Chronic pain poorly understood, costing Canada billions

One in five Canadians suffer from chronic pain, and if you're one of themillions affectedand you're lucky you have a doctor who knows how to treat yoursymptoms.

But if you need to see a pain specialist, wait times are long. Verylong frequently more than a year.And many live far from the country's publicly funded pain clinics, because large areas of Canada have little or no access to appropriate paincare.

The impact?

Three quarters of the people waiting for care atCanadian pain clinics say it interferes with their normal work life.More than half suffer from severe levels of depression. And almost 35 per centreport that they've considered suicide.

According to the Canadian Pain Society, chronic pain is an expensive problem,not only to the patient but also to society as a whole.It costsbillions of dollars a year in health costs, lostproductivity, notto mention the social cost to lives that are derailed by addiction ordepression.

Chronic pain

So what is chronic pain?

Dr. Mary Lynch, a professor of pain medicine atDalhousie University, calls it pain that persists long after normalhealing should have occurred, usually at least three to six months.

And the best person to diagnose it is not a doctor or pain specialist, she says.It's the patient.

"Pain is what the patient says it is," explains Dr. Lynch, quotingDr. Ron Melzack, a fellow pain specialist from McGill University. "Thepatient really is the best one to tell you about their pain and whatit feels like to them, and you need to believe that."

Dr. Lynch, alsodirector of painresearch at Queen Elizabeth II Health Sciences Centreand the past president of the Canadian Pain Society,is part of an in-depth examination of chronic pain on CBC Radio'sTheSunday Edition this weekend.

Another misconception about chronic pain is who suffers from it.

"A lot of people think that chronic pain is something only olderpeople get, but in fact one in five children suffer from recurrent orchronic pains," explains Jennifer Stinson, a nurse clinician scientistin the Research Institute at SickKids hospital in Toronto. "The most common areheadaches, abdominal pain, back pain and general muscular-skeletalpains."

In fact, both Stinson and Dr. Angela Mailis-Gagnon say they have hadpatients tell them they would rather have cancer than chronicpain.

Diagnosis

Dr.Mailis-Gagnon is the founder and director of the Comprehensive PainProgram of the Toronto Western Hospital, a specialist of the RoyalCollege of Physicians and Surgeons, and a professor in the Faculty ofMedicine at the University of Toronto.She says chronic pain hits a wide variety of people. Some areamputees, burn victims, or have suffered grievous bodily injury, butmany have not.

"We see patients who don't have a definable physical condition, butthey are highly disabledand they are very emotionally disturbed," she says.

Stinson, who also works as a nurse practitioner in the Hospitalfor Sick Children's Chronic Pain Program, says convincing people yousuffer from chronic pain can be exceedingly difficult.

There's this assumption that if you treat theunderlying disease, than the pain will get better. But that is aninaccurate assumption.- Dr. Mary Lynch, professor of pain medicine

"Health care providers, the public, even [thepatient's] friends don'tbelieve they have chronic pain, because for most of the conditionsit's invisible. They look perfectly normal ... but this pain has asignificant impact on their life."

Dr. Lynch says surgery itself can be a major cause.

"After surgery, [chronic pain] is a huge problem. About 10 per cent of peoplesubsequent to many kinds of surgery ... will be left withpost-surgical nerve damage pain from the nerves and tissues that hadto be cut for the surgery."

Health care workers themselves bear some of the blame. Research has found thatonly 30 per cent of ordered pain medication is actually given topatients after surgery. Dr. Maylis said it comes down to poor painmanagement training.

"We get very little training as students. We get very little trainingas practitioners," she said, adding that some veterinarians get fivetimes more training in pain management than medical doctors.

But efforts are afoot to address this shortcoming.

Stinson saysthe University of Toronto's Centre for the Study of Pain hasintroduced interdisciplinary pain training programs for medicalstudents to try to improve the situation. As well, Ontario's Ministryof Health recently announced a new $1.3 million telemedecineeducational program to teach doctors in remote parts of the provinceabout managing chronic pain.

One of the core missions of medicine may be to alleviate pain, butcompeting interests often get in the way.

"Unfortunately, we continue to exist in a disease-focused medicalsystem where the focus is on treating the disease, the pathology, thecancer, the diabetes, the lung troubles, rather than dealing with theactual experience of the patient, which includes pain," Dr. Lynch explains.

"On top of that,pain is still considered to be just a symptom of an underlyingdisease, rather than being recognized as a disease in its own right. There's this assumption that if you treat theunderlying disease, than the pain will get better.But that is aninaccurate assumption."

Access also remains a challenge. Dr. Lynch pointed to a recent study that found that for more than a third of publicly funded pain clinicsin Canada, the average wait time is more than a year. Vast parts ofthe country have no pain clinic services at all.

"I think the situation for children is even more bleak," Stinson added, explaining that there are only eight pediatric pain clinics inthe entire country.

Funding for pain research only makes up one quarter of one per cent ofall health-related research.

Stinsonwould like to see a national pain strategy. But all threepain specialists complained that there is little leadership comingfrom the federal government on the issue.

"Wherever you turn your eye, pain is there," said Dr. Maylis. "And wedo very little for it."

[Listen to The Sunday Edition's full documentary on chronic pain on CBC Radio 1 on June 22 starting at 9 a.m. Eastern.]