Chronic pain training introduced for B.C.'s family doctors

Dr. Ian Schokking says he runs into cases of unresolved pain every day in his Prince George, B.C., practice.

"At least on a daily basis in my office, and at least 10 per centof patients in emergency and the after-hours clinic have pain issues. Many of them without regular follow-up, without a lot of support."

Despite thedaily encounters, he says medical school did not prepare him to deal with the issue.

"Training in chronic pain in medical school was probably zip, almost none," Schokking says."There was not any real focus on chronic pain, [it] wasn't really on anybody's radar."

He says he has really learned more about pain only in the last 10 years, but not in any real coordinated way.

60 doctors spearheadpain training

But the situationis changing. A new chronic pain medicineprogram developed by the Doctors of B.C.,formerly known as theB.C. Medical Association, is now underway.

Sixty physicians from all over B.C. are wrapping up a course on the latest pain management research and techniques.The idea is these doctors will head back to their communities and train more than 500 other family doctors by the end of the year.

Dr. MichaelNegraeff, a pain specialist at Vancouver General Hospital who helped develop the course, saidthe program's impact should be especially feltin smaller communities with no access to pain specialists.

"Chronic pain is really an orphaned condition in medicine," Negraeff said.

Physicians are traditionally trained to look at pain as a symptom of something else, and not a problem in and of itself.

A study published in 2009 in the journal Pain Research and Managementeven found that Canadian veterinary students received fivetimes more training in pain management than Canadian medical students.

Negraeff said the new B.C. program is designed to give doctors skills and techniques to help patients right away.

"[It] might be how to teach a patient how to breathe properly because that will help calm their nervous system," Negraeff says.

"There are also more traditional approaches with how to use medications and various types of pain: neuropathic pain would have a different approach than pain from bone or joint disease."

But, he said,there needs to be an understanding that doctors may not be able to completely eliminate someone's pain.

Negraeff said the real measure of pain management success won't be eliminating all of a patient's pain, but will be apparent as an improvement in quality of life.

"It is often the most important and sometimes the only thing you can do to help people,"he said.

Program to expand to other health professionals

The training program launched lastfall, and Schokkingsays he has already seen some impressive resultswith the tools he has learned.

"I have had 10 or 15 patients who have gotten off of the painkillers they were on for yearswith as-good-as or better functioning using alternative strategies," he said.

The non-profit advocacy group Pain B.C., which played a key role in lobbying for the new training program, isnow working with the governing bodies of other health care professionals to create similar programs for them.

MariaHudspith,Pain B.C.'s executive director, said training for pharmacists should beginin May and a number ofphysiotherapists should be able to begina programin September.

"In the long run, what we want to see are these interdisciplinary networks of providers," she said.

"So we might be able to say, 'You know, in Salmon Arm we have three GP pain champions, we have a pharmacist pain expert,' ...so [we're] really trying to create these informal networks that can better support people living with pain."

As for reaching the health care experts of the future, Canada's Royal College of Physicians and Surgeons recently accredited a brand new pain medicine sub-specialty.

Medical schools across the country are now in the process trying to launch their programs, but theUniversity of British Columbia says it hasnotsecured funding for a pain medicine program.

The province has yet to agree to step in and fund pain management training for B.C.'s medical students, but it is making increasing funding in chronic pain awareness for practicing healthcare professionals.

On Monday, the government of British Columbia announced a $1-million grant to support Pain B.C.'s programs, which includesonline and in-person pain management consultations for patients and educational opportunities for doctors, pharmacists, nurses, and other health care workers.

The $1-million grant is in addition to a $1,255,000 investment the Ministry of Health had made to Pain B.C.'s doctors education program, which launches a new session today.

More in this series:

• Why was John Silva's chronic painundiagnosedfor so long?
• 1 in 5 Canadians struggle with chronic pain