Serge Perrot is a rheumatologist and pain doctor at the head of the Pain Evaluation and Treatment Center at Cochin AP HP hospital, Paris. Professor of Therapeutics at Paris-Cité University, he also carries out research on the physiopathology of joint pain and the mechanisms of action of analgesics within the Pathophysiology and Clinical Pharmacology of Pain Laboratory (Inserm U987, Boulogne -Billancourt).
How would you describe your activity within the CETD of Cochin hospital?
Serge Perrot : As I frequently tell my students: we do not treat pathologies, we must practice transversal medicine centered on humans and not on a sum of biological parameters. Our patients are affected by complex diseases, they very often come to us at the end of a complicated journey, some have even been rejected by other specialties. The challenge and interest of my activity is to give meaning to the journey of these often desperate patients. The pain they endure seems to them like nonsense or a deprivation of meaning: they do not understand why they got there, what the diagnosis is and the cause of the pain, why nothing works. I strive to give meaning to their journey, to build with them therapeutic care that makes sense in relation to what they have experienced and who they are. This requires apprehending and understanding somatic aspects as well – what is the underlying disease and its context, a progressive cancer? in remission? – what are the psychological dimensions? Indeed, many pain patients are people whose life journey, sometimes childhood, has been marked by significant trauma which is reactivated by the experience of illness, whether cancer, fibromyalgia, polyarthritis. , etc.
What is your view on pain management as it is practiced today in France?
S.P. : There has been a lot of progress in recognizing the importance of pain and the need for its management. Notable progress has also been made regarding the acceptance of opioid treatments. However, it is estimated today that pain treatment centers treat around 300,000 people, which is ultimately very few compared to the 8 to 10 million pain sufferers in France, according to studies. In fact, pain medicine remains constructed as end-of-course medicine. We see patients too late who suffer from complex, refractory pain.
How could we change the situation?
S.P. : I think we need to reverse this model so that the treatment of these complex patients occurs much earlier. General practitioners have an important role to play here upstream. Evaluating pain takes time, 30 to 40 minutes, so this exercise should be valued in the same way as specific general medicine consultations that concern diabetes or kidney failure. Our organization of care should therefore be profoundly amended to promote early detection with increased use of screening tools as well as teleconsultation which can help to alleviate the problem of medical deserts and increasingly problematic medical demographics. In fact, the lack of adequately trained doctors and paramedical staff as well as the budgetary difficulties that we encounter contribute to this care still being considered secondary. The lack of young doctors truly motivated by this activity constitutes for me a significant source of concern for the future of pain medicine but more broadly for medicine.
What is the place of non-pharmacological interventions in pain management?
S.P. : We know today that the more chronic the pain, the less effective the medications are. The use of non-drug interventions is recognized as being able to play an important role because, when used appropriately, they can help calm the brain and reactivate the body. Cognitive behavioral therapy techniques, hypnosis, meditation, etc. associated with appropriate physical activity make it possible to effectively manage suffering and mental distress and to reactivate bruised bodies that have become non-functional.
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