Letter to the Editor
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 26, 2024; 12(15): 2682-2685
Published online May 26, 2024. doi: 10.12998/wjcc.v12.i15.2682
Differences between the healthcare systems of Quebec and France for the treatment of pain due to spinal disorders
Lea Evangeline Boyer, Mathieu Boudier-Revéret, Min Cheol Chang
Lea Evangeline Boyer, Department of Physical Medicine and Rehabilitation, CHU de la Réunion, Reunion Island CIC 1410, France
Mathieu Boudier-Revéret, Department of Rehabilitation Medicine, University of Montreal Health Center, Montreal, QC H2X 3E4, Canada
Min Cheol Chang, Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu 705-717, South Korea
Author contributions: Boyer LE, Boudier-Revéret M and Chang MC designed the study, performed the study, analyzed the data and wrote the manuscript. All authors have read and approved the final manuscript.
Supported by National Research Foundation of Korea Grant, No. 00219725.
Conflict-of-interest statement: The authors report no relevant conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Min Cheol Chang, MD, Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 317-1, Daemyungdong, Namku, Daegu 705-717, South Korea. wheel633@gmail.com
Received: February 14, 2024
Revised: April 8, 2024
Accepted: April 15, 2024
Published online: May 26, 2024

In Quebec, Canada, the public healthcare system offers free medical services. However, patients with spinal pain often encounter long waiting times for specialist appointments and limited physiotherapy coverage. In contrast, private clinics provide expedited care but are relatively scarce and entail out-of-pocket expenses. Once a patient with pain caused by a spinal disorder meets a pain medicine specialist, spinal intervention is quickly performed when indicated, and patients are provided lifestyle advice. Transforaminal epidural steroid injections are frequently administered to patients with radicular pain, and steroid injections are administered on a facet joint to control low back or neck pain. Additionally, medial branch blocks are performed prior to thermocoagulation. France’s universal healthcare system ensures accessibility at controlled costs. It emphasizes physical activity and provides free physical therapy services. However, certain interventions, such as transforaminal and interlaminar epidural injections, are not routinely used in France owing to limited therapeutic efficacy and safety concerns. This underutilization may be a potential cause of chronic pain for many patients. By examining the differences, strengths, and weaknesses of these two systems, valuable insights can be gained for the enhancement of global spinal pain management strategies, ultimately leading to improved patient outcomes and satisfaction.

Keywords: Spinal pain, Healthcare system, France, Quebec, Pain treatment

Core Tip: The public healthcare system in Quebec, Canada, provides free services; however, patients with spinal pain face long waiting times for specialist appointments and limited physiotherapy coverage. Spinal interventions, including transforaminal epidural steroid injections for radicular pain, are performed quickly upon consultation with a pain specialist. In contrast, France's universal healthcare system emphasizes physical activity and offers free physiotherapy; however, certain interventions, such as epidural injections, are underutilized, potentially contributing to chronic pain. Each system has advantages and disadvantages. Understanding these differences can inform global spinal pain management strategies and enhance patient satisfaction and outcomes.