Menaces sur la prise en charge des patients souffrant de douleur chronique en France: une formation et des structures douleur chronique fragilisées.

Context: Chronic Pain Structures (CPSs) provide care for patients with the most complex and refractory chronic pain in France. In 2018, 245 CPSs were accredited by the Regional Health Agencies (ARS). Despite this significant territorial coverage, the CPSs are now under threat. Objective: The aim of this study is to obtain a snapshot of the care offered by the CPSs, by specifying both the characteristics of the CPSs and the demographics of the professionals practicing there. Methodology: The survey was conducted under the aegis of the SFETD (Société française d'étude et de traitement de la douleur) among all the CPSs accredited by the ARS. CPS managers were asked to complete an online questionnaire on the characteristics of the CPS and the demographics of the medical and nonmedical staff. Results: Of the 245 CPSs, 223 (91%) responded. Although the territorial coverage of the CPSs is respected, with a median of 0.59 pain doctors per 100,000 inhabitants in France, there is great heterogeneity in the distribution of full-time equivalents (FTEs) from one region to another, with a variation of a factor of 2.8 for doctors and a factor of 5 for psychologists and nurses. The least endowed regions are the Centre-Val de Loire region and the Grand Est region. Fifty-four percent of CPSs offer consultations for both cancer pain and chronic non-cancer pain. Only 6% of CPSs are dedicated to children's pain. The median waiting time is three months, with extremes of up to a year. A total of 835 physicians, representing 388 FTEs, work in the CPSs. Only 58% of the physicians are tenured; 18% work full-time and 43% work less than 0.2 FTE. The retirement of 177 physicians is expected within five years, representing 91 FTEs, or 24% of total medical FTEs. Conclusion: The sustainability of CPS in France is threatened in the next five years. It is urgent to act. Concrete measures are proposed by the SFETD to anticipate the announced disaster. [ABSTRACT FROM AUTHOR]