Chronic pain treatment, including use of opioids, needs major overhaul: report

One in five Canadians lives with chronic pain, according to a new report by the Canadian Pain Task Force.

It's one of the findings from the report which lays out the current state of chronic pain in Canada and is meant to guide the government on how to help those living in pain.

The report is also meant to guide governments on how opioids should be used as treatment.

Fiona Campbell, a pediatric anesthesiologist and director of the chronic pain team at SickKids Hospital in Toronto, is a co-chairs of the task force and president of the Canadian Pain Society. She spoke with the CBC's Conrad Collaco about what the report says about treating long-term pain in Canada. You can read an abridged and edited version of the interview or listen to the full audio interview by hitting the play button above.

Fiona Campbell, president of the Canadian Pain Society

How do you know if you're suffering from chronic pain?

Well, I think it's very important to distinguish between acute pain that everyone experiences in order to protect our bodies from harm. Chronic pain is quite different. It's pain which persists for longer than three months and is associated with emotional distress such as anxiety or depression. In fact, it doubles the risk of suicide, so there may be associated emotional impact and certainly physical impact.

So, activities of daily living such as getting dressed, being able to attend school if you're a child, holding down a job, participating in your hobbies — people can become quite socially isolated as well, and people may have chronic pain related to an underlying medical condition such as rheumatoid arthritis or after a catastrophic car accident, for example. The World Health Organization has just defined pain as a disease in its own right where it's a disorder of the pain messaging system in the body, a little bit like a fire alarm going off even though there is no fire.

So, how widespread is this? How many people are impacted here in Ontario?

One in five Canadians lives with chronic pain. That would be three million Ontarians, including children. In people who suffer with chronic pain it is often moderate or severe in intensity and it disproportionately affects women, older people, veterans and Indigenous populations.

What did your report discover about where the gaps are and where our ability to treat chronic pain is lacking?

We found that there are gaps in a number of areas. There are gaps in the education system — healthcare professionals becoming trained may lack the knowledge and tools to be able to treat pain properly. The second gap is in funding for research. There is inadequate funding to understand fully the mechanisms involved in pain and for developing new treatment. And thirdly, and this is like the biggest, is gaps in access to care. So, care across Canada and Ontario is very fragmented. When I talk about care I've already mentioned primary care providers but there's lack of access to publicly funded physical therapists such as physiotherapists occupational therapists chiropractors.

And there's a lack of access to mental health providers to address the significant mental health component that may accompany chronic pain. Finally, the gold standard of treatment is inter-professional chronic pain clinics which are nonexistent in remote and rural communities. In fact, some provinces have none. Now, a few years ago, the Ontario provincial government invested in pain clinics. So, for example, Hamilton has very good pain clinics, Toronto as well — London, Kitchener and Thunder Bay — but really outside of urban centres there aren't any. Ottawa has good services as well.

Now, all of those cities that you just mentioned, as well as many others in Ontario and around the country, are dealing with an opioid crisis and we know that opioids can play a big role in treating pain. How should opioids be used for pain treatment.

This is such a critically important point for people to understand. There is an opioid crisis. Twelve people, predominantly young people, are dying every day from an opioid-related death largely related to illicit fentanyl being in this country. So, if you take a small amount of fentanyl, it will stop you breathing and you can die. However, in addition to the opioid crisis we also have a pain crisis and we need to strike a balance. There's a pendulum that we need to strike in making opioids available for pain treatment, while minimizing opioid-related harm and risk. There are many treatments that can be used to prevent and treat pain including non-opioid pain medicines and also physical and psychological interventions that are evidence-based but, sadly, not all publicly funded. We need to do everything we can to minimize the need for using opioids, but we must be prepared to use them for patients in whom they make a great benefit for their health-related quality of life for some people who are taking opioids safely and effectively.

Some health care professionals are cutting off their opioids for fear of reprisals from professional organizations, so these patients are going into withdrawal, suffering in silence or going to emergency rooms, seeking illicit opioids on the street and dying and some are considering and have committed suicide. So, it's a really critical pendulum which has swung too far away from opioid prescribing. We must get this balance back but we can't do it in a non-thoughtful way.

What alternatives are there to opioid treatment?

I talk about a "three P's approach" to pain control, so pharmacological or pills medication, physical strategies and psychological strategies. The pharmacological strategies are simple analgesics such as acetaminophen and anti-inflammatory medications, but there are also adjuvant medications that need to be prescribed for certain kinds of pain [along with] physical strategies — being physically healthy, taking exercise, using ice and heat, positioning. Seeing physical therapists, occupational therapists, chiropractors may all help for active treatment and psychological strategies. So, we know that if you're paying less attention to pain through watching Netflix, engaging with your friends and so on you have less and less of your brain available to focus on pain and that can sometimes dial down time as well, in addition, to formal treatments such as mindfulness cognitive behavioural therapy and so on.

What are you hoping this report achieves?

First of all, we're really excited that Health Canada has taken this on because they're really very important. There needs to be coordination at a policy level between the federal, provincial and territorial governments to address chronic pain as a devastating and important public health issue. The first thing we need is policy coordination in an overarching way but there are three other things we need as well.

We need to have better prevention and education. We need better research and implementation of research findings and we need better access to care. So, it is our hope that in the next report where we are looking at best practices — that will be delivered in one year across Canada — it is my hope that we end up with a national pain strategy.