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Douleur et état de stress post-traumatique

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Santé mentale et douleur

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Résumé

L’association de douleurs et d’un état de stress post-traumatique apparaît d’autant plus fréquente qu’un accident, des blessures, ou une atteinte physique sont liés au traumatisme. L’état de stress post-traumatique (ÉSPT), défini dans le DSM-IV-TR [1], confronte un sujet « au réel de la mort » et de manière plus générale à la mort ou à des blessures graves chez d’autres individus. Ceci se traduit par une peur intense, une détresse, un sentiment d’impuissance ou d’horreur. Le sujet est considéré en stress aigu dans le mois qui suit l’événement. Le stress post-traumatique survient au-delà de ce mois, il comporte des reviviscences du traumatisme, l’évitement de situations similaires, un émoussement affectif et une hyperactivation du système neurovégétatif avec une hypervigilance. Ces symptômes persistent au moins un mois. La prévalence d’un ÉSPT varie selon les traumatismes : 39 % chez les sujets survivant à un accident de la voie publique [2], 39 % chez les victimes d’une agression [3], 7 % chez les survivants d’un homicide [4]. Souvent, ces états post-traumatiques s’accompagnent d’autres affections comorbides tels les troubles de l’humeur, des symptômes anxieux, l’abus de substance [5, 6]. Parmi les comorbidités figurent les troubles douloureux ; ils peuvent être plutôt associés à la cause du stress traumatique, à la suite d’une blessure accidentelle ou de guerre, mais aussi s’inscrire comme une conséquence, comme le sont parfois les troubles musculosquelettiques. Selon le DSM-IV-TR [1], le trouble douloureux associe des facteurs psychologiques et une affection médicale générale. On parle de douleur chronique si ce trouble persiste audelà de six mois.

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Authors and Affiliations

  1. Interne des Hôpitaux de Toulouse, DES psychiatrie, Hôpital de Casselardit Purpan, 31059, Toulouse Cedex, France

    A. Yrondi

  2. Département universitaire de psychiatrie, CHU Sherbrooke, CHUS-Hôtel-Dieu, Québec, Canada

    J.-F. Corbin

  3. Faculté de médecine de Toulouse Rangueil, Hôpital de Casselardit Purpan, 31059, Toulouse Cedex, France

    L. Schmitt

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Yrondi, A., Corbin, JF., Schmitt, L. (2013). Douleur et état de stress post-traumatique. In: Santé mentale et douleur. Springer, Paris. https://doi.org/10.1007/978-2-8178-0307-4_12

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  • DOI: https://doi.org/10.1007/978-2-8178-0307-4_12

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