“We must be able to offer a culture other than that of medicine”

Tribune. The Nobel Prize for Medicine, awarded on October 4 to the Americans Ardem Patapoutian and David Julius for the discovery, in particular, of the cutaneous temperature receptor TRPV1 has given pride of place to pain research. Since its creation in 1901, this is the first time that the Swedish Academy has crowned work on this theme and yet none of us will be spared from physical suffering!

Its chronic form affects 12 million of our fellow citizens and 70% remain insufficiently relieved. Only 3% are taken care of in pain centers. These are saturated (a quarter of delay on average, an eternity when one suffers) and deprived of substantial means.

Besides the anemic resources, other factors explain this distressing observation. First of all, the specialty, algology, struggles to be recognized as a discipline in its own right. While pain represents the first reason for consultation in general medicine, less than twenty specific hours of teaching are devoted to it throughout medical studies.

On the other hand, the almost systematic drug response to chronic pain should question us. Analgesic molecules – including morphines, antiepileptics and antidepressants -, available everywhere thanks to the close network of more than 20,000 pharmacies, the first-line therapy remains in the face of this medical, but also social scourge of chronic pain. Difficulties in accessing pain-relieving structures, less than 300, where therapeutic alternatives are available, encourage the long-term prescription of these molecules. The health drama of the opioid crisis, masked by that due to Covid, and its 81,000 overdose deaths in the United States for the year 2020 alone, warns us of the large-scale and long-term prescription of opioids . The graves of Prince, Michael Jackson or Whitney Houston are the most visible of a gigantic cemetery where half a million Americans lie.

Opioid crisis

The situation in our country is not comparable, but the evolution is there: the number of deaths from prescribed opioids has tripled in recent years. Since February, pregabalin (Lyrica), a star antiepileptic in the treatment of neuropathic pain, has been considered a narcotic because of its increased risk of misuse. Long-term antidepressants also have their share of effects on the psyche, weight or libido.

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