In Ontario, the current system for chronic pain care is uncoordinated and unbalanced, leaving many patients misdiagnosed, inappropriately treated or under treated, and suffering. Treatment of complex chronic pain like neuropathic pain can be highly specialized and requires a comprehensive approach to be optimally effective. Of critical concern is the fact that access to the best, evidence-based treatments that are appropriate (medications, spinal cord stimulators, implantable pumps, psychological therapies, exercise therapy, etc.) are often unavailable or must be paid for out of pocket by the patient.
For those suffering from neuropathic and other chronic pain, the problem is magnified by the fact that there is very little awareness amongst policy makers, the insurance industry, medical professionals and the public about chronic pain.
Currently, there is very little chronic pain education in Canadian medical schools and there is no formal training or certification for pain experts in Canada. This is clearly evident from a recent survey supported by the Canadian Pain Society of over 40 health professional educational programs across Canada that addressed the extent of formal pain education for dental, medical, nursing, occupational therapy, pharmacy, and physical therapy programs. Remarkably, on average, in medical and dental programs for example, less than 16 hours are devoted to pain and its management throughout the years of study, with veterinary students getting five times more training in pain than medical students.
Where there are multidisciplinary pain clinics, and there are few in Ontario, patients often face long waiting lists to access the clinicians who do understand their pain. Those who are not able to get a proper diagnosis or effective pain management often self-medicate with alcohol and drugs. Addictions to these substances then lead to a whole host of other societal problems.
Chronic pain is a serious public health concern, as it affects 20-30% of Ontarians, and is one that is only expected to grow as our population ages. And it is not just the personal costs to the person suffering from unrelieved pain. There is also a significant financial burden to the patient as well as economic costs to society as a whole. Chronic pain in Ontario is not only undertreated, but also inappropriately treated resulting in wasted taxpayers' dollars within the public healthcare system that currently funds several ineffective treatments while does not support several evidence based and appropriate treatments.
The costs of chronic pain to the Canadian economy have been estimated to be more than $6 billion a year in direct healthcare costs, and $37 billion per year in productivity costs related to job loss and sick days. This translates roughly into $2.1 billion and $13 billion respectively in Ontario. To put this value into perspective in relation to the healthcare costs of other disorders, it is as much as for cardiovascular disease or cancer, and twice as much as depression.
The frustrations of both patients and the clinicians who treat them, along with researchers and other individuals concerned with neuropathic pain, was the catalyst behind the creation of ACTION Ontario, with the goal of furthering awareness, education and access to treatment. Those involved with ACTION Ontario strongly believe that the province urgently needs an overall provincial pain strategy that addresses the treatment of chronic pain through a comprehensive approach. Other Canadian jurisdictions, such as Nova Scotia, Quebec and Alberta, have embarked on comprehensive pain strategies, while British Columbia is currently working on its own comprehensive pain strategy. Lessons from these strategies can be applied to Ontario to enable the development of a comprehensive pain strategy without recreating the wheel.
Key components of a comprehensive pain strategy would include:
- Education - A comprehensive strategy on chronic pain would ensure that the assessment and treatment of pain would be integrated into the curriculum of all medical schools and healthcare professional training programs in Ontario.
- Access to care - A comprehensive strategy on chronic pain would embrace a continuum of care that includes patient self-management, access to pain specialists and supports for primary care providers. It would also integrate best practices for care in chronic pain, recognize chronic pain as a chronic disease and integrate it into chronic disease management.
- Access to treatment - A comprehensive chronic pain strategy must ensure access to a range of treatment options for chronic pain, including non-addictive pharmaceutical options, procedures, psychological counseling, and physical therapy, among others. A range of treatment options is needed as no two chronic pain patients are alike.
- Health Promotion and Prevention – A comprehensive strategy on chronic pain must look at health promotion and prevention strategies, including vaccines for preventable conditions like shingles, as well as methods to minimize progression of acute pain to chronic pain.
- Research - A comprehensive strategy on chronic pain would ensure that a greater share of the government's investments in medical research go into pain research.
The time is now to develop and implement a comprehensive pain strategy for the province of Ontario, in order to more effectively treat chronic pain, more efficiently use existing health system resources and to decrease the social costs of the illegal use of pain medications.