Les douleurs périopératoires restent problématiques et souvent insuffisamment traitées. Au vu des limitations des approches médicamenteuses, l'hypnose est prometteuse comme adjonction à une prise en charge multimodale de la douleur aiguë chirurgicale. En effet, l'hypnose bénéficie d'un intérêt croissant tant des patients que de la communauté médicale. Elle peut se pratiquer en phase pré-ou postopératoire, pour aider à la gestion de symptômes momentanés (douleur et anxiété), mais aussi en peropératoire, soit en remplacement d'une technique anesthésique ou en complément de celle-ci (hypnosédation). Cet article vise à clarifier les différentes utilisations possibles de l'hypnose antalgique en périopératoire, ainsi que les bénéfices qui peuvent en être attendus. Perioperative hypnosis: What analgesic impact ?Perioperative pain is a burden that often is insufficiently addressed. Considering the limitations of pharmacological approaches in this context, hypnosis is a promising technique as part of a multimodal management plan for acute surgical pain.There is a growing interest for hypnosis from patients and the medical community. It can be practiced in the pre-or post-operative setting for acute symptom management (pain and anxiety), as well as per-operatively as a substitute to anesthetic care, or as a complement (hypnosedation). This article aims to clarify these different uses of hypnosis for perioperative analgesia, as well as the benefits that can be expected.

Acupuncture et douleur chronique : guide pratique à l'usage des médecins généralistes Des récentes recommandations cliniques internationales de différents comités d'experts incluent l'acupuncture au même titre que les traitements médicamenteux ou interventionnels pour le traitement de douleurs chroniques. Dès lors, cette technique de médecine traditionnelle chinoise trouve sa place dans un plan de traitement antalgique en médecine générale, et ne devrait pas être réservée au dernier recours suite à l'échec de toutes les autres modalités. Dans l'esprit d'une antalgie intégrative, cet article propose un aperçu d'indications actuellement validées, ainsi que quelques clefs pour le médecin de premier recours qui souhaite orienter son patient vers un traitement d'acupuncture. Acupuncture and chronic pain : practical considerations for primary care physiciansDifferent international clinical guidelines from expert committees recommend acupuncture on equal terms with conventional pharma cological or interventional techniques for the management of chronic pain. Thus, this traditional Chinese medicine technique has won its place in a primary care chronic pain management plan. It should not be reserved as a last resort, when all other techniques have failed. Inspired by the concept of integrative medicine, this article proposes an overview of currently validated indications, and offers some tools for the primary care physician who wishes to orient a patient towards an acupuncture treatment.

Background: (FM). Fibromyalgia (FM) is a very prevalent and debilitating chronic pain disorder that is difficult to treat. Mindfulness-based techniques are regarded as a very promising approach for the treatment of chronic pain and in particular FM. The Mindfulness-Oriented Recovery Enhancement (MORE) intervention, a mindfulness-based group intervention, has shown beneficial effects in opioid-treated chronic pain patients, including reduced pain severity, functional interference, and opioid dosing, by restoring neurophysiological and behavioral responses to reward. First evidence for a hypodopaminergic state and impaired reward processing in FM have been reported. However, little is known about its impact on dopamine (DA) function and in particular with regard to DA responses to monetary reward in FM. The aim of the present study protocol is to evaluate if MORE is able to restore the DA function in FM patients, in particular with regard to the DA responses to reward, and to reduce pain and mood complaints in FM.Methods/design: The present study is a multi-center RCT with 3 time points: before the intervention, after completion of the intervention and 3-months after completion of the intervention. Eighty FM patients will be randomly assigned to either the MORE intervention (N=40) or to a wait-list control group (N=40). Additionally a comparison group of healthy women (N=20) will be enrolled. The MORE intervention consists of eight 2-hour long group sessions administered weekly over a period of 8 weeks. Before and after the intervention, FM participants will undergo [18F] DOPA Positron Emission Tomography (PET) and functional MR imaging while performing a monetary reward task. The primary outcome will be endogeneous DA changes measured with [18F] DOPA PET at baseline, after the intervention (after 8 weeks for control group), and at 3 months’ follow-up. Secondary outcomes will be (1) clinical pain measures and FM symptoms using standardized clinical scales 2) functional brain changes 3) measures of negative and positive affect, stress and reward experience in daily life using the Experience Sampling method (ESM) 4) biological measures of stress including cortisol and alpha-amylase.Design: If the findings of this study confirm the effectiveness of MORE in restoring DA function, reducing pain and improving mood symptoms, MORE can be judged to be a promising means to improve quality of life in FM patients. The findings of this trial may inform health care providers about the potential use of the MORE intervention as a possible non-pharmacological intervention for FM.Trial registration: ClinicalTrials.gov NCT 04451564. Registered on 3 July 2020. The trial was prospectively registered.