Health ministry has no plans to set up pain clinic

The development of a multidisciplinary clinic in Saskatchewan to help people manage chronic pain has long been on Dr. Susan Tupper’s radar.

The issue of pain management has gained increased attention as Canada’s problem with opioid abuse has grown.

Earlier this year, the Canadian Medical Association Journal published an updated guideline for opioid therapy and non-cancer pain, in part as a response to concerns that Canadians are the second-highest per capita users of opioid medication in the world, according to the CMA Journal’s website. The guidelines suggest that caregivers explore non-opioid, non-drug therapies to treat pain.

Tupper has been a physical therapist for 25 years. Her graduate studies focused on the issue of pain, and she has been actively pressing for the establishment of multidisciplinary pain clinics.

“It’s speculation at this point how soon that will be, but we are actively working toward (it)," she said. “It is a very important piece, primarily because ... (for) the diagnosis of chronic pain, the identification of what’s actually happening, you have to eliminate a lot of other potential pathologies ... that might be happening. It really is an exhaustive assessment,” she said.

Primary caregivers would often benefit from having more supervision of a patient to ensure they’ve done their due diligence and covered everything, she said.

Medical professionals generally take what’s called the “four P” approach to treating chronic pain, Tupper said: pathologic (use of medicine), physical, psychological and preventative. She said the health region does have services that deal with each of the four Ps. A multidisciplinary clinic would address all of them in a common space. No such clinic exists in Saskatchewan.

A spokesperson for the Ministry of Health said there is no current plan to adopt a pain clinic model. Pain management for patients is incorporated into most health services and care. “The ministry is always looking for opportunities to work with partners to improve patient experience (i.e. Saskatchewan Spine Pathway, LiveWell with Chronic Pain Program),” the statement read. The LiveWell with Chronic Pain program has been available since 2013-14 in Saskatoon and Regina, and has expanded to most of the former health regions. “The problem with pain is a huge issue,” Tupper said, estimating that one in five people in Saskatchewan lives with chronic pain, and approximately 40,000 people live with what she describes as an “extreme” pain problem.

“The services, the solution for addressing pain is much bigger than creating a new pain clinic. Certainly it’s an issue that will always rest on the shoulders of primary care and as well, self management,” she said.

One particular treatment for pain that Tupper said is “incredibly” effective is exercise. She said the body produces its own “opioids” and other neuro-transmitters with repeated exercise. Medications are moderately effective for a third of people who use them, she added.

“Any one single approach to treatment is fairly limited in effectiveness, but you get much greater benefits if these different components of care — so exercise, counselling, medications, all of these different things — are added together,” she said.

Some family physicians, physical therapists and other medical professionals in the province have taken additional training for pain management, she noted.

“I guess the best approach for an individual is to ask the clinicians that they’re meeting with whether they have an interest in pain and have taken additional training.”

A list of resources is available on the Saskatchewan Health Authority’s website.