Chili pepper patch, millimeter waves, music therapy, these ways that help to escape from the “hell of stubborn chronic pain”
|Chronic pain affects 30% of the population. MAXPPP – Rafael Ben-Ari/Avalon
Nearly one in three adults suffers from chronic pain. But it is not inevitable, explains Dr. Patrick Ginies, head of the pain assessment and treatment center at Montpellier University Hospital, on the occasion of World Pain Day, October 14.
An anesthesiologist and resuscitator by training, Dr. Patrick Ginies runs a pioneering service, opened in 1979 at the Montpellier University Hospital. Pepper patches, smartwatch, magnetic stimulation, etc., he points out that current care is increasingly opening up to non-drug techniques.
Dr. Patrick Ginies is a pioneer in the fight against pain. FREE MIDI
Nearly one in three French people suffer from chronic pain, are we at a turning point in treatment??
There is a new strategy, because in 70 years of research, we have made a lot of progress in understanding the mechanisms of pain, but we have no new medication.
There are many new molecules tested on animals, but when we move on to humans, we are faced with side effects such that we stop using the products. Which also raises questions about research protocols, which always start with animals.
In Montpellier, for example, we are currently testing a molecule in a phase 2 trial that has had spectacular effects on animals, but we are afraid that things will not be as conclusive when we move on to humans.
In the next five years, there will be no new drugs on the market.
Today, we are stuck with “classic” painkillers, codeine, Tramadol…
That's it. With the particularity that from December 5, these products will be prescribed on secure prescription.
Which means?
There is always anxiety about what is happening in America with painkillers: misuse, to the point of a health scandal. In 2023, 130,000 people died in the United States from opioid misuse.
“Morphine misuse can make you hyperalgesic, you're raw”
But we are not there in France!
Not at all, indeed. But we have a few hundred, 400 or 500 accidents, each year, due to these painkillers.
It is this fear of large-scale misuse that makes us realize that there are diversions of painkillers, misuse that is increasing. Hence the need for greater rigor in prescribing, with secure prescriptions, renewable every month.
So-called “classic” painkillers, such as Doliprane, will still be available over the counter. But weak opioids and morphine, those classified as “level 2”, will be more controlled. They will be controlled like morphine, which is a level 3 painkiller.
Why ?
Because there have been excesses. For fibromyalgia, for example, people are in so much pain that there has been misuse of morphine.
Morphine still relieved patients ?
No, it has no effect. On the contrary, if prescribed incorrectly, morphine makes people hyperalgesic! Patients are flayed alive, it is a paradoxical effect.
Pain is not necessarily treated with chemistry…
For a long time, it was believed that there were only pains of the flesh, inflammations, cancers, fractures, abscesses… these pains are well controlled.
Where there has been progress is in the management of neuropathic pain, pain due to small lesions of the nerves, which send electrical short circuits: it is shingles, people who have had multiple operations on sciatica, spinal trauma, operated breast cancers, irradiations… They explode. And we have new strategies: local anesthetics via patches, for example.
We have a patch based on cayenne pepper. For the past four or five years, we have been treating twelve patients a day. We put a patch on for an hour, every three months. And we have significant results: by giving a “slap” to the pain circuits, we reduce the pain by up to 50%. Then often it erases it, and it reduces its intensity.
Better understand pain. Midi Libre – SOPHIE WAUQUIER
The explosion of non-drug techniques
Within a well-defined framework, it is not a question of playing sorcerer's apprentices…
Of course, with a protocol and handling instructions, the power of this pepper is ten times greater than the hottest pepper.
This option is part of the explosion of non-drug techniques.
But this ain’t all…
The other revolution is the explosion of non-drug techniques, this time for chronic pain. The treatment includes therapeutic education to understand the mechanisms of pain, and the behaviors that cause pain, that make you enter this hell of chronic pain.
There is no miracle solution, there is a collaborative approach between the patient and the medical team.
It's psychology?
It's more complicated. Psychiatrists often fail on chronic pain patients, who are faced with the failures of all specialties: neurological, rheumatological, oncological…
Every person who has chronic pain has a little bit of social disruption, a little bit of psychological disruption, a little bit of biological disruption. We need to understand how the patient got there, how they can get out of it, and we get help from non-drug techniques. What's new is that some of them are validated.
What is it ?
Music therapy, with the validated Music Care technique: you choose your piece of music, and it is worked on, the music lengthens, slows down… the improvement is around 30%. Many pain relief centers, and thermal centers like Lamalou and Balaruc-les-Bains, have this practice. A file has been submitted to the drug agency, it has been validated but not yet reimbursed.
We are also working with so-called “millimeter” waves, on the principle of neurostimulation, for fibromyalgia, for example, and people who have a lack of pain control: a team from Grenoble has invented a watch, Remedee, which thus stimulates morphine-based pain control. It has been validated as medical equipment. The first study was 60% positive, for patients with chronic pain.
Another avenue: transcranial magnetic stimulation. The studies are starting to come out. We are finally bringing old techniques, such as hypnosis, back into fashion.
It's a paradigm shift, a change in doctors' perspective. It takes a few months to enter chronic pain, but years to get out of it. The challenge is complicated. In France, 17% to 20% of the population is in the hell of stubborn chronic pain.
“The effectiveness of cannabis is modest”
And cannabis has an interest ?
Everyone asks us. We're done experimenting. CBD is available over the counter, anyone can try it. It has a slight anxiolytic effect. THC is not very analgesic, but a bit of a soporific, a bit of a sedative… and a bit of a ban. The Canadians who liberalized cannabis five years ago did not make the expected turnover. As soon as you authorize it, it loses its effectiveness…
The effectiveness on the general population is modest, it may be of interest depending on personalities and pathologies, it has proven its effectiveness when you have multiple sclerosis. But it does not work on fibromyalgia. And it has side effects, it causes a decrease in alertness, you cannot drive…
What advice would you give to someone suffering from chronic back pain, the "illness of the century" as they often say ?
Pain often comes from a “poor adjustment”, excessive tension in all the acts of daily life, day and night, years before its onset, with people who have sometimes established a rigidity in their body schema since childhood! I'm not going to send him to the shrink, he'll tense up even more! And the rheumatologist is not going to question him about his initial body schema… This pain is an armor, which was put in place to protect oneself from an archaic, sometimes minor, suffering, which, without this shell, could explode the core of the individual's personality.
For 40 years, we have been looking for a faulty mechanism. But that is not the problem… everyone has hernias, parrot beaks, osteoarthritis… and not everyone has pain. In this person, it will trigger twice as much pain.
In the consultation that will be conducted at the pain unit, we will try to deprogram this operation. We improve 52% of patients. But pain is a complex phenomenon, we sometimes prefer to keep it because we do not know how to express our discomfort differently.
The problem remains access to these consultations, how long do you have to wait, six months, a year ?
If you call to make an appointment, there will be a long wait. You always need a letter from a doctor. People who have cancer, or a very serious illness, a severe migraine, have a consultation within the week. For intermediate situations, it will be a few months. And finally, since we are overwhelmed with requests for fibromyalgia, it will be more like nine months.
We have trained 3,000 nurses in 40 years, doctors… But five to six million French people are “in pain”, and there are 300 full-time equivalent specialized doctors. Our discipline does not attract, we manage the failure of other disciplines, and the consequences of a stressful society.
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