Prise en soins de la douleur en EHPAD

The prevalence of pain increases with age. For elderly patients who are often frail, polypathological and polymedicated, the evaluation of the risk/benefit of treatments seems essential. The World Health Organization has established a scale for analgesic use. The dominant principle is that the inefficacy of an analgesic leads on to the use of higher-grade substances. The aim of this work was to study the place given to level II analgesics by physicians practicing in nursing homes in managing nociceptive pain. We carried out an observational, declarative, qualitative and quantitative, descriptive study, based on questionnaires sent by email to seventy-seven doctors practising in nursing homes in the Maine and Loire département in western France. Eighteen percent of the physicians responded. Level II analgesics were rarely used in these long-term care homes. They ranked in third position, well after paracetamol and level III analgesics. The use of level III analgesics at very low doses with progressive increase was the most common attitude. The main reason for reluctance to use Level II analgesics was their poor tolerance. The preferred level II analgesic was paracetamol/opium powder/caffeine (Lamaline) for 60% of the physicians who used them, amounting to 46% of all physicians who participated in the study. A broader study could help to draw more definite conclusions.