Chronic Pain: The Elephant in the room that no one wants to see

I do not have enough space and time to cover all these issues here (for those interested I have dealt with all these questions and many more in my book BEYOND PAIN). I do plan, however to cover specific pain issues in these columns in certain groups such as pain in women (including the subject of fibromyalgia one of the readers raised), pain in the elderly, pain in kids (your children and grandchildren), pain in different cultures and the list goes on. As well, from time to time I will address some of the specific issues you raise through emails to “Ask the Experts” site of CARP Action Online.

For now, however, I want to touch some major issues with chronic pain: The estimated annual cost of pain from all causes in USA is approximately $61.2 billion per year and approximately $6 billion per year in Canada (estimates that are really quite small if one takes in account lost work days, health care direct costs, out of pocket expenses, disability and other payments). What these figures do not include, is the immense cost of human suffering that cannot be expressed in dollar figures. Despite this, chronic pain seems to be unrecognized and is highly undertreated in most parts of our country. When it comes to research less than 1% of all research funds is devoted to pain research (even though Canada is a true pioneer in many research fronts including children’s pain, imaging the brain, pain genetics etc). When it comes to waiting to be seen by doctors skilled in chronic pain, wait lists across the country vary between many months to 5 years.

Family doctors are our “gate keepers” and manage 90% of chronic pain. But, our doctors have not been trained in medical schools to deal with pain (a veterinarian gets 5 times more training in dealing with our animals than your doctor). They need more time to deal with the complex physical and psychosocial issues that come with chronic pain, but the fee-for-service system does not allow proper remunerative time, nor do they have access to resources such as nurses, psychologists or social workers to assist them in getting the “whole person picture” of their patients with chronic pain. And of course, many Canadians do not have a family doctor to start with. Doctors who specialize in treating pain are few and far bewteen and their training may be variable as there are no standards to dictate their training, nor is there a formal specialty in chronic pain condoned by the Canadian College of Family Physicians or the Royal College for specialists.

Many chronic pain sufferers do not have access to doctors treating pain due to distance or just because such doctors and clinics do not exist in large parts of the country. Many treatments for chronic pain (outside interventions such as injections and surgery) are not funded by the fee-for-service system in our country unless you have a third party coverage such as workers compensation or extended health care. These treatments include not only medications but most importantly, physical and psychological treatments and “whole person treatments” in well organized pain clinics and setting. Everything I said in previous columns for neuropathic pain, applies to chronic pain as well in general.