livre blanc structures douleur en france

!"#$%&'!()*&+&,-$.*-.$%,&/0.!%.$&%)&1$()*%&+&,1%-/&
2&
LIVRE&BLANC&&
STRUCTURES&DOULEUR&EN&
FRANCE&
Prise& en& charge& de& la& Douleur& Chronique& en& France& en&
2014-2015
Document&élaboré&par&
la&Société&Française&d’Etude&et&de&Traitement&de&la&Douleur&(SFETD)&
Coordination:&Christelle&Créac'h&
Groupe& de& travail:& Justine& Avez-Couturier,& Véronique& Barféty-Servignat,& Christine&
Berlemont,&Didier&Bouhassira, Jean-Michel&Gautier,&Michel&Lanteri-Minet,&Serge&Perrot,&
Virginie&Piano.

!"#$%&'!()*&+&,-$.*-.$%,&/0.!%.$&%)&1$()*%&+&,1%-/&
3&
&
SOMMAIRE
&
&
& & & & & & & & & &
1&-&La&douleur&chronique&:&un&enjeu&de&société&& & &&&&&&&&&&&&&&&&&&45
& & &
&
&
2&-&L’offre&de&soins& & & & & & & & & &&&&&&&&&
&3626&!78&89:;<9;:78&/=;>7;:&7?&1:@?<7A&B7&>@&?@C88@?<7&D&>EFG7&HI:&&&&&&&&&4J&
&3636&%9@9&B78&>C7;K&B78&89:;<9;:78&/=;>7;:&7?&1:@?<7&7?&&3L2M&&&&&&&&&&&&&&&&&&42N&
&36N+&!7&OC?@?<7H7?9&B78&89:;<9;:78& & & & & &&&&&&&&&&&&&&&&&&&&43L&
&
& & &
3& -& Interactions& & entre& les& Structures& douleur,& les& autres&
professionnels&de&santé&et&les&associations&de&patients&&
& N626&!78&>C7?8&D&>PC?9Q:C7;:&B78&89:;<9;:78&& & & & & &&&&&&&&&4NL&
&N636&!78&89:;<9;:78&B=;>7;:&79&>78&@;9:78&87:RC<78&B@?8&>PST4C9@>&&&&&&&&&&&&&&&4NL&
&N6N6&!78&C?97:+<>;BU&>78&:Q87@;KU&>78&8=<CQ9Q8&:QGC=?@>78&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&4N2&
&N656&"?97:@<9C=?8&@R7<&>78&,=<CQ9Q8&,@R@?978&)@9C=?@>78&&&&&&&&&&&&&&&&&&&&&4N3&
&N6M6&"?97:@<9C=?8&7?9:7&>78&89:;<9;:78&B=;>7;:&79&&
&>78&(88=<C@9C=?8&B7&4@9C7?98&&&&&&&&&&&&&&&4N3&
&
&
&4-&La&formation&et&l’enseignement&&
&5&626&!@&O=:H@9C=?&HQBC<@>7U&>P7?87CG?7H7?9&;?CR7:8C9@C:7&&
&&&&&&&&&&&&B@?8&>78&O@<;>9Q8&&B7&&HQB7<C?7& & & & & & &&&&&&&&4NM&
&563&!78&O=:H@9C=?8&"/%&&& & & &&&& & & & &&&&&&&&&4NJ&
&56N&!78&O=:H@9C=?8&B78&48V<S=>=G;78&&& & & & &&&&&&&&&&&&&&&&&&&&&&45L&
& & &
&
5-&La&recherche&dans&le&domaine&de&la&Douleur&en&France:&
&M62&%9@9&B78&>C7;K&& & & & & & & &&&&&&&&&&&&&&&&&&&453&
&M63&!@&$7<S7:<S7&<>C?CW;7&@;&87C?&B78&,9:;<9;:78&/=;>7;:& & &&&&&&&45M&
&
&

!"#$%&'!()*&+&,-$.*-.$%,&/0.!%.$&%)&1$()*%&+&,1%-/&
N&
&
&
&
&
&
&
6&–&Analyse&stratégique&:&&
points&forts,&points&faibles,&opportunités,&menaces,&&
quelles&orientations&pour&demain&?&&&&&&&&&&&&&&45X&
&
&
7-&Conclusions&& & & & & & & & & &&&&&&&4M2&
&
Annexes& & & & & & & & & & &&
(??7K7&"A&Y:Q87?9@9C=?&B7&>@&,1%-/& & & & & & &&&&&&&&4M3&
(??7K7&""A&0Z[7<9CO8&B;&*0!!%\%&B78&%),%"\)()-,&& & &&&&&&&&&&&&&&&&&&&
B7&>@&/0.!%.$&+&*%/&& & & & & & & & &&&&&&&&4MN&
(??7K7&"""A&!78&*@4@<C9Q8&]&B=;>7;:&^&7?&1:@?<7&& & & &&&&&&&&&&&&&&&&&&&&4M5&
(??7K7&"#A&Y:Q87?9@9C=?&B7&>E(1Y($& &
(??7K7&#A&!7&$Q87@;&"?87:H&B7&$7<S7:<S7&8;:&>@&/=;>7;:&&7?&1:@?<7&&&&&&4M_&
& &&
&
&
Bibliographie& & & & & & & & & &&&&&&&&4M`&
&
& &

!"#$%&'!()*&+&,-$.*-.$%,&/0.!%.$&%)&1$()*%&+&,1%-/&
5&
&
&
1&–&La&douleur&chronique&:&un&enjeu&de&société&&
& La& douleur& chronique& correspond& à& un& syndrome& multidimensionnel& exprimé&
par& la& personne& qui& en& est& atteinte.& Selon& l’HAS& (2008)&1,& il& y& a& douleur& chronique,&
quelles& que& soient& sa& topographie& et& son& intensité,& lorsque& la& douleur& présente&
plusieurs&des&caractéristiques&suivantes&:&
- 47:8C89@?<7&=;&:Q<;::7?<76&
+&B;:Q7&@;+B7>D&B7&<7&W;C&789&S@ZC9;7>&4=;:&>@&<@;87&C?C9C@>7&4:Q8;HQ7U&?=9@HH7?9&8C&>@&B=;>7;:&
QR=>;7&B74;C8&4>;8&B7&N&H=C86&&
- :Q4=?87&C?8;OOC8@?97&@;&9:@C97H7?96&
- BQ9Q:C=:@9C=?&8CG?COC<@9CR7&79&4:=G:788CR7U&B;&O@C9&B7&>@&B=;>7;:U&B78&<@4@<C9Q8&O=?<9C=??7>>78&
79& :7>@9C=??7>>78& B;& 4@9C7?9& B@?8& 878& @<9CRC9Q8& B7& >@& RC7& [=;:?@>Ca:7U& @;& B=HC<C>7& <=HH7& D&
>PQ<=>7&=;&@;&9:@R@C>6&
!@&B=;>7;:&<S:=?CW;7&47;9&b9:7&@<<=H4@G?Q7&A&
- B7&H@?CO789@9C=?8&48V<S=4@9S=>=GCW;786&
- BP;?7&B7H@?B7&C?8C89@?97&B;&4@9C7?9&BE;?&:7<=;:8&D&B78&HQBC<@H7?98&=;&D&B78&
4:=<QB;:78&HQBC<@>78&8=;R7?9&C?R@8CR78U&@>=:8&W;PC>&BQ<>@:7&>7;:&C?7OOC<@<C9Q&D&8=;>@G7:6&
- BP;?7&BCOOC<;>9Q&B;&4@9C7?9&D&8P@B@497:&D&>@&8C9;@9C=?6&
&
&
& &
&
&
&
&
&
&
Y:a8&B7&3Lc&B7&>@&4=4;>@9C=?&O:@?d@C87&@B;>97&8=;OO:C:@C9&B7&B=;>7;:&<S:=?CW;7&
BPC?97?8C9Q&H=BQ:Q7&D&8QRa:7&87>=?&>EQ9;B7&,-0Y)%Y&7OO7<9;Q7&7?&Y=4;>@9C=?&GQ?Q:@>7&
e'=;S@88C:@&79&@>6U&3LL`f&26&

!"#$%&'!()*&+&,-$.*-.$%,&/0.!%.$&%)&1$()*%&+&,1%-/&
M&
&*7997&4:QR@>7?<7&4@887&B7&Xc&<S7g&>P7?O@?9&B7&J&D&2N&@?8&e#@?&/C[h&(6&79&@>6&3LLXf&3&D&XLc&
<S7g& B78& 8;[798& FGQ8U& ;?& 9C7:8& BE7?9:7& 7;K& 4:Q87?9@?9& B78& B=;>7;:8& <S:=?CW;78& 8QRa:78&
e$@44=:9&i(,&3LLLf&46&&!P7?W;b97&jY@C?,-0$kj&5U&:Q@>C8Q7&7?&3LLJU&BQH=?9:7&W;7&&55&c&B78&
4@9C7?98&BQ<>@:7?9&87& 87?9C:&87;>8&B@?8&>7;:& <=HZ@9&<=?9:7&>@& B=;>7;:&79&3& 4@9C7?98&8;:&N& 87&
87?97?9& @?KC7;K& =;& BQ4:CHQ8& 7?& :@C8=?& BP;?7& B=;>7;:& <S:=?CW;76& *7<C&C>>;89:7& ZC7?& >7&
:797?9C887H7?9&H@[7;:&B7&>@&B=;>7;:&<S:=?CW;7&8;:&>7&4>@?&QH=9C=??7>&e<@SC7:&?l2&,1%-/f&66&
,;:&>7&4>@?&8=<C@>U&&BP@4:a8&>PQ9;B7&j%*0)%Yj&5M&c&B78&4@9C7?98&B=;>=;:7;K&<S:=?CW;78&8=?9&
<=?<7:?Q8&4@:&B78&@::b98&B7&9:@R@C>&B=?9&>@&B;:Q7&H=V7??7&<;H;>Q7&BQ4@887&5&H=C8&m@?&76&&
&
Les médecins consultés&8=?9&@R@?9&9=;9&>78&HQB7<C?8&GQ?Q:@>C89786&0:U&<7;K+<C&?7&47;R7?9&4@8&
@88;:7:& >@& 4:C87& 7?& <S@:G7& G>=Z@>7& B7& <78& 4@9C7?98& 97>& W;7& >7& :7<=HH@?B7& >Ei(,U& O@;97& B7&
97H48U& B7& 8=;9C7?666& !78& <=?8;>9@9C=?8& @R7<& B78& 4@9C7?98& 8=;OO:@?9& B7& B=;>7;:8&<S:=?CW;78&
4:7??7?9& B;& 97H48U& =:& >@& B;:Q7& B7& <=?8;>9@9C=?& ?E789& 4@8& R@>=:C8Q76& *78& <=?8;>9@9C=?8&
:7W;Ca:7?9&4@:&@C>>7;:8&;?7&@44:=<S7&4>;:C+BC8<C4>C?@C:7&79&4>;:C+4:=O788C=??7>>7&8&U&@C?8C&W;7&
B78&<=??@C88@?<78& & B@?8& B78& B=H@C?78& 4S@:H@<=>=GCW;78& 79& ?=?& 4S@:H@<=>=GCW;78& 4=;:&
>78W;7>8&>78&8=CG?@?98&?7&8=?9&4@8&9=;[=;:8&8;OOC8@HH7?9&O=:HQ86&&
&
&
&
&&&
&
&
&
!7;:&7OOC<@<C9Q&:74=87&8;:&W;@9:7&O@<97;:8&C?BC847?8@Z>78&8A&
+&>7&financement&d'équipes&pluri-disciplinaires&et&pluri-professionnelles&C?<>;@?9&@;&87C?&
BE;?&HbH7&8C97&B78&HQB7<C?8U&B78&47:8=??7>8&B7&8=C?8&4@:@+HQBC<@;KU&B78&48V<S=>=G;78U&B7&
4:=O788C=??7>8&8=<C@;K&666&
+&>@&compétence& préalable& des& professionnels& de& soins& dans& le& domaine& de& la& douleur&
chroniqu7U&<=H4Q97?<7&@88;:Q7&G:F<7&D&>@&O=:H@9C=?&;?CR7:8C9@C:7&e<@4@<C9QU&/".f&H@C8&@;88C&
G:F<7& @;K& Q<S@?G78& 7?9:7& >78& & 4:=O788C=??7>8& B7& >@& B=;>7;:& e:Q;?C=?8& >=<@>78U& :QGC=?@>78U&
<=?G:a8&?@9C=?@;K&79<666f6&
Les&structures&d’évaluation&et&de&traitement&de&la&douleur&(centres,&consultations)&
ont&été&créées&justement&pour&pallier&à&ces&difficultés&et&améliorer&la&prise&en&
charge&des&patients&douloureux&chroniques.&