La vitamine D : une nouvelle cible pour les réanimateurs ?

The detection of an ubiquitous vitamin D receptor in humans in the recent years has dramatically increased our knowledge regarding vitamin D effects. Besides its bone effects, pleiotropic effects of vitamin D have been reported in humans suggesting a key role for this hormone in metabolic control and immunity. To date, the impact of vitamin D insufficiency has been studied in the general population. However, recent studies have reported a high prevalence of vitamin D insufficiency in critically ill patients. Some data also suggest an association between vitamin D deficiency and hypocalcemia, bone demineralization, and mortality rate in the intensive care setting. Due to its role in immunity, we cannot rule out the possibility that vitamin D contributes enhance severe illness-related pro-inflammatory status resulting in increased morbidity and mortality. However, these hypotheses need to be assessed by large clinical studies in the intensive care setting. Furthermore, a possible beneficial effect of vitamin D supplementation, with or without associated calcium, remains to be demonstrated in well-designed randomized controlled trials.     

Quelles cibles d’hémoglobine pour les pathologies cérébrales ?

Anaemia is a frequent complication in patients suffering from primary brain injuries and often considered as a burden for secondary brain insult. The optimal haemoglobin level in these patients remains unknown. Red blood cells transfusions in patients with traumatic brain injury, subarachnoid haemorrhage, and ischemic cerebrovascular accident can improve cerebral oxygen delivery but also result in significant complications. The aim of this review is to report the most important data on the role of anaemia and blood transfusion in the critically ill patients with acute brain damage.     

La réponse cérébrale à la douleur des autres

A better understanding of brain mechanisms related to the communication of pain could lead to novel means by which to improve pain management in clinical settings. This paper reviews the neuroscientific literature examining brain processes related to the perception of others’ pain. While the direct experience and the observation of pain in others rely on similar brain systems, numerous variables related to the observer, the person in pain, and their interaction can influence the degree of proximity between these representations.     

Pourquoi et comment vient-on à l’éducation thérapeutique dans une structure douleur ?

Patients suffering from chronic pain referred to a pain clinic often combine a painful illness with multiple psychosocial difficulties. Pain medicine is a holistic medicine where health professionals are properly trained to evaluate and offer thoughtful solutions to most of these encountered difficulties. However, despite this health care provider’s commitment, patients do not necessarily get better. Patient therapeutic education, which means a qualitative change of posture from both the protagonists, favors knowledge and know-how exchanges and helps patients build a new strategy to achieve their autonomy. This paper considers some reflections and questioning from two physicians involved in the treatment of chronic pain patients, trained in therapeutic education and who offer it to their patients.     

« L’évaluation psychologique » en structure d’évaluation et traitement de la douleur chronique : une nouvelle figure de la paradoxalité ?

Through a definition of psychodynamic psychological assessment in clinic pain, the authors reveal paradoxical points at work between patients and the expression of their chronic pain, the position of clinical psychologist and his evaluation, and psychic temporality of the subject along with the order of the French High Authority of Health and its logic of profitability.This will not only highlight these stumbling blocks, but also attempt to unravel issues in order to show the emergence of an additional paradoxality written in the patient’s relation to himself.     

La nécrosectomie pancréatique endoscopique : une nouvelle arme dans l’arsenal thérapeutique de la nécrose infectée

Endoscopic pancreatic necrosectomy appears to be an effective treatment and less morbid than traditional open necrosectomy. In this article, we propose to define the indications, describe the technique and positioning the endoscopic pancreatic necrosectomy in the treatment of infected necrosis, particularly in relation to surgical techniques.     

Impact de la douleur sur les processus cognitifs chez l’animal : approche comportementale et structures cérébrales impliquées

Pain is a multidimensional experience, often associated with cognitive impairments. In preclinical research, only a few studies have assessed these aspects in laboratory animals and working in this research field could help to better understand the complex interactions between pain and cognitive impairments. This review presents the main behavioral tests and studies evaluating cognitive capacities in painful animals, as well as the potentially involved brain structures and mechanisms.     

Des enjeux de la compulsion de répétition dans la relation thérapeutique

The author is studying the effects of the symptomatic repetition into therapeutic relation. How does the therapist can live the relapses of patient or the escalation of its disorders during the treatment? What senses and functions have these repetitive painful realities? According to hypothesis proposed here, the compulsion of repetition doesn’t only have the effect of mortiferous destructivity at the patient, but it’s a sign of a process of change in its psychic functioning, the sign of a possible expression of aggressiveness.     

Optogénétique et douleur chronique : une stratégie applicable chez l’humain ?

The current treatments for chronic pain produce limited efficacy but severe side effects. An alternative strategy is to directly modulate neuronal activity through the use of optogenetics, a gene therapy involving photo-activatable proteins. In animal models, this approach has been shown to decrease inflammatory and neuropathic pain. Recent significant progresses allow to predict clinical applications in analgesia in the next decades.     

Gestion de la douleur chronique : l’approche québécoise

Quebec has adopted in recent years a vision of the organization of services focused on networking and prioritization for people with chronic pain. This vision encompasses aspects of clinical work, training and research in a network inspired by the learnings extracted from the implementation of the Quebec trauma system, which has already demonstrated its very convincing results. The setup of the network for the management of chronic pain is already in progress and it provides encouraging results.     

Angiogenèse: de la physiologie à la thérapeutique

• •- Vasculogenesis, angiongenesis and arteriogenesis

• •• Angiogenesis in embryonic development vasculogenesis
• •• Angiogenesis

• •- Vessel formation
• •- Mechanical hypothesis
• •- Biological hypothesis: role of the angiogenic growth factors FGF and VEGF
• •• Combined hypothesis: angiogenesis and vascular remodelling

• •- Therapeutic angiogenesis in cardiovascular diseases
• •• Critical limb ischemia
• •• Myocardial ischemia

• •- Gene therapy
• •- Angiogenic growth factor therapy
• •- Tumour angiogenesis
• •- Angiogenesis in healing wounds

     

éducation thérapeutique du patient obèse, une approche de la complexité

In obesity, the pathophysiological and somatic disease dimensions are closely woven with the lifestory and intimate behaviours of the person. This complexity leads caregivers to question their way of thinking therapeutic patient education (TPE) and to develop new ways of learning, involving cognitive but also emotional and sensory individual dimensions. We report the reflections and the experience of the department of therapeutic education for chronic diseases (Geneva hospital) in this domain.     

Prise en charge de la douleur chronique non cancéreuse en Belgique: un état des lieux

From 2005, a global policy aiming to improve chronic pain management is progressively installed in Belgium. Three types of structures presently exist: 73 algological functions, 36 multidisciplinary pain teams, and 9 multidisciplinary reference centers. On request of the Belgian Ministry of Public Health, an interuniversity research team conducted an evaluation (in 2010–2011) of these structures and recommendations for the future. Their observations and conclusions are summarized in this paper.     

Imagerie cérébrale et douleur : perception unique,réseaux multiples

Here, the “pain matrix” is designed as a fluid system, made up of lots of networks interacting with each other. A nociceptive matrix receiving spinothalamic input (mainly the operculo-insular region) ensures the specific nature of somatic pain, and is the only thing that, if destroyed, results in selective impairment of heat and pain perception. The transition between a cortical nociception and conscious pain is dependent on a secondary network that includes at least the anterior, posterior parietal and prefrontal insular regions. These secondary regions are not specifically nociceptive: their stimulation does not lead to pain and when destroyed pain relief is not generated; their joint activation is necessary for the conscious perception of pain, its attentional modulation and the control of associated vegetative reactions. The immediate pain experience that ensues may even be transformed based on beliefs, emotions and expectations of the individual, through the activity of tertiary regions, including the perigeniculate cingulate, orbitofrontal and limbic networks. The pain that we remember is the result of continuous interactions between these sub-systems, and the substantial changes in the pain experience can be obtained by acting on each of them.