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Posts Tagged "chronic"

18Jul

New report calls for overhaul of chronic pain treatment

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A new report from the Canadian Pain Task Force is calling the issue of chronic pain a “significant public health issue” and says the health sector has a chance to overhaul how it is treated to better help Canadians.

The report notes that one in five Canadians are thought to live with chronic pain, with two-thirds of those reporting their pain as moderate to severe.

“People living with pain have limited access to the services they require and often face stigma and undue suffering as a result of their condition,” the report reads.

Chronic pain has been recognized by the World Health Organization as a disease, and is defined as pain persisting or recurring for longer than three months, associated with significant emotional distress, significant functional disability and the symptoms are not better accounted for by another diagnoses.

It notes chronic pain more often afflicts those in populations living in poverty, Indigenous peoples and women, among others.

The opioid overdose crisis has also complicated the treatment options for those suffering from chronic pain.

The task force claims people who could benefit from opioids to manage pain are now facing barriers to obtain a prescription.

“There is a need to promote shared decision-making between health care professionals and people living with pain. Prescribing decisions must be based on the unique needs of the individual, but this is not supported by the current environment.”

The report calls for better co-ordination between the provinces and territories as a starting point.

“Provincial/territorial policies and efforts could be better coordinated to reduce duplication of effort, maximize efficiency and implementation of best practices, and ensure people living with pain have the same level of care across Canada,” the report reads.

Pain BC – an organization that looks to help those suffering from chronic pain in British Columbia – welcomed the report and its conclusions.

“This report makes Health Canada aware of what Canadians with pain have known for too long: that pain care is largely not accessible, many health care providers lack the knowledge and skills to manage pain and breakthroughs in research are hampered by lack of funding,” said Executive Director Maria Hudspith in a statement. “We hope this report lays the foundation for a national pain strategy that will improve the lives of Canadians who live with pain.”


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26May

Daphne Bramham: Tougher new regulations promise more agony for chronic pain-sufferers

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One in five Canadians lives with chronic pain, but the cries of an estimated 800,000 British Columbians are not only being ignored, their suffering is being exacerbated by regulators limiting their access to both drugs and treatment.

First, in a move unprecedented in North America, the B.C. College of Physicians and Surgeons imposed mandatory opioid and narcotic prescription limits on doctors in 2016 in an attempt to avoid creating additional addicts and having more prescription drugs sold on the street.

Physicians who don’t comply can be fined up to $100,000 or have their licences revoked.

Now, the college is setting tough regulations for physicians administering pain-management injections.

“I’m enraged,” says Kate Mills, a 33-year-old, palliative care nurse who has been on disability leave for the past 18 months. “People like me are living in chronic, intractable pain and being ignored by doctors who are either too scared or too callous to care.”

She has an uncommon, congenital condition that causes chronic inflammation near her sacroiliac joint and in her lower back, which pushes down on her nerves causing “exquisite pain” down her leg.

Her first doctor essentially fired her, refusing to treat the pain. The next one prescribed Oxycodone to help Mills through until she was able to receive a steroid injection at a clinic, which kept the pain in check for several months.

But by the time the injection’s effects were wearing off, her GP went on extended medical leave. The locum assigned to Mills refused to prescribe her any medication and told her to go to an emergency room where she was given a prescription.

After numerous ER visits, Mills finally found a doctor two weeks ago who is willing to provide medication for her between injections. But he agreed only after Mills signed a contract agreeing that she won’t sell the drugs, will only go to one pharmacy and take the drugs only as prescribed.

She is lucky, though. Her pain management clinic will likely meet the college’s new standards that were developed by an advisory panel over the past three years out of concern about patient safety.

“Increasingly,” the college says on its website, “Procedural pain management is being provided in private clinics and physician offices, but without much guidance on appropriate credentials, settings, techniques and equipment.”

The new regulations would require physicians’ offices or clinics to become accredited facilities with standards on par with ambulatory surgery centres.

That means having tens of thousands of dollars’ worth of equipment including resuscitation carts, high-resolution ultrasound, automated external defibrillators and electronic cardiograms with printout capability.

The college acknowledges that “patients do not require continuous ECG monitoring. However, the cardiac monitoring equipment must be available in the event a patient has an unintended reaction to the procedure.”

The disruption for patients will be huge, according to Dr. Helene Bertrand, a general practitioner, pain researcher and clinical instructor at UBC’s medical school.

She estimates that up to 80 per cent of the offices and clinics where the injections are currently being done won’t measure up and already wait times are up to 18 months.

When the new requirements come into force, Bertrand predicts patients will be waiting anywhere from four to seven years for treatment.

Bertrand herself will have to quit doing prolotherapy, which she has done for the past 18 years on everything from shoulders to necks to spine to ankles. That’s despite the fact she’s never been sued, never had a complaint filed with the college and has published, peer-reviewed research that revealed an 89 per cent success rate among 211 patients in her study group.

(Prolotherapy involves injecting a sugar solution close to injured or painful joints causing inflammation. That inflammation increases the blood supply and deposits collagen on tendons and ligaments helping to repair them.)

The college will not grandfather general practitioners already doing injection therapies. Instead it will restrict general practitioners to knees, ankles and shoulders. All other joint injections must be done by anesthetists or pain specialists.

For Joan Bellamy, that’s a huge step backward.

She’s suffered from chronic pain since 1983 and “undergone the gamut of medical approaches, often with excessive waits: hospital OP (outpatient), pharmacology, neurology, orthopedics, spinal, physiatry and private.”

Since 2000, she’s had multiple injections that have made a difference. But her doctor doesn’t meet the new qualifications.

“I am afraid that without her expertise … that pain will become an intolerable burden, and any search for treatment will result in inconceivable wait times and will debilitate me,” Bellamy wrote in a letter to the college and copied to me.

The near future for pain-sufferers looks grim with most physicians able to offer them little more than over-the-counter painkillers.

Ironically at a time when the provincial medical health officer and others are lobbying hard to have all drugs legalized so that addicts have access to a safe supply, chronic pain-sufferers are being marginalized. For them, it’s more difficult than ever to get what they need.

It’s forcing many of them facing a lifetime of exquisite and unbearable pain to at least contemplate one of two deadly choices: Buy potentially fentanyl-laced street drugs; or worse, ask for medically assisted dying.

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6May

New B.C. study links chronic disease, health care costs to where you live

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People who live in walkable neighbourhoods and have access to parks in Metro Vancouver save the health-care system tens of millions of dollars each year, and have lower rates of chronic illness than those who don’t, according to a new study.

The report, called Where Matters, used data from two existing studies — the My Health, My Community Survey, and the B.C. Generations Project — and clearly shows the correlation between health and neighbourhood design, said study lead Lawrence Frank.

“That’s unusual. Then, we monetized all those results and showed wildly reduced health-care costs, relatively speaking, across the continuum of place types — from the most sprawling, exurban, car-dependent to the most walkable urban. That’s never been shown before, no one’s ever had that,” said Frank, who is a professor in sustainable transport and the director of the Health and Community Design Lab at the University of B.C.

Direct health-care costs — such as medication and hospital visits — for diabetes are 52-per-cent less for those living in walkable areas than in car-dependent areas. The cost for hypertension is 47-per-cent less, and for heart disease is 31-per-cent less.

Walkability is a measure of the physical characteristics of neighbourhoods that support walking, such as a higher concentration of housing units, a mix of land uses and smaller block sizes.

The direct health-care costs for those living near parks are also significantly lower. The spending on diabetes is 75-per-cent lower for people who live near six or more parks than those who live near zero to one park. The costs are 69-per-cent lower for hypertension and heart disease.

Dr. Patricia Daly, chief medical health officer for Vancouver Coastal Health, said at the report’s unveiling on Monday that containing costs is important in the health-care system, but it shouldn’t be the only reason to create healthy environments and improve the health of the population.

“We need to do this because our citizens value this. They value their good health, the good health of their family, their friends and their loved ones,” Daly said. “When municipal, provincial governments and other decision makers are thinking about what work needs to be done, they should be keeping this in mind.”

Daly said she hopes the report will give those decision makers good data to make healthy decisions.

The report also shows, unsurprisingly, that people who live in walkable areas and near parks get more exercise and are healthier.

Those living in a somewhat walkable area or a walkable area are 20- and 45-per-cent more likely, respectively, to walk for transportation than those living in car-dependent areas. They are also more likely to meet the weekly recommended level of physical activity.

People in walkable areas are 42-per-cent less likely to be obese and 39-per-cent less likely to have diabetes than car-dependent people. Those in moderately walkable areas are 17-per- cent less likely to have heart disease.

Living in a walkable area means people are 23-per-cent less likely to have stressful days. They are also 47-per-cent more likely to have a strong sense of community.

People living in an area with six or more parks are 20-per-cent more likely to walk for leisure or recreation, and 33-per-cent more likely to meet the weekly recommended level of physical activity than those living in an area with no parks.

They are 43-per-cent less likely to be obese, 37-per-cent less likely to have diabetes, 39-per-cent less likely to have heart disease and 19-per-cent less likely to have stressful days. Those living near six or more parks are also 23-per-cent more likely to have a strong sense of community belonging.

Frank said he hopes that the study will make those in power more comfortable acting on making investments in active transportation and developing policies around growth and development that support physical activity and active living.

Andrew Devlin, manager of policy development for TransLink, called the work “cutting edge” and said the onus will be on governments and agencies like TransLink to take the information and use it to create policy.

“I think what’s really unique to this piece of work, besides being a local data set for us to draw from to make decisions, is really the monetization element of it,” he said.

James Stiver, manager of growth management and transportation for Metro Vancouver, said the information will help with the future development of regional plans.

“This work is critically important to the work we do at Metro Vancouver and ties really nicely into the theme of the work we do connecting transportation to infrastructure to build complete communities,” said Stiver.

The project was a collaboration between Metro Vancouver, the Real Estate Foundation of B.C., the City of Vancouver, and TransLink, which contributed a total of $320,000 to the project, and the University of B.C.

“What makes it really cool is that all of these agencies are working together, and that’s what could make this region a better place,” said Frank.

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3Apr

National chronic pain task force a first step: federal health minister

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‘People with chronic pain are often underemployed or unemployed because they simply cannot work and not all of us have extended health benefits and even health benefits run out,’ says Andrew Koster.


‘People with chronic pain are often underemployed or unemployed because they simply cannot work and not all of us have extended health benefits and even health benefits run out,’ says Andrew Koster.


CHAD HIPOLITO / CANADIAN PRESS files

The federal health minister is forming a national task force to provide input on how to better prevent, treat and manage chronic pain, which affects one in five Canadians and is often addressed with opioids.

Ginette Petitpas Taylor said in an interview Wednesday the task force will provide information on barriers that may prevent people suffering with persistent pain from receiving the treatment they need.

“This is the first step in addressing the issue of chronic pain in this country,” she said, adding the eight members will consult with governments and advocacy groups around the country and provide an initial report in June, followed by two more over the next couple of years.

Petitpas Taylor made the announcement in Toronto at the 40th annual scientific meeting of the Canadian Pain Society, which has long called for a national pain strategy, especially as the opioid crisis has exacerbated the stigma around prescribing and use of the pain killers.

She said she committed to exploring the creation of a national pain task force after a discussion with patients, clinicians and researchers at a symposium in Toronto last year, when she heard people living with pain often feel their condition is misunderstood and services are inconsistent.

“We have to recognize that Canada’s a big country and we certainly know there’s inconsistent services in provinces and territories so I have to really have a good understanding of what’s available and what’s happening out there,” Petitpas Taylor said.


Ginette Petitpas Taylor, Minister of Health, stands during Question Period in the House of Commons on Parliament Hill in Ottawa on Thursday, Sept. 21, 2017.

Sean Kilpatrick /

The Canadian Press

Advocates for pain patients presented the former Conservative government with a plan in 2012, but Petitpas Taylor said it’s too early to say whether such a plan will be introduced.

Andrew Koster, who suffers from debilitating lower back and knee pain from a type of arthritis called ankylosing spondylitis, said he’s concerned the task force’s work will go nowhere if there’s a change in government in October.

“I’m looking for signs from the government that they’re taking this seriously and it’s not just something to state during an election campaign,” he said. “There has to be definite action.”

Koster, who will have surgery on his left knee next month following an operation on the other one last year, said he can no longer afford to pay $100 a week for acupuncture to deal with daily pain after he voluntarily reduced his opioids over concerns about any long-term consequences.

“People with chronic pain are often underemployed or unemployed because they simply cannot work and not all of us have extended health benefits and even health benefits run out,” he said from Victoria.

He said it’s crucial for the task force to identify non-drug costs for patients and provinces for services such as physiotherapy, occupational therapy and acupuncture as part of any strategy it may come up with in its final report.

Andrew Koster, who suffers from debilitating lower back and knee pain from a type of arthritis called ankylosing spondylitis, pictured at his home in Victoria in 2018.


Andrew Koster, who suffers from debilitating lower back and knee pain from a type of arthritis called ankylosing spondylitis, pictured at his home in Victoria in 2018.

CHAD HIPOLITO /

CANADIAN PRESS files

Serena Patterson, a 60-year-old psychologist in Comox, has lived with pain associated with fibromyalgia for over half her life and also developed migraines that prevented her from continuing her teaching job at a college.

She said a three-year task force seems excessive, especially because advocacy groups have enough information on health-care gaps and patients wait too long to see specialists.

“I think we know that people are dying in an opioid epidemic and chronic pain patients are high on that list,” Patterson said.

“I would hope that this three years would be building, not more research. What needs to be built is a network of multidisciplinary team programs that are accessible, that are in rural areas as well as urban areas, that provide not only medical support but psychological as well as social support to help people be full participants in their life and in their community.”

Dr. Norman Buckley, scientific director of the Michael G. DeGroote Institute for Pain Research and Care at McMaster University in Hamilton, said hundreds of organizations, patients, clinicians and researchers came together in providing the federal government with the strategy in 2012. There was no action at the time but he said the opioid epidemic has now made that unavoidable.

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