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Evaluation de l’efficacité de la prise en charge à un an de 46 lombalgiques chroniques rebelles, par un Centre de Traitement de la Douleur

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Douleur et Analgésie

Résumé

Nous décrivons les caractéristiques et les modalités de prise en charge d’une cohorte de 46 patients lombalgiques chroniques rebelles hospitalisés sur une période de 13 mois dans le Centre de Traitement de la Douleur d’un Centre Hospitalier Universitaire français, et évaluons les résultats obtenus à un an grâce à une batterie d’indicateurs reconnus. Nous avons inclus 26 femmes et 20 hommes d’âge 50.8±13.9 ans, lombalgiques chroniques depuis plus de 6 mois (la durée des lombalgies était de 130±91 mois), sans distinction d’âge, rebelles aux thérapeutiques antérieures, ayant eu plus de 3 mois d’arrêt de travail la dernière année chez les patients en activité. Dix-neuf patients (41%) avaient été opérés du rachis, 5 avaient été victimes d’un accident du travail. Vingt-neuf patients (63%) présentaient des diagnostics associés douloureux à d’autres sites.

Les patients ont bénéficié d’une prise en charge pluridisciplinaire médicale, fonctionnelle, psychologique, et socio-professionnelle, avec une hospitalisation initiale de 10 jours, et un suivi à 3, 6 et 12 mois. A 12 mois, une amélioration significative a été observée pour l’ensemble des critères de jugement: l’échelle visuelle de la douleur (sur 10), cotée à 7.2±1.5 avant traitement est passée à 4.1±1.9 à 12 mois (p<0.0001); l’échelle visuelle du retentissement fonctionnel est passée de 7.2±1.3 avant traitement à 4.1±1.9 (p<0.0001); le périmètre de marche est passé de 1664±2485 mètres avant traitement à 3254±3108 mètres (p<0.0001); le temps d’inactivité diurne est passé de 2.4±1.9 heures avant traitement à 1.1±1 heures à 6 mois (p<0,001). Chez les 23 patients en arrêt de travail, 10 patients (43%) ont repris leur activité antérieure à 12 mois; 16 patients ont bénéficié d’une adaptation de poste ou d’une procédure de reclassement professionnel, 7 patients d’une mise en invalidité. Au terme du suivi, 10 patients avaient réalisé une nouvelle imagerie de seconde intention, 11 avaient consulté un autre spécialiste différent du réseau initial et aucun n’avait eu recours à nouveau à la chirurgie.

Il s’agit d’une étude préliminaire, sans groupe contrôle, qui semble confirmer l’efficacité, se maintenant à 12 mois, des Centres de Traitement de la Douleur chez le lombalgique rebelle.

Summary

Objectives: This study describes the methods used to manage a cohort of 46 patients with refractory low back pain during a 13-month period in the Multidisciplinary Pain Center of a French teaching hospital.

Methods: The patients (26 women and 20 men, 51 years of age (13.9 SD) had experienced chronic low back pain for more than 6 months (130; 91 SD), and were refractory to previous therapy. Twenty-three patients (50%) had undergone spinal surgery. These patients received multidisciplinary care (medical, functional, psychological and socioprofessional), with initial hospitalization for 10 days and follow-up at 3, 6 and 12 months.

Results: At 12 months, significant improvement was observed for all judgment criteria. Pain evaluations on a Visual Analog Scale (0–10), decreased from 7.2 (1.5 SD) before treatment to 4.1 (1.9 SD) at 12 months (p<0.001); those for functional effects from 7.2 (1.3 SD) to 4.1 (1.9 SD) (p<0.001). Walking distance increased from 1,664 m (2,485 SD) to 3,254 m (3,108 SD) (p<0.001); daily inactivity time decreased from 2.4 h (1.9 SD) to 1.1 h (1 SD) (p<0.001). Ten (43%) of 23 sick leave patients had returned to their jobs at 12 months, 16 benefited from an adaptation of their working conditions, and 7 were considered as disabled. At 12 months, 11 patients had seen another specialist outside the initial network, none had undergone surgery. Conclusions: This preliminary study without a control group confirms the efficacy of a Pain Center in managing refractory low back pain over a 12-month period.

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Authors and Affiliations

  1. Centre d’Evaluation et de Traitement de la Douleur, CHU Nord, F-44093, Nantes Cedex

    J. Nizard, Y. Meas, J.- M. Lanoiselée & Y. Lajat

  2. Laboratoire de Santé Publique, Centre Hospitalier Universitaire, Nantes, France

    P. Lombrail & J. -M. Nguyen

  3. Laboratoire de Thérapeutique, Centre Hospitalier Universitaire, Nantes, France

    G. Potel

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  1. J. Nizard
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  2. P. Lombrail
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  3. G. Potel
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  4. Y. Meas
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  5. J.- M. Lanoiselée
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  6. B. Robin
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  7. J. -M. Nguyen
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  8. Y. Lajat
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Correspondence to J. Nizard.

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Nizard, J., Lombrail, P., Potel, G. et al. Evaluation de l’efficacité de la prise en charge à un an de 46 lombalgiques chroniques rebelles, par un Centre de Traitement de la Douleur. Doul. et Analg. 16, 187–196 (2003). https://doi.org/10.1007/BF03008070

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  • DOI: https://doi.org/10.1007/BF03008070

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