Background and Importance In health institutions, pain management is an obligation from diagnosis to treatment. However, in mental health, it is difficult to treat it because psychiatric diseases may alter the perception of the pain and there are drug interactions (DI) between psychotropic drugs and analgesics.
Aim and Objectives The aim of the study is to find guidelines on pain management in psychiatry and review the current state of analgesic prescriptions in our psychiatric units.
Material and Methods A bibliographic search on pain management in psychiatry was carried out and an observational audit of analgesic prescriptions was done, at a given day, in the five psychiatric units of our establishment.
Data are expressed as average +/- standard deviation and results as percent.
Results The bibliographic search offers pain assessment scales in psychiatry even if they are not specific to this population. Nevertheless, there is not any consensus on the therapeutic pain management in mental health, neither at national nor international level.
The day of the audit, on 88 patients, 47 (53%) were treated with analgesics. These patients were 50 +/- 17 years old and the sex-ratio was 1.04.
Fifty prescription lines for analgesics were identified. The main molecules found were : paracetamol, prescribed alone on 42 prescriptions (90%), and tramadol, alone on 2 prescriptions (4%) or co-prescribed with paracetamol on 2 prescriptions (4%). One prescription (2%) included paracetamol/opium + ibuprofen.
Of all the painkillers, 90% were prescribed conditionally, including 79% ‘if needed/pain’; 14% ‘if Analog Visual Scale > 3, temperature > 38°C’; 7% ‘if Analog Visual Scale > 3’.
A DI analysis has been performed between analgesics/psychotropics and a single prescription with an association not recommended (tramadol/paroxetine with risk of inefficiency of tramadol due to metabolic inhibition) was found. The absence of contraindication can be explained by the pharmaceutical analysis of the prescriptions.
Conclusion and Relevance Following this audit, a cross-referenced table of existing DI between analgesics/psychotropics was made and alternative treatment in case of DI was proposed. These works, and also reminders of the scales that can be used in psychiatry to assess pain and the possibilities of treatment according to the mental disorder, were presented to psychiatrists during a session to facilitate their pain management.
Conflict of Interest No conflict of interest
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