Douleurs induites par les soins: épidémiologie, retentissements, facteurs prédictifs

Douleur et Analgésie (Impact Factor: 0.09). 01/2008; 21(3):126-138. DOI: 10.1007/s11724-008-0103-6

ABSTRACT En dépit d’une prise de conscience récente, les douleurs liées aux soins sont très fréquentes et sous-évaluées, en particulier
dans les populations fragiles (âges extrêmes, troubles de la conscience, de la communication…). Il est difficile, à partir
des études publiées, de définir des facteurs de risques « universels » pour ces douleurs. La mémoire d’un geste est corrélée
au pic d’intensité douloureuse ressentie au cours du geste. La mise en place de protocoles antalgiques et leur évaluation
restent insuffisantes, y compris chez l’enfant. La prévention de ces douleurs nécessite une plus grande sensibilisation des
personnels soignants et le développement de protocoles antalgiques efficaces.
Although the health sector has recently become more aware of procedural pain, it nevertheless occurs very frequently and is
still under estimated, in particular in fragile populations (extreme age, consciousness disorders or difficulties with communication).
The published studies do not help define “universal” predictive factors for such pain. It tends to be remembered as at its
peak of intensity. There is insufficient evidence concerning implementation and evaluation of analgesic protocols, including
in children. The prevention of such pain requires greater awareness on the part of nursing staff and the development of effective
analgesic protocols.

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    ABSTRACT: Clinical and laboratory investigations of neonatal pain suggest that preterm neonates have an increased sensitivity to pain and that acute painful stimuli lead to the development of prolonged periods of hyperalgesia. Non-noxious stimuli during these periods of hyperalgesia may expose preterm neonates to established or chronic pain. Acute physiologic changes caused by painful or stressful stimuli can be implicated as important factors in the causation or subsequent extension of early intraventricular hemorrhage (IVH) or the ischemic changes leading to periventricular leukomalacia (PVL). Therapeutic interventions that provide comfort/analgesia in preterm neonates were correlated with a decreased incidence of severe IVH. Long-term follow-up studies of preterm neonates may substantiate the preliminary data associating repetitive painful experiences with some of the neurobehavioral and developmental sequelae resulting from neonatal intensive care.
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    ABSTRACT: Self-destructive behavior in current society promotes a search for psychobiological factors underlying this epidemic. Perinatal brain plasticity increases the vulnerability to early adverse experiences, thus leading to abnormal development and behavior. Although several epidemiological investigations have correlated perinatal and neonatal complications with abnormal adult behavior, our understanding of the underlying mechanisms remains rudimentary. Models of early experience, such as repetitive pain, sepsis, or maternal separation in rodents and other species have noted multiple alterations in the adult brain, correlated with specific behavioral phenotypes depending on the timing and nature of the insult. The mechanisms mediating such changes in the neonatal brain have remained largely unexplored. We propose that lack of N-methyl-D-aspartate (NMDA) receptor activity from maternal separation and sensory isolation leads to increased apoptosis in multiple areas of the immature brain. On the other hand, exposure to repetitive pain may cause excessive NMDA/excitatory amino acid activation resulting in excitotoxic damage to developing neurons. These changes promote two distinct behavioral phenotypes characterized by increased anxiety, altered pain sensitivity, stress disorders, hyperactivity/attention deficit disorder, leading to impaired social skills and patterns of self-destructive behavior. The clinical important of these mechanisms lies in the prevention of early insults, effective treatment of neonatal pain and stress, and perhaps the discovery of novel therapeutic approaches that limit neuronal excitotoxicity or apoptosis.
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    ABSTRACT: The purpose of this secondary data analysis of findings from a larger procedural pain study was to examine several factors related to pain during tracheal suctioning. In addition to tracheal suctioning, other procedures studied included turning, wound drain removal, femoral catheter removal, placement of a central venous catheter, and wound dressing change. A total of 755 patients underwent the tracheal suctioning procedure that was performed primarily in intensive care units (93%). A 0-10 numeric rating scale, a behavioural observation tool, and a modified McGill Pain Questionnaire-Short Form were used for pain assessment. Pain intensity scores were significantly greater during the tracheal suctioning procedure (M=3.96, S.D.=3.3) than prior to (M=2.14, S.D.=2.8) or after (M=1.98, S.D.=2.7) tracheal suctioning. Few patients received analgesics prior to or during the procedure. Surgical, younger, and non-white patients reported higher pain intensities. Although mean pain intensity during tracheal suctioning was mild, almost the half of the patients reported moderate-to-severe pain. Individualized pain management must be performed by healthcare providers in order to respond to patients' needs as they undergo painful procedures such as tracheal suctioning.
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