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Over the past few decades, researchers have made it possible to better understand the mechanisms of pain. But pain, especially in women, is still accompanied by many misconceptions. We take stock.

First reason for consultation with the general practitioner and in the emergency services, pain affects more than one in five French people. In question, often acute pain that occurs during an accident or illness. This unpleasant sensation then acts as an alarm signal. Sometimes, however, pain appears without it being possible to identify a precise origin (fibromyalgia for example) or/and settles down over time, resists treatment, and leaves less and less respite to those who suffer from it.

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Pain is controlled by the internal circadian clock.

Physical or psychological pain: many analogies

We perceive this exacerbated sensory reaction with specialized nerve endings (2000 to 3000 nociceptors per mm2) located under the skin, in our viscera, around the muscles, at the level of the heart… The nerves then conduct the painful messages to the spinal cord , which itself transmits them to the brain allowing us to “feel” it and memorize it.

Neurobiologist Michel Lazdunski notices many analogies between physical pain, which can become chronic, and psychological pain, which frequently leads to depression and/or post-traumatic stress. Pain is perceived subjectively, according to our sensitivity, our personal history, our culture, our relationship to illness, etc.

Pain is a challenge for the doctor

pain hypersensitivity could be related to psychological factors, such as “certain personality traits, difficulty in identifying and expressing emotions, or even a traumatic experience associated, for example, with mistreatment or sexual abuse”, notes Dr. Didier Bouhassira, neurologist. Therefore, the treatment that works for one may not provide relief for another. That’s the whole difficulty.

Moreover, according to the French Society for the Study and Treatment of Pain (SFETD), 70% of people who suffer from moderate to severe chronic pain do not receive appropriate treatment. “Pain is a challenge for the doctor, he must know how to adapt admits Dr. Patrick Sichère, rheumatologist.

In order not to let it set in, before surgery for example, doctors are increasingly taking into account the risk factors for chronic pain (anxiety, depression, gender, etc.), in order to optimize and individualize care.

>> And when the pain is already there? “IYou have to start by listening and reassuring the patient. Then, offer him multidisciplinary care, combining medication, therapeutic education, rehabilitation, psychological help and as many techniques that will help relieve him and allow him to regain control over the pain.

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Women consume more painkillers
TRUE. The latest report, dating from 2019, from the National Agency for the Safety of Medicines and Health Products (ANSM) is clear: 60% of analgesic consumers are consumers (respectively 57.7% for weak opioids and 60.5% for strong opioids).

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Women’s pain is often underestimated
TRUE. A study published in 2021 in the journal Journal of Painreaches the same conclusion as another conducted by English and Canadian researchers in 2016: pain and equivalent physical manifestation, the pain of the women is more generally perceived as being less “serious”. Women are also more often referred to psychotherapy rather than drug treatment.

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Our brain is unable to control pain
FAKE. It manufactures hormones itself, endorphins, enkephalins, which have an effect comparable to morphine. Secreted mainly by the pituitary gland and the hypothalamus when we practice certain activities, these molecules bind to specific receptors in the heart of the brain, thus acting on pain, relaxation and well-being.

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Placebo effect does not work on pain
FAKE. It can have morphine-like effects on the most severe pain. We are all potentially sensitive to the placebo effect, which involves the release of enkephalins in the brain. The perception of pain actually varies according to our expectations, the representation we have of our treatment and the relationship of trust we have established with the doctor. A person who feels listened to, recognized in their suffering and who understands why they are in pain and what the treatments can do for them will perceive their pain less intensely.

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Men and women do not keep the same memory of pain
TRUE. Various studies have shown that boys remember more of a big shock or a fall in sports, while women have more diffuse memories, probably because their life is “impregnated with pain” (periods, childbirth) .

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The larger the lesion, the more intense the pain
FAKE. In at least a quarter of people followed in centers specializing in the treatment of pain, there is no inflammatory problem or neurological lesion to explain the chronic pain. This is the case of fibromyalgia, glossodynia (burning sensations of the tongue), temporomandibular joint syndrome or irritable bowel syndrome.

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After surgery, it is normal to have pain
TRUE if there is no treatment. In general, we cut the skin, the muscles, so it is logical that it is painful, and the more the intervention is important, the more the pains are. To prevent these pains and prevent them from being stored in the bone marrow and brain, they are now treated during and after the operation. In a certain number of cases, however, chronic pain will set in, which is one of the possible complications, due to damage to peripheral nerves.

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You can feel pain in a limb that you no longer have
TRUE. This is referred to as phantom limb pain. All people who have had an amputation have the impression, at first, of having preserved, for example, the amputated leg or arm, and 40% of them feel pain in this limb. This sensation is linked to inconsistencies between sensory data, for example the sight which indicates the absence of a hand, and the internal representation of the body registered in our brain (presence of the hand).

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