In Canada one in five people live with chronic pain. This includes children.
Access to specialized pain care from a multidisciplinary team is the gold standard for people with debilitating pain, both adults and children. However, there are not enough specialized chronic pain clinics and most clinics have a one to two year waiting list. When it comes to children, until recently there were only eight pediatric multidisciplinary chronic pain clinics in Canada with several provinces having no access to these services. There has been also lack of intensive rehabilitation programs for those children most severely disabled by their pain. Some pediatric patients go to the United States to receive care. This is challenging for families and expensive for society. This problem is made even worse because health care providers in the community don’t get enough training in the assessment and management of chronic pain in general, including the appropriate prescribing and monitoring of opioids.
Consumer groups, such as ACTION Ontario and People with Neuropathic Pain (PNP) have been actively lobbying the provincial government for more chronic pain services for both adults and children. Put together, all of these factors helped raise awareness about chronic pain and the need for better healthcare services. In Ontario specifically, there has been a fair amount of progress as the Ministry of Health and Long Term Care (MOHLTC), the Ontario Medical Association, and healthcare providers from the pediatric and adult health centers in Ontario have come together to form the Chronic Pain Advisory Network.
A subgroup of this Chronic Pain Network is the Pediatric Academic Chronic Pain Advisory Network. It was developed in 2013 to advise on developing a provincial strategy for managing pediatric chronic pain. This network is being co-chaired by Drs. Fiona Campbell and Christina Lamontagne, together with Dr. Garry Salisbury, Senior Medical Advisor Health Services Branch (MOHLTC). This group also includes sub-committees focused on research and evaluation, education, and clinical care agendas. A pediatric Network study found that children and youth seen at a tertiary referral chronic pain clinic used other healthcare services far less than those who didn’t. This positive finding led to MOHLTC investment in pediatric chronic pain programs; this investment will lead to better access to more pain services for children and their families in Ontario.
The Pediatric Network has so far received funding for, two new chronic pain programs at the Children’s Hospital of Western Ontario in London and at McMaster Children’s Hospital in Hamilton, the enhancement of two existing programs at SickKids in Toronto and Children’s Hospital of Eastern Ontario in Ottawa, and the creation of the first intensive inpatient program in Ontario between SickKids and Holland Bloorview Kids Rehabilitation Hospital, with a second to be established in Hamilton.
The Pediatric Network has developed and is piloting a pediatric chronic pain registry at SickKids led by Dr. Jennifer Stinson. This national registry collects a variety of information about patients across the country. The data can be compared and shared to help inform decision-making. It can also be used to inform research questions. Due to the size of the registry, research questions will be more meaningful and the answers will be more useful to pediatric patients and healthcare providers. The information being collected will also help researchers and policy makers to understand the impact of pediatric pain on society. Such as; Who is at risk? What does pain cost the healthcare system? Finally, the pediatric pain registry will also help the MOHLTC and other funding bodies make decisions about how best to support children and young adults with chronic pain, such as funding more multidisciplinary pediatric chronic pain clinics and pediatric pain networks across provinces.
It is hoped that the Adult Academic Pain Network under the umbrella of MOHLTC will follow in the successful steps of the Pediatric Network.
Fiona Campbell BSc, MD, FRCA Staff, Department of Anesthesia and Pain Medicine Co-director, SickKids Pain Centre The Hospital for Sick Children, Toronto Associate Professor, Department of Anaesthesia Faculty of Medicine, University of Toronto
Jennifer Stinson, RN-EC, PhD, CPNP Mary Jo Haddad Nursing Chair in Child Health Senior Scientist, Child Health Evaluative Sciences Nurse Practitioner, Chronic Pain Program The Hospital for Sick Children Associate Professor, Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto
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