Roger Collier | CMAJ | March 28, 2018
Waking up in pain every day is a fact of life for many Canadians.
Little has been written about the infrastructure in Canada’s health care system to support Canadians struggling with chronic pain. There’s a good reason for that, according to Maria Hudspith, executive director of Pain BC.
“There is no health care infrastructure for people with chronic pain,” she said.
Across Canada, associations such as Pain BC are struggling to raise awareness and improve education about chronic pain and pain management, but it hasn’t been easy. Some chronic health problems, such as diabetes and heart disease, have “massive machinery” around them to raise money and improve care, noted Hudspith. But persistent pain remains a problem that medicine seems ill-equipped to address.
“Veterinary students receive more education on pain assessment and management than any health care student,” said Hudspith.
Pain BC was incorporated in 2008. It was started by a volunteer board of directors made up of clinicians with experience caring for patients with chronic pain. “They started this organization because they saw that the system was so broken for their patients and they wanted to do something about it,” said Hudspith.
The association raises awareness of the importance of early intervention in cases of acute pain, so these episodes don’t progress into chronic pain because they were managed poorly. It also advocates for complex-care fee codes so doctors can spend more time with patients with chronic pain; earlier access to clinicians if chronic pain is suspected among youth; and improved access to services such as physical therapy and psychological treatment for people with persistent pain, who are also at increased risk of anxiety and depression.
“We have been vociferous advocates for building a system of care for people with chronic pain that is focused on incorporating non-pharmacological approaches into a whole pain toolbox,” said Hudspith, noting that pain medication may still be part of a pain-management plan for some people.
Before it was forced to close from lack of funding last November, the Canadian Pain Coalition also promoted the concept of addressing chronic pain using more than just a prescription pad. “You really have to create a pain-management plan in order to take your life back and adapt so you can have a healthy, happy, productive life despite the pain,” said Lynn Cooper, the former coalition’s president, who has struggled with chronic pain following a back injury. “We can no longer be passive patients. It doesn’t work with chronic pain.”
The coalition was formed in 2002. Until its recent closure, it worked to raise awareness about the “silent epidemic” of chronic pain in Canada. “The idea was to bring as many voices together as we could,” said Cooper. “We were formed because it was recognized that it was important to bring together health professionals, scientists and people living with pain to speak with a more solid voice.”
The group had provided input on opioid prescription guidelines, advocated for better pain management in long-term care facilities, and educated the public on all available options for addressing chronic pain. Still, despite the years of advocacy, the “pain community is pretty small,” said Cooper.
Another association, the Canadian Pain Society, has highlighted the inadequate investment in pain research and lack of education about pain in health care. It promotes access to interprofessional health teams to manage chronic pain. The topic of pain has received more attention from the public of late, although for an unfortunate reason, noted Dr. Fiona Campbell, a pediatric anesthesiologist and the president-elect of the Canadian Pain Society.
“This opioid crisis is now an opportunity to raise awareness about chronic pain,” she said.
Campbell noted some recent progress. There has been some investment in pain research. And Ontario, in particular, has devoted more resources to pain clinics. But there is still much more that needs to be done, said Campbell.
“The Canadian Pain Society is very passionate about the need for a national pain strategy,” said Campbell. “We need something helping behind the scenes in a coordinated, pan-Canadian way.”
Connect with CMAJ