There are better treatment options for pain

Opioids are not the best answer for chronic pain but cost puts them out of reach

Congratulations to The Spectator for opening a new avenue of conversation in the opioid crisis. This real and raging crisis is burying the larger issue of pain management. The two articles, one highlighting the feelings of abandonment of people suffering from chronic pain and the other presenting alternatives to drugs for treating pain are vital to the battle with opioid use.

I am one of those seniors who need a voice. Chronic pain has been a burden in my life for almost 20 years. I lost my career, my pension, financial security and my sense of direction. I have carved a new, limited quality of life thanks to the care of a pain specialist and access to health insurance.

Now I wish to speak out about the crisis swirling about us — the use of opioids in pain management.

I have researched this crisis within a crisis. My sources include The Spectator, other major dailies, the 2016 census, JAMA, PAIN, fellow sufferers and pain management specialists. Here is what I’ve learned.

There are alternatives that complement drugs for treating pain. The challenge is cost. Few of these choices are covered, fewer seniors have coverage and the costs are beyond most pensioners. Treatments such as therapeutic massage, physio, Chiropractic, acupuncture, osteopathic and other relevant treatments cost between $65 to $95 per hour.

The problem with non-drug treatment is lack of funding for patients who need it most. Chronic pain patients are often unemployed, poorly supported financially and often with good primary care to advocate for them. And an insurance policy might cover three months of treatment per year.

There is increasingly strong evidence that practically all of the strong physical/ neurological mechanisms underlying chronic pain are poorly addressed by the strong opioids. While Gabapentin and pregabalin are covered, buprenorphine/ naloxone, tramadol and tapendadel, that are more effective than strong opioids and less likely to produce tolerance and dependence are not covered through Trillium, Ontario Works or ODSP. To seek relief patients are driven to doctor shopping, expensive trips to the emergency ward, after hour clinics and finally to the streets.

People in pain will not stop seeking relief despite the risks. Is turning patients to the streets worth the savings gained in not covering these medications and subsidizing alternatives that support drug therapy?

My life is filled with constant pain, a cane, depression, all consuming fatigue and a new identity — a disabled parking sticker. My regime includes effective pain medication, limited access to alternate therapies and the time spent with a pain specialist and my understanding family doctor. I have limited insurance coverage and constant support from my family.

One problem in a 15 minute doctor visits doesn’t meet the need. Doctors need more time to help pain patients and should be paid for that time. I learned that training veterinarians in Ontario receive more chronic pain education than f amily doctors. As seniors live longer, chronic pain grows into a larger crisis year by year. In 2012, approximately 35 per cent of Ontario doctors would not prescribe opioids to any patient either chronic or terminal. A chronic pain sufferer I know recently went to the street for relief from an industrial accident incurred 20 years ago.

As your reporter learned from one patient, “I was told to reduce, so I did. It’s terrible. It’s very, very hard.” It’s especially hard when the doctor’s bag of tricks includes alternatives that so many cannot afford. A doctor can prescribe an opioid drug that is covered yet non opioid medications that are more effective are beyond the reach of the patient.

Chronic pain costs — in dollars, in training, and in quality of life. According to the 2016 census and Ontario’s population share, our portion of the annual direct cost of chronic pain is $2.3B. Our portion of the productivity cost is $14.3B. Sixty per cent of chronic pain sufferers eventually lose their jobs. For those still working the median sick leave is 28.5 days per year. Waiting to access chronic pain care cost the patient a median of $17, 544 in lost labour time.

Health care in Canada is not supposed to be dependent upon the depth of your pocket. Yet it’s clear that people, especially seniors, without insurance or sufficient, stable income cannot afford the effective treatments for chronic pain. Yet can access medications that are proven not to be the best choice. Can covering the costs of effective medications and access to alternate therapies cost more than the current burden of $2.3B and $14.3B?

As more people become seniors and live longer, the percentage of chronic pain sufferers will rise. Current employment trends offer less stability and reduced insurance protection. The upcoming increase in the minimum wage will help people meet basic food and shelter costs but it will not address the costs of medication and alternate therapies. The cost of living prohibits most people from buying private insurance.

It is my fear that chronic pain sufferers who cannot afford effective medications and alternate therapies will continue to be part of the opioid crisis and will grow in number as we age.