Chronic pain - Alberta doctors tackle the problem
Eight years ago, Ravinder Khunkhun was in a horrible accident.
Her right hand got sucked into a roller at the linen factory where she worked, essentially burning off the skin. Her hand recovered but the pain continued, lasting for years.
"The pain was so bad I can't handle it. I'm screaming and crying. Doctors are saying 'what is going on with me?' "
Khunkhun visited eight specialists over three years and ingested so much pain medication she could hardly stay awake.
But physicians in Canada are poorly equipped to handle cases like hers.
"Veterinarians get far more education on pain than physicians do," says Dr. Gay Wardell, who eventually diagnosed Khunkhun with Regional Chronic Pain Syndrome.
Dr. Wardell is one of a rare breed as a pain specialist.
He says it's not surprising Khunkhun had a hard time finding proper treatment. Medical students in Canada only receive, on average, four to five hours of training on chronic pain.
But things are starting to change.
It's back to school
For 40 years Dr. Brian Cornelson treated patients as a family doctor, many of whom had chronic pain.
But he felt like he was "flying blind."
"We didn't get any training in chronic pain when I was in medical school."
He says it meant he didn't always have a "systematic approach" to treating the disease.
"It was, well I'll try this with this person and with the next person I'll try the same thing because that seemed to help. Or, well that didn't help with the last person so I'll try something different."
Dr. Cornelson, who recently became medical director at the East Calgary Family Care Clinic, has registered in some ongoing medical education into the disease, offered through the University of Calgary.
Today, he is shadowing a doctor at Calgary's Chronic Pain Centre, the only clinic in the city dedicated entirely to treating this disease. The clinic gets 250 to 300 referrals a month.
He says the training has made him aware of a number of things, including the fact that opiate pain killers (like morphine and OxyContin) are not that effective in treating chronic pain.
"They don't do a lot for pain over a long period of time. The effect of the drug gradually wanes and if you try to increase it then you start to develop side-effects from the opioids."
In fact, the drugs can induce hypersensitivity to pain.
Dr. Cornelson says he will become more conservative in prescribing these pain killers.
Still not enough research
Pain medicine is in its infancy in Canada.
There are only three physicians currently training to be pain specialists — and none of them are in Alberta.
The first ones will be certified in 2016.
The University of Calgary medical school just added pain to its curriculum this fall.
Dr. Lori Montgomery, medical director at the Chronic Pain Centre, says to improve education you need better research.
"People who are teaching want to have hard evidence. They don't want to go in and talk to medical students and family doctors in training and talk about 'stuff I think because I treat people with chronic pain.' They want to have hard research to talk about."
But there's still a long way to go. According to the Pain Society of Canada, only 0.25 per cent of total funding for health research in Canada goes into studying pain.
