[Development of pain resource nurses: towards a national cooperation protocol]. / Évolution des infirmiers ressource douleur : vers un protocole de coopération national.

Improving access to specialized pain management centers for the 20% of French people suffering from chronic pain is a major challenge for our healthcare system. Less than 3% of these people receive appropriate care in one of the Chronic Pain Centers (SDC) in France. The current care offer is therefore not sufficient despite the constant increase in the number of SDC. Recognition of the expertise of Pain Resource Nurses (IRD) working in these structures and the delegation of protocolized activities would be one possible response to improve access to care and the quality of care for chronic pain patients by freeing up medical time for the care of new patients.

[Territorial resources and access to care in the case of chronic pain]. / Ressources territoriales et accès aux soins en cas de douleur chronique.

To respond to the complexity of the management of patients with chronic pain, an adapted and structured biopsychosocial approach is necessary. Created and managed by committed caregivers, regulated and financed by decision-making bodies, chronic pain assessment and treatment centres form part of the patient care pathway.

Adherence of French GPs to chronic neuropathic pain clinical guidelines: results of a cross-sectional, randomized, "e" case-vignette survey.

BACKGROUND AND AIMS: The French Pain Society published guidelines for neuropathic pain management in 2010. Our aim was to evaluate the compliance of GPs with these guidelines three years later. METHODS: We used "e" case vignette methodology for this non interventional study. A national panel of randomly selected GPs was included. We used eight "e" case-vignettes relating to chronic pain, differing in terms of the type of pain (neuropathic/non neuropathic), etiology (cancer, postoperative pain, low back pain with or without radicular pain, diabetes) and symptoms. GPs received two randomly selected consecutive "e" case vignettes (with/without neuropathic pain). We analyzed their ability to recognize neuropathic pain and to prescribe appropriate first-line treatment. RESULTS: From the 1265 GPs in the database, we recruited 443 (35.0%), 334 of whom logged onto the web site (26.4%) and 319 (25.2%) of whom completed the survey. Among these GPs, 170 (53.3%) were aware of the guidelines, 136 (42.6%) were able to follow them, and 110 (34.5%) used the DN4 diagnostic tool. Sensitivity for neuropathic pain recognition was 87.8% (CI: 84.2%; 91.4%). However, postoperative neuropathic pain was less well diagnosed (77.9%; CI: 69.6%; 86.2%) than diabetic pain (95.2%; CI: 90.0%; 100.0%), cancer pain (90.6%; CI: 83.5%; 97.8%) and typical radicular pain (90.7%; CI: 84.9%; 96.5%). When neuropathic pain was correctly recognized, the likelihood of appropriate first-line treatment prescription was 90.6% (CI: 87.4%; 93.8%). The treatments proposed were pregabaline (71.8%), gabapentine (43.9%), amiptriptylline (23.2%) and duloxetine (18.2%). However, ibuprofen (11%), acetaminophen-codeine (29.5%) and clonazepam (10%) were still prescribed. CONCLUSIONS: The compliance of GPs with clinical practice guidelines appeared to be satisfactory, but differed between etiologies.