1998-2008 : les « tops » et les « flops » de la lutte contre la douleur

This last decade has seen an enormous amount of work devoted to the field of pain, from pharmacological development to care practices. But looking back at the large body of publications generated, one could be disappointed with the result. Most drugs used in 2008 were already available 10-years ago. Notable advances include the new attitude of the public authorities in France (Neuwirth law), the codification of the use of antiepileptics as medications for neuropathic pain, reasonable use of an equimolecular mixture of oxygen and nitrogen protoxide, the rotation of opiates, reasonable use of opiates for non-cancer pain. Conversely, the enthusiasm of many medical teams has been replaced by deception: difficulty with cyclo-oxygenase inhibitors type 2, insufficiencies in the demonstration of the usefulness of cannabis, difficulty in managing undesirable effects of opiates, imperfect response to postoperative pain, etc. In all, there appears to be a widening gap between fundamental research and routine clinical practice. Here again, retrospection offers a source of modesty.