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Background Chronic pain affects approximately 30% of the general population, severely degrades quality of life (especially in older adults) and professional life (inability or reduction in the ability to work and loss of employment), and leads to billions in additional health care costs. Moreover, available painkillers are old, with limited efficacy and can cause significant adverse effects. Thus, there is a need for innovation in the management of chronic pain. Better characterization of patients could help to identify the predictors of successful treatments, and thus, guide physicians in the initial choice of treatment and in the follow-up of their patients. Nevertheless, current assessments of patients with chronic pain provide only fragmentary data on painful daily experiences. Real-life monitoring of subjective and objective markers of chronic pain using mobile health (mHealth) programs can address this issue. Objective We hypothesized that regular patient self-monitoring using an mHealth app would lead physicians to obtain deeper understanding and new insight into patients with chronic pain and that, for patients, regular self-monitoring using an mHealth app would play a positive therapeutic role and improve adherence to treatment. We aimed to evaluate the feasibility and acceptability of a new mHealth app called eDOL. Methods We conducted an observational study to assess the feasibility and acceptability of the eDOL tool. Patients completed several questionnaires using the tool over a period of 2 weeks and repeated assessments weekly over a period of 3 months. Physicians saw their patients at a follow-up visit that took place at least 3 months after the inclusion visit. A composite criterion of the acceptability and feasibility of the eDOL tool was calculated after the completion of study using satisfaction surveys from both patients and physicians. Results Data from 105 patients (of 133 who were included) were analyzed. The rate of adherence was 61.9% (65/105) after 3 months. The median acceptability score was 7 (out of 10) for both patients and physicians. There was a high rate of completion of the baseline questionnaires and assessments (mean 89.3%), and a low rate of completion of the follow-up questionnaires and assessments (63.8% (67/105) and 61.9% (65/105) respectively). We were also able to characterize subgroups of patients and determine a profile of those who adhered to eDOL. We obtained 4 clusters that differ from each other in their biopsychosocial characteristics. Cluster 4 corresponds to patients with more disabling chronic pain (daily impact and comorbidities) and vice versa for cluster 1. Conclusions This work demonstrates that eDOL is highly feasible and acceptable for both patients with chronic pain and their physicians. It also shows that such a tool can integrate many parameters to ensure the detailed characterization of patients for future research works and pain management. Trial Registration ClinicalTrial.gov NCT03931694; http://clinicaltrials.gov/ct2/show/NCT03931694

Resume La douleur est le critere de jugement le plus souvent utilise dans l’arthrose pour evaluer les patients, a l’echelon individuel mais egalement au cours des essais cliniques. Toutefois, il est important de se poser la question de savoir quelle est la difference pertinente entre deux etats douloureux pour le patient souffrant d’arthrose. Apres avoir rapporte les caracteristiques de la douleur arthrosique et sa variabilite en fonction de differents facteurs, la notion de douleur acceptable dans l’arthrose est presentee. Les notions de difference clinique minimale importante (MCII) et d’etat symptomatique acceptable (PASS) sont fondamentales pour juger l’evolution favorable ou pas des patients arthrosiques. La superiorite de la notion « d’aller bien » par rapport a celle « d’aller mieux » est expliquee.

Transcranial magnetic stimulation (TMS) is a non-invasive method for activating specific areas of the brain. There are two variants, repetitive TMS (rTMS) and direct TMS. Rapid changes in an electrical current induce a magnetic field, which in turn induces an electrical current in a nearby conductor. When a coil is positioned over the brain, rTMS delivers very brief and painless magnetic pulses to the brain. Initially, rTMS was developed as a treatment for depression. Since then, potential indications have been extended to the treatment of chronic pain, most notably in patients with rheumatic diseases. Thus, active research is being conducted into rTMS effects in fibromyalgia, chronic low back pain, and type I complex regional pain syndrome. Studies have established that rTMS is safe; provides pain relief, at least in the short-term; and improves the psychological correlates of chronic pain. These data support further development efforts with the goal of using rTMS in patients with chronic pain, including those with rheumatic diseases. French physicians have shown a high level of interest in rTMS, and the first French recommendations for using this method were issued in 2011. Further research is needed to determine the optimal stimulation parameters, session frequency, and session duration, as well as the best indications. Physicians who see many patients with chronic pain, such as rheumatologists, should be aware of this developing non-pharmacological and safe treatment modality, which can be of considerable help to their patients.

Resume La stimulation magnetique transcrânienne est une technique de stimulation des aires cerebrales non invasive, qui recouvre deux systemes de stimulation : la stimulation magnetique transcrânienne repetitive (SMTr) et la stimulation transcrânienne directe. En faisant varier rapidement un courant electrique, un champ magnetique est cree. Celui-ci induit a son tour un courant electrique dans un element conducteur place a proximite. C’est le principe par lequel la SMTr envoie, par l’intermediaire d’une bobine positionnee sur le crâne, une impulsion magnetique indolore sur l’encephale pendant une duree tres breve. Apres son utilisation en psychiatrie pour le traitement de la depression, la SMTr est actuellement developpee dans la douleur chronique et notamment en rhumatologie. Ainsi, cette technique est particulierement etudiee dans la fibromyalgie, la douleur chronique lombaire et le syndrome douloureux regional complexe de type I. La SMTr s’avere sans risque avec une efficacite antalgique au moins a court terme, et une action sur des parametres psychologiques de la douleur chronique. Ces elements permettent d’envisager son developpement en recherche et dans les soins des patients douloureux chroniques, notamment en rhumatologie. La France s’est particulierement interessee a cette technique puisque les premieres recommandations sur l’utilisation de la SMTr sont parues en France en 2011. Des recherches sont encore necessaires pour preciser les parametres de stimulation, la frequence et la duree des seances, ainsi que les indications preferentielles. Les medecins de la douleur chronique, en particulier les rhumatologues, doivent connaitre cette approche en expansion, non medicamenteuse et sure, qui peut apporter une aide utile aux patients.

Objectives To analyze pain in systemic sclerosis (SSc), especially its impact and coping strategies, compared with the reference painful inflammatory rheumatological condition, rheumatoid arthritis (RA). Methods We carried out a cohort study of consecutive inpatients with SSc and RA visiting three university hospitals. We analyzed pain, pain-related interference with daily life, pain catastrophizing, and attitudes, together with quality of life (QoL). Results In total, 173 patients were included and 153 were analyzed: 82 SSc and 71 RA patients. Pain frequency did not differ between the two groups (60.8% and 73.1%, respectively), but pain dimension scores in SSc patients were not correlated with disease activity and were significantly lower than those in RA patients. A neuropathic component was associated with higher pain scores in both conditions. Pain was more frequent and more intense in patients with diffuse cutaneous SSc than in patients with limited SSc, but its impact was similar. Pain and its functional consequences interfered less with daily life in SSc than in RA, consistent with the lower expectations concerning the benefits of drug treatment in SSc. However, pain catastrophizing played an important role in both groups. Conclusion Pain intensity and dimension scores are lower in SSc patients, particularly those with limited disease, than in RA patients and are not correlated with disease activity. In both conditions, a neuropathic component is associated with higher pain scores and pain catastrophizing is frequent.