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Master Thesis

Prise en charge ambulatoire de la douleur chronique non cancéreuse du sujet âgé : état des lieux d'une consultation conjointe gériatre/algologue au CETD de Caen et étude du bénéfice obtenu sur le contrôle de la symptomatologie douloureuse et son vécu

Abstract : Introduction: chronic pain syndrome (CPS) is a complex condition that is difficult to assess and manage. It mainly affects the elderly (30 to 50% of those over 65 years of age and more than 80% in institutions). However, this constantly growing population is more fragile and therefore more exposed to harmful consequences for its independence and autonomy in case of unattended CPS. Its adressment therefore represents a major challenge, but paradoxically, there is no structure specialized in the management of CPS in the elderly in France. This is why a "pain in the elderly" consultation involving an algologist and a geriatrician was created in April 2014 at the CETD in Caen. Objective: the objective of this study was therefore to carry out an inventory of the evaluation and care proposed by this consultation between 2014 and 2018. As well as to study the benefit on the control of patient's painful symptomatology and their experiences of it. The latter, through a remote re-evaluation of the Brief Pain Inventory (BPI) and the Pain Catastrophizing Scale (PCS). The evolution of the results obtained on these two questionnaires was our main judgement criterion. Patient satisfaction with the consultation was a secondary outcome measure. Results: management via the "pain of BP" consultation involved 74 patients, 83.6 years old on average (DS 6.6), mainly women (61; 82.4%), living at home (59; 79.7%) and with independence and preserved autonomy (average ADL 5.1 DS 1.4 / average IADL 1.6 DS 1.4). 54 patients (73%) were at risk of falls, 41 patients (55.4%) showed signs of depression, 29 patients (39.2%) were at risk of undernutrition and 27 patients (36.5%) had cognitive issues. The PCS were mainly multisite (67.6%), secondary to osteoartritis. The management proposed at the end of the consultation did not lead to a significant increase in the average number of analgesics (p=0.66). 40 patients (54.1%) received day (HDJ) or week (HDS) hospitalization and as many received physiotherapy. 50 patients (68%) received TENS. The BPI Three of the items evaluated by this questionnaire were significantly improved at the end of the consultation: maximum pain (p=0.042), actual pain (p=0.03), mood (p=0.015). The PCS was re-evaluated in 19 patients (25.7%), the difference in the mean scores obtained was not significant (p=0.17). Conclusion: the "pain in elderly" consultation made it possible to adress many fragile subjects and provide them with specialized care through the geriatric care system. It also seems to have provided patients with satisfaction in terms of controlling their painful symptomatology.
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Master Thesis
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Submitted on : Monday, March 9, 2020 - 4:16:29 PM
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Sandrine Lecarpentier. Prise en charge ambulatoire de la douleur chronique non cancéreuse du sujet âgé : état des lieux d'une consultation conjointe gériatre/algologue au CETD de Caen et étude du bénéfice obtenu sur le contrôle de la symptomatologie douloureuse et son vécu. Médecine humaine et pathologie. 2019. ⟨dumas-02502958⟩

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