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[e-med] (3) Le médecin, le malade et la douleur


  • From: pat.trouiller@netclub.mg
  • Date: Mon, 3 May 2004 09:33:47 -0400 (EDT)

E-MED:(3) Le médecin, le malade et la douleur
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A titre d'information et pour élargir la problématique de la douleur, j'ai
lu un papier intéressant sur " Douleur et malnutrition: actualisation " de
Jacques Jobert et al., dont je copie ci-dessous le résumé (l'article
peut-être demandé directement à Remed), dont les auteurs font parties de
l'ONG, "Douleurs sans frontières".

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PAIN AND MALNUTRITION: AN UPDATE

Jacques Jobert (1,2), Sophie Laurent (1,3), Jean-Pierre Alibeu (1,2),
Orvalho Augosto (3), Pierre Emmanuel Colle(4)

1: Douleurs sans frontières (NGO Paris France); 2: Centre de la douleur, CHU
Grenoble France; 3: Gabinete da Dor, Universitade Eduardo Montale, Maputo,
Moçambica; 4 : Faculté de Médecine Grenoble

SUMMARY

Is there any connection between pain and malnutrition? Do these disorders
develop at the same time without any connection with each other or are they
closely interlinked? Patients suffering from malnutrition due to very
different causes such as cancer, cystic fibrosis, AIDS/HIV, often present
with a common symptom: anorexia, leading to a cachexia-anorexia syndrome. In
case of malnutrition due to a proteino-energetic deficiency, the onset of
anorexia reveals a complication. ln these disorders, there are identical
biological signs: secretions of pro-inflammatory cytokines represented by
the TNF-a, and neuropeptides. These substances are algogenic, at least
because of the sensitization of pronociceptive systems.

Renutrition relieves pain and, as far as one can tell, the treatment of pain
can somewhat improve the nutritional state of the patient. Anorexia seems to
be a pain marker. The treatment must include a dietetics aspect in order to
adjust the TNF-a secretion, anti TNF-a medicines, and standard analgesics in
accordance with the WHO¹s recommendations. Surveys concerning specific pain
scales, the treatment pharmacology, dietetics, and adjuvants must be carried
out as well as serious studies in order to determine a specific way of
handling the pain-malnutrition syndrome.

Keywords: pain; malnutrition; anorexia; cachexia; pronociception; TNF-a

***************

Patrice Trouiller
pat.trouiller@netclub.mg

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