Why are we in this mess? The reasons are many: Poor education in chronic pain of students who study to become doctors, pharmacists, nurses and dentists (a veterinary student get five times more education how to manage pain in animals than a medical student does for humans); poor continuing education for practicing physicians when they are out in the community treating patients; inappropriate fee schedules that do not allow physicians to spend more time with pain patients (it takes 30 seconds to write a prescription for pills and 30 minutes or more to take a detailed history and try to get to the root of an individual’s complex pain problem); lack of specialized pain clinics and, in many cases, formal training of those who deliver pain services; lack of funding for therapies other than opioid drugs (there are many other non-opioid drugs, as well as forms of treatments such as psychological therapies, physical treatments, complementary medicine like acupuncture, etc. that can help patients with chronic pain, most of which must be paid by the patients themselves); lack of services for patients with pain and addiction; lack of a concerted strategy to empower regulators and law enforcement agencies to deal with criminal activities and drug diversion; and the list goes on.

In its comprehensive report, the CPSO provided 31 explicit recommendations, calling upon the Government of Ontario to address four crucial areas: Education – Promoting Safe and Effective Opioid Use; Access to Health Resources; Technology – Prescription Tracking, and Addressing Diversion – Regulation and Enforcement. In the end, what the crisis requires is a coordinated, organized, strategically thought “whole person” process. Moreover, the opioid crisis cannot be divorced from the underlying problem of poor management of chronic pain. A comprehensive pain strategy is needed for Ontario — a strategy that will start from patient self-management and prevention of chronic pain and will lead to a coordinated system of care, including hospitals and specialty pain clinics.

I have talked about such a strategy on several occasions in this forum. Other provinces have such a strategy. You as the voters, patients, advocates for your family members, or simply interested in people’s wellbeing, should join your voices with us, physicians, other healthcare providers, educators, administrators, and law enforcement agents in asking our government officials to address the crisis of overtreated and seriously undertreated chronic pain.

Please respond to the public health and pain questionnaire included in this newsletter.

Angela Mailis Gagnon, MD, MSc, FRCPC(PhysMed)
Director, Comprehensive Pain Program,
Senior Investigator, Krembil Neuroscience Centre
Toronto Western Hospital,
www.drangelamailis.com
Chair ACTION Ontario www.actionontario.ca

Keywords: pain, healthcare, drugs