Ask the Doctor: Doors are closing on pain sufferers

December 20, 2011 – Readers of my column will know that I have been addressing a great number of topics concerning chronic pain for over two years now.  Sometimes, I reported on a number of painful syndromes or discussed their scientific basis.   I also wrote about my patients and shared of their stories with you, some cases were heart breaking and others full of hope, courage and achievement.   I have also written systemic issues such as the impact chronic pain has on Canadians and its emotional toll, the financial cost to society and the desperate need for a comprehensive pain strategy.  I’ve addressed the lack of awareness, knowledge and political will to deal with an immense problem that is only increasing in scope as the population ages.

The stories that I will share with you today will further demonstrate how our administrators and lawmakers lack vision and how as a result, chronic pain sufferers are re-victimized.  Since I live and practice in Ontario, I know of stories affecting patients in that province but I am fairly confident that they reflect the reality in other provinces as well.  Particularly those that lack comprehensive pain management strategy.

Several years ago, my own hospital closed down a small chronic pain program that offered cognitive behavioural management (which is truly needed for chronic pain patients). The savings to the hospital budget? Meagre. The loss? Immense in terms of my ability to get much needed help for my patients. A year and a half ago, the pain clinic at St. Joseph’s hospital in Toronto as well as the Kingston Pain clinic closed for similar reasons with similar impact.  The latest victim is the Sunnybrook Pain Clinic that has been helping sufferers for 25 years. It currently serves over 3,000 patients and it is slated for closure next spring in 2012.

What provisions, you might ask, have been made for its patients? None. The remaining hospital based pain clinics are overloaded, barely function and some of the existing ones are already in danger of closing or losing members of their staff. Patients from the Sunnybrook pain clinic are desperately knocking at ACTION’s door to make the public aware of these closures.  Meanwhile, administrators, lawmakers and politicians have made every effort to keep it off the public’s radar.

As we make headway in Ontario towards the creation of comprehensive pain management, the Royal College of Physicians and Surgeons (the national body that certifies the physicians who have obtained specialty training) is working to establish the sub-specialty of pain management. This will require an additional 2 years of training in qualified institutions and special exams and certification thereafter before a physician can say he/she is certified in Pain Medicine. The irony is that these specialty-training positions are supposed to start in 2014 across the country. This begets the following question: where are the doctors going to be trained if hospital programs are closing down? Every time a clinic closes down, its members go to other clinics to work (which becomes harder and harder) or stop practicing pain management altogether. Valuable and irreplaceable resources are lost and it will be very difficult to rebuild a clinic once it is lost.

Here is another example that illustrates how bad things have gotten in Ontario (one of the many I can recite since I know the system inside out). The Hospital for Sick Children in Toronto, has a wonderful, well organized, multidisciplinary pain clinic for kids. However, when they reach the age of 18, they are considered adults and not eligible for care. By the time they become young adults with painful conditions and disabilities, are left to fend for themselves, seeking pain management, without any proper planning and longitudinal care for transition to adult pain clinics.

Two months ago I saw a young man who had just turned 18. Three years before, at the age of 15, he had had a serious car accident and had broken several bones in his leg, had many surgeries and had to deal with serious and chronic infections of the wounds. His dream had been to play professional football. Before the accident he had achieved a very high status at a level which was close to becoming professional.

One would expect that this was a career ending injury, but my young patient did not think so. Against ALL odds he has returned to training 3 hours a day for a year now, has applied to several universities and hopes he will be accepted and given an athletic scholarship. This young man (whose deformed leg made me cringe) came to see me for one very simple reason. His family physician after his discharge from the Sick Kids’ pain clinic, adamantly refused to prescribe for him a strong opioid that had sustained this young man through the past year of his grueling training. The irony? The dose of the drug was “imperceptible”, so small that it was good for babies, but was enough to keep this strong-willed young man in pursuit of his dream.

All the stories I shared with you here, are examples of a disjointed and broken system of care for those suffering from chronic pain. This is why I, my colleagues, my patients, ACTION (the not for profit organization I chair in Ontario), and national bodies such as the Canadian Pain Society, work together to push for a better system, a system that must provide comprehensive care for all those who suffer from chronic pain. If you suffer from unrelenting chronic pain or you have a love one who suffers, please join any of these bodies and talk to your physicians, your MPs and MPPs. The more our voices are heard, the more chance we have to make policy makers understand the problem of chronic pain.

 Angela Mailis Gagnon, MD, MSc, FRCPC(PhysMed)

Director, Comprehensive Pain Program,

Senior Investigator, Krembil Neuroscience Centre

Toronto Western Hospital,

Chair ACTION Ontario