Fight against pain: “Stop talking to patients, it’s in your head”

On this World Day Against Pain, Professor Serge Perrot, rheumatologist at the Cochin Hospital in Paris, refuses the term “unexplained pain”.

Fight against pain:
Fight against pain:

Serge Perrot, rheumatologist, is in charge of the pain center of the Cochin hospital (AP-HP) in Paris and author of “The pain, I get out of it” (Ed In Press). On this world day of struggle against pain, the professor notes that there is still huge progress to be made in this area.

You refuse the term “unexplained pain”. Why ?

SERGE PERROT.Because it’s wrong! We can not say that they are unexplained. For a long time, we have only recognized the so-called “nociceptive” pain, responsible for inflammation such as polyarthritis, diseases such as cancer. To have 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 yet healed. But during the intervention, he had cut small nerves, his electrical circuit of pain was damaged. This is the category of “neuropathic”. We had to fight to get her accepted. And today, a third classification called “nociplastique” has just been finally recognized, that of a disturbance of the functioning of the pain. In some people, this system is less effective like car brakes that let go. As a result, they have diffuse pain for no reason. This is the case of 
fibromyalgia , irritable bowel syndrome. To say that they are unexplained is to do old-fashioned medicine.

Is this new form of pain known to doctors?

We still have difficulties. In medicine, we like markers: MRIs, radios, find the causes. But you have to train the doctors. A few days ago, I explained to 500 of them at Les Entretiens de Bichat that there was no need to talk about unexplained pains, imaginary diseases, that there was an explanation. They were very interested and receptive. For the past ten years, medical schools have finally taught 20 hours of pain classes. It’s not huge but better than nothing. There are also nearly 250 centers specialized in this field in France. It’s a real step forward.

Pain is no longer the poor relation of medicine, as has often been said?

There is still a lot of progress to be made. Many centers of pain are going to disappear for lack of resources in hospitals. When there are financial difficulties, we will not remove anesthesia service or rheumatology but the first target is ours! Colleagues tell me sometimes, it’s not a specialty, everyone deals with pain. It’s wrong. We are here to diagnose rare and little known diseases. There are still patients who tell me “I was told that I had nothing, it was in my head” while they suffer from low back pain, tendonitis, headache. I answer them: it’s in your head of course, it’s the brain but it’s 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?

If. Depression may be the cause of these symptoms. In this case, I refer them to a psychiatrist but I do not deny their suffering. She is real. In France, we are a Catholic country, the pain is redemptive, it promises a little piece of paradise. Whoever goes wrong is a slacker. You have to get rid of this design. It makes the sick suffer. They ask to be recognized.

Do we better treat pain that was said to be unexplained today?

Yes. The mechanisms of algodystrophy, a complex regional pain syndrome, are better understood. Before, we put a plaster to the patient, especially telling him not to move. It was the worst thing. On the contrary, they must activate. Fibromyalgia is also better known. The pathways of pain may be disrupted by hormonal variation in women with menopause or abrupt cessation of sport in youth. We use hypnosis, physical exercise, balneotherapy, and medications to treat them. We must stop denying the pain of patients. Let’s stop telling them, it’s in your head!


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