By Pat Anson, PNN Editor
In March, Health Canada created a new national task force to study how to prevent and treat chronic pain and remove barriers to pain treatment. Health Minister Ginette Petitpas Taylor called it “the first step in addressing the issue of chronic pain in this country.”
One in five Canadians lives with chronic pain and -- like their counterparts in the United States -- many have trouble just finding a doctor willing to treat them. Some patient advocates were skeptical of Health Canada’s task force and its plan to release an initial report this summer, followed by two more reports in 2020 and 2021. It sounded like bureaucratic foot dragging.
“We are happy they are actually acknowledging chronic pain is an issue. However, the time frame is wrong and a little bit too late,” said Barry Ulmer of the Chronic Pain Association of Canada (CPAC).
Four months later, that initial report from the task force has now been released. It calls pain a “significant public health issue” in Canada and admits the nation’s healthcare system often fails to treat pain patients. Efforts to rein in opioid prescribing — such as Canada’s opioid guideline — have made a bad situation worse.
“Some Canadians have been unable to access opioid medications when needed for pain and function. Others have faced undue barriers to obtaining or filling their opioid prescriptions, and some have had their opioid dose abruptly lowered or discontinued. This has resulted in unnecessary pain and suffering, and has led some Canadians to obtain illegal drugs to treat their pain,” the task force found.
“People living with pain have limited access to the services they require and often face stigma and undue suffering as a result of their condition. This stigma often intersects with other forms of discrimination related to poverty, housing and employment instability, mental illness, race and ethnicity, and other factors further complicating the challenge of living with pain. Canadians living with pain and their loved ones simply deserve better.”
Patients Not Believed
In its short history, the task force completed an ambitious review of pain care in Canada; holding public workshops, meeting with federal and local governments, and consulting with healthcare providers and researchers. Importantly, the panel also reached out to the pain community and invited 12 Canadians living with chronic pain to share their experiences. Many said they had poor access to pain care or were not believed by healthcare providers.
“I was bounced between various outpatient clinics and utilizing the ER multiple times a month and making no progress,” one patent said. “I was consistently questioned whether or not I was making up the pain for attention, or if the pain was due to a mental health condition.”
“While I am fortunate to be seen periodically by a pain specialist, I do not have access to a multidisciplinary pain clinic where key services, such as physiotherapy and psychology are provided. Many patients in my community have even less (or no) access to a pain specialist and are unduly suffering as a result. They do not know where to turn,” another patient said.
“I found the transition from the pediatric pain clinic to the adult pain clinic very difficult. At the pediatric pain clinic they have a multi-disciplinary team, which include a psychologist, a physiotherapist, a nurse, and a pain specialist. At the adult pain clinic they only have a physician who is amazing but is overstretched, sometimes I can only get an appointment every 6 months,” another patient told the task force.
Pain Education Lacking
Improving pain education in Canada’s medical schools was one of the first goals identified by the task force. In a review of 10 Canadian universities, the panel found that 68% of the medical programs were not providing any designated hours for pain education. Incredibly, veterinary students receive 2 to 5 times more pain education than that of health science students.
The panel also found that pain care in Canada is largely dependent on where people live and what type of insurance they have; that pain patients need better access to psychological support, physical therapies and other healthcare services; and that more research and better evidence is needed to help providers make informed decisions on pain care.
“This report makes Health Canada aware of what Canadians with pain have known for too long: that pain care is largely not accessible, many health care providers lack the knowledge and skills to manage pain and breakthroughs in research are hampered by lack of funding,” said Maria Hudspith, co-chair of the task force and Executive Director of Pain BC, a patient advocacy group in British Columbia.
“We hope this report lays the foundation for a national pain strategy that will improve the lives of Canadians who live with pain.”
Not everyone is happy with the direction the task force is taking. CPAC called it a “knee jerk” reaction to the pain crisis that continues to spread stigma about pain patients and their use of opioid medication.
“You see it again in this report,” CPAC’s Ulmer said in a statement. “Pain patients are supposedly often mentally ill—somehow, the need for relief has been recast as mental illness, though it seems pretty sane to me. And patients are repeatedly said to be at high risk of addiction.”
Last month, a federal task force in the U.S. released a final report on recommended best practices for pain management. It found nearly identical problems as the panel in Canada — and called for a balanced approach to pain treatment that focuses on individualized patient care, not rigid prescribing guidelines that have triggered a pain crisis for millions of Americans.