Philippe Poulain - Academia.edu (original) (raw)
Papers by Philippe Poulain
Journal of Clinical Oncology, 2016
212 Background: Methadone is used more and more as a second-line treatment for refractory cancer ... more 212 Background: Methadone is used more and more as a second-line treatment for refractory cancer pain in palliative care patients. Methods: The study aimed to compare the effect of two methadone titration methods (Stop and Go vs progressive titration) in 146 palliative care cancer patients with pain inadequately relieved or intolerant to level 3 opioids. The primary endpoint was the rate of success/failure at Day 4 defined by pain relief (reduction of at least two points of the numerical scale (0 - 10) AND a pain score < 5 for 2 consecutive days) AND no overdose (Rudkin scale ≥ 3 AND respiratory rate < 8/min). Results: Pain was nociceptive in 16% and mixed in 84%. 85% of the patients had breakthrough pain. Half received oxycodone, 1/5 fentanyl, 1/5 morphine and < 10% hydromorphone. Reasons for switching were lack of efficacy isolated (56%), or with intolerance to previous opioid (38%). More than 2/3 of the patients reached a pain score < 5 for two days at D4, adequate pa...
Oncologie, 2011
La décision d’arrêt d’une chimiothérapie palliative en situation métastatique est un mélange comp... more La décision d’arrêt d’une chimiothérapie palliative en situation métastatique est un mélange complexe d’enjeux thérapeutiques, humains et éthiques. La qualifi cation même de « palliative » associée à la chimiothérapie fait débat entre les oncologues et les médecins de soins palliatifs. De manière un peu paradoxale, ce sont les oncologues qui revendiquent l’adjectif « palliatif » dès la première ligne de chimiothérapie au stade métastatique (c’est-à-dire dès que le but du traitement est un allongement de la durée de vie, même très prolongé, et/ou de la qualité de vie), alors que les médecins de soins palliatifs le repoussent aux ultimes lignes thérapeutiques.
Pain, 1990
AllgemeineIntenshmedizin, A4020I~sbn1&,Austria ACC Hall E Abs No 358 * OF INvF.STIGATIoN. Pol... more AllgemeineIntenshmedizin, A4020I~sbn1&,Austria ACC Hall E Abs No 358 * OF INvF.STIGATIoN. Polypharmacy of opioids or their bolus administration in intensive care often results in inadeauate analgesia and sedation. as well as cardiorestitorv instability. This study evaluated the quality of anagosedatik by continuous administration of ihe opioid sufenknil in polytraumadzed patients suffering from pain. METHODS: We analyzed the quality of analgosedation in 30 polytraumatized adult patients undergoing controlled mechanical ventilation. Our loading infusion was 1 ~g/kg/b sufentanil and the maintenance infusion was adjusted according to changes in clinical (coughing, moving etc.) and cardiovascular parameters. In group I (n=19) adequate analgosedation was achieved with sufentanil alone, whereas in group II (n=ll) we had to supplement this regimen by a continuous infusion of m&z&m, sting with 0.07 mgkg/h. No other opioids were administered. Respiratory, cardiovascular, hepatic and renal parameters, as well as side effects common to opioids were recorded.
La vie des patients atteints par le cancer, meme s'il n'est pas guerissable, est devenue ... more La vie des patients atteints par le cancer, meme s'il n'est pas guerissable, est devenue plus longue grâce aux progres des traitements de la maladie et aux soins de support parmi lesquels la prise en charge de la douleur, l'accompagnement et les soins palliatifs jouent un role preponderant. Si les douleurs sont toujours la, elles sont le plus souvent previsibles ou identifiables et traitees grâce a la pharmacopee qui s'est amelioree tant en qualite qu'en choix cette derniere decennie. Le developpement de techniques complementaires non medicamenteuses permet aussi de completer le traitement de la douleur, une sensation multiple et complexe. Les auteurs donnent un regard clair, precis, didactique mais non exhaustif, sur les connaissances actuelles en matiere de douleurs liees aux cancers. Il est aussi fait etat de la recherche et des dernieres avancees dans le domaine. Cet ouvrage, ecrit par des medecins, des infirmiers et des psychologues, tous specialistes de la ...
Bulletin Du Cancer, 1991
This pilot study was undertaken in a group of 7 patients receiving morphine either by oral route ... more This pilot study was undertaken in a group of 7 patients receiving morphine either by oral route under a controlled release form (Moscontin tablets), or by subcutaneous route with continuous infusion. Complete pharmacokinetics over 24 h were carried out with blood samples taken every hour. The measurements of morphine and of its metabolite, morphine-6-glucuronide (M6G) were performed by high-performance liquid chromatography (HPLC) with coulometric detection, using nalorphine (NAL) as an internal standard. The morphinics were extracted on a Bond Elut C18 column according to a double liquid-solid extraction. The extract was chromatographed by ion-pairing on a mu Bondapak C18 column, 10 microns (300 x 3.9 mm). The minimal detectable concentrations were respectively 1 and 5 ng/ml for M and M6G. When Moscontin was given at dosages 1 mg/kg/d, a difference appeared and gradually rose to a M/M6G ratio of 1.3 +/- 0.04. With subcutaneous infusion, the plasma levels of M6G were from 2 to 17-f...
Douleurs : Évaluation - Diagnostic - Traitement, 2017
Journal of Clinical Oncology, 2014
TPS6639 Background: Previous clinical trials have confirmed the efficacy and safety of fentanyl p... more TPS6639 Background: Previous clinical trials have confirmed the efficacy and safety of fentanyl pectin nasal spray (PFNS), as a rapid analgesic agent in cases of Breakthrough pain in cancer (BTPc),...
Pain, 1993
To assess the contribution of pharmacological tolerance to increasing doses of morphine, 29 cance... more To assess the contribution of pharmacological tolerance to increasing doses of morphine, 29 cancer patients requiring oral morphine to treat pain were studied by two teams working independently. The first team assessed physical impairment, pain intensity and pain treatment. The second team assessed depressive disorders (DSM III criteria), emotional and behavioural depressive patterns (Retardation Depressive Scale, Polydimensional Mood Scale). All patients were seen at the initiation of morphine therapy and followed to the first morphine dose modification. Evaluations were carried out in outpatient clinics except staging investigations which were undertaken at the beginning and at the end of the study. Our results showed that (1) in 24 of the 25 patients for whom morphine doses were increased, progressive disease was recorded; (2) in 4 patients, morphine doses were not increased and in these patients their disease was stable or in remission; and (3) changes in depressed mood were not correlated with pain intensity. These data strongly suggest that, instead of pharmacological tolerance, the main factor resulting in increasing oral morphine requirement in cancer pain management is pain increase due to disease progression.
Current Medical Research and Opinion, 2009
The efficacy of intranasal fentanyl spray (INFS) was compared with that of oral transmucosal fent... more The efficacy of intranasal fentanyl spray (INFS) was compared with that of oral transmucosal fentanyl citrate (OTFC) for the relief of cancer-related breakthrough pain (BTP) in an open-label, crossover trial. Adult cancer patients receiving stable background opioid treatment and experiencing BTP episodes were recruited from 44 study centres in seven European countries (Austria, France, Germany, Italy, Poland, Spain and the United Kingdom); of the 196 patients enrolled, 139 were randomised to receive INFS followed by OTFC, or vice versa. Patients were titrated to an effective dose of one agent (50, 100 or 200 microg INFS; 200, 400, 600, 800, 1200 or 1600 microg OTFC) to treat six BTP episodes, then titration and treatment were repeated with the other agent. The primary outcome was patient-recorded time to onset of &amp;amp;amp;amp;amp;#39;meaningful&amp;amp;amp;amp;amp;#39; pain relief. Secondary outcomes included pain intensity difference (PID) at 10 and 30 minutes (PID(10), PID(30)), sum of PID at 15 and 60 minutes (SPID(0-15), SPID(0-60)), ease of administration, treatment preference and relationship between background opioid dose and effective INFS dose. Additional outcome measures included proportions of episodes with &amp;amp;amp;amp;amp;gt; or =33% and &amp;amp;amp;amp;amp;gt; or =50% pain intensity (PI) reduction, and PID at additional time points. NCT00496392. Among the intention-to-treat population (n = 139), median time to onset of &amp;amp;amp;amp;amp;#39;meaningful&amp;amp;amp;amp;amp;#39; pain relief was 11 minutes with INFS versus 16 minutes with OTFC; 65.7% of patients attained faster time to &amp;amp;amp;amp;amp;#39;meaningful&amp;amp;amp;amp;amp;#39; pain-relief onset with INFS (p &amp;amp;amp;amp;amp;lt; 0.001). PID was statistically significantly greater for INFS than OTFC from 5 minutes post-dosing. Significantly more INFS-treated breakthrough pain episodes achieved clinically important pain relief (&amp;amp;amp;amp;amp;gt; or =33% and &amp;amp;amp;amp;amp;gt; or =50% PI reduction) up to 30 minutes post-dosing. The proportions of episodes treated with INFS and OTFC achieving a PI reduction of &amp;amp;amp;amp;amp;gt; or =33% at 5 minutes were 25.3% versus 6.8% (p &amp;amp;amp;amp;amp;lt; 0.001), and at 10 minutes were 51.0% versus 23.6% (p &amp;amp;amp;amp;amp;lt; 0.001), respectively; the proportions of episodes treated with INFS and OTFC achieving a &amp;amp;amp;amp;amp;gt; or =50% PI reduction at 5 minutes were 12.8% versus 2.1% (p &amp;amp;amp;amp;amp;lt; 0.001), and at 10 minutes were 36.9% versus 9.7% (p &amp;amp;amp;amp;amp;lt; 0.001), respectively. Higher SPID(0-15) and SPID(0-60) scores were achieved with INFS (p &amp;amp;amp;amp;amp;lt; 0.001). More patients preferred INFS than OTFC (p &amp;amp;amp;amp;amp;lt; 0.001) and more patients found it very easy/easy to use. Both treatments were well tolerated. In the safety population (n = 139), 56.8% (n = 79) of patients experienced &amp;amp;amp;amp;amp;gt; or =1 AE during the trial. The only AE that occurred in &amp;amp;amp;amp;amp;gt; or =5% of patients in either treatment group was nausea. Among those patients who experienced serious AEs (13.7%, n = 19), none were considered to be related to either study medication. There was a weak correlation between effective INFS doses and background opioid doses. In this open-label, randomised, crossover trial, significantly more patients attained faster &amp;amp;amp;amp;amp;#39;meaningful&amp;amp;amp;amp;amp;#39; pain relief with INFS than OTFC, and more patients preferred INFS to OTFC.
Clinical Pharmacokinetics, 2013
Archives of Internal Medicine, 2008
Bulletin Du Cancer, Nov 1, 2018
![Research paper thumbnail of [Coordination of external care, an original supportive care component at the Gustave Roussy Institute]](https://attachments.academia-assets.com/85917842/thumbnails/1.jpg)
](Soins; la revue de référence infirmière, 2006
1. The vibration-evoked startle response mediates rapid withdrawal in burrowed larval lampreys (a... more 1. The vibration-evoked startle response mediates rapid withdrawal in burrowed larval lampreys (ammocoetes). Ammocoetes withdraw in response to vibration by contracting pre-existing lateral bends in the trunk and tail, thus pulling their heads deeper into the burrow. 2. The motor effects of an ammocoete startle response are dependent on preexisting posture. Areas of lateral body curvature contract more and exhibit larger electromyogram (EMG) amplitudes on their inner sides than on their outer sides. 3. Both of the anterior Mth and posterior Mth' (Mauthner) cells and both of the B| and B 2 (bulbar) Miiller cells fired action potentials in response to vibration of the otic capsules. Both B 3 and B 4 Miiller cells were inhibited by vibration, while M (mesencephalic) and ^ (isthmic) Miiller cells were inhibited by ipsilateral vibration and excited by contralateral vibration. 4. Simultaneous action potentials in both of the anterior Mth cells were appropriate and sufficient for initiating the startle response EMG in a semi-intact preparation. 5. This study demonstrates a Mauthner-initiated startle response which activates musculature on both sides of the body to produce a rapid withdrawal movement and is thus adapted to the eel-like form and burrowed lifestyle of larval lampreys.
The aim of this study is to publish recommendations on the use of painkillers in the elderly, in ... more The aim of this study is to publish recommendations on the use of painkillers in the elderly, in sensitive, isolated or highly dependent patients. These recommendations have been prepared by a group of experts in the field of pain and geriatrics from several scientific societies: French Society for Research and Pain Treatment (SFETD), French Society of Geriatrics and Gerontology (SFGG), French Society for Palliative Support and Care (SFAP), French Society for Assistive Oncology (AFSOS).
Douleurs : Évaluation - Diagnostic - Traitement, 2019
Douleur et Analgésie, 2018
Douleurs : Evaluation - Diagnostic - Traitement, 2009
ABSTRACT This article focuses on three key challenges for the management of chronic pain and brea... more ABSTRACT This article focuses on three key challenges for the management of chronic pain and breakthrough pain for cancer and non cancer patients. The first question concerns the use of transdermal fentanyl in the management of severe chronic pain. The second question approaches the problem of breakthrough pain in cancer patients discussing its identification and management in clinical practice. The third question focuses on the treatment options available for breakthrough pain, and the pharmacological aspects of mucosal administration of fentanyl. Each question examined in detail by one of the three authors of this article.
Journal of Clinical Oncology, 2016
212 Background: Methadone is used more and more as a second-line treatment for refractory cancer ... more 212 Background: Methadone is used more and more as a second-line treatment for refractory cancer pain in palliative care patients. Methods: The study aimed to compare the effect of two methadone titration methods (Stop and Go vs progressive titration) in 146 palliative care cancer patients with pain inadequately relieved or intolerant to level 3 opioids. The primary endpoint was the rate of success/failure at Day 4 defined by pain relief (reduction of at least two points of the numerical scale (0 - 10) AND a pain score < 5 for 2 consecutive days) AND no overdose (Rudkin scale ≥ 3 AND respiratory rate < 8/min). Results: Pain was nociceptive in 16% and mixed in 84%. 85% of the patients had breakthrough pain. Half received oxycodone, 1/5 fentanyl, 1/5 morphine and < 10% hydromorphone. Reasons for switching were lack of efficacy isolated (56%), or with intolerance to previous opioid (38%). More than 2/3 of the patients reached a pain score < 5 for two days at D4, adequate pa...
Oncologie, 2011
La décision d’arrêt d’une chimiothérapie palliative en situation métastatique est un mélange comp... more La décision d’arrêt d’une chimiothérapie palliative en situation métastatique est un mélange complexe d’enjeux thérapeutiques, humains et éthiques. La qualifi cation même de « palliative » associée à la chimiothérapie fait débat entre les oncologues et les médecins de soins palliatifs. De manière un peu paradoxale, ce sont les oncologues qui revendiquent l’adjectif « palliatif » dès la première ligne de chimiothérapie au stade métastatique (c’est-à-dire dès que le but du traitement est un allongement de la durée de vie, même très prolongé, et/ou de la qualité de vie), alors que les médecins de soins palliatifs le repoussent aux ultimes lignes thérapeutiques.
Pain, 1990
AllgemeineIntenshmedizin, A4020I~sbn1&,Austria ACC Hall E Abs No 358 * OF INvF.STIGATIoN. Pol... more AllgemeineIntenshmedizin, A4020I~sbn1&,Austria ACC Hall E Abs No 358 * OF INvF.STIGATIoN. Polypharmacy of opioids or their bolus administration in intensive care often results in inadeauate analgesia and sedation. as well as cardiorestitorv instability. This study evaluated the quality of anagosedatik by continuous administration of ihe opioid sufenknil in polytraumadzed patients suffering from pain. METHODS: We analyzed the quality of analgosedation in 30 polytraumatized adult patients undergoing controlled mechanical ventilation. Our loading infusion was 1 ~g/kg/b sufentanil and the maintenance infusion was adjusted according to changes in clinical (coughing, moving etc.) and cardiovascular parameters. In group I (n=19) adequate analgosedation was achieved with sufentanil alone, whereas in group II (n=ll) we had to supplement this regimen by a continuous infusion of m&z&m, sting with 0.07 mgkg/h. No other opioids were administered. Respiratory, cardiovascular, hepatic and renal parameters, as well as side effects common to opioids were recorded.
La vie des patients atteints par le cancer, meme s'il n'est pas guerissable, est devenue ... more La vie des patients atteints par le cancer, meme s'il n'est pas guerissable, est devenue plus longue grâce aux progres des traitements de la maladie et aux soins de support parmi lesquels la prise en charge de la douleur, l'accompagnement et les soins palliatifs jouent un role preponderant. Si les douleurs sont toujours la, elles sont le plus souvent previsibles ou identifiables et traitees grâce a la pharmacopee qui s'est amelioree tant en qualite qu'en choix cette derniere decennie. Le developpement de techniques complementaires non medicamenteuses permet aussi de completer le traitement de la douleur, une sensation multiple et complexe. Les auteurs donnent un regard clair, precis, didactique mais non exhaustif, sur les connaissances actuelles en matiere de douleurs liees aux cancers. Il est aussi fait etat de la recherche et des dernieres avancees dans le domaine. Cet ouvrage, ecrit par des medecins, des infirmiers et des psychologues, tous specialistes de la ...
Bulletin Du Cancer, 1991
This pilot study was undertaken in a group of 7 patients receiving morphine either by oral route ... more This pilot study was undertaken in a group of 7 patients receiving morphine either by oral route under a controlled release form (Moscontin tablets), or by subcutaneous route with continuous infusion. Complete pharmacokinetics over 24 h were carried out with blood samples taken every hour. The measurements of morphine and of its metabolite, morphine-6-glucuronide (M6G) were performed by high-performance liquid chromatography (HPLC) with coulometric detection, using nalorphine (NAL) as an internal standard. The morphinics were extracted on a Bond Elut C18 column according to a double liquid-solid extraction. The extract was chromatographed by ion-pairing on a mu Bondapak C18 column, 10 microns (300 x 3.9 mm). The minimal detectable concentrations were respectively 1 and 5 ng/ml for M and M6G. When Moscontin was given at dosages 1 mg/kg/d, a difference appeared and gradually rose to a M/M6G ratio of 1.3 +/- 0.04. With subcutaneous infusion, the plasma levels of M6G were from 2 to 17-f...
Douleurs : Évaluation - Diagnostic - Traitement, 2017
Journal of Clinical Oncology, 2014
TPS6639 Background: Previous clinical trials have confirmed the efficacy and safety of fentanyl p... more TPS6639 Background: Previous clinical trials have confirmed the efficacy and safety of fentanyl pectin nasal spray (PFNS), as a rapid analgesic agent in cases of Breakthrough pain in cancer (BTPc),...
Pain, 1993
To assess the contribution of pharmacological tolerance to increasing doses of morphine, 29 cance... more To assess the contribution of pharmacological tolerance to increasing doses of morphine, 29 cancer patients requiring oral morphine to treat pain were studied by two teams working independently. The first team assessed physical impairment, pain intensity and pain treatment. The second team assessed depressive disorders (DSM III criteria), emotional and behavioural depressive patterns (Retardation Depressive Scale, Polydimensional Mood Scale). All patients were seen at the initiation of morphine therapy and followed to the first morphine dose modification. Evaluations were carried out in outpatient clinics except staging investigations which were undertaken at the beginning and at the end of the study. Our results showed that (1) in 24 of the 25 patients for whom morphine doses were increased, progressive disease was recorded; (2) in 4 patients, morphine doses were not increased and in these patients their disease was stable or in remission; and (3) changes in depressed mood were not correlated with pain intensity. These data strongly suggest that, instead of pharmacological tolerance, the main factor resulting in increasing oral morphine requirement in cancer pain management is pain increase due to disease progression.
Current Medical Research and Opinion, 2009
The efficacy of intranasal fentanyl spray (INFS) was compared with that of oral transmucosal fent... more The efficacy of intranasal fentanyl spray (INFS) was compared with that of oral transmucosal fentanyl citrate (OTFC) for the relief of cancer-related breakthrough pain (BTP) in an open-label, crossover trial. Adult cancer patients receiving stable background opioid treatment and experiencing BTP episodes were recruited from 44 study centres in seven European countries (Austria, France, Germany, Italy, Poland, Spain and the United Kingdom); of the 196 patients enrolled, 139 were randomised to receive INFS followed by OTFC, or vice versa. Patients were titrated to an effective dose of one agent (50, 100 or 200 microg INFS; 200, 400, 600, 800, 1200 or 1600 microg OTFC) to treat six BTP episodes, then titration and treatment were repeated with the other agent. The primary outcome was patient-recorded time to onset of &amp;amp;amp;amp;amp;#39;meaningful&amp;amp;amp;amp;amp;#39; pain relief. Secondary outcomes included pain intensity difference (PID) at 10 and 30 minutes (PID(10), PID(30)), sum of PID at 15 and 60 minutes (SPID(0-15), SPID(0-60)), ease of administration, treatment preference and relationship between background opioid dose and effective INFS dose. Additional outcome measures included proportions of episodes with &amp;amp;amp;amp;amp;gt; or =33% and &amp;amp;amp;amp;amp;gt; or =50% pain intensity (PI) reduction, and PID at additional time points. NCT00496392. Among the intention-to-treat population (n = 139), median time to onset of &amp;amp;amp;amp;amp;#39;meaningful&amp;amp;amp;amp;amp;#39; pain relief was 11 minutes with INFS versus 16 minutes with OTFC; 65.7% of patients attained faster time to &amp;amp;amp;amp;amp;#39;meaningful&amp;amp;amp;amp;amp;#39; pain-relief onset with INFS (p &amp;amp;amp;amp;amp;lt; 0.001). PID was statistically significantly greater for INFS than OTFC from 5 minutes post-dosing. Significantly more INFS-treated breakthrough pain episodes achieved clinically important pain relief (&amp;amp;amp;amp;amp;gt; or =33% and &amp;amp;amp;amp;amp;gt; or =50% PI reduction) up to 30 minutes post-dosing. The proportions of episodes treated with INFS and OTFC achieving a PI reduction of &amp;amp;amp;amp;amp;gt; or =33% at 5 minutes were 25.3% versus 6.8% (p &amp;amp;amp;amp;amp;lt; 0.001), and at 10 minutes were 51.0% versus 23.6% (p &amp;amp;amp;amp;amp;lt; 0.001), respectively; the proportions of episodes treated with INFS and OTFC achieving a &amp;amp;amp;amp;amp;gt; or =50% PI reduction at 5 minutes were 12.8% versus 2.1% (p &amp;amp;amp;amp;amp;lt; 0.001), and at 10 minutes were 36.9% versus 9.7% (p &amp;amp;amp;amp;amp;lt; 0.001), respectively. Higher SPID(0-15) and SPID(0-60) scores were achieved with INFS (p &amp;amp;amp;amp;amp;lt; 0.001). More patients preferred INFS than OTFC (p &amp;amp;amp;amp;amp;lt; 0.001) and more patients found it very easy/easy to use. Both treatments were well tolerated. In the safety population (n = 139), 56.8% (n = 79) of patients experienced &amp;amp;amp;amp;amp;gt; or =1 AE during the trial. The only AE that occurred in &amp;amp;amp;amp;amp;gt; or =5% of patients in either treatment group was nausea. Among those patients who experienced serious AEs (13.7%, n = 19), none were considered to be related to either study medication. There was a weak correlation between effective INFS doses and background opioid doses. In this open-label, randomised, crossover trial, significantly more patients attained faster &amp;amp;amp;amp;amp;#39;meaningful&amp;amp;amp;amp;amp;#39; pain relief with INFS than OTFC, and more patients preferred INFS to OTFC.
Clinical Pharmacokinetics, 2013
Archives of Internal Medicine, 2008
Bulletin Du Cancer, Nov 1, 2018
Soins; la revue de référence infirmière, 2006
1. The vibration-evoked startle response mediates rapid withdrawal in burrowed larval lampreys (a... more 1. The vibration-evoked startle response mediates rapid withdrawal in burrowed larval lampreys (ammocoetes). Ammocoetes withdraw in response to vibration by contracting pre-existing lateral bends in the trunk and tail, thus pulling their heads deeper into the burrow. 2. The motor effects of an ammocoete startle response are dependent on preexisting posture. Areas of lateral body curvature contract more and exhibit larger electromyogram (EMG) amplitudes on their inner sides than on their outer sides. 3. Both of the anterior Mth and posterior Mth' (Mauthner) cells and both of the B| and B 2 (bulbar) Miiller cells fired action potentials in response to vibration of the otic capsules. Both B 3 and B 4 Miiller cells were inhibited by vibration, while M (mesencephalic) and ^ (isthmic) Miiller cells were inhibited by ipsilateral vibration and excited by contralateral vibration. 4. Simultaneous action potentials in both of the anterior Mth cells were appropriate and sufficient for initiating the startle response EMG in a semi-intact preparation. 5. This study demonstrates a Mauthner-initiated startle response which activates musculature on both sides of the body to produce a rapid withdrawal movement and is thus adapted to the eel-like form and burrowed lifestyle of larval lampreys.
The aim of this study is to publish recommendations on the use of painkillers in the elderly, in ... more The aim of this study is to publish recommendations on the use of painkillers in the elderly, in sensitive, isolated or highly dependent patients. These recommendations have been prepared by a group of experts in the field of pain and geriatrics from several scientific societies: French Society for Research and Pain Treatment (SFETD), French Society of Geriatrics and Gerontology (SFGG), French Society for Palliative Support and Care (SFAP), French Society for Assistive Oncology (AFSOS).
Douleurs : Évaluation - Diagnostic - Traitement, 2019
Douleur et Analgésie, 2018
Douleurs : Evaluation - Diagnostic - Traitement, 2009
ABSTRACT This article focuses on three key challenges for the management of chronic pain and brea... more ABSTRACT This article focuses on three key challenges for the management of chronic pain and breakthrough pain for cancer and non cancer patients. The first question concerns the use of transdermal fentanyl in the management of severe chronic pain. The second question approaches the problem of breakthrough pain in cancer patients discussing its identification and management in clinical practice. The third question focuses on the treatment options available for breakthrough pain, and the pharmacological aspects of mucosal administration of fentanyl. Each question examined in detail by one of the three authors of this article.