Chronic pain: do patients get the care and treatment they deserve?


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35 comments

  1. Hillel M. Finestone

    Great job. Very interesting information that needs to be out there, to stimulate more dialogue about the lack of services for patients who are experiencing chronic or even just beginning pain. Thanks for quoting me. For the record I am “Professor, Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Ottawa”.

    • Vanessa Milne

      Thanks for letting us know – we’ve updated the story to reflect that.

  2. Julie Carl

    What good news that there are workshops for chronic pain. I never knew that and I suspect most people do not. That’s news you can really use.

  3. Dr. Martin Owen

    This is why I have closed my practice to go into chronic pain medicine full time. I would love to see project ECHO or similar come to Alberta. Glad to see my Alma Mater, Queens’, innovating in this area. Keep up the great work.

    • Kathy

      We need More caring doctors such as yourself to care about us suffering Day & Night with chronic pain. Myself I cry and most days can NOT walk in the morning.
      My doctor has now since Quit being a family doctor to work palitive care At the hospital. He has another new dr there for only 6 months.
      I have to find a dr. I am terrified. I have no one , no where to turn.
      Can a new Dr. Deny me because of the meds I am on. ? Even know they also have patients wearing fentanyl patches ??
      Would they be that cruel and would a dr generally not accept anyone on high doses. I am aware I will be brought down. I have to accept that but I should not have to accept to.be lowered WELL below what WILL still hopefully help me.
      Drug abusers have done this. And now we must pay the price. How fair is that. They go to detox or what ever. As we continue to suffer.
      I am so terrified stressed and getting depressed due to worrying if the new dr I am
      To see next month will not accept me.
      Can you help by letting me know what’s going on with patches and pain and the amount of medication is it being told by the government what WERE allowed for pain ? They are NOT Doctors!!! You ppl are. You went to school. Took extra coarses etc. For the government to now DICTATE what dr’s. Can and. And can NOT do or perscribe.

    • Kathy

      Are you in Ontario ?
      In the Collingwood area by any chance ?

    • Kathy

      Are you in the Collingwood area in Ontario by any chance ?

  4. Ellen N Thompson

    The article does not reflect the realities observed thru 35 years in pain management. We do have the skill and knowledge to CURE most cases of back and neck pain with simple means if we provide effective therapies prior to 6 months ( post accident/ injury ). The long wait times quoted ensure the maximum number transition to chronicity. An Ottawa clinical project aiming to triage and treat individuals with spinal pain persisting beyond 8 weeks, but less than 6 months found that interventions such as tr. pt. and paravertebral inj. cured a high percentage of patients. Importantly, initial high levels of psychological distress disappeared as soon as sleep and normal function was restored.

  5. Ruth Dubin

    HI Ellen, I agree that the transition from acute to chronic pain can be prevented, and people living with chronic pain can achieve better quality of life and re-engagement in meaningful activities.
    As you know I got my start in chronic pain with a “slipped disc” and years of low back pain. What worked for me was to continue to go to aerobics classes, do my simple stretches and the pain eventually subsided to just a whisper that bothers me only if I sit too long.

    Likely genetics and the lack of severe childhood adversity, plus the financial stability to pay for a gym membership were in my favour.
    Fortunately Ontario is supporting the Chronic Pain Self Management program which we trialed in 2006-7, along with an exercise program at the YMCA which continues to this day.
    Our society is sedentary, with too much junk food (cheaper than vegies and fruit), and no gym class in high schools. A cultural shift has to happen to redress all these harms.
    So it takes more than a village to change our culture…Many hands make light work and a broad public health perspective is a must.

  6. John Crosby

    As an emergency and family doctor for 43 years I have had very few patients develop chronic pain because I treat acute pain very aggresively. I try to keep the patient working and advise physiotherapy and chiropractic and I avoid prescribing narcotics. Instead I recommend tylenol in maximum doses and NSAIDS (non steroidal anti inflammatory drugs) like Aspirin Aleve and Advil. They are non addicting and really work in the right doses.
    Heat, ice, massage and exercise help a lot too.
    Dr. John Crosby, Cambridge.

    • The required name

      This is in no way an answer to this issue. And unfortunately, the approach of many doctors. Non narcotic non narcotic non narcotic is the only catch phrase you know. How about you answer the calls of those who DO need them. There is a world of patients who have not had the same experience, and just because you fail to look in their direction, does not mean they don’t exist/are not suffering daily because of it. Any professional can direct themselves towards the easy work. In your case, you have the “privileged” of dismissing those who you cant cure (in this case) as drug addicts/non compliant, and that is EXACTLY what the problem is. Too many doctors with too much pride, who instead of acknowledging the limitations of our medical system, unload the afflicted as non compliant or of a different affliction, to avoid failure. Its time that the public starts telling you folks exactly what is up. Any person hell bent on finding a solution to their pain (which is many), has already tried all of the above mentioned, and turns to them regularly (even when they know its not the answer). Grow up and do your job , you have in no way addressed the issue we are talking about here. You have segued into a different time and place, which is long passed. That ship has sailed for most, and the medical community has told them “tough sht” (We don’t know how to regulate you the way we want to, so you cant have it), even though we have the technology/pharmacology to address it. Your response is of the likes of MANY that are given in doctors offices around the country, where the patient is essentially ignored after months, years or even decades of unrelenting pain. They have clawed and saved their way to that day, just to have you spit in their face, and push them out with no answer much less relief. While that may just be another appointment to you , it is very often a life altering event for that patient. If you are not up to the challenge, then you should gracefully bow out (and I mean of practice, not of the appointment). Doctors are the last leg of defense that the chronic pain community has, and you are cowering in the false narrative pushed by govenment agencies with a clear agenda. SAVING PEOPLE FROM ADDICTION, WHO WILL HAVE NO LIFE OTHERWISE, IS A POINTLESS ACT.

      • Kristine

        I agree completely. We are ignored, treated on a ‘but you might become an addict’ mentality.

      • Kathy

        Well said.
        Thank you for posting your comment. I am terrified what will happen as they are now weening me down off my meds. To what the Government THINKS is the highest for everyone. No 2 ppl are alike with pAin. Yet these clowns seem to think so. I want to know why our Dr’s who went to school for many years and took an Oath to help the sick. Are cowering in the corner. Even know many agree the smart Doctors do NOT agree. I have never thought about suicide but I think about it almost every day now. If I take my own life due to my chronic pain I pray the truth comes out and not Government lies.
        Again
        Loved your post

      • Rose

        AGREED! Why aren’t all us chronic pain suffers able to start some sort of class action? I mean is it not a violation of our human right to be pain free? The ” non narcotic” medication does not work and destroys your stomach and liver!

    • William Cowdy

      Thanks for the wonderful recommendations Doc. But how about the poor bastard with post polio, fibromyalgia, arthritis, a non functioning left shoulder, a torn rotator cuff on the right shoulder, herniated and degenerated discs in the neck and lower back, among myriad other complaints. I have all of that and at age 71, no one wants to operate on any of it. I cannot use NSAIDS as they cause bleeding internally, and 1300 mg of Tylenol 3 or 4 times a day is not healthy. But then there is that wonderful physiotherapy or Chiropractic aid which MOST seniors couldn’t afford that you suggest. Take your head out of the sand, and realize that not everyone can afford or access the aid you suggest.

    • James Pookay

      I agree with your recommendation regarding keeping people at work or early return to work.

      At the walk-in clinic, I’m constantly being asked to give people medical leave for extended amounts of time without a clear physical limitation and patients that insist that they can’t return to work in any form.

      When I do grant leave, I find most people don’t actually engage in any active recovery activities or programs (physio, counseling, retraining, etc). They just seem to languish for weeks and months on end, don’t improve, but then show up on the deadline where there leave expires demanding more time off with no new recovery plan.

  7. Heather Divine

    One piece that was not given enough attention is the importance pain self-management. At People in Pain Network, a nonprofit that establishes peer-led, pain self-management support groups, we realize that a person living with pain may see a healthcare provider for 20 minutes a month, and the remaining 43,180 minutes every month are theirs to self-manage their pain.
    Pain impacts the body, mind and spirit and so people need guidance and education to learn to make adjustments to their body, mind, spirit and environment to live well with pain. They need help tp build a new normal. Our groups provide a safe place, with trained peer leaders, so people can share the struggles and just as importantly, learn and share knowledge about solutions and community resources and celebrate successes. Pain self-management is one of the bigger pieces of the multi-discipline approach to managing persistent pain. I have been learning and practicing my own pain self-management skills for over 26 years now so I do understand how important this piece is.

  8. Samantha Fashler

    Great article! It describes important issues in pain management and patient care.

  9. MJ Bailey

    Good article. Yes we need more research but I’d prioritize early treatment programs. It took 18 months for me to see a pain specialist. I was seriously depressed by then and the pain was there to stay, along with sleeplessness and anxiety. I had zero knowledge about what I was going through and how to deal with it other than rest, ice or heat, and stretching exercises which I did faithfully with little relief. Yes, train the GPs. Also, Doctors, stop trying to push patients off opiods and onto marijuana oil just because you’re getting hassled by your oversight organization for writing what they think are too many prescriptions. How about some science there instead of just trying to get the organization off your backs.

  10. DEREK MF PRIZZI

    So we still must just WAIT. WE KNOW ALL OF THIS…it has not changed since the beginning of time . These programs are wastefull and demeaning to anyone involved. To sit and pay someone to tell you how to do things you are already doing, and to coach you on aspects you don’t need coaching in (just in case you might not know) IS NOT HELP! The average response to an idea like this, is that the person is not receptive, or a non compliant. The fact of the matter is, that people need to be given the simple tools to manage themselves. Painkillers are a SIMPLE tool, that play a role in a grand scheme of tools, that YES…have ramifications if not used properly ( just like a power tool , car, stove etc ) Those SIMPLE tools have been taken away, and then we sit there scratching our heads, wondering why this isn’t working. Kill pain, life can continue and the next step sized up…but sooooo many cannot reach that first step and then fail as a result. If the person needs help there after…THEY CAN ASK FOR IT. A majority of the problems that a chronic pain patient is facing HAVE NOTHING TO DO WITH THEM. We are regularly fighting regulations and biased doctors, we regularly must change plans and medications that are working just fine for us. We are told things we find to help do not , and those that don’t, DO…and if we dare challenge the idea, we are dismissed. Most times this dismissal puts us back to the start , where years to decades of progress are smite in an instant. There is a constant disruption of balance in our lives, from outside sources telling us that they are here to help. There will never be a program in the world that will allow for a medical professional to be in control of all these aspects, WHILE STILL MAINTAINING THE FREEDOMS THAT PATIENT HAS A GOD GIVEN RIGHT TO . ANY PERSON WHO HAS HAD THEIR INDEPENDENCE STRIPPED FROM THEM, WILL BE LIVING IN CONSTANT EMOTIONAL CHAOS. THAT DOES NOT MEAN IT IS THE FAULT OF A MEDICATION, CONDITION OR CHOICE. LIVING IN CHRONIC PAIN IS A ROLLER COASTER… A ROLLER COASTER; THAT IS NOT IN ANY WAY ACKNOWLEDGED BY OUR MEDICAL SYSTEM… A ROLLER COASTER; THAT IS IN FACT, USED TO EXTORT THE PATIENT BY PROTOCOL. Just because people decided that they were not comfortable with an idea (largely due to the rumors perpetuated by hungry media companies), we now must surrender every bit of privacy and self meaning to accommodate THEIR feelings and comfort….all for a reason that is NONE OF THEIR BUSINESS. Once the aspect of freedom (and a general respect for human life) is addressed, you will see the progress you are looking for…untill then, forget about it! You are doing nothing but harm…a small amount of medication or health complicating procedure, is in no way vindication of the god like role you have all played in forcing most chronic patients to suffer needlessly. No one wants to live a life with some counselor breathing down their neck every second of it (especially while racked with pain and frustration), nor should they have to . Pain and getting injured is a fact of life , get over IT and YOURSELF. You are taking NORMAL people , and CREATING the monsters you say started this all.

    • Kathy

      And possibly more suicides then drug over doses by drug addicts. NOT chronic pain sufferers such as myself. I am terrified what will happen when they lower me so low that my pain will. Be unbearable. They will also turn many into heroin addicts. Causing even more deaths. Where does it end ???
      Pain ppl or drug addicts.
      So far the chronic pain sufferers are the only LOSERS here !

  11. Elizabeth Rankin

    Patient access to Interdisciplinary Teams is the best way for most patients’ problems. My personal issues with a large L5S1 herniated disc were not resolved “medically” they were resolved with Physiotherapy, Cranio-scaral Therapy and Homeopathy using Arnica & Hypericum. Even though a neurosurgeon informed me I’d only get better with surgery, I persisted with those I knew were helping me. Yes, the medical route provided the CAT scan but otherwise my experience was a dead end. I’d decided I wasn’t going to go the route of powerful prescribed opioids so I made the right decision for me. A year later, knowing I’d successfully recovered using a team approach (none recommended by a doctor) I decided to write the neurosurgeon. I wanted this doctor to know patients shouldn’t be told they’ll never get better without surgery. This letter generated a phone call from the surgeon.

    I think our health care system needs an overhaul beginning with a willingness to incorporate the right team of professionals to help patients work out their single or multi problems. We all know the doctor-patient only scenario has failed to provide the best approach. This articles brings many issues to light. Change is needed if we want to “first help patients.” Doing so will reduce the burden to patients and provide more tax dollars to revamp the system. We need up to date technology for patients and practitioners to “move into 21st. century health care.”
    If this were to happen we could eliminate the many levels of bureaucracy that fund various jurisdictions, or would we?

  12. William Cowdy

    When I can afford to do so I use medical marijuana, as per my prescription. I cannot afford to buy what I am allowed, particularly since tax, and shipping must also paid. I do not believe that either the Feds or the provincial government gives a damn about chronic pain, other than paying lip service to the need to improve distribution of opioids to chronic pain sufferers, while stopping the distribution of same all together. If they did, they would have made medical marijuana easier to access by sufferers, rather than making it almost impossible to find a doctor that will prescribe it. Sound confused, try and find a clinic that will prescribe marijuana without charging hundreds of dollars to the applicants for the privilege of being legal.

  13. Martie Whitaker MA

    Dr. Hanse Clarke, Director of Pain Services at Toronto General Hospital, stated recently in the Toronto Star that fentanyl, an extremely effective medication for chronic pain patients, “should be reserved for the exclusive use of cancer patients”. These kind of irresponsible and silly comments do a great deal of harm to chronic pain patients.

    Martie, 56, has tried just about every pain modality, including an implant4ed pain pump. It wasn’t until she was put on a low dose fentanyl pain patch that she experience significant pain relief. Because of this pain relief, Martie is able to take care of her elderly mother, volunteer as a crisis counsellor (and helps run this program at her church) and to even sing in a performance choir. Without the medication, Martie can do nothing besides lie in bed in agony.

    Martie’s pain patch is only part of her pain management strategy. She also uses exercise, meditation, the services of a trained guide dog and massage therapy when she an afford it

    You should do a better job of checking on your sources. Clarke is a menace to the pain community.

    • Pret

      I fell 28 months ago. Have been told by family doctor, Physio,massage therapyst,pain clinic,(Prolotherapy), back clinic. They can not help. “Do what you can do, take medication). Before fall, walked 8-10 miles a week. Very happily married, great family. Now becoming very depressed, drugs and I do not get along very well. Help please!

  14. Robin

    I am a 40 year old woman who has been suffering in chronic pain for six and a half years. I have two amazing children, but sadly I had to give up the vision of the kind of mother I planned to be and instead sit by and watch as they have grown up before me. I am one of the lucky ones who has an inter-disciplinary pain clinic in the community where I live. However, it was over two and a half years before I was referred to the clinic, was almost a year before I was seen by one of their physicians and over five years before I received a CRPS diagnosis. I have attended every kind of education session they have offered, been to counselling, practice regular self care, and still suffer in extreme pain, every minute of every day.
    I am one of the pain patients who is being treated with opioids. I have tried coming off them and the hell of trying to live like that was pure torture. It was not the fact that I felt like I “needed” this medication, it was the fact that I lost all ability to function in my affected limbs. Patient led care in Chronic Pain Management is so important. I am the only one that can say if those opioids are truly helping me or not. How is it right that someone who does not know me, does not know the excruciating pain I endure and will endure for the rest of my life, can come along and say that pain sufferers should not be treated with opioids. I am one of the patients who had tried everything imaginable, spent my family’s entire savings and more, all in an effort to reduce my pain. Unfortunately, I am also one of the ones where everything I tried, failed to make a difference.
    I also pay into MSP, our province’s health care plan. I have never missed a payment, and have never once paid late. However, I have found out that they are no longer willing to pay for one of the nerve blocks I get at my pain clinic. I have been receiving these nerve blocks for the last couple of years and require them every two weeks so that I continue to have functional use of my right arm. We have tried spacing them out further and every time I regress to the point that I cannot even pick up a fork to eat my dinner. But a government official can once again determine what is best for me and forbids to pay my doctor for providing me with an obviously effective treatment. I do not understand how they can do this. Our MSP is not supposed to be an elective health care plan. I desperately need this treatment to function and to be a mother to my children and a wife to my husband. I need this treatment so that I do not question my will to live.
    In summary, I was not effectively diagnosed within a reasonable time frame and therefore did not receive timely treatment that would have possibly lead to a better outcome. I had to wait a significant amount of time to access a multi-disciplinary pain clinic. I finally found a treatment that provided increased function in my daily life, although it needs to repeated bi-weekly, only for my provincial medical system to deny my access to this treatment. I spent my family’s entire savings and more on all types of natural health care and therapy, all for very little benefit. And now, my opioid prescription is being threatened by changing rules on the distribution of narcotics to people in pain.
    I am a human being, a contributing member to society. I did not kill someone in a past life or do anything else that would make me deserve the sentence I have been dealt. I have been sentenced to a life inside a prison of pain. I have to try and hold my head up high under the unsurmountable weight of grief, grief that is caused by all I miss out on and all I have had to give up in life. I have many years ahead of me still, and have to continue on knowing that I will suffer like this with every breath I take. Is it too much to ask to allow me to decide what is right for my health moving forward? Is it too much to ask that you let me tell you what my very own evidence based treatment looks like? What works for me may be very different than what works for the next person with chronic pain, that is why it is essential that those trying to reduce pain ensure that they are actively involving their patient in the ongoing treatment plan.
    We need more patient led care, more evidence based treatments, more chronic pain funding and more access to services and treatments before we will ever make headway on the epidemic of Chronic Pain.

    • Kristine

      Excellent post. No one knows our story, what it is like to be in our shoes.

  15. Karen

    Our medical care system has me confused and angry. I have lived with chronic pain for twenty years and every time I find medication that works they start to regulate heavily due to street value on these pain medications. I have been on the same meds and strength for years and now have been forced to reduce to a level that does not cover what I need, which cause alot of anxiety and depression and a feeling of worthlessness due to being treated like a street junky.

  16. Sheila Erickson

    I’ve been in pain for years I m at the stage where there seems to be no help it’s so frustrating the article is enlightening

  17. Phil

    I have aids there is no cure just a longterm treatment as a result of all the drug trials it has left me with as the neroligist said was the worst case of Aids related phneropathy . Along with getting run Down in parking lot leaving me with a back that doesn’t work and I was on oxycodone it worked now I moved to a different town and thy this kind met hi done is the answer well it don’t help my back the only thing it does is keep me so doped out of it iam sleeping all the time it’s like I have been shelved and am us less in society what a great feal in a wrath less piece of flesh can’t wait this is. US less no one ever pays a tent ion any way I can’t take the pain any more I know what pain people suffed

  18. Joanna

    Chronic pain patients have been totally abandoned by heartless politicians who should leave doctors alone to manage their patients as they see fit, and also by selfish, fearful, lying physicians who will not risk their incomes or lifestyles in order to actually help people. It is disgusting.

  19. Christine Coletti

    While the need for Education exists for Healthcare Providers, so does the Need to Generate Much MORE resources for patients awaiting spinal surgery – a quick look in google or google scholar, and academic resources comes up VERY THIN on a Patients hand guide to ‘Thrive and Survive’ – while awaiting Spinal Surgery – or even a Specialist Consultation.

    It is so key to have a close relationship with your family MD and your pharmacist, physio, acupuncturist, RMT (Massage). We spend a fortune, end up on disability and then no longer have the funds to try and relieve pain – a vicious cycle. There are lots of topical ointments that can be formulated to help with spinal column direct pain, along with the use of anti-epileptics, or anti-depressants. Titrating (increasing doses) and becoming familiar with each drug you are given is key (being a RN for 31 years gives me a little more education) – but this needs to be part of the comprehensive team care needed.
    There is little out there to help patients cope, the resources are generally for Health Professionals and provide little education for patients – Thankfully Australia, Great Britain (NHS) have some great resources. Sad that Canada does not have these – I highly recommend patients search the web around the world to find resources to cope in the long waitlists.

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