A 'community of practice' to help chronic pain sufferers in northwestern Ontario

Doctors, nurses and physiotherapists across northwestern Ontario are getting more information on the best way to treat chronic pain, thanks to an innovative program operated by St. Joseph's Care Group in Thunder Bay, Ont.

Project ECHO (Extension for Community Healthcare Outcomes) uses videconferencing and other online technologies to bring together pain management experts in Thunder Bay with healthcare professionals from across the region for weekly tutorials.

Each session consists of a quick lesson on pain management, and then one of the primary care providers presents a case, with the goal of getting recommendations to help that patient manage his or her chronic pain.

'A community of practice'

"We're seeing a community of practice being built," said Tim Larocque, a researcher with Project Echo. "It's a really friendly and welcoming environment that allows them to learn from each other, and it's really great."

He gave the example of two physiotherapists who work in separate communities and had never met in person but got to know each other through the weekly sessions and then began to connect at other times so they could collaborate on the design of a new brace for their clients, who were facing similar issues.

Project ECHO, which was launched in May 2018, can be life-changing for people in small communities who used to have to travel to Thunder Bay or southern Ontario for treatment, said program manager Alison Warwick.

'Whole point is to keep patients in community'

"Our communities are very small and isolated, and so we don't have easy access to services like you would in Toronto, and you can't get on the bus and go downtown to a hospital. Up here, we really have to rely on each other to share expertise, and the whole point of ECHO is trying to keep patients and clients in their community as opposed to having them come to big urban centres," she said.

Travelling to a major centre is not only costly and exhausting for some trying to cope with chronic pain, but it can sometimes result in suggestions that simply "wouldn't make sense" for a person living in a tiny town.

"For example, a recommendation might be for a patient to swim frequently, but a lot of our communities don't have a pool, so because we're all from the northwest, I think our hub is really in tune with what communities have and what options are available," said Warwick.

Provides guidance on 'opioid stewardship'

Another key component of Project Echo is that it gives primary care providers much needed information and guidance on opioid stewardship by offering a better understanding of when to prescribe opioids and how to wean people off painkillers.

"That means taking into account certain people's conditions and what they need in terms of pain relief and the appropriate prescribing of opioids for their management of chronic pain," said Larocque. 

Warwick said the provincial government has also given funding to bring all the participants together in person for an educational workshop around prescribing and deprescribing the drugs.