Fight Against Pain: “Stop Talking To Patients, It’s In Your Head”Malik Qasir
Serge Perrot, rheumatologist, is in charge of the pain treatment center at the Cochin hospital (AP-HP) in Paris and author of “La Pain, J’en Sors” (Ed In Press). On this World Pain Day, the professor notes that there is still much progress to be made in this area.
You refuse the term “unexplained pain”. Why ?
SERGE PERROT. Because it’s wrong! We cannot say that they are unexplained. For a long time, we recognized only the pain known as “nociceptive”, responsible for inflammations such as polyarthritis, of diseases such as cancer. Having pain was necessarily a sign of a problem. Then, twenty years ago, we realized that there could be unnecessary pain. For example, a woman with breast cancer continued to suffer. It was said, it is not possible, it is still cured. But during the operation, he cut his nerves, his electrical pain circuit was damaged. This is the category of “neuropathic”. We had to fight to get it accepted. And today, a third classification called “nociplastic” has just been recognized, that of a pain functioning disorder. In some people, this system is less effective than loose car brakes. Therefore, they have diffuse pain for no reason. This is the case of
fibromyalgia, irritable bowel syndrome. To say that they are unexplained is to practice traditional medicine.
Is this new form of pain known to doctors?
We still have difficulties. In medicine, we like markers: MRI, X-rays, finding the causes. But you have to train the doctors. A few days ago, I explained to 500 of them, at the Bichat Interviews, that it was not necessary to talk about unexplained pain, imaginary illnesses, that there was an explanation. They were very interested and receptive. Over the past decade, medical schools have finally delivered 20 hours of pain education. It is not huge but better than nothing. There are also nearly 250 centers specializing in this area in France. It is a real step forward.
Is pain no longer the poor relation of medicine, as has often been said?
Much remains to be done. Many pain treatment centers will disappear for lack of resources in hospitals. In case of financial difficulties, we will not remove an anesthesia or rheumatology service, but the first objective is ours! My colleagues sometimes tell me that it is not a specialty, everyone takes care of the pain. It’s wrong. We are here to diagnose rare and little known diseases. There are still patients who tell me “they told me that I had nothing, it was in my head” while they suffer from low back pain, tendonitis, headache. I answer them: it is in your head of course, it is the brain but it is not psychological. There is a pain dysfunction and I explain to them that we will try to adjust the thermostat again.
Are there no psychological factors?
Depression can be the cause of these symptoms. In this case, I refer them to a psychiatrist but I do not deny their suffering. It is real. In France, we are a Catholic country, the pain is redemptive, it promises a little corner of paradise. Whoever is mistaken is a slacker. You have to get rid of this design. It hurts the sick. They ask to be recognized.
Should we better treat the pain that was said to be unexplained today?
Yes. The mechanisms of algodystrophy, a complex regional pain syndrome, are better understood. Previously, we put a bandage on the patient, telling him in particular not to move. It was the worst thing. On the contrary, they must activate. Fibromyalgia is also better known. The pain pathways can be disrupted by hormonal changes in postmenopausal women or abrupt withdrawal from sport in young people. We use hypnosis, exercise, balneotherapy and drugs to treat them. We must stop denying the pain of patients. Stop telling them, it’s in your head!