pain consultations, or even, for the most complex cases, Pain Assessment and Treatment Centers (CETD) . These centers bring together different professionals (anesthesiologist, neurologist, psychiatrist, psychologist, rheumatologist, pain resource nurse, social worker, etc.) and use specific techniques (music therapy, hypnosis, acupuncture, etc.). Only the attending physician (general practitioner or specialist) can refer a patient to one of these centers or consultations