Prise en charge des douleurs neuropathiques chroniques sévères : résultats de l'« Enquête patients, soins et intervenants de la douleur neuropathique » (Epsidone)

The objective of the Internet EPSIDONE survey was to gain information regarding the management of chronic neuropathic pain in France. To access the questionnaire, the participants had to be more than 18 years old, have a permanent address in France, and suffer from chronic pain (defined as pain for more than 3 months) with neuropathic characteristics identified with the DN4 questionnaire. About 2000 questionnaires were completed between April and August 2008 (78% of the participants were women, aged between 30-60 years). Three quarters of the participants (74%) suffered from intense pain lasting for more than 2 years (60% of the respondents). Pain was mostly located in the back (76%) and/or the lower limbs (70%). The reported causes were mainly: disc hernia (22.7%), vertebral osteoarthritis (16%), surgery (9.3%), nerve injury (9.3%), CRPS (6.7%). About half of the participants (47%) were not aware of the existence of centers specialized in pain management in France and those who knew the existence of such facilities, were not able to localize the pain center closest to their place of residence. In addition to the GPs (68.5% of the respondents), pain was the reason for consulting several other health professionals (more than 5 for 64% of the participants). More than 43% of the participants were not receiving any treatment for their pain. Those who were treated (57%) received mostly NSAIDs and physiotherapy (54%); only 32% received a specific neuropathic pain treatment: antidepressants (32%) or anticonvulsants (24%). Non-pharmacological treatments were used by a minority of participants: 13% were treated with TENS and 3% with chronic spinal stimulation. More than 30% of the participants had received more than 5 treatments and half of the participants judged that their current treatment was inconvenient. The treatments had been prescribed by a GP (40%), a rheumatologist (20%) or a pain specialist (14.5%). These results confirm the major difficulties associated with pain management in France and underscore poor patient awareness about pain centers.