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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

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. CLINICALTRIAL ClinicalTrial.gov NCT03931694; http://clinicaltrials.gov/ct2/show/NCT03931694

Resume La restriction d’usage du clonazepam doit favoriser la suppression des benzodiazepines au long cours chez les patients douloureux chroniques. Si la substitution s’averait utile, les auteurs proposent un tableau d’equivalence des benzodiazepines.

Les myalgies et arthralgies, chroniques et fluctuantes, empoisonnent la vie du patient. Elles sont souvent rebelles aux therapeutiques usuelles. L’association de la kinesitherapie aux traitements pharmacologiques favorise une meilleure antalgie.

En médecine générale, le motif de consultation « céphalée » est fréquent. Malgré une prévalence importante, 12 à 21% de la population générale, cette pathologie reste encore sous-estimée, sous-diagnostiquée et sous traitée. Une révision des recommandations professionnelles concernant la prise en charge diagnostique et thérapeutique de la migraine de 2002, a été élaborée en 2013. L’objectif de notre étude était de connaitre la pratique des médecins généralistes de Picardie dans la prise en charge diagnostique et thérapeutique des patients migraineux. Le but également était de savoir si cette pratique est en adéquation avec les dernières recommandations. Afin de réaliser cette enquête épidémiologique transversale, un questionnaire destiné aux médecins généralistes de Picardie a été envoyé. Sur les 547 questionnaires envoyés, 212 ont été remplis et ont pu être exploités. Notre travail a montré que les critères IHS sont globalement bien connus par les médecins généralistes. Malgré cela 42% d’entre eux prescrivent une imagerie cérébrale. Le handicap engendré par la migraine est évalué par 36% des médecins interrogés grâce à la mise en place d’un agenda de crise. Nous constatons au niveau thérapeutique que l’utilisation des AINS prédomine dans le traitement de crise en 1ère intention et que le traitement par béta-bloquant reste celui le plus utilisé dans le traitement de fond. La pratique des médecins généralistes concernant la prise en charge diagnostique des patients migraineux semble en corrélation avec les recommandations avec toutefois une difficulté dans la prise en charge thérapeutique notamment dans le traitement de fond de 2e intention. Le handicap engendré par la migraine reste un point crucial dans la prise en charge de ces patients.