Chronic pain concerns more than 12 million French people. In order to improve the quality of life of these patients, the High Authority for Health (HAS) has just published a guide on the health course of people affected by this condition.
Why this guide?
The management of chronic pain and the training of professionals still need to be improved. Notably :
- The delays in treatment remain too long, knowing that the later the treatment, the more complex the situation and the limited possibilities for improvement;
- About 70% of patients do not have appropriate care;
- Territorial inequalities in access to specialized care persist.
Faced with these findings, HAS is proposing a new organization of care centered on the needs of the patient, in order to provide everyone with a graduated and appropriate response. The objectives are in particular to reduce the handicap, prevent social, professional or school exclusion and improve the quality of life.
Support at three levels
HAS offers graduated support at three levels:
- Level 1 mobilizes first and second line health professionals in town: general practitioner, primary care team (ESP) ideally composed of a nurse, physiotherapist, pharmacist, psychologist, and if necessary second line specialist doctors in town (psychiatrist, neurologist, rheumatologist, oncologist, pediatrician, etc.). Other professionals, who are not health professionals, can be mobilized (APA-S teachers [Activité Physique Adaptée-Santé], social service assistant, etc.). The attending physician remains the coordinator and responsible for the patient’s health journey.
- Level 2 calls on specialized consultations and centers dedicated to the assessment and treatment of chronic pain (chronic pain structure – SDC) which must be attached to a public or private health establishment.
- Level 3 concerns chronic pain assessment and treatment centers which are multi-purpose, multi-professional, multi-disciplinary and must be attached to a public or private health establishment. It is recommended to have at least one center per region.
Depending on the territory, the SDC is a chronic pain assessment and treatment consultation (level 2) or a chronic pain assessment and treatment center (level 3). The centers have the same missions as level 2 consultations but also have missions of their own, level 3.
A prominent place for city medicine
The care pathway proposed by HAS gives a preponderant place to city professionals who constitute the first level, and proposes to create an interface between the city and the specialized structures for support of city professionals and better coordination between the city and the hospital. Treating physicians must be able to request support for pain assessment and treatment consultations in their territory, for example by means of an interface that relies in particular on telehealth services: dedicated hotline, teleconsultations, tele-expertise , multi-professional summary meetings and multi-disciplinary consultation meetings by videoconference, data sharing tools and services for sharing and disseminating knowledge. Ultimately, this interface should allow the increasingly complex management of chronic pain patients by doctors in the city and better coordination with the second level.
Whatever the level of care, it is essential that the attending physician continues to monitor his patients and ensure the coordination of care.
