ABSTRACT: Les céphalées induites par abus médicamenteux sont des céphalées chroniques invalidantes qui sont dues à la surconsommation
de tous les traitements symptomatiques anti-migraineux et qui se surajoutent à la céphalée originelle. Des facteurs psychosociaux
interviennent généralement. La prise en charge est multimodale, mais la seule et indispensable solution curative unanimement
admise est le sevrage des médicaments incriminés. L’objectif de cet article est d’analyser dans notre cohorte de 43 patients
les caractéristiques de leurs céphalées et de leur abus médicamenteux, mais aussi d’évaluer d’une part l’efficacité du sevrage
qu’ils ont effectué et d’autre part, données tout à fait originales, le vécu au décours de ce sevrage et le réajustement de
leur mode de vie.
The daily headaches result from the chronic overuse of analgesic and specific antimigrain drugs (ergotamine triptan). Psychosocial
factors may largely explained. The withdrawal of analgesic drugs as well as multimodality approach are indispensable treatment.
This article analyze a cohort of 43 patient. We review the clinical features of headache, analgesic overuse, the rate of successful
and conditions of withdrawal, the regular follow up, educational and coping aspects.
Douleur et Analgésie 04/2012; 15(3):115-124. · 0.05 Impact Factor
ABSTRACT: Cette étude propose une analyse de la qualité de vie de patients migraineux à l’aide du questionnaire «Profil de la Qualité
de Vie Subjective» (PQVS) déjà validé auprès de nombreuses populations en bonne santé ou porteuses d’affections somatiques
et psychiatriques (13 000 sujets). Cette étude transversale concerne 110 patients consultant dans des Centres hospitaliers
spécialisés. Le questionnaire présente dans cette population des propriétés psychométriques satisfaisantes. Il paraît apte
à différencier divers états de gravité de la migraine, et objective une relation claire entre la fréquence des crises et l’altération
de la qualité de vie. Si la qualité de vie des patients migraineux apparaît moins bonne que celle de sujets tout venant, en
revanche elle est nettement meilleure que celle de patients présentant des pathologies graves (cancer), psychiatriques, ou
encore que celle de patients présentant des lombalgies chroniques.
Cet instrument devrait donc être utile pour suivre l’évolution de ces patients.
110 Patients suffering from chronic headaches, and consulting in specialized hospital centers were studied with the questionnaire
«Subjective Quality of Life Profile» (SQLP). This questionnaire has already been validated among 13 000 subjects either in
good health or suffering from various somatic or psychiatric diseases. Results relative to the psychometric properties of
the questionnaire in the migraine population are satisfactory. The questionnaire is able to differentiate headeaches with
different severity. It also appears that the frequency of the crisis is negatively correlated with patients quality of life.
Migraine patients’ quality of life appears less satisfactory than the healthy subjects’ one. However, Migraine patients have
a much better quality of life than patients with very severe diseases (cancers), or psychiatric diseases, or chronic back
pain. This questionnaire should be usefull to study Migraine Patients outcome.
Douleur et Analgésie 04/2012; 15(3):147-153. · 0.05 Impact Factor
ABSTRACT: Les douleurs neuropathiques de la face, d’origine iatrogène (chirurgie, traitement odontologique, radiothérapie etc) sont
assez mal connues et sous-estimées. La symptomatologie clinique est parfois complexe, les signes neuropathiques sont souvent
associés a des signes sympathiques ou musculaires, expliquant les diagnostics difficiles et les confusions avec d’autres algies
de la face. Les spécificités neurophysiologiques de l’innervation trigémino-sympathique l’expliquent en partie. Toutes les
spécialités médico-chirurgicales sont impliquées. Les différents tableaux cliniques, les examens paracliniques aidant le diagnostic,
ainsi que certaines propositions thérapeutiques, sont passés en revue.
The incidence of post chirurgical and post radiotherapic neuropathic pain is unknowed. Clinical diagnosis is difficult with
idiopathic neuropathic pain and neurovascular facial pain. The neuropathic symptoms are associated with para sympathetic reflex,
musculoskeletal disorders or rhinosinusitis disease.
We review, the specific trigemino vascular and sympathetic mechanisms of the facial pain, clinical pain features of each specialist
surgery, diagnostic tools (endoscopy, CT, anesthetic local test..), and specific treatment.
Douleur et Analgésie 04/2012; 15(3):137-145. · 0.05 Impact Factor
ABSTRACT: Medication-overuse headache (MOH) management usually includes a medication withdrawal. The choice of withdrawal modalities remains a matter of debate.
We compared the efficacy of in-patient versus out-patient withdrawal programmes in 82 consecutive patients with MOH in an open-label prospective randomized trial. The main outcome measure was the reduction in number of headache days after 2 months and after 2 years. The responders were defined as patients who had reverted to episodic headaches and to an intake of acute treatments for headache less than 10 days per month.
Seventy-one patients had a complete drug withdrawal (n = 36 in the out-patient group; n = 35 in the in-patient group). The reduction of headache frequency and subjective improvement did not differ between groups. The long-term responder rate was similar in the out- and in- patient groups (44% and 44%; p = 0.810). The only predictive factor of a bad outcome 2 years after withdrawal was an initial consumption of more than 150 units of acute treatments for headache per month (OR = 3.1; 95% confidence interval 1.1-9.3; p = 0.044).
Given that we did not observe any difference in efficacy between the in- and out-patient withdrawals, we would recommend out-patient withdrawal in the first instance for patients with uncomplicated MOH.
Cephalalgia 06/2011; 31(11):1189-98. · 3.43 Impact Factor
ABSTRACT: PURPOSE: Facial pain is a frequently encountered symptom in general medical practice and encompass a wide group of facial problems. As correct diagnosis can usually be reached by history and physical examination for well defined typical clinical entities (trigeminal neuralgia, cluster headache) atypical facial pain may have many other potential causes (sinuses infection, temporomandibular joint syndrome, dental disorders...) so that diagnosis not appear an easy task. CURRENT KNOWLEDGE AND KEYPOINTS: Anatomical and physiological organization of facial nociceptive system, particularly trigeminal system, may explain the variability of facial pain. Although symptoms have been clearly identified mechanism of pain production remains controversial. Several factors (psychological, neurological, endocrine...) and mechanisms (neuropathic, vascular, myoarticular) may coexist and explain trouble in diagnosing and treating facial pain. FUTURE PROSPECTS AND PROJECTS: Better knowledge in identifying the cause of facial pain may lead to improve patient care and avoid patient frustration, medical nomadism, repetitive dental and otolaryngologic procedures, and finally non-compliance with treatment.
La Revue de Médecine Interne 10/2005; 26(9):703-16. · 0.61 Impact Factor
ABSTRACT: To evaluate the quality of life of patients treated in a pain center.
Sixty eight patients were assessed during their first consultation, then 6, 12 and 18 months later, using a quality of life questionnaire "SQVP or Subjective Quality of Life Profile" validated in French populations and a panel of questionnaires for the monitoring of chronic pain, recommended by the ANAES (French Agency for Health Assessment).
Results showed that: the patients' quality of life was clearly deteriorated (lowest quality in the data base--14,000 patients--with regard to the SQVP); the profile obtained (severe handicap) suggests that the lumbagos are part of a psychiatric context; the patients' quality of life clearly improves after 6 months' treatment, but the pain only stabilizes later.
La Presse Médicale 12/2001; 30(35):1727-32. · 0.67 Impact Factor
ABSTRACT: These daily or near-daily headaches result from the chronic overuse of all immediate relief antimigraine drugs: ergotamine, analgesics, and/or more recently triptans. Like for much chronic daily headaches, the International Headache Society diagnostic criteria for drug abuse headaches are difficult to apply. Generally, patients confuse primary headaches (usually migraines) with interparoxysmal tension-type headaches called "rebound headaches". Psychosocial factors may play a role. Insidiously, a compulsive automedication results, often in anticipation of headache. This headache syndrome resists symptomatic and prophylactic treatment. These headaches are frequent, very disabling and socioeconomically costly. They are still largely underdiagnosed. Drug-induced headaches may be restricted to those patients who are already headache sufferers. The pathogenesis is not clearly understood: it may involve a deficience of inhibitory pain modulation, a hyperactivation of nociceptive facilitatory systems, and the peripheral and central effects of the incriminating drugs. The withdrawal of all offending analgesic drugs and a multimodality approach are indispensable, but the therapeutic protocoles are actually very heterogeneous and poorly estimated. Non-drug means could be very helpful. Effective education of headache sufferers and regular follow-up are essential to avoid relapses. Prognosis factors have been evoked, but may not be significant for the long term outcome. The rate successfull of is actually estimated at 60 p. cent at five years. The benefits of an adequate management encourage early recognation of drug-induced headaches. This article has in view to take stock of the literature at the end of 1999, and to help physicians become mora aware of this problem and develp a more preventive attitude.
Revue Neurologique 11/2001; 157(10):1221-34. · 0.49 Impact Factor
ABSTRACT: It would be simplistic to consider the reality of pain as nothing more than heightened sensitivity to the pain. There are actually five types of pain, and it is often difficult to distinguish between them. Whereas hypernociceptive pain is mainly treated with analgesics belonging to one of the three categories as defined by the WHO, the mechanisms and treatment of the other four types of pain are very different It is obvious that close co-operation between the various healthcare professionals is indispensable in the treatment of these patients, while keeping in mind that the physician is "a symbol, an intermediary, a medicine that's better than medicine: the medicine works because it's a symbol - it's a symbol because it works". (P. Queneau and G. Ostermann.)
Annales Pharmaceutiques Françaises 04/2000; 58(2):112-20.
ABSTRACT: Studying midazolam-induced amnesia offers an interesting approach to the organization of normal memory processes, since memory performance can be studied in the same subject in "on" and "off" drug conditions.
The present study investigated the effect of midazolam on skill learning. The task and the experimental design we used also allowed us to assess the effect of midazolam on priming and explicit memory.
Eighteen patients who underwent minor ear surgery and who were anaesthetized with intravenous midazolam, and 18 matched control subjects participated in a mirror reading task on 2 separate days. Patients were tested under midazolam on day 1 and without any medication on day 2. The mirror reading task was made of French words, some of which repeated across trial blocks, others being new.
Patients under midazolam read new mirror written words faster with practice, which attested for intact skill learning. Moreover, they read repeated words faster than new words with practice, which was interpreted as reflecting intact priming abilities. These spared implicit memory capacities were observed along with severe explicit memory impairments. Learning for both new and repeated mirror written words on day 2 was similar in patients and in controls, which was interpreted as suggesting that the implicit learning that occurred on day 1 under midazolam was normal.
The quality of skill learning, both in terms of speed of and lasting effect, was normal under midazolam in the task we used. In the context of the present task, midazolam offers an interesting, reversible model of amnesia.
Psychopharmacologia 08/1999; 145(2):139-43. · 4.08 Impact Factor