Ask the Doctor: Talking with CARP members

On Tuesday, September 11, 2012, I delivered a talk as a chronic pain physician and as chair of ACTION Ontario, to the Mississauga Ontario CARP chapter. Although I’ve given many public lectures over the years, this was my first time talking directly to CARP members.  I was told that there might be anywhere between 25-50 people maximum (this reflects the usual number of attendees for these types of organized talks). Upon arrival at the arranged conference room, I was stunned to find it totally packed to capacity with several more people standing (I counted about 90-100 seniors).  Before me, a physician (an experienced, knowledgable and articulate family doctor) talked about different vaccines and their value for seniors (from influenza shots to travel vaccines and shingles vaccine). The audience asked numerous questions and I listened carefully. The questions were well thought out and appropriate.

Then my turn came. By then it was 8:00 pm (20 minutes later than planned) and the room was getting hot.  I shared research data of Statistics Canada with attendees: the percentage of older persons suffering from chronic pain, that have been at home or in chronic care facilities; the types of pains each gender suffers most; the expected increase of chronic pain in seniors as the population of Canada ages etc. I also tried to educate them by providing photos of people with different pain conditions.

I also shared with them some very special data from my own research. Back in 2008, my team and I published a paper in a scientific journal that outlined our experience with seniors 65-95 years of age that we had seen in my pain clinic, and compared them to younger individuals. We found striking differences between older people and younger pain patients as follows:

  • Musculoskeletal disorders (like arthritis, back problems etc) affected 41% and neuropathic conditions (arising from injury to the nervous system) affected 35% of the older patients.
  • Men had mostly neuropathic disorders and women had mostly musculoskeletal problems.
  • Musculoskeletal disorders included primarily back, shoulder, neck, hip or knee problems.
  • The most common neuropathic diagnoses were postherpetic neuralgia and peripheral nerve injury.
  • The single most common musculoskeletal diagnosis was back pain, affecting 20% of the population and was more common in men.

The strangest finding of all, however, was the fact that patients over 65 had a lot more physical problems when compared to the typical 40-50 year old chronic pain patient, but, paradoxically, a lot less depression, anxiety and pain than those in the younger groups.  How could this be? We reviewed other published papers in older patients, and they had shown similar findings to ours. We felt that our older patients had less pain and mood problems despite their big physical issues, because they had a stoic attitude, accepted pain as a ‘natural part of aging’, and had much lower involvement with litigation, compensation and adversarial issues.

As an experienced pain physician I love working with older individuals.  They are grateful for the little help we can offer them (I would like to say I perform miracles but that would be a big fat lie, as I can only help a little with my skills). They listen to what I say, and if I give them some medication (in very small quantities), they are also grateful for the modest pain relief they may get. They do not ask for the stars and the sky, nor for irrational promises I cannot give them. Almost half of the older patients in our research paper had immigrated to Canada before 1960 (as at that time 92% of all immigrants were indeed from Europe while after 1990, almost 80% of the immigrants come from Asia).

Those older folks (immigrants and Canadian born) were raised with “old work ethics”, fought adversities, worked hard to build their families and fortunes and as they advanced in age they decided to seek some help. It is not unusual for me to ask a 75 year old with serious problems “how come and you seek help now and not earlier”? I often get a response like: “Oh, when we came to Canada, we had to work hard to support the family, pay the mortgage, send the kids to school and help them with the grandchildren (the list goes on)… It’s only now that we are able to find some time to look after ourselves.”

I was supposed to talk 30 minutes and answer questions for 10 minutes. This did not work like that as our interaction lasted a lot longer. Questions were coming from right and left, some reflecting personal pain issues and others questioning the system of pain care and ways to navigate it, or general questions of interest, such as: “why do I need an MRI on my back”? In short all the questions were appropriate, valid, well expressed and the audience was terribly interested. Some had read the columns and dissertations I have written for CARP Action Online and they were well informed and educated.

It was late at night in a hot room with questionable air conditioning and we were all tired. However, my audience showed me their appreciation with rounds of loud applause and several wonderful comments and compliments for the talk. The educational material I brought for ACTION Ontario was snatched.

I have no doubts many CARP members from the Mississauga chapter will join ACTION. My first experience with CARP seniors was indeed, overwhelming and rewarding

Thank you Mississauga chapter for the opportunity to meet you.


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

Director, Comprehensive Pain Program,

Senior Investigator, Krembil Neuroscience Centre

Toronto Western Hospital,

Chair ACTION Ontario