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On the occasion of World Pain Day, Professor Bouhassira, neurologist specializing in pain, takes stock of pain centers. Who are they for and when should they be used?

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When to consult a pain center?

Twelve million French people suffer from chronic pain, pain that can be treated in consultations or pain centers . Initiated in 1998, these consultations are spread throughout France.

When to contact the pain centre?

Pr Bouhassira, neurologist : “We are sent the most complicated and difficult to manage patients for whom we have not found a solution. If the patient is failing treatment, he must be sent to a pain center. The big question, when? Ideally, it’s not too early, and especially not too late, after one or two treatment failures…”

Also read: End chronic pain

Pr Bouhassira, neurologist: ” The first consultation requires a letter from a general practitioner or a specialist. The centers offer  multidisciplinary care  : “The  drugs  are only a small part of the treatment because they have a partial effect on pain, comments on We also use kinesitherapy, physiotherapy, psychotherapy for the more psychological aspect, complementary medicine with hypnosis , acupuncture and sometimes osteopathy, neuromodulation techniques. We try to find the best combination for each patient.”

Why are the centers overwhelmed?

Pr Bouhassira, neurologist:  “The appointment times in pain centers are long; the bare minimum is 3 months, but it’s often much longer… We can’t do better because the number centers has not increased, it is rather decreasing and the same goes for the number of specialists (30% of specialists will retire in the next 5 years and will not necessarily be replaced). need to transform the care pathway, but generalists and specialists can do a lot.

Some patients do not require a consultation, so we redirect them when we have done their assessment. Others have mild to moderate pain but are very anxious and want specialist advice. But they take the place of other patients! There are also quite a few patients who are at the limit with a psycho-social context, which would fall under more psychiatric care (in addition to the field of the psychological component of chronic pain).”

How to improve the situation?

Pr Bouhassira, neurologist:  “The centers cannot manage the 12 million French people who suffer from chronic pain. Even if not all of them require a pain consultation, we are faced with a very significant demand which we cannot meet. We cannot multiply the structures but we have to find solutions, which will necessarily go through colleagues, perhaps with networks. course in pain and chronic pathologies. This requires an investment from the public authorities, training of general practitioners and specialists and therefore it requires a little means. The subject is topical and it is one of the priorities of our minister…”

There is no miracle solution but there are some initiatives, with for example a “pain thread cutter” tool. It is a questionnaire that we are trying to validate with general practitioners, to help them determine the degree of urgency and prioritize certain patients. It is being validated. But this requires an investment from the general practitioner and certain specialists, training and it is a step that is not easy.

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