By Lethbridge Herald Opinion on November 19, 2020.
It’s been more than 30 years since I became a statistic – one of the one-in-five Canadians who move from having acute pain to chronic pain. Now, I’m part of a community of more than seven million Canadians in a similar situation.
I developed chronic pain after a workplace accident and I now live with neuropathic pain, fibromyalgia and migraines. Undermanaged persistent pain can negatively impact everything about you – physically, psychologically, spiritually, emotionally and socially. It can negatively affect your ability to work inside and outside the home. It impacts important time spent with family and friends, and creates physical and emotional obstacles to your productivity during the workday.
Unless you live with it, you can’t understand the devastating invasion on our lives. The pain is 24/7 and the physical effects are often invisible, which can make the pain easier for others to dismiss and not recognize as a health priority. There are also related burdens to the health-care system and economy.
Chronic pain is one of the most common reasons to seek health care in Canada and it is estimated the direct cost to manage chronic pain is $7.2 billion per year, according to the Canadian Pain Task Force. When the direct and indirect costs of chronic pain are combined, including the cost of productivity loss, it soars to approximately $56 to $60 billion every year. At the individual level, the out-of-pocket costs such as physiotherapy or mental health support can be nearly $18,000 per year. (Source: Canadian Pain Task Force, https://www.canada.ca/
While chronic pain has been recognized as a disease in its own right, it is complex and should be treated as such. The stigma that people living with chronic pain face also cannot be forgotten. Words like “complainer,” “malingerer” and “drug seeker” are still heard all too often. And most recently, with the devastating opioid crisis, there can be a stigma associated with receiving a prescription of opioids for chronic pain management.
Medication is just one of the many aspects of managing chronic pain. People need access to a multidisciplinary approach to managing pain, which includes occupational therapy, physical therapy, psychosocial counselling and rehab, much of which is not publicly funded. Patients also need opportunities to learn self-management skills, and to participate in creating a pain management plan that will help them adapt their lives to living well with chronic pain.
With opioid-related injuries and deaths continuing to rise across Canada, we need more education and improved processes to curb illicit use, efforts to establish concrete support for those dealing with substance use disorder, and increased education for health-care professionals regarding the prescribing of opioids for chronic pain. However, it can’t be ignored that this heightened attention to the opioid crisis harms people living with chronic pain.
In the shadows of the opioid crisis and efforts to dramatically reduce opioid prescribing, people in the pain community live in fear that their physician will stop prescribing opioids, and that their ability to function with chronic pain will be lost. They also fear that if they don’t comply, they will be “fired” by their doctor.
While pain management is an essential health-care service, pain prevention and control has inevitably also been affected by the ongoing COVID-19 pandemic. As our health-care system and professionals adapt to pandemic restrictions, the everyday realities and hardships of living with chronic pain and the need to receive the necessary medication are ongoing. Now, more than ever, there is an urgent need to prioritize patient safety and reduce stigma by modernizing the prescription process to make paper prescriptions a thing of the past, allowing prescribers, patients and pharmacists to be part of the same conversation.
Last year, I became aware of a new comprehensive e-prescribing service when I participated in a working group for PrescribeIT, a national, patient-centred e-prescribing service from Canada Health Infoway. PrescribeIT has the potential to eliminate so many of my concerns, as it lets prescribers send electronic scripts directly to the pharmacy, without uncertainties about errors, forgery or fraud. It also ensures secure two-way communication between prescribers and pharmacists. Any concerns about dosages or potentially dangerous drug interactions can be addressed immediately, and patients aren’t left waiting for the medication they need.
Another promising development is the Canadian Pain Task Force that was launched by Health Canada last year to better understand and address the needs of Canadians who live in pain, and advise government decision-makers accordingly. This holistic look at pain management, which focuses on the perspectives of people with lived experience, is a tremendous step in the right direction. I’m hopeful that thoughtful and meaningful change is on the horizon for improved chronic pain management in Canada.
Lynn Cooper is a national advocate, spokesperson, educator and pain research and education advisor to the Canadian Injured Workers Alliance, working to improve pain management for all Canadians.