Comprehensive Chronic Pain Care: The pioneers, the movers and the ones left behind!

Several years ago a group or Canadian researchers and clinicians recognized that while chronic pain was a major health problem, it was not on the radar of government bureaucrats and hospital administrators. The group knew they needed to make policy makers understand that chronic pain needs a comprehensive care approach. So, they lined up a number of people and organizations they needed to “buy into” the plan, i.e., the stakeholders. They identified services that already existed and also the problems within the system for services that did not exist, by conducting interviews and surveys, while they reviewed the literature to find out what other people and countries had done. They created a vision, a well-drawn plan of action, and decided what the outcomes were to be in order of priority (for example, seamless care, quick access etc). Finally, they created a “business plan” to show the authorities why it was worth creating comprehensive pain care. Then, they submitted the plan to the region’s budget committee, together with specific strategies how their proposal was going to be a) carried out and b) evaluated. This hard work paid off. The original plan was funded for a few years. When its value was proven, it expanded and became all-inclusive to form the current system.

Calgary was the “first” in Canada to do something about chronic pain. By now, the system has expanded to involve all regions of the province of Alberta and has undergone a rather extensive reorganization under the Alberta Health Services. In this new format, the Acute Pain Services have been detached from the chronic pain services (a change that is not welcome by all). However, on the positive side, the Chronic Pain Centre continues relatively unchanged. The first satellite pain clinic has been established for non-complex chronic pain patients in a Primary Care Network (organized networks of family doctors serving a segment of a population). The primary care pain team in this first clinic is comprehensive and includes the services of two family doctors, a physiotherapist, a behavioural consultant, pharmacist, nurse practitioner, Kinesiologist, Dietician etc. The hope is that this will expand to other Primary Care Networks in the city and rural areas. In the long run, all these community clinics will be linked with the Chronic Pain Centre and provide timely care and services for patients near their home. Plans are also in the works to develop collaboration with AddictionsServices for patients with “problem drug use behaviour”.

In other words, this care is truly COMPREHENSIVE and all inclusive, from the community to the specialist level and hospital based chronic pain clinic with everybody having access to “stepped-up” care. This type of care is not only about drugs or surgery but about the “whole person”, body and spirit combined, including prevention and wellness/ self-management programs for the patients.

Quebec followed. In 2006, the Ministry of Health and Social Services asked the Québec Health Services and Technology Assessment Agency (Agence d’Evaluations des Technologies et des Modes d’Intervention en Santé = AETMIS) to describe the “landscape” of health care services for patients with chronic pain and the treatments offered. AETMIS looked at France, the Veterans Health Administration in the United States, and Australia, which have prioritized management of chronic pain services and recommended that:
a) Chronic Pain be recognized as a major chronic health problem;
b) Resources be allocated accordingly,
c) Educational strategies for health care professionals should be put in place,
d) Chronic pain services must be monitored, and
e) Research must be supported and be integral to a comprehensive care model.
AETMIS concluded that appropriate, timely, and scientifically based treatment of chronic pain patients will have an impact on: Health-care policymakers in government, managers at health-care facilities, health-care professionals and patients and their families who share the burden. Right now, Quebec chronic pain services are a “work in progress” with a significant number of people involved to make this happen.