Too Few Doctors Understand Pain: The Need for Organized Services

Susan is a 50-year-old mother of two daughters, a businesswoman and active in her community. She describes herself as blessed in every way save for one thing; frequent tortuous headaches accompanied by what she describes as “a feeling of poison running through my whole body” that she has endured over the last ten years. Susan is not alone. Disabling chronic pain is a major health care and societal problem of epidemic proportions.

Chronic pain is a complex biopsychosocial phenomenon that can have a profound impact on people’s lives. The condition persists beyond the normal time of healing and is conservatively defined as pain that persists for longer than the expected time of healing (3 or 6 months).

Who’s affected in BC?
In Canada, one in three people are affected by chronic pain. That is over 1.5 million people in BC. The cancer literature reports that 65% - 75% of all cancer patients experience pain during their disease.¹ This then equates to 93,642 – 108,049 people in BC. In BC, it is estimated that up to 54% or 227,266 children (0 to 18 years) will develop or are born with chronic pain conditions.

Disabling chronic pain is a major health care and social problem of epidemic proportions. It is the most frequent cause of suffering and disability that seriously impairs quality of life. The impact of chronic pain on the lives of the sufferers and their families can be devastating, affecting the patients’ functioning, mood, sleep, social relationships and quality of life.² Uncontrolled pain continues to be the single most common cause of disability amongst working-age adults in Canada.³ The 3 most frequent causes are back problems, arthritis and migraines.⁴

• Pain robs individuals of their physical health impacting organ function and leading to muscle wasting, impaired immuno-competence and alterations in blood flow;

• Pain is the number one reason people seek health care treatment, accounting for about half of all physician visits.⁵ Seven million Canadians are taking medication for pain at any one time;⁶

• Untreated acute pain can lead to chronic pain syndromes and increased disability. It leaves more people disabled than cancer or heart disease (Sinatra, Torres and Bustos, 2002);

• Acute postoperative pain is followed by persistent pain in 10 – 50% of individuals after common operations – hernia repair, breast and thoracic surgery, leg amputation and coronary artery bypass surgery. The resulting chronic pain can be severe in about 2-10% of these patients (H. Kehlet et al, 2006);

• It impacts psychological well being and is often associated with erosion of self esteem, depression, anxiety and spiritual distress (Henwood and Ellis, 2004);

• Most frequent cause of suffering and disability that seriously impairs quality of life – devastating to the individual and his/her family;

• In the 1995 Canadian National Population Health Survey it was reported that people with severe chronic pain had seen a physician more often (average 12.0 versus 3.8 consultations) and had longer hospital stays (average 3.9 versus 6.7 days);

• Kaiser Permanente, San Diego, reported – those with chronic pain are five times as likely to utilize health care services. Fifty-eight percent of them experience symptoms of depression or anxiety, co morbidities that increase the utilization of health care resources (M. Sipkoff, 2003).

The financial burden of chronic pain in Canada is astronomic. Chronic pain is costly not only to the patient but also to society as a whole. Expenditures on chronic pain include both direct costs related to treatment and provisions of health care services, and indirect costs such as those associated with loss of productivity resulting from absenteeism, lost tax revenues and disability payments.⁷ According to the Neurosciences Canada Brain Repair Program, the annual cost of chronic pain, including medical expenses, lost income, and lost productivity, but not the social costs, is estimated to exceed $12.5 billion.⁸ This is equivalent to $1.65 billion annually for BC. Chronic pain is said to be costing society more than cancer, heart disease and HIV combined. That’s health care costs, lost productivity and disability.⁹

While persistent pain is not directly life threatening, it can cause a major disruption of lives leading to physical disability, loss of job, financial hardship, relationship breakdown and major depression. It is clear that persistent pain frequently does not respond to simplistic treatment– for example, painkillers. This lack of effectiveness causes despair among patients and many simply suffer alone and in silence.

Today, oral pain medications make up only one aspect of effective pain control. Leading edge pain management centers focus on a holistic approach and provide medical, interventional and psychological therapies through multidisciplinary teams. These teams often comprise of anesthesiologists, psychiatrists, internists, rehabilitation specialists, nurse practitioners, physical and occupational therapists and psychologists.

Complementing these programs are the advanced neuromodulation techniques which are currently only being done at St. Paul’s Hospital and Victoria’s Royal Jubilee Hospital. Examples include dorsal column stimulation that uses electrical pulses to alter pain signals to the brain and the implantable spinal drug delivery system that supplies controlled, continuous pain medications directly onto the spinal cord. Also, for many forms of low back pain and spine pain, techniques such as radio frequency lesionning are also very helpful.

Despite the known problem and costs, services for people with chronic pain are grossly inadequate. Primary care physicians, specialists and other frontline health workers are not equipped with the skills and knowledge to help patients with moderate to severe chronic pain. Pain is a resistant care issue across disciplines. Dr. Brenda Lau is one of the founding executive members of the BC Provincial Pain Initiatives committee whose vision is to address the problem of poor pain services at the system-wide level. This strategic initiative crosses disciplines, health regions, and health sectors. Within the overall strategy there are sub working groups concerned with developing strategic initiatives including the following: pain care education; regionally coordinated pain services; internet resources; chronic pain registry; optimal pain care in residential and acute care facilities; and advocacy.

Dr. Brenda Lau is also the new Director of the Division of Pain Management at Surrey Memorial Hospital where a comprehensive Pain Management Clinic is in development. This center is targeted to be the main tertiary level resource center for the Fraser Health Authority, which currently has no formally organized pain services.

Biography Dr. Brenda Lau is a Consultant Anaesthesiologist from Vancouver, Canada and a Fellow of the Australian and New Zealand College of Anaesthetists Faculty of Pain Medicine (FFPMANZCA). She completed her Master of Medicine (MM) in Pain Management with Professor Michael Cousins at the University of Sydney in 2007. Her professional interests include neuromodulation techniques, cancer pain management and operations research. Currently, she is the Director of the Division of Pain Medicine Surrey Memorial Hospital and a consultant Interventional Pain Specialist with the St. Paul’s Hospital Pain Center. Brenda Lau, MD, FRCPC, FFPMANZCA, MM (painmgt)

¹ www.bc.cancer.ca/ccs/internet/standard
² Bonica’s Management of Pain, 3rd Edition, Chapter 10, Basic Considerations of Chronic Pain, Lippincott, Williams and Wilkins, pg. 242.
³ Statistics Canada – Housing, Family and Social Statistics Division. A Profile of Disability in Canada. Statistics Canada. 89-577-XIE, 1-24.2001.
⁴ Elliott AM, Smith BH, Penny KI, Smith WC, Chambers WA. The epidemiology of chronic pain in the community. Lancet 1999;354:1248-52.
⁵ Moulin, DE, Clark AJ, Speechley M, Morley-Forster PK. Chronic pain in Canada- prevalence, treatment, impact and the role of opioid analgesia. Pain Res. Manag. 2002: Tables and Figures: Manuscript Version 4, May 17, 2006.
⁶ Mason, V.L., Skevington, S.M. Osborn, M. (2004) Development of a pain and discomfort module for use with the WHOQOL-100. Quality of Life Research 13:1139-1152.
⁷ Turk D.C., Chronic non-malignant pain patients and health economic consequences. Eur.J.Pain 2002;6:353-55.
⁸ Neuroscience Canada Brain Repair Program. Transforming Research on Chronic Pain. www.neurosciencecanada.ca
⁹ Lake, H., A Life of Pain: In a Special 2-Part Services, pg1

ACCP 2008 Annual General Meeting

19 ACCP members attended the 2008 Annual General Meeting held on June 28, 2008 at the Chili Thai Bistro from 4:30 to 5:30. At the meeting, chairs of fi ve committees gave committee reports. Directors were elected for the 2008/2008 year. Awards were presented to the outstanding member volunteers for the year and departing board directors: Edmond Wong, Peter Hu, and Jeremy Chan. Winnie Sung was elected as the president of ACCP.

2008/2009 Board of Directors

Re-elected: Winnie Sung, Jenny Li
Newly Elected: Julie Sue, Brenda Lau
Returning without Further Election: Annie Lee, Doug Purdie, Grace Kuo, Selena Sit, Wendy Chang

Some of the 2008/2009 Board of Directors at the Annual General Meeting.

Some of the ACCP volunteers at the Annual General Meeting.

ACCP Executive Committees:

Infrastructure and Governance
Marketing and Communications (marketing@accp.ca)
Community Relations and Advocacy (community@accp.ca)
Membership (membership@accp.ca)
Professional Development and Youth (development@accp.ca)
Fundraising

If you are interested in finding out more about, or volunteering on one of our committees, please e-mail the relevant departments.