In order to improve the quality of life of patients suffering from chronic pain, the High Authority of Healthin partnership with the College of General Medicine (CMG) and the French Society for the Study and Treatment of Pain (SFETD)publish a health journey guide to provide a graduated response adapted to each person. The objective is to strengthen prevention, improve lead times and promote coordination of all the players involved in this care.
“This course gives pride of place to community medicine, to its collaboration with chronic pain structures as well as to the proper mobilization of specialist hospital services. The level of care seeking is determined by the needs of the patient. ”
Pathology that affects more than 12 million French people, chronic pain is defined as pain that persists or recurs for more than 3 months¹. Chronic pain alters the quality of life of people who suffer from it and has a strong impact on the lives of those around them. It has significant repercussions on the physical, psychological, social, professional or school levels, and it is a source of disability.
While the three national pain control plans (1998 to 2010) have made progress possible, the management of chronic pain and the training of professionals still need to be improved. Indeed, the waiting times remain too long with regard to international criteria. To date, it is estimated that 70% of patients do not have appropriate care. Moreover, territorial inequalities in access to specialized care persist, particularly for the most vulnerable populations. However, the later the treatment, the more complex the situation and the limited possibilities for improvement.
It is in this context that the HAS, in partnership with the CMG and the SFETD, publishes a health journey guide for people with chronic pain and proposes a new organization of care. Focused on the needs of the patient, this organization gives a prominent place to city professionals, and proposes to create an interface between the city and the chronic pain specialist structures for support of city professionals and better coordination between the city and the hospital. hospital. The objective is to reduce the disability, a corollary of pain, to prevent social, professional or school exclusion and to improve the patient’s quality of life.
“To date, it is estimated that 70% of patients do not have appropriate care”.
Community medicine, the cornerstone of three-level care
Through this guide, the HAS thus presents a management graduated in three levels, in response to the complexity of the patient’s situation. Each level offers multi-professional and multi-disciplinary team care:
– level 1, the city
– level 2, SDCs (chronic pain assessment and treatment centres) and specialty hospital services
– level 3, chronic pain assessment and treatment centres.
Called upon to care for the greatest number of patients, first and second line healthcare professionals in town thus constitute the first level of management of chronic pain. The attending physician is the coordinator and responsible for this course, he relies on a primary care team which ideally includes, in addition to the attending physician, a nurse, a physiotherapist, a pharmacist and a psychologist, and mobilizes doctors if necessary. city specialists.
La HAS préconise de créer une interface ville/hôpital (niveau 1 / niveau 2) En cas de difficulté rencontrée au premier niveau de prise en charge, le médecin traitant peut solliciter le soutien des Consultations d’évaluation et de traitement de la douleur de leur territoire. Hautement qualifiées pour la prise en charge de la douleur chronique, ces structures peuvent soutenir la médecine de ville au moyen d’une interface qui s’appuie notamment sur des services de télésanté : hotline dédiée, téléconsultations, télé expertises, réunions de synthèse pluriprofessionnelles et réunions de concertation pluridisciplinaires en visioconférence, outils de partage des données et services de partage et de diffusion des savoirs. A terme, cette interface doit permettre la prise en charge de plus en plus complexe de patients douloureux chroniques par les médecins en ville et une meilleure coordination avec le deuxième niveau.
For patients suffering from stubborn chronic pain that does not respond to well-conducted treatments in level 1, the doctor calls on the second level of care. The patient is sent for a diagnosis, an evaluation or a specific treatment either to a Chronic pain treatment evaluation consultation, which is able to treat any type of chronic pain, or to a hospital department of specialty according to the type of chronic pain (for example in neurology for chronic headache or neuropathic pain, in rheumatology for chronic musculoskeletal pain, etc.).
When patients present situations that are too complex for a second level supportthey can be oriented towards a Chronic Pain Assessment and Treatment Center for a multidisciplinary consultation meeting, an additional assessment or a specific technical act that can only be carried out and level 3, or hospitalization. Whatever the level of care, it is essential that the attending physician continues to monitor his patients and ensure the coordination of his care.
A journey centered on the needs of the patient
HAS reminds that the management of a person with chronic pain must be developed and implemented with their agreement and participation. This support may indeed require a change in lifestyle, professional reclassification or commitment to a new life project.
HAS considers that support from professionals is necessary to maintain or even strengthen the patient’s autonomy, help him manage his disease and his treatments himself and support him in his lifestyle changes. The doctor must know how to rely on caregivers and families for fragile or dyscommunicating patients, in particular dependent elderly people and people with physical, sensory, psychological or intellectual disabilities.
¹Definition de l’International association for the study of pain task force on wait-times (IASP)
• Health journey of a person with chronic pain – PROFESSIONAL PRACTICE IMPROVEMENT TOOL – (PDF) Haute Autorité de Santé, February 2023 .
