Canada needs national pain strategy to provide care, lower costs: advocates
When Jeanine Mcdonald heard a pop in her low back as she bent down to pick up a lid from a box, she had no idea she’d ruptured a disc and would wait three months for surgery. Then a second disc ruptured and left her in more debilitating chronic pain, the kind that millions of Canadians live with daily.
In Mcdonald’s case, a condition called cauda equina syndrome, involving a bundle of spinal-cord nerves, causes severe neuropathic pain in her lower legs and feet, forcing her to wear leg braces and forearm crutches so she can walk. Her neurosurgeon told her there’s no known reason why the two discs ruptured three years apart, in 2005 and 2008, leaving her able to work only one day a week for a non-profit organization helping families of special-needs kids.
“There’s super sharp pins-andneedles type of pain and what I call fire feet, which is a burning type of pain that happens,” McDonald said. “And there’s what I refer to as Charlie horses on steroids. You have to find humour in it or you just lose your mind.”
Mcdonald spent two years in search of a specialist who prescribed her current cocktail of medications including opioids so she could function. She also gets treatment from a psychiatrist specializing in conditions including those affecting the spinal cord, and counts on support from a patient-advocacy and health professionals’ group called Painbc.
It’s considered the most patient-focused group in the country among several organizations that are pushing for a national pain strategy, which would see the federal government establish a framework for provinces and territories to deliver programs addressing awareness, education for health professionals, early access to care and research.
Dr. Fiona Campbell, presidentelect of the Canadian Pain Society consisting of clinicians, patients and educators, said groups involved in chronic-pain initiatives, including in British Columbia, Ontario, Quebec, Saskatchewan, Alberta and Nova Scotia, want better as chronic well, services pain, before which people for changes acute develop pain the central nervous system and could affect mental health.
The society announced a national pain strategy at a summit in Ottawa in 2012 but the federal government did not adopt it.
“We’re now at what one might call a tipping point, where the ducks are aligning,” said Campbell, an anesthesiologist and codirector of the Pain Centre at the Hospital for Sick Children in Toronto.
“There’s more of an appetite and awareness about pain, which has probably arisen related to the opioid crisis, which is not the same as saying all people with chronic pain are taking opioids or affected by the opioid crisis. It just means it’s become more sentient in the public mind.”
Dr. Norman Buckley, scientific director of the Michael G. DEGroote Institute for Pain Research and Care at Mcmaster University, also heads the Chronic Pain Network through a five-year funding arrangement with the Canadian Institutes of Health Research. He said the aim is to train researchers and translate that knowledge into policy action.
“Guys come in, they sit in my office and cry because they can’t pick up their grandchildren,” Buckley said of patients with back pain, one of the most common chronic-pain conditions, along with arthritis. and provincial plinary the incorporates search. ate While Jacques country past Saskpain pain groups president funding Laliberte, clinics, with care are including a working for as Quebec strategy of well multidisci- the immedi- Painbc to as leads Que- that get rebec Patients, province expertise Association at established said hospitals that of Chronic in linked centres 2010, Pain with the of four ating chronic-pain of regional its universities services. centres before to provide creto “Our have main support activity groups right through- now is out we have the province about 17 of of Quebec them,” said and Laliberte, who nearly broke his neck in a snowboarding accident in 2003 before taking on the role of leading the association he helped form at the urging of a doctor. More regional centres are needed in Quebec, Laliberte said, adding: “We’re still striving to get chronic pain understood by decision makers.” In Ontario, the provincial government enhanced funding in 2016 for its current 18 multidisciplinary clinics as part of a pain management plan that includes a strategy to prevent opioid addiction. It also expanded training for primary care providers via casebased learning and video-conferencing sessions to manage chronic pain, the province’s Health Ministry said in a statement.