Seventy-eight percent of the population declares being concerned by pain, directly or
indirectly. Chronic pain, defined as pain that has lasted for more than three months, affects
more than one third of the French population. The national survey of the French Society for
the Study and Treatment of Pain (SFETD), conducted in 2009, reveals that the most widespread
chronic pain is low back pain (20%).
Pain not only affects the body, but also destroys the person who endures it. A comparative
study by Attal et al. carried out on a sample of 1,591 chronic pain sufferers and 1,237 non
pain sufferers shows a major impact of pain on the individual's quality of life (SF12), sleep
(MOS sleep) and anxiety and depression (HADS).
The 2009 report of the French National Authority for Health (HAS) shows that chronic pain
generates a significant societal cost. Low back pain is the leading cause of activity
limitation in people aged 45 to 65, and the third leading cause of chronic disability. It is
the leading cause of disability in people under 45 years of age, and the leading cause of
work stoppage and occupational disease.
The reference tool for assessing pain is currently the Visual Analogue Scale (VAS). However,
several factors considerably limit the relevance of an exclusive use of this tool:
For the patient: the intensity of pain is objectively influenced by many parameters such
as the time of day, stress, position, duration of evolution, mechanical or "neuropathic"
character, paroxysms, etc. These are all elements that objectively disrupt the
evaluation performed by the VAS. When the subjective and emotional dimension is included
in these elements, the cloudiness of "true" perception of such a sensation increases
even more.
Difficulties of evaluation for the carer: carers are therefore confronted with a lack of
relevance of objective pain evaluation tools, and researchers have to deal with data
that are often not very reproducible. A fortiori, the second problem arising from this
concerns the difficulty of comparing the effectiveness of different therapeutic
strategies. The VAS cannot, for example, take into account the pain dominance in the
case of multi-site pain, nor the surface area of the pain zone or even less its typology
or topology. This information is however essential to determine the choice of the most
appropriate therapeutic strategy.
The difficulties of evaluation for the health care system: in fact, beyond the
therapeutic wandering imposed on certain patients on a "micro" scale, it must be
considered that this randomness of evaluation has an impact on the entire health care
system. When a decision has to be made to reimburse a particular expensive drug or
implantable medical device for pain relief, this reflection has to be extended to the
"macro" level. This review thus reveals a threefold need for innovation in pain
assessment: for the patient, for the caregiver and for the healthcare system.