My pain is another
François MOUTET, MD[1]
Pain is a signal and the information coming from the patient is it’s analyse. Allodynia is the definition of the phenomenon where the stimulation is different -in greek alloV -from the one we thought we would provoke a pain at that level – in greek odunh. To paraphrase Rimbaud (a famous French poet), « My pain is another » ! If the physiological phenomenon is better known, the treatment is still a hazardous road for the therapist.
The long path opened by Claude J. Spicher has got our attention since 2005 and a member of the team had followed the course in 2006. Since, almost every member of the hand therapy team had benefit from it. The method, standardised therefore reproducible, giving quantified results, gives objectivity on a subjective theme. This objective aspect of pain and the sensibility in a given territory - and its regression in surface and severity- is not a lesser advantage: for the therapist and the patient.
The possible quantification gives the opportunity to evaluate the method itself and to proceed with statistical observations. Exchanges with others therapists are then facilitated.
Results, when they do not respect the expected evolution, give the opportunity to put in question either the therapist or patient. When the treatment has not evolved, questioning the choice of territory for counter stimulation is in order. Does the patient follow the instructions? Was the evaluation done right the first time? Is it the best therapeutic strategy or protocol? Like very often with matter of research, questions have as much importance as answers.
It is regrettable that the method detractors do not put in question the scientific evaluation of the subject. It comes from recent discoveries about somaesthetic phenomenon that did not fully revealed their possibilities. Claude J. Spicher open this path to fruitful developments with observations from field men, incubators of sensibility, “skin-o-logist”, that with their observations, analyses and questioning promotes progress and research.
Like any hospital unit specialized in hand emergencies, we are a high debit organisation, essentially in charge of evaluation and orientation for this type of patients. That is where the necessity is, for the therapists working in that kind of facility, to know about somatosensory rehabilitation. We encourage it with the creation of a continuing course in Grenoble in 2017.
Those few lines are the fruit of a common reflexion with the therapists and collaborators of the Unité de Chirurgie de la Main et de Brûlés SOS Main Grenoble in the CHU Grenoble Alpes.
Grenoble, July the 13th 2016
Translated by the editorial board
[1] Professeur émérite, consultant, CHU Grenoble Alpes ; Chirurgie Plastique Réparatrice et Esthétique, Chirurgie de la Main et des Brûlés, SOS Main Grenoble ; CS 10217 ; F- 38043 Grenoble ; Pastpresident of the French Society for Hand Surgery fmoutet@chu-grenoble.fr
