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Letter: Medicine often fails chronic pain patients

Dealing with chronic pain? Chances are you haven’t found a doctor who knows how to manage it.

Medicine has progressed significantly. It has been able to treat many diseases and a variety of complex conditions, but has yet to understand chronic pain; let alone find a cure or even relief from it.

One in five Canadians suffers from chronic pain, with lower back being the most common. Approximately half of those suffering from chronic pain report suffering for more than 10 years.
Chronic pain is misunderstood. For most individuals, pain is something that exists for a limited time but then slowly goes away. But chronic pain is pain that’s constant, one that gives no indication of when it will go away or if it even will. Chronic pain is complex and can’t be ranked by a 1-to-10 pain chart, and can only truly be understood by those who experience it.

Chronic pain can dampen an individual’s life, preventing them from performing activities they once could. It has been reported to be associated with the worst quality of life, even when compared to other chronic diseases such as lung or heart disease.

Constant pain can hold sufferers back from engaging in life, leading to damaged relationships, loss of employment, isolation from society, and depression.

Constant pain can hold sufferers back from engaging in life, leading to damaged relationships, loss of employment, isolation from society, and depression. Chronic pain patients also have increased suicide rates and feelings of hopelessness. Now the problem is much more than just physical pain.

Physicians often look at pain as a symptom and not a problem itself. Medicine, generally, focuses too much on treating disease and the etiology, and less on treating pain. The targets are diseases or abnormalities that can be caught by blood tests, X-rays or MRIs. Treatment of pain focuses on finding the underlying cause with the expectation that pain would be resolved. But we now know that pain persists beyond injury.

Family doctors, who are usually the first line of care, often lack training in pain management since there is minimum training provided in medical schools. Referrals, if one is lucky, are then made to a pain specialist. In Canada the wait time can start at one year, and patients’ health often deteriorates and pain escalates while waiting to be seen.

Why is this important? Aside from the strain on the individual, it affects society. Chronic pain (including health-care and productivity costs) is costing Canada a fortune — a whopping $56 billion to $60 billion! This is more than the cost associated with cancer, heart disease and HIV combined.

Patients experiencing pain are often disregarded by physicians: “There’s nothing much that can be done, just take your meds,” as the doctor hands over a list of narcotics.

We have a rising problem where physicians are over-prescribing opioids, especially in Newfoundland and Labrador, which is counter-productive to pain management. This is a dangerous direction that our society has shifted in, and fuels addiction. Many chronic pain sufferers are addicted to prescription narcotics, feeding the opioid crisis, which in turn has led to the failure of medicine.

Pain-medication related deaths are increasing, with one-quarter of the deaths being from suicide.

Since many physicians lack in providing this support, chronic pain sufferers often slip through the cracks. So, is chronic pain just not something physicians can deal with properly?

In my opinion, physicians need to take a holistic approach in treating chronic pain by spending time and understanding patients’ experiences, opening conversations on how pain affects their day-to-day life, and providing genuine advice.

Pain management should be recognized as a human right. Chronic pain treatment plans should include chronic pain management, using evidence-based tools to provide patient education, self-management support, and collaboration with interdisciplinary pain management teams.

Improvements to the medical curriculum should be made by placing more emphasis on caring for chronic pain and management and the psychological impact of pain, while providing physicians with more training. The cure for chronic pain is not in a pill.

Most importantly, doctors need to make their patients feel that there’s always something that can be done to help them. And they should definitely think twice before grabbing their tamper-resistant prescription pad.

 

Ahmed Khawer

St. John’s

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