Chronic pain poorly understood, costing Canada billions

One in five Canadians suffer from chronic pain, and if you're one of the millions affected — and you're lucky — you have a doctor who knows how to treat your symptoms.

But if you need to see a pain specialist, wait times are long. Very long — frequently more than a year. And many live far from the country's publicly funded pain clinics, because large areas of Canada have little or no access to appropriate pain care.

The impact?

Three quarters of the people waiting for care at Canadian pain clinics say it interferes with their normal work life. More than half suffer from severe levels of depression. And almost 35 per cent report that they've considered suicide.

According to the Canadian Pain Society, chronic pain is an expensive problem, not only to the patient but also to society as a whole. It costs billions of dollars a year in health costs, lost productivity, not to mention the social cost to lives that are derailed by addiction or depression.

Chronic pain

So what is chronic pain?

Dr. Mary Lynch, a professor of pain medicine at Dalhousie University, calls it pain that persists long after normal healing should have occurred, usually at least three to six months. 

And the best person to diagnose it is not a doctor or pain specialist, she says. It's the patient.

"Pain is what the patient says it is," explains Dr. Lynch, quoting Dr. Ron Melzack, a fellow pain specialist from McGill University. "The patient really is the best one to tell you about their pain and what it feels like to them, and you need to believe that." 

Dr. Lynch, also director of pain research at Queen Elizabeth II Health Sciences Centre and the past president of the Canadian Pain Society, is part of an in-depth examination of chronic pain on CBC Radio's The Sunday Edition this weekend.

Another misconception about chronic pain is who suffers from it.

"A lot of people think that chronic pain is something only older people get, but in fact one in five children suffer from recurrent or chronic pains," explains Jennifer Stinson, a nurse clinician scientist in the Research Institute at SickKids hospital in Toronto. "The most common are headaches, abdominal pain, back pain and general muscular-skeletal pains."

In fact, both Stinson and Dr. Angela Mailis-Gagnon say they have had patients tell them they would rather have cancer than chronic pain.

Diagnosis

Dr. Mailis-Gagnon is the founder and director of the Comprehensive Pain Program of the Toronto Western Hospital, a specialist of the Royal College of Physicians and Surgeons, and a professor in the Faculty of Medicine at the University of Toronto. She says chronic pain hits a wide variety of people. Some are amputees, burn victims, or have suffered grievous bodily injury, but many have not.

"We see patients who don't have a definable physical condition, but they are highly disabled and they are very emotionally disturbed," she says. 

Stinson, who also works as a nurse practitioner in the Hospital for Sick Children's Chronic Pain Program, says convincing people you suffer from chronic pain can be exceedingly difficult.

There's this assumption that if you treat the underlying disease, than the pain will get better. But that is an inaccurate assumption.- Dr. Mary Lynch, professor of pain medicine

"Health care providers, the public, even [the patient's] friends don't believe they have chronic pain, because for most of the conditions it's invisible. They look perfectly normal ... but this pain has a significant impact on their life."

Dr. Lynch says surgery itself can be a major cause.

"After surgery, [chronic pain] is a huge problem. About 10 per cent of people subsequent to many kinds of surgery ... will be left with post-surgical nerve damage pain from the nerves and tissues that had to be cut for the surgery."

Health care workers themselves bear some of the blame. Research has found that only 30 per cent of ordered pain medication is actually given to patients after surgery. Dr. Maylis said it comes down to poor pain management training.

"We get very little training as students. We get very little training as practitioners," she said, adding that some veterinarians get five times more training in pain management than medical doctors.

But efforts are afoot to address this shortcoming. 

Stinson says the University of Toronto's Centre for the Study of Pain has introduced interdisciplinary pain training programs for medical students to try to improve the situation. As well, Ontario's Ministry of Health recently announced a new $1.3 million telemedecine educational program to teach doctors in remote parts of the province about managing chronic pain.

One of the core missions of medicine may be to alleviate pain, but competing interests often get in the way.

"Unfortunately, we continue to exist in a disease-focused medical system where the focus is on treating the disease, the pathology, the cancer, the diabetes, the lung troubles, rather than dealing with the actual experience of the patient, which includes pain," Dr. Lynch explains.

"On top of that, pain is still considered to be just a symptom of an underlying disease, rather than being recognized as a disease in its own right. There's this assumption that if you treat the underlying disease, than the pain will get better. But that is an inaccurate assumption."

Access also remains a challenge. Dr. Lynch pointed to a recent study that found that for more than a third of publicly funded pain clinics in Canada, the average wait time is more than a year. Vast parts of the country have no pain clinic services at all.

"I think the situation for children is even more bleak," Stinson added, explaining that there are only eight pediatric pain clinics in the entire country. 

Funding for pain research only makes up one quarter of one per cent of all health-related research.

Stinson would like to see a national pain strategy. But all three pain specialists complained that there is little leadership coming from the federal government on the issue.

"Wherever you turn your eye, pain is there," said Dr. Maylis. "And we do very little for it."

[Listen to The Sunday Edition's full documentary on chronic pain on CBC Radio 1 on June 22 starting at 9 a.m. Eastern.]