On September 1, 2021, Dr. Aurore Maire will join the team at the Institut Franco-Européen Multidisciplinaire de prise en charge de l'endométriose (IFEMENDO). A recognized algologist, she was already involved in patient care as part of dedicated day hospitals. Today, she is inaugurating a specific pain consultation.
Hello, Dr Maire. You've just set up a consultation dedicated to pain at IFEM ENDO. Can you tell us about your background?
- I began my specialization in pain medicine at Lariboisière Hospital in Paris. I chose this path after realizing that pain, despite being one of the main reasons for medical consultation, is too often undervalued. In 2020, I moved to Bordeaux, where I split my time between the Centre d'évaluation et de traitement de la douleur at CHU Pellegrin and the Consultation douleur at Hôpital Bagatelle. I then went on to coordinate the Bagatelle Pain Consultation on a full-time basis, while also taking part in the endometriosis day hospital at IFEMENDO. In 2024, I decided to devote myself fully to patients suffering from chronic pelvic pain by joining the Institute's team.
What role does the algologist play in the care of patients with endometriosis?
- The algologist takes over from other professionals when first- or second-line treatments fail. Their role is to provide specific expertise in the management of complex pain, and to consider the patient as a whole, taking into account her physical, psychological and social needs.
Do all patients with endometriosis need to consult an algologist?
- No. If pain is well controlled by simple analgesics (paracetamol, antispasmodics, anti-inflammatories) or hormonal treatments, a consultation with an algologist is generally not necessary.
How does a pain consultation work?
- The consultation begins with a listening session, during which the patient shares her pain history. The algologist identifies the key elements of this history and also explores any comorbidities or other chronic pain.
A detailed interview follows, focusing on treatments already tried, their efficacy and any side effects. A targeted clinical examination is then carried out to gain a better understanding of the mechanisms at play and guide treatment.
Finally, time is devoted to explaining pain mechanisms and drawing up a personalized treatment plan. This plan may include drug or non-drug treatments, depending on the patient's needs and expectations.
What treatments can you offer?
We often combine drug and non-drug treatments, which are complementary.
Drug treatments :
- Crisis treatments: paracetamol, antispasmodics, anti-inflammatories, nefopam, weak opioids (lamaline, tramadol, codeine). We avoid strong opioids wherever possible, due to the risk of dependence and induced hyperalgesia over the long term.
- Background treatments: certain antiepileptic or antidepressant drugs (amitriptyline, duloxetine, venlafaxine, gabapentin, pregabalin) can reinforce natural pain control mechanisms. For neuropathic pain, we can also use lidocaine patches.
Non-drug treatments :
- Transcutaneous neurostimulation (TENS)
- Physiotherapy (general, pelvic, balneotherapy)
- Pelvic osteopathy
- Posturology/podology
- Adapted physical activity (yoga, Pilates)
- Hypnosis
- Acupuncture
- Mindfulness meditation
- Food advice
- Psychotherapy (support, CBT, EMDR, sex therapy, etc.)
Thank you, Dr Maire, for your commitment to the patients at our center and for your invaluable expertise.
