Chronic pain is now recognized by the WHO, but seeking treatment remains an obstacle

John Firstbrook, CEO of Firstbrook Insurance, recounts his experiences with back problems after a diving accident in his youth left him in pain, even after several surgeries.Fred Lum / The Globe and Mail

“Heart patients”: This is how one doctor described those who came to him with chronic pain, according to Maria Hudspith, founding executive director of Pain BC.

“He said, ‘I see their names on my agenda for the day and my heart is aching because I have so little to offer them,” recalls Ms. Hudspith, the doctor telling her.

Today, resources to treat chronic pain remain “woefully inadequate” in this country, said Ms. Hudspith, whose national non-profit organization works to improve the well-being of people living with pain. Ms. Hudspith also co-chairs the Canadian Pain Task Force, a group that now advises the federal government on how chronic pain is understood, prevented and managed in this country – starting with the growing recognition that pain is a problem. real and serious health. .

“For a long time, chronic pain was understood as some kind of fiction or character flaw – the idea that people seek secondary gain from an insurer, or try to retire from work, seek sympathy, or obtain pain relief, medication from a doctor, ”Ms. Hudspith said.

The concept of chronic pain as a separate health problem is not widely understood: “When pain becomes chronic, it really becomes a disease of the nervous system,” Ms. Hudspith explained. “It becomes a condition in itself, not just a symptom of something else.”

This month, the World Health Organization legitimized chronic pain as a condition in its own right in the latest revision of its International Classification of Diseases. Experts believe this change will validate the experiences of those living with pain and strengthen patient care.

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The January 1 review makes it clear that chronic pain can present as a secondary symptom of another condition or as a stand-alone diagnosis. It also recognizes the disability and distress associated with pain. Importantly, the new WHO classification offers multiple diagnostic codes for chronic pain, meaning that patients could have greater access to various pain treatments and benefit from better reimbursement from insurers for their care. Experts believe the review will also improve data collection on this condition, with clearer statistics essential to shaping public policy.

“For those in the pain community, this recognition is a long, historic moment,” said Ms. Hudspith. “Of course, it takes a decade for the classification to really filter and be seen in a doctor’s office.”

About 7.6 million people – or one in five Canadians – live with chronic pain, according to 2019 data from Statistics Canada. The problem takes a heavy economic toll: Health care costs and lost productivity due to pain-related absenteeism and unemployment cost an estimated $ 40 billion in 2019, according to Health Canada. The number of people affected is expected to increase as the country’s population ages: one in three Canadians over the age of 65 will experience this problem.

Yet the problem remains poorly understood both by the public and by many health professionals. Those who suffer from near constant pain often find it difficult to keep the medical system engaged with their case: the cause may never be diagnosed, and their pain only changes, not heals.

Health care workers urgently need better training on these issues, said Hudspith. Last January, a new program on pain prevention, diagnosis and treatment was released for the country’s 17 medical schools – a change that is reflected in similar training for nurses, pharmacists and social workers. . There is also a movement towards mentoring programs that see expert centers – pain specialists, family physicians, pharmacists, social workers, occupational therapists and physiotherapists – counsel other primary care providers on their most critical cases. difficult in monthly virtual seminars.

“There is tremendous variability in the response to chronic pain,” said Michael Ford, an affiliate orthopedic surgery scientist with the Holland Bone and Joint team at Sunnybrook Health Sciences Center in Toronto.

Although he is retired from the surgery, Dr Ford sees patients experiencing significant pain in the joints, knees, hips, lower back and neck due to degenerative diseases, which usually appear with the disease. ‘age. It also helps patients after car accidents, work accidents and sports injuries.

Many have lived with the pain for long periods of time, said Dr. Ford. Some describe the immense stress of having to systematically prove to those around them that they are suffering. It’s a cycle that can lead to depression, which can make pain worse, Dr. Ford explained. “We are talking about human beings here. We are not just talking about thorns. There is an important component of the psyche when it comes to how a person deals with chronic pain.

Dr. Ford has been helping one of his patients for three decades. Although John Firstbrook is now 65, his pain started in high school. At a pool graduation party, the 17-year-old attempted to dive from a window at the host’s house into the pool and ended up fracturing his cervical spine, at his neck .

Several years later, Mr. Firstbrook had another accident, this time skiing, with the tip of his ski stuck in a tree hidden by deep powder. “I found myself doubled over in a ditch,” he recalls. “I’ve done quite a bit of damage again.”

From the age of 17 after the first accident, he suffered from stabbing pains with neck movements. The young man has undergone a series of procedures, including numerous neck fusion surgeries at all levels of his spine between the brainstem and the top of the rib cage. “It was like putting your finger in the dike and a new water point would appear a meter away,” he said.

Eventually the neck fusions set in. “For a temporary period, I had no more pain. It was wonderful, ”said Mr. Firstbrook, President and CEO of Firstbrook Insurance Group.

The reprieve will not last. In his early 30s, he began to experience sudden, severe pain in his lower back, as well as difficulty walking.

Slowly, his doctors assumed the problem could be genetic: Mr. Firstbrook’s grandmother also had extreme spine problems. Dr Ford explained that his patient is genetically predisposed to Scheuermann’s disease, which involves an accelerated degenerative change in the spine, especially the lower back. “This results in a herniated disc in the bone and a change in the shape of the vertebrae,” said Dr. Ford, noting that the disease causes “almost constant pain”.

After undergoing more than a dozen surgeries, Firstbrook and his medical team decided to stop this route until they saw a major breakthrough in the treatment of mechanical back pain. “There is a time when you have to do this,” Mr. Firstbrook said. “It’s hard to hear it and it’s hard to live it.

Today, exercise is a mitigating force in his life. Importantly, her personal trainer Dan Newberry first called her surgeon to understand her limitations before going on a diet. “What he brought is discipline and a clearer approach. It changed the way I function, ”Mr. Firstbrook said, noting that fitness has dramatically improved his mental outlook. “At 7 am most of the time I can’t stand. But at 5 p.m., I’m at level 15 on the treadmill and doing 45 minutes.

Her surgeon explained that careful exercise programs can be beneficial for people with chronic pain: “If it hurts to move, you don’t move, so you get stiff and weak. It also increases the pain, ”said Dr. Ford.

The treadmill allows Mr. Firstbrook to lean forward while walking, which alleviates some discomfort. Over the summer during the pandemic, he changed his routine, walking miles of hills near his Toronto home with a friend.

“While living with chronic pain is challenging, you can still have a meaningful and positive life,” said Firstbrook.

More support is needed for people with chronic pain, Ms. Hudspith said. Pain BC offers a support line of social workers as well as peer support groups and one-on-one coaching, which aim to help people understand the links between pain and stress and improve their quality of life.

Ms. Hudspith advocates more specialized clinics for people with complex pain, arguing that the Canadian medical system still lacks specific infrastructure for chronic pain, the kind that exists for other chronic conditions such as diabetes, arthritis. , cancer, heart disease and stroke.

“For the most part, people are mismanaged in primary care,” Ms. Hudspith said. “They are looking to the private sector in a dispersed fashion, looking for a chiropractor, physiotherapist, yoga therapist or psychologist, if they can find one and pay for it.”

She and other experts are urging more robust early assessment and intervention so that patients’ acute pain does not become chronic. She mentions a number of hospital “pre-adaptation” and transient pain management programs aimed at eliminating chronic cervical pain directly before and after surgery.

“Just as the movements were built to think holistically about mental health, wellness, addiction and its links to other social issues,” Ms. Hudspith said, “this is where we are. we’re headed for chronic pain. “

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