Chronic Pain

Retiring on a Low Income?

Many of us with chronic pain are receiving some form of income replacement such as WSIB or disability insurance. These usually end at age 65, if not before, with the result that our retirement incomes will be quite low [compared to our former employment income]. Do you think that YOU might have to retire on a low income? Will your income be low for a long time BEFORE you retire? Then maybe you need to start planning NOW!

Reducing housing costs takes both advance planning and strategy! There are both seniors’ & co-operative non-profit apartment buildings across the province, where the rent only increases to cover expenses. Some of these have long waiting lists but others are available with only a few months’ notice! Rent-geared-to-income apartment buildings [RGI] often have waiting lists of five to seven years but heh; you’re going to age anyways, so why not apply now. [These RGI buildings usually charge a max. 35 % of income.] There are specialized disability apt. units as well, fully accessible for those using scooter, wheelchairs and other assistive devices. The means test for these apartment units are based on an individual’s or family’s INCOME, not their ASSETS. 

There is one excellent web site designed for those of us ‘Retiring on a Low Income’ and that is “OPEN POLICY On- tario by John Stapleton” []. I recommend that everyone read it. It gives much practical advice for those of us cur- rently on low incomes. Its strength lies in advising us how to prepare properly for our future retirement! 

The following is an example from this website. Financial advisors are constantly advising people to put money into an RRSP but this is bad advice for those who expect to receive the Guaranteed Income Supplement [GIS] when they retire. The reason: money taken out of an RRSP is taxed as income for that year, reducing or eliminating the GIS. Money taken from a Tax Free Savings Account [TFSA] does NOT affect the GIS. Also please visit for information regarding the Trillium drug/health benefit plan. 

Other topics that he tackles are: 1. Maximizing the G.I.S. 2. The advan- tages of taking Canada Pension at age 60. 3. The smartest way to save before age 65 4. The smartest way to save after age 65. 

You Are Not Allowed To Be Negative!!!

I had just come back from attending the Canadian Pain Society annual conference in Winnipeg. I go to this conference every year to present some of my research work, see the research work of other colleagues and acquire new knowledge. Such conferences as well provide opportunity to meet with colleagues around the country and network.

The night before the end of the conference, I was having a bite to eat with a colleague, a mature female physician looking after pain patients for many years, while discussing stories that we thought were unusual or unique. I now feel compelled therefore, to share with you one of my colleague’s recent encounters with a 38-year-old woman who had been hurt in the performance of her duties as a nurse and had developed a chronic pain condition. Let’s call my colleague Dr. M and the patient RN.

RN walks to the doctor’s office visibly upset and agitated. Dr. M asks her to explain exactly what her problem was. RN speaks loud and fast, giving details about her workplace accident and making unflattering comments about her work supervisor and the care she received from her doctors. After 10 minutes of incessant talking, RN paused realizing that Dr. M who has remained totally silent, is scribbling some vertical lines on her note pad.

RN: What are you doing Dr. M?
Dr. M: I am drawing a line every time you use a negative word such as pain, anger, upset, insensitive, not understanding etc. So far in these 10 minutes I marked 38 negative words.
RN: You must be kidding! I find this very rude.
Dr. M: 39!
RN: You certainly seem to be insensitive to my pain!
Dr. M: 40, 41!
RN. This is a joke. You seem to ridicule my pain. I think you are worse than all the other ignorant doctors I saw so far.
Dr. M: 42, 43, 44, 45!
RN: Can you tell me why you use this approach with me?
Dr. M: You are overloaded with negative and angry feelings. These can only feed and increase your pain. Have you discussed with your family how they feel when you come across always so angry and negative?
RN: Leave my family alone. They proved to be indifferent, insensitive, selfish and uncaring anyway.
Dr. M: 46, 47, 48, 49!
RN: Enough! Next you will hear from me, it would be when I file a complaint against you with the College of Physicians (RN storms out of the room).
Dr. M: 50! 

I was amazed. In our line of work, we see a few disgruntled patients who are always dissatisfied with our care, obnoxious, verbally abusive towards us as physicians but also the support staff (secretaries etc), and complain about the care we give them. This type of patients takes a real toll on physicians’ emotions as we have to undergo lengthy processes to exonerate ourselves.

I admire you, I said to my colleague. How did you manage to get through this whole encounter? This is a definite recipe for disaster with a sure complaint to the College of Physicians and Surgeons (the provincial body that grants our license to practice).

Dr. M. nodded. I thought for sure, she was going to file a complaint but I could not resist pointing out her constant negativity. Nevertheless, nothing happened for a couple of months.

And then, I asked with great curiosity. Did she file a complaint?

No, Dr. M. replied. To the contrary, she asked to see me again. I was not happy at all given our previous consult and I expected another shouting encounter. But strangely, it did not happen. To the contrary, I saw a calm woman, coming into my office, sitting in a chair opposite to me and greeting me with a smile. I was stunned. I reciprocated the greeting and asked her what happened.

RN: When I left your office a few weeks ago, I was extremely angry with you for pointing out that I was negative. I went home and asked husband and kids to tell me frankly what they thought of my pain and my general mood. To my surprise, they let me know that they find me angry, negative and complaining all the time.
Dr. M: So, what did you do after you had this talk with the family?
RN: I decided to mark down all my negative thoughts every waking hour of the day for a few days. I then realized with disgust that I could not last longer than five minutes before an angry thought or feeling would pop into my head, which I had to write down. I became very aware of my negative feelings. I am now ready to ask you to help me, so that I can harness my thoughts and maybe I can somehow control my pain.

To make the long story short, Dr. M. worked with RN on her medications for pain and to set objectives and targets for therapy and her recovery. RN responded well to structured goals and also joined a Mindfullness Based Stress Reduction program, to learn to relax. Today, she has returned part time to work on modified duties and works towards her goal to return to full time nursing duties soon.

The story is very didactic and I use it to talk to other pain patients regarding negative feelings and thoughts. Learn to control and curtail negative thoughts and for sure, your pain perception will decrease substantially. Trained professionals, such as pain physicians, psychologists, social workers etc., can very much help you to navigate the sea of negative emotions and restore your emotional balance. 

Angela Mailis, MD, MSc, FRCPC(PhysMed) CIPP/UHN Consultant Adjunct Clinical Professor, Dept. of Medicine University of Toronto, Director, The Pain & Wellness Centre, Vaughan, ON Chair ACTION Ontario

Helping Your Brain Cope With Chronic Pain

Over the years, many researchers and health care professionals alike have come to understand that pain is not a solitary central nervous system (CNS) process; that is, what you feel is not pain alone. Other CNS processes play a role in our experience and sensation of pain. These include areas of the brain involved in fear and anxiety; attention and vigilance; and memory and past experiences. As the pain becomes more chronic, these other processes take on a more prominent role. Someone in constant pain will become more vigilant and attentive to his/her symptoms so that pain always feels in the forefront of their lives. As well, being more aware of your pain along with fear/anxiety of causing further pain with physical activity (based on experience), makes many people feel that they have to restrict and limit their activities to avoid more pain. Feeling constant pain, being restricted by pain, and having at times to make dramatic changes to one’s lifestyle to accommodate pain can make people feel more anxious, stressed and depressed. They do not feel in control of their pain, their feelings or their lives. Pain is therefore a WHOLE person problem, an interplay of both the mind (our emotions) and the body.

Psychologists who specialize with chronic pain patients understand the interplay between the mind and body. By the time we see a pain patient, he/she has undergone multiple medical assessments and treatments with minimal to some relief of symptoms. Psychologists understand that emotions, thoughts and vigilance play a role in “amplifying” the pain experience. Have you ever noticed that when you are feeling very stressed, angry or depressed that your pain seems worse? Or that your pain seems less intense when you are caught up in an activity that grabs your attention or makes you feel happy? Psychologists, like myself, focus on teaching patients more effective ways to cope and manage their pain by helping them to change negative thoughts and feelings, reducing stress, improving sleep, and setting goals to engage in more positive daily activities. Making positive changes to these areas serve to lower the “amplification” of pain. This is accomplished through various psychological strategies.

For example, Cognitive-Behavioral Therapy (CBT) is often used to help patients become more aware of their negative thoughts and feelings and to develop alternative ways to look at problem areas (including pain) so that the patient can resolve them without getting caught up in them. Patients learn relaxation training and/or mindfulness meditation to teach them ways to reduce muscular tension through the body and to relax the mind, which helps to

reduce stress levels. Helping patients resume some of their daily activities is accomplished by utilizing the various skills acquired in sessions, setting small goals that are achievable and gradually increasing the level of activity while staying in control of pain. A pain psychologist will tailor the strategies to the needs of each patient and treatment goals are discussed at the very beginning so that the patient and psychologist are on the same page in terms of the patient’s needs and expectations.

Research has consistently shown that psychological counseling is one of the most effective treatment strategies for chronic pain. If you have been struggling with depression, anxiety, stress, and/or anger because of chronic pain, then it may be time to contact a pain psychologist to help lessen your emotional suffering and to get you on a more positive path to living a good life with pain. 

Karen Spivak is a registered Psychologist by the College of Psychologists of Ontario since 1990. She received her Ph.D. in Psychology from Concordia University in Montreal in 1987 and pursued post-doctoral training at the Addiction Research Foundation and the Clarke Institute of Psychiatry. Since 1992, Dr. Spivak has maintained a private practice, providing psychological assessments and treatment for chronic pain, depression, anxiety, stress and post-accident adjustment difficulties In addition, she is a consultant with the Comprehensive Interdisciplinary Pain Program at the Toronto Rehabilitation Institute, and she provides counselling to pain patients as part of the interdisciplinary team at the Pain and Wellness Centre in Vaughan, Ontario.

Karen Spivak, Ph.D. C.Psych Comprehensive Interdisciplinary Pain Program @ Toronto Rehab Institute & Pain and Wellness Centre, 2301 Major Mackenzie Dr. West Vaughan, ON L6A 3Z3 tel: 416-587-0512 fax: 1-844-358-9308