Douleur et Analgésie

, Volume 14, Issue 3, pp 159–162 | Cite as

Utilisation des antidépresseurs chez les patients souffrant de douleurs chroniques: quelle congruence entre prescription et notice d’emballage?

  • C. Cedraschi
  • V. Piguet
  • J. Desmeules
  • A. F. Allaz
  • W. Fischer
  • P. Dayer
Article

Résumé

Différentes études font état d’une consommation médicamenteuse inappropriée et/ou excessive chez les patients souffrant de douleurs chroniques. Les patients disposent de diverses sources d’information à propos des médicaments. Ces sources peuvent leur fournir des informations congruentes ou non, correspondant ou non à leurs représentations et expériences préalables. Les antidépresseurs, fréquemment prescrits dans le contexte de douleurs chroniques, sont associés à un nombre élevé d’effets indésirables. Ces effets, ainsi que les représentations qu’en ont les patients, constituent des déterminants importants de la non-observance. Nous avons investigué la manière dont les individus s’informent au sujet des médicaments, et si cette information pourrait contribuer à rendre compte des problèmes d’observance que soulèvent les antidépresseurs chez les patients douloureux chroniques. Nous avons interrogé des patients douloureux chroniques et des sujets ne souffrant d’aucune douleur ni maladie. Les notices d’emballage constituaient la source la plus couramment citée dans les deux groupes, avant toute autre, y compris le médecin. Pour les deux groupes, l’information qui’ils souhaiteraient «idéalement» recevoir devrait venir du médecin et concerner en particulier l’indication et le mode d’action du médicament. Ces résultats suggèrent que les patients pourraient combiner les différentes sources d’information et les utiliser «à la demande». Parmi les 16 notices soumises à une analyse de contenu, 15 faisaient référence au traitement de la dépression. Seules 5 notices évoquaient la douleur comme indication possible, dont 3 citaient des symptômes physiques sans cause organique ou liés à la dépression. Les autres indications comprenaient les TOC, la boulimie et la phobie sociale. L’analyse de contenu des indications montre qu’elles ont une connotation clairement psychologique. Ainsi, la noncongruence entre la prescription d’antidépresseurs à visée antalgique et les notices pourrait rendre compte d’une partie au moins des difficultés d’observance que soulèvent ces médicaments.

Mots-clés

Douleur chronique antidépresseurs notice compliance relation thérapeutique 

Summary

Inappropriate and/or excessive medication use is commonly observed in chronic pain patients. Patients have various sources of information about medication. These sources may provide congruent or non-congruent information, which may in turn fit or not into the patients’ representations and/or previous experiences. Antidepressants, often prescribed to chronic pain patients, are associated with a high number of adverse effects. Adverse effects and representations patients have of adverse effects are major determinants of non-compliance. We investigated what information people look for when taking medication; and whether this information may contribute to explain compliance problems when prescribing antidepressants to chronic pain patients. We interviewed chronic pain patients and pain-free, non-patient controls. Patient information leaflets were the most common source of information, ahead of others, including physicians, whereas «ideal» information mainly relied on doctor-patient relationships in both groups. These results suggest that various sources of information are meant to be combined, and used «as needed». Out of the 16 patient information leaflets submitted to content analysis, 15 referred to the treatment of depression. Further indications included obsessive-compulsive disorders, bulimia, and social phobia. Only 5 evoked pain as a possible indication among which 3 mentioned physical symptoms linked to depression or with no organic cause. Content analysis of antidepressant patient leaflets showed that they point to indications which have a clear psychological connotation. Thus, non-congruence between patient information leaflets and prescription of antidepressants for their possible analgesic effect may account for part of non-compliance problems with such medication.

Key-words

Chronic pain antidepressants patient information leaflets compliance patient-therapist relationship 

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Copyright information

© Springer-Verlag 2001

Authors and Affiliations

  • C. Cedraschi
    • 1
  • V. Piguet
    • 1
  • J. Desmeules
    • 1
  • A. F. Allaz
    • 2
  • W. Fischer
    • 3
  • P. Dayer
    • 1
  1. 1.Centre multidisciplinaire de traitement et d’évaluation de la douleur, Divisions de Pharmacologie Clinique et Toxicologie CliniquesHôpital Cantonal Universitaire de GenèveGenève 14
  2. 2.Département de Médecine InterneClinique de Médecine Interne de réhabilitationGenève 14
  3. 3.Département de PsychiatrieUnité d’investigation sociologiqueGenève 14

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