Mr. J originally reacted strongly to my last proposal: “My God, doctor, I do not want to get hooked and addicted”! It took me time to convince Mr. J. and the daughter who always accompanied him that he needed the drug and that he would not get hooked because he had a good medical reason to take it. I also promised that I would start him with baby doses. Three years later, at the remarkable age of 92, (though he hardly even looks like he could be in his early 70s), Mr. J. continues to use the medications I prescribed, including liquid morphine in baby doses. I am not kidding you, he uses few drops every day with a dropper!
He is doing very well. He is not free of pain, but the pain is much better controlled and he has a very active life as he is a widow living alone. As a matter of fact he just went to Europe for a long holiday. Leaving my office, ready to pack and go with the family to his trip, he gave me a big hug and a warm kiss. “Without you doctor, I would have been unable to go to this trip”. “By the way” he continued, “did I tell you, you are my 41st doctor”? I could not believe my ears. Over the course of a few years seeking a diagnosis and a treatment for this pain, poor Mr. J had seen 40 doctors before seeing me! The daughter assured me he had kept meticulous notes and recorded all encounters with the medical and non-medical practitioners he had met over the years, so I had to believe him.
Why did Ms. M. have to go all the way to Wisconsin to find a doctor for her neuropathic pain when there was a pain clinic next door to her? Why didn’t her family doctor or her neurosurgical specialist refer her to my clinic or other pain clinics located in hospitals affiliated with universities? Why had Mr. J. been forced to seek out 40 other physicians and countless non-medical practitioners before he got a proper diagnosis and treatment? Why were some of his important medications not covered by the system even if he was over 65? How much money did my patients spend out of their own pockets throughout the years of their ordeals? Where did Mr. J. get his fear of being hooked on drops of morphine?
If you recall my previous paper, I can’t talk but I can feelwhy are people with physical or cognitive disabilities in institutions so badly treated when it comes to pain? The answer is simple: because this province and several other provinces do not have a comprehensive strategy for pain management, a strategy that will equip professionals, public at large, patients, administrators and policy makers with the necessary education to tackle the problem, identify the gaps in care, coordinate existing resources, reallocate funds from money wasted in the system to processes that are useful and effective, provide smooth flow from one level of care to the other and even provide the public with techniques to prevent and self-manage pain. In the next few issues we’ll address some of these gaps of pain care in Ontario and other provinces and discuss what you can do to have your voice and opinion heard.
