Alain Moreau

Douleurs musculo-squelettiques non systématisées diffuses et déficit sévère en vitamine D. Étude avant-après en médecine générale

OBJECTIVES The objective of this study was to evaluate the effect of the correction of vitamin D deficiency (defined by a rate≤50 nmol/l) on the pain, fatigue and quality of life. METHODS A pragmatic prospective study was conducted in Rhone-Alpes area, in general practices between February 1 and April 30, 2009. All patients aged 18 to 50 years consulting for diffuse musculoskeletal pain and/or chronic unexplained fatigue, with the only abnormality deficient serum vitamin D were enrolled in this study. They might agree to complete questionnaires on quality of life, pain assessment and control their vitamin D levels after treatment. RESULTS Forty-nine complete records were analyzed. The deficiency was severe (mean 26 nmol/l). High doses of vitamin were necessary to correct deficiency, between 400,000 to 600,000 units. The correction of vitamin D deficiency resulted in a significant decrease in the level of pain intensity according to verbal rating scale (P=0.034) and the Digital Scale (P<0.001), consumption of analgesics (P=0.002) and discomfort in carrying out activities of daily living following: the shopping, cleaning, walking for more than a kilometer (P<0.001) and dressing (P=0.012). CONCLUSION The correction has had a positive impact both physical, mental and social activities. Non-specific musculoskeletal pain or unexplained asthenia are common in primary care. Make a dosage of vitamin D and correct deficits is a necessity before performing complex and expensive examinations.

Development and validation of the short version of the diabetes obstacles questionnaire (DOQ-30) in six European countries.

Abstract Background: Patients with type 2 diabetes reveal different obstacles in living with the disease. The EGPRN initiated a qualitative research EUROBSTACLE to create a broadly conceptualized diabetes-related quality of life (DR-QoL) instrument. It led to the development of the diabetes obstacle questionnaire (DOQ), a five-point Likert-scaled measure, consisting of 78 items in eight scales. Objectives: To develop and validate a short, easy-to-use version of the DOQ. Methods: A cross-sectional study with the DOQ was carried out. Participants answered the DOQ and GPs added some clinical data from their medical records. Data of 853 patients from Belgium, France, Estonia, Serbia, Slovenia, and Turkey were included in the analysis. The selection of items for the short version of the DOQ was achieved with exploratory factor analysis (EFA). Construct validity was proved with EFA and Pearson correlations between the DOQ and the new DOQ-30. Internal reliability was established with Cronbach’s alpha. Results: DOQ-30 resulted in 30 items in nine subscales. It explained 49.8% of items’ variance. It shows a considerable good internal reliability and construct validity. Conclusion: The DOQ-30 is a five-point Likert-scaled broadly conceptualized measure of DR-QoL. It addresses a variety of obstacles, such as social, psychological, cognitive and behavioural. The DOQ-30 is ready for implementation in general practice and research in Europe as a valuable instrument to assess DR-QoL.

Patients and their chronic pain: How do they perceive it?

Chronic pain is one of the most common reasons for consulting a general practitioner, with incidence assessed at 20 to 50% depending on the country and the studies.‘J We undertook a descriptive study with the aim to determine how patients ‘bear’ their chronic pain, how well they adhere to the treatment and what the impact is on quality of life. A questionnaire was given to adult patients with non-cancerous chronic pain, not linked to AIDS, which had been present for more than three months. We used the ANAES questionnaire^.^ Altogether 148 patients (36 men and 108 women) were included in the study. Table 1 presents the main results. This study was the first to provide data about non-cancerous chronic pain according to the patient’s viewpoint in general, practice in France. The duration of the pain is long since 36% of the patients had been suffering for more than ten years and 54% for more than five years. This could be explained by the fact that most of the pain is osteoarticular in nature and that the patients’ average age was high. In all the studies we reviewed, we found a predominant for chronic pain of osteoarticular origin. Adverse events, such as an accident at work, or a bereavement, represent triggering elements in 38% of the cases and