AHS looks to handle needs after pain clinic closes to new patients
With the pain clinic at Medicine Hat Regional Hospital not taking new patients, Alberta Health Services is working on other ways to address the need.
A more multi-disciplinary manner is the goal, said Dr. Vince DiNinno, associate medical director for AHS and consulting physician to the Medicine Hat Recovery Centre.
“Not every patient with chronic pain requires medication. Not every patient requires an intervention, and so we want to be able to better define what patients actually need,” said DiNinno.
This could mean a “centralized triaging system in the south zone to direct patients to the proper care,” said DiNinno, who believes there are three reasons to refer a pain patient to a specialist. When an intervention could be effective, everything else has been tried, or you need reaffirmation that what you’re doing is correct.
The hospital pain clinic has a wait time of 18-24 months for new patients, a recent AHS letter to doctors states.
Family doctors can always consult with one of the pain specialists on the best course of action, said DiNinno. If the patient’s condition changes dramatically and the family physician feels they need to be seen urgently, the specialists at the hospital’s pain clinic are open to communication with the family doctor and seeing patients on a priority basis.
In Alberta this year, four people dealing with chronic pain died by suicide, says HELP (Helping to Ease Alberta’s Pain).
Chronic pain patients are often treated like addicts, and when their medication is cut back to the point where they can’t function, they have lost all hope, says Tracy Fossum, director HELP. Pain patients often feel alone and as though they are in the middle of a fight.
Fossum says 30 per cent of the population is dealing with chronic pain, and where the pain is “life altering” there is an even greater call for help.
“Chronic pain is certainly recognized as one of the risk factors for suicide, and again family physicians are well aware of that,” said DiNinno. “That certainly would be a trigger to have that patient reassessed.”
At the moment reassessment would be at a pain clinic but options for “psychological support and cognitive behavioural treatment” would provide more appropriate help, said DiNinno.
Three years ago the hospital’s pain clinic had to stop taking in new patients because the waiting list was too long. A concentrated effort was put in place to discharge patients back to the care of the family doctor but that was only partially successful.
The new guidelines for prescribing opioids, and some patients needing to been seen by specialty clinics is playing a role in the volume of patients, said DiNinno.
The long-term solution is not necessarily more pain specialists.
“I don’t believe that that is the problem. We can add another physician and drop the wait time to 12 months, then within a couple of years we would be back to the level,” said DiNinno. “I think we need to do things a little differently.”
The only other chronic pain clinic in Medicine Hat is the Wardell Centre for Chronic Pain Disease. New referrals are triaged and some are seen almost immediately if the situation warrants, said Dr. Gaylord Wardell, anesthesiologist and pain specialist. The wait list can be two years.
BGSA Radiology also offers some treatment options for chronic pain and it has no waiting list, said Thomas Strain CEO. They accept referrals from physicians.