Epaule douloureuse: prise en charge ambulatoire [Shoulder pain in ambulatory practice].

Scapulalgias or omalgias are a frequent complaint, with more than half of them being linked to an injury of the rotators cuff. As they often become chronic, omalgias result in higher rates of absenteeism and significant health care costs. Scapulalgias have three main causes: posttraumatic, intrinsic of the joint, or extrinsic. The extrinsic omalgias, either of neurologic, cardiovascular, pulmonary, or abdominal etiology, require swift identification, as their treatment is often an emergency. Most of the scapulalgias can be treated conservatively. Main factors of poor prognosis are old age, women gender and associated cervicalgias.

La fonction de Moi auxiliaire dans la prise en charge des douloureux chroniques [The role of the auxiliary ego in the care of the chronic pain patient]

La prise en charge des patients souffrant de douleurs chroniques, à l'interface entre corps et psyché, nécessite une approche globale et souvent un réseau de soins coordonnés, contenant et stable. La psychiatrie de liaison a naturellement trouvé sa place dans ce réseau de soins spécifiques auprès des différents soignants impliqués. Les réflexions issues de cette expérience ont pour objectif de mieux comprendre le rôle thérapeutique des soignants et font émerger la notion de Moi auxiliaire comme élément clé dans le traitement de ces patients. Dans cet article, nous reprendrons les fondements historiques et conceptuels de la fonction de Moi auxiliaire pour nous intéresser à ses différentes applications dans ces prises en charge : consultation médicale, psychothérapie individuelle ou de groupe, colloque interdisciplinaire. The management of the patient suffering from chronic pain, situated on the interface between body and psyche, necessitates a global approach and often a coordinated, stable and containing network of care. Liaison psychiatry has become part of this network, together with various health care professionals from somatic disciplines. Based on these experiences, this article aims to better understand the therapeutic role of those who take care of the chronic pain patient by identifying the auxiliary ego as a key element of care. The historical development and conceptual framework of the auxiliary ego are utilized to highlight its roles in the different aspects of care of these patients:in the medical consultation, individual psychotherapy, group psychotherapy and in the interdisciplinary meetings.