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The world Day against the pain, October 20, 2008, is dedicated this year to the theme "pain and cancer." The opportunity for the professionals of health to make a state of the places on the hold in charge of the cancerous pain and on the perspectives of future. The pains are frequently associated to the cancerous illness. The hold in charge of the cancerous pains improved but remains even insufficient, notably the one taking in account all pains. Some therapeutic innovations are announced but the financial and human means risk to miss to take better in charge the pains. Pain and cancer The pain frequently bound to the cancers is a problem that touches a very numerous population. In France, there are more 300 000 new cases of cancer every year and 700 000 patients are treated annually for this illness. Two to 3 millions people are concerned if one counts people in remission. The cancer is responsible for pains during his evolution: pains bound to the local, regional development or metastasique of the cancer, induced by anti-tumorous treatments or acts to diagnostic aim. He can be also responsible for pains séquellaires (pains due to the aggressive treatments against the cancer), pains that can become chronic. "A third of the patients in active phase of the treatment and more of the 2/3 of those in advanced phase suffer" indicates Dr Louis Brasseur, anesthetist in the Center René Huguenin, in Holy Cloud. The patients having some metastases have more risk to suffer. The strong pains to very strong are more frequent at patients having several types of pain.                      The 4 types of pain:  Pain by excess of nociception: pain that occurs at the time of an injury, of a lesion of cloths, of a traumatism, of an inflammation, of an infection;  Pain neuropathique: pains due to a lesion of the peripheral nerves or the central nervous system;  Psychogenic pain: psychological origin pain;  Pain idiopathique: pain explained badly.
Besides, the pain has the psychological repercussions that are also to take in account. "One now considers that the pain can have some repercussions on the survival: the people whose pain is treated better would have a survival longer" note the Dr Brewer. The pain bound to the better treated cancer A survey on the hold in charge of the pain in 20 centers of the cancer permitted to note some improvements between 1991 and 2004. "In 1991, the pain bound to the cancer was underestimated everywhere" explains the Dr Brewer, one of the authors of the survey. "In 2004, the pain is valued better, sometimes same over-valued in some establishments" it adds. The first work of 1991 showed that 25% of the patients that didn't suffer had no treatment. In 2004, all patients had a treatment. "Besides, the light pains were not treated in 1991, today them he is" announced the Dr Brewer. Of 2004 to 2008, the improvement reinforced itself. Some pumps allow the patients of himself auto to manage strong analgesics, one can implant some medicines to the level of the spinal cord or the brain, one can use the radiotherapy to fight the pain" indicates the Dr Krakowski, medical oncologist, center A. Vaudrin, in Vandoeuvre the Nancy. But "too many patients suffer again" underlines the Dr Brewer A hold in charge to improve Unfortunately, the hold in charge is unequal. In some places in France, the patients don't benefit from the treatments that they would be in right to wait, by ignorance of what can be made or because it appears complicated to put in place. But if the WHO protocol (therapeutic scale) is followed to the letter, 3/4 of the patients are relieved.                WHO protocol: therapeutic scale      To every stage (pain that intensifies) is associated a treatment Level 1: analgesics non opioïdes Level 2: opioides weak and intermediate Level 3: opioides strong Level 4: surgery of the pain
Then, the patients don't dare to speak again of their pain or don't tell their physician that the pain is not relieved by a first treatment. The patients are not aware enough. "Too many false ideas reduce the speech of the hold again in cancerous charge to the situation of life" end underlines the Dr Thierry Delorme, consultation of the pain, Institute Curie. Some nursing neglectful the pains, notably pains séquellaires. "A third of the healed patients suffer during years from pains sequellaires but no survey has been made on this topic" indicates this physician. The access paroxystiques of the pain (peaks of pain) are not relieved enough. "One is interested again too much in general therefore in the pain one gives the not necessarily "adapted treatments notes the Dr Brewer. "However, the pains are different according to the mechanism" underlines the Dr Ivan Krakowski. The pains neuropathiques is not for example sensitive to morphine. "Sometimes, the solutions against the pain are not medicinal and can be very simple: functional rehabilitation, social, psychological" accompaniment underlines this oncologist. But the care of support, name given jointly to the set of the care and the supports necessary to the patient to the oncologic treatments "is even anecdotal in France, contrary to the United States" deplores the Dr Louis Brasseur. Of the therapeutic innovations but a lack of means "These last years, one saw to develop themselves of the models-animal to study the pain: it is going to succeed to new treatments, of new approaches in the future" announces the Dr Brewer. New shapes galéniques for the analgesics aiming to relieve the pain as soon as possible is going to appear: of the sprays (they should arrive in France from one year or one year and half), of the patchs. Some micro-pumps are to the survey. A new analgesic, the Ziconotide intrathécal saw the day: he acts on other targets of the pain....  Research against the pain is in full bubbling" underlines the Dr Krakowski. However, the structures pain is in danger. "The possibilities of financing of the structures pain are weakened with the new fashion of pricing to the activity" deplores the Dr Bruxelle, President of the Society French of survey and treatment of the pain (SFETD). Besides, he thinks that" 30% of their physicians are going to leave to the retirement of 8 years, without "hoped sufficient recruitment. A lack of strengths and means that would put in peril a clinical research of quality. The assessment and the treatment of the pains of the cancer are mentioned like important objectives to reach in the Plan of struggle against the pain 2006-2010. In practice, will one have enough means to achieve these objectives?...                                                                                                                      2009-02-06
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