Prise en charge de la douleur chronique et réseaux ville-hôpital.

Abstract

Introduction: In France, pain is the leading cause of medical consultations, and chronic pain affects nearly 12 million people. Its management remains delayed, unequal, and often inadequate, with an average wait time of over three years to access specialized services. This delay is due in part to a lack of training among general practitioners, overly siloed medical expertise, and uneven distribution of specialized centers. These factors lead to diagnostic delays, unequal access to care, and a significant societal cost. Innovative regional models, such as the one implemented in Vendée, offer promising avenues for reorganizing care pathways.

Methods: The study is based on an analysis of the chronic pain care network in La Roche-sur-Yon (Vendée), coordinated by Dr. Pluchon. This network, linked to the local hospital group GHT85, includes seven local care sites. The analysis was conducted by a national steering committee composed of three heads of CETDs (Chronic Pain Treatment Centers) from diverse contexts. The methodology included interviews with patients, health care professionals, and hospital management, as well as activity data from the PMSI databases. The objective was to identify key success factors, deployment conditions, and the value created for all stakeholders.

Results: Between 2018 and 2022, pain management activity at the La Roche-sur-Yon center increased by 58%, and by 59% across nearby sites, while the patient outflow rate dropped by more than 20%. Centralized coordination, a single point of entry for appointments, advanced consultations, and staff mobility helped reduce wait times (in some cases by a factor of 4), improve distribution of resources, and ease access to specialist care-even for patients in remote areas. The model promotes shared protocols, regular regional multidisciplinary meetings (RCPs), and continuous upskilling of local health care providers.

Discussion: This innovative regional model brings multiple benefits: reduced inequalities in access, a local network of expertise, more appropriate treatments, decreased diagnostic delays, and medical-economic gains. It offers a concrete response to the shortage of pain specialists and the need for local follow-up. Its success relies on strong coordination, shared tools, collaborative organization, and professional commitment. The model is now being extended to other regions (Sud Seine-et-Marne, Nîmes) through a national pilot program based on common indicators and a shared data platform. The Vendée network illustrates the potential for nationwide reform in chronic pain management.