Too Many People Hurt

In the previous columns I had presented examples of blatant problems with our system of pain care in Ontario (I can only talk about the system I live and practice in) and what has been called the “Opioid Public Health Crisis” of Ontario, the largest province in our country that is home to more than 38% of the Canadian population. I pointed out the double tragedy that affects thousands and thousands of Ontarians when it comes to powerful pain killers: too many drugs for very few who do not need them or abuse them, too little or none for many who need them and can benefit from them.

Last week I had the honor to be invited to Queen’s Park to attend the introduction of new legislation by the Minister of Health of Ontario, Deb Matthews, as I am member of the expert panel (called the Narcotics Advisory Panel or for short NAP) that has provided the Minister with expertise and advice how to handle the problem of opioid abuse. This new legislation will allow health care providers (doctors, pharmacists, nurses) to communicate with each other freely and will ultimately result in an electronic prescription monitoring system in Ontario. It was heart -warming to realize that the opposition wholeheartedly supported the legislation and pointed out to the government that we need a) facilities to treat those who are addicted and b) opioid abuse cannot be dealt effectively unless the whole issue of how chronic pain is diagnosed and managed in Ontario, is addressed. But HOW BIG is the problem of chronic pain? I analyzed the results of the polling of 3508 respondents from last newsletter’s questionnaire. The question posed was: Do you or does a family member suffer from chronic pain (more than 3 months duration)? The way the question was posed does not allow me to accurately estimate the number of responders (out of 3508) who had chronic pain themselves. However, once the question was answered to the affirmative, I can estimate how well the pain sufferer was treated, what kind of treatments did she/he have, how they were paid etc. I want to share with you the shocking numbers . In brackets, I make comments in italics.

• Nearly half of the responders (48%) had chronic pain (pain lasting more than 3 months) or knew of a family member who did (clearly chronic pain has affected the lives and families of half of all responders);
• The commonest pain problem was arthritis (for 43% of those with chronic pain), followed by low back pain (21%), other types of pain including neuropathic pain (14%) and chronic widespread pain or fibromyalgia (8%) (indeed studies show that musculoskeletal problems become common as we age);
• Half of the chronic pain sufferers had experienced some or a lot of difficulty having their pain diagnosed correctly (I knew this);
• 7 out of 10 chronic pain sufferers felt that their physicians had poor or partial only knowledge how to diagnose and treat their pain (I had an intuitive feeling this was the case but the numbers now confirm it);
• A third of chronic pain sufferers had their life affected very much by their pain (that is a very high number);
• While 10% of the chronic pain sufferers were receiving no treatment (I assume that their pain is mild), of those who did, one third found their treatment partially or totally ineffective (not surprising);
• In regards to the primary treatment they were receiving, the majority of chronic pain sufferers (58%) were taking prescription medications, 9% pain medications over the counter, and one in six physiotherapy or complementary medicine treatments (massage, acupuncture, naturopathic treatments etc) (in reality, many chronic pain sufferers use more than one treatment at the same time);
• In regards to coverage for treatments/ medications, 38% of the chronic pain sufferers had private insurance, 27% were covered by government old age pension plans and 25% had benefits from their job. Despite this coverage, one third could not afford to pay for some or many treatments (this is bad but not unexpected);
• One in four chronic pain sufferers had been referred to a pain clinic (this is a very high number for a sample of the general population and I never expected it);
• One in four chronic pain sufferers had visited the emergency department at least once for their pain (consider how much taxpayer’s money is spent in seeking health care);
• When the question was asked of all (with or without chronic pain) if “they feel patients in their province suffering from chronic pain are being properly served with the current system of care”, 45% stated they did not know. My interpretation is that this subgroup did not have pain and knew nothing about the care of people with chronic pain. However, of those who had an opinion (which means they were familiar with the system of care for themselves or their family member) 70% of all the responders felt the current system does not serve well patients with pain;
• Similarly, when the readers were asked if they saw a need for a comprehensive pain strategy, 28.4% of the responders had no opinion. Of those who did, a whopping 90% felt that a comprehensive strategy was needed to address the problem of chronic pain in their province (this was a “no brainer”).