La douleur chronique en soins palliatifs ou… empreinte de l'insaisissable

In the context of palliative care management, pain may sometimes resist to biomedical logic: it remains present and refractory. Instead of a single pharmaceutical answer without any consideration for the meaning of pain, we are putting forward the concept that pain at the end of life would be for some patients “totem” as a reminder of an old trauma, as a teller of a “significant” something about their lives. Elusive symptom, we offer the concept of “pain as a totem” that would be explained as an adaptative function of the patient's narrative. Too often misunderstood as such in palliative care, pain would then reflect the redynamisation of mental process together with the difficulties on which the subject builds up his personality. Through four clinical situations, we first, shall consider examples of the adaptative function of “pain as a totem”. Each time, we shall examine the true meaning of pain in the light of the own subject knowledge. Second, we shall extract the ethical and epistemological postures on which such a concept is supported with. Together, a tentative of modelisation of care management of the painful patient will be submitted.