chronic pain experts and advocates call for awareness and action in canada
5 minute read
chronic pain comes at a very high cost for people who can’t work or need care, for the economy, and for the stretched resources of our healthcare system. it’s the leading cause of missed work in canada.
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you can’t always see it or tell that someone is feeling it, but it’s there. chronic pain is an invisible disease, undermining the lives of as many as 20 per cent of canadians who are trying to cope and have their symptoms validated and treated.
“pain is not a symptom of your cancer. it’s not a symptom of your surgery or a symptom of osteoarthritis. this in and of itself is a problem, and it is something you’re going to have to live with. and we have to create structures to help people move forward,” says dr. hance clarke, medical director of the pain research unit at the toronto general hospital and president of the canadian pain society. “pain is the number one driver of disability in this country.”
the cost of chronic pain
chronic pain comes at a very high cost for people who can’t work or need care, for the economy and for the stretched resources of our healthcare system. it’s the leading cause of missed work in canada. according to latest data from the canadian institute for health information (cihi), the most common reason for an emergency room visit is pain—abdominal, pelvic, throat or chest.
as clarke points out, “the hundreds of millions we pay out is a consequence of disability related to pain. so, if you want to start reducing the cost and reducing healthcare funds and reducing the burden on the economy, we should partner with folks who are tackling better ways to get on top of pain, how we improve the pathways and the multidisciplinary care that’s needed for individuals who live with pain.”
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his dad worked in an auto factory loading bumpers and had 5,000 tons of steel fall on him. he could have died. “i remember i was in grade 12 and we were in the icu talking to the doctors,” he recalls. they said he had an excellent chance to live, despite a fractured neck and crushed hip, and hours of surgery. he lived with pain throughout his life for another 30 years.
watching his dad fight to regain his abilities influenced clarke to study brain and behaviour science, leading to a phd and founding the first-ever transitional pain service to help people at risk for chronic pain and pain-related disability after surgery. the team is dedicated to transitioning patients from acute pain to chronic pain with management strategies, and the evidence-backed program has been replicated around the world.
“pain is a nervous system signal. and how do we fix pain? you can’t fix it, but you can dampen down that signal. and what are the three pillars? it’s using your brain, it’s exercise and it’s things we can give you, like medications and needles. the portion of the population that does well are the ones who figure out it’s all three.”
now clarke is taking his call for action and collaboration for better pain treatment to the streets as the canadian pain society goes on a pain parade this friday, may 2 from victoria college in toronto to queen’s park, ending at the goldring student centre at the university of toronto for a public event and barbecue. researchers, clinicians, advocates and politicians will be gathering at the university of toronto may 1 to may 4 for the canadian pain society annual scientific meeting to discuss the latest clinical data, chronic pain treatment best-practices and opioids.
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opioid epidemic and the search for new solutions
why is chronic pain such a huge problem, with some calling it a silent public health epidemic? it’s been shoved to the background in a landscape of high-profile health problems until much more recently. the world health organization declared chronic pain a disease in 2022, finally opening doors for devoted pain experts like clarke.
“let’s go back to the 70s. what were the treatments for pain?” he says of a medical specialty that lags far behind well-funded oncology and cardiology. “it was bed rest. there were no interventions related to pain. and we’re now in a space where all people want to talk about is oxycontin.”
opioids like oxycontin were considered the most effective treatment for pain relief, but the result has been a crisis of rapid increase in opioid overuse, misuse and overdose deaths that has occurred since the 1990s. the crisis surrounds both prescription and illicit opioids, like heroin and fentanyl, leading to “the land of unintended consequences,” clarke says.
prescribing of these narcotics has reduced and the content formulations that were really causing problems for people now have a huge pipeline and investment of companies looking at receptors related to pain for better drug discovery, like research out of johns hopkins university in baltimore.
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he explains that multidisciplinary pain clinics are one of the much-needed solutions to pain intervention because pain coexists with so many other conditions, including mental health, anxiety, depression, substance use and trauma. people who experience any type of trauma and have a pain issue have a difficult time rebuilding their lives.
“it’s all related to trauma,” he says. “we’re thinking about adolescent trauma, childhood trauma, sexual abuse, physical abuse, those types of things, even having medical interventions can be trauma, whether that’s for a lifesaving procedure or just an elective procedure, and you’re left with, guess what? your body’s not exactly the same.”
focusing on patients for a better future
when he works with patients, he tells them they have a six-month window following a treatment intervention to know where the body is going to land. if pain is part of the outcome, patients can live with that pain for months or years, needing help and support to figure out how to function as close to where they were before the intervention.
“for about 80 per cent, you’ll move on with your life and you’ll head back to where you were, but for 20 per cent, you’re looking at these kind of consequences from whatever intervention or whatever issue you had in your life that now linger for the rest of your life.”
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that said, clarke stresses the inequity of research funding that is minimal for pain despite the costs to the healthcare community in canada that totals more than heart disease, cancer and hiv combined.
part of the solution is supporting clinical intervention and basic science intervention to move toward improving care. at the patient level, the multidisciplinary approach would tear down the silos where patients, for example, who have a substance use problem and a pain problem have to seek out two or more different providers who treat these conditions separately.
“patients need one place to go where they can have all of the care encapsulated and that’s back to that multidisciplinary structure within family, health teams and pain teams.”
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