Review article

Physical modalities in chronic pain management

Grâce aux études SPARCLE, la prévalence de la douleur chez les enfants atteints de paralysie cérébrale est aujourd’hui mieux connue. Elle est de 60 % chez les enfants de 8 à 12 ans et s’élève à 69 % chez les 13–17 ans. Le soulagement de la douleur a également été identifié comme une question prioritaire dans une enquête prospective de la Fondation Motrice publiée en 2009. Pourtant la douleur, et en particulier la douleur iatrogène, reste sous-traitée dans cette population bien que nous disposions de nombreux outils d’évaluation. L’usage des outils d’évaluation requiert de bonnes connaissances de leurs qualités et limites psychométriques. Mais l’évaluation de la douleur ne se limite pas à l’application d’échelles de mesure. Des connaissances actualisées concernant les modalités d’expression de la douleur et les capacités d’y faire face des personnes douloureuses sont indispensables. Les recommandations internationales insistent sur l’importance d’une approche pluridisciplinaire depuis l’évaluation jusqu’à la prise en charge, pour augmenter les effets synergiques de plusieurs options thérapeutiques (pharmacologiques et non pharmacologiques). Enfin, il semble également utile de questionner nos représentations de la douleur manifestée par les personnes au développement atypique.

With SPARCLE studies, the prevalence of pain in children with cerebral palsy is now better known: 60% of children aged 8 to 12-years-old and amounts to 69% in adolescents 13 to 17-years-old. The pain relief was also identified as a priority issue in a prospective study of la Fondation Motrice published in 2009. Yet iatrogenic pain is under-treated in this population although many assessment tools are validated. The use of assessment tools requires good knowledge of their psychometric properties and limitations. But pain assessment is not limited to the application of a scale. Current knowledge regarding the pain expression and ability to cope in this population are essential. International guidelines stress the importance of a multidisciplinary approach from assessment to management, in way to increase the synergistic effects of several therapeutic options (pharmacological and non-pharmacological). Finally, it also seems worthwhile to question our representations of pain reported by those with atypical development.

The purpose of this study was to investigate the effect of infra-red (IR) in patients with chronic non-specific low back pain (NSLBP). Ten patients with NSLBP (5 men and 5 women) and disease duration of 21.7 ± 11.50 months participated in this pilot study. Patients had a mean age of 36.40 ± 10.11 years (range = 25–55). Patients were treated with infra-red (IR) for 10 sessions, each for 15 min, 3 days per week, for a period of 4 weeks. Outcome measures were the Numerical Rating Scale (NRS), the Functional Rating Index (FRI), the Modified–Modified Schober Test (MMST), and the Biering-Sorensen test to assess pain severity, disability, lumbar flexion and extension range of motion (ROM), and back extensor endurance, respectively. Data were collected at: baseline - study entry (T0); end of 5th treatment session after 2 weeks (T1); and end of the treatment after 4 weeks (T2). The results of the ANOVA demonstrated a statistically significant main effect of IR on all outcomes of pain, function, lumbar flexion-extension ROM, and back extensor endurance. The treatment effect sizes ranged from large to small. IR was effective in improving pain, function, lumbar ROM, and back extensor endurance in a sample of patients with NSLBP. Treatment effect sizes ranged from large to small indicating clinically relevant improvements primarily in pain and function for patients with NSLBP.