The Price of Inaction

Not too long ago, Canada announced that one of the places getting budget cuts was to pain clinics. Just the other night, I decided to look up this new “screw-you” to pain patients, and came across a new paper, entitled: “‘I live this life in pain’; Canadians with Chronic Pain Struggling to Find Help, Hope”.-^1
It is said that one in five Canadians suffer from Chronic Pain^2. This is unacceptable.  First came the war on drugs, that ended up impacting Canadian Pain sufferers more than it does the individuals who choose to use these medications for the wrong reasons. The war on drugs crossed over into the medications category when they went after OxyContin.  There were seemingly benign changes made to make it tamper-proof for the individuals who want it for the high. Other regulations went into effect on March 1, 2012 ^3. For instance, the doctors that decide to keep treating their pain patients will now have to apply within one year to keep prescribing OxyNeo to their previous OxyContin recipients.  There has been no proper preparations for this. As all the doctors go to scramble, patients will be at risk of losing access to their maintenance medication.  Further, ‘many provincial and federal drug plans have “de-listed” Oxy Neo’.^4  This means that there is no longer coverage.  Many people in this condition have lost their ability to work, to function the same as others, and to be limited by the pain. People that suffer from Chronic pain are isolated from the community. When you lose the ability to finish your education, or to work, you lose your independence. Family and friends also often turn their backs, because of the stress they deal with in having a friend in pain.  And the people that do stay, they try, but little things like whimpering or crying when you’re in pain can eat at them.  The stress leads to sleep deprivation, and that sleep deprivation gets to your nerves.
Chronic pain sufferers are twice as likely to commit suicide. ^5   This too, is unacceptable.
Not to mention the Doctors that are scared off from treating a chronically ill individuals because of all of these new regulations, as well as the heat now being placed on doctors who prescribe narcotics to patients due to the celebrity attention that has been raised.  The only problem is, the average pain sufferer doesn’t have that kind of power to get them to freely hand of unnecessary and redundant medications.  So once again, the only people ibeing hurt by these seemingly harmless new regulations are the people who live in agony every day.^6  Now doctors are deciding patients with a chronic condition that will require them to prescribe “high risk” medications, simply aren’t worth the trouble. You  can see just how bad it can be in the MacLean’s article which speaks of the ordeals patients have to go through to get in touch with a doc willing to handle their case:

Many adults still have trouble getting pain treatment—even before the delisting. One of Jovey’s patients was turned down by more than 20 doctors when looking for a new general practitioner to replace a retired one. It takes patience, extra work, and even some courage to take on a patient with chronic pain: in addition to the mountains of paperwork behind prescribing opioids, and the omnipresent fear of onerous inspection by the provincial colleges of physicians and surgeons, there’s just too much time required to deal with the complicated issues of chronic pain which—even on a good day—cannot be cured, only managed ^7.

 In the article “I Live this Life in Pain^8“, it runs the numbers of people in pain and various wait times associated with publicly funded Pain Clinics:

Pain is virtually ignored in discussions about health reform. Wait times for treatment at publicly funded pain clinics in Canada average one to three years. The chronic pain clinic at Vancouver’s St. Paul’s Hospital has a 3 1/2-year wait list of about 1,300 patients. In Calgary and Ottawa, the wait time to see a pain doctor can be a year or longer. At the Alan Edwards Pain Management Unit at the Montreal General Hospital, the waiting list is 700 names long.^9

 It goes on to say that “for children in pain, the situation is equally bleak”.^10 Unfortunately, this is something I can relate to with my own battle as a child in chronic pain.

In my own case, I had a doctor who did too much too fast.  He operated on me in the office, without consent. He then mishandled my case, and kept telling us, “she’s too young for a pain condition” or “it’ll go away” “one more year, that’s it” and so forth. It took me ten years to finally feel ready to leave his practice. He had me sufficiently terrified that if I left, I would not get another doctor, or no doctor would understand my case, and I will be screwed…
What made this worse, was Health Care Connect.  I called them in desperation because I had gone through a trauma that was caused by my doctors neglect and lie.  Apparently it did show that I was anemic, not yet extremely low, but since he said nothing was wrong, I went on like there wasn’t anything.  After returning to classes and passing out when leaving one of them, I was terrified to see a health professional because of the threats made earlier by my GP (he had said he couldn’t “guarantee my care” if I saw another doctor). When I told them, they agreed I needed to get away, but said they couldn’t do anything to help.  When I asked if they could help me find a doctor, or is there a way to get one without going through health care connect, the answer was no. Doctors should be allowed to take on patients in an emergency situation like being on tons of medications to monitor an illness, and having the threat of losing the only person that can prescribe them to you with no one in place to take over…
Now, with Health Care Connect, you phone in, and tell the people there you are leaving your current GP and in need of another. It can take up to three weeks just to get “detached” from the office, and then you go on a list with thousands of other names all waiting.  The minimum amount of time would be 7weeks, and that’s if you get on the short list, and went right to the top, rather than the bottom.  By Shortlist I mean the “high risk” or “needs a doctor NOW” list. It’s even worse for pain doctors, and with the budget being cut, the wait times will only grow.  The wait times for people looking for a Pain doctor can reach up to three and a half years.^11 We need to have more pain clinics, not cutting back on them.

Further, Doctors need to be able to treat the patient that has gone through trauma or they read the signs as something other than a normal reaction.  When you’re young, you’re told that doctors are like Policemen, they are trust worthy and want to help you feel better.
It’s inevitable that you will develop a fear of hospitals and doctors, and have some anxiety in those situations, after all that has happened before this, but some doctors aren’t trained to assess their patients who suffer from a chronic illness, so they take it as an over dramatization, or something similar. There needs to be training or case studies in the curriculum to teach up in coming doctors that there are more than one kind of patient.

There is an extreme financial burden placed on those suffering and those who are trying to help them^12.  Those that suffer from a pain condition will often develop other issues such as Anxiety and depression. The question whether the depression should be treated as “depression” or as as symptom of the pain condition is still being debated. What needs to happen is a new approach to treating it, either way.  For myself, I never felt depressed.   I was active in the community, I loved the interests I had had since a kid, and I bounced back as hard as I could so I didn’t get left behind. 
These reports all show the same thing: There NEEDS to be a National Pain Strategy. Right now, the cost stands at $6 billion per year in health care costs ^13 and an estimated $37billion in lost productivity^14 This accounts for more than Cancer, heart disease and HIV combined. ^15
However, the biggest costs are those the patients themselves face.  We need the government to hear our voice and realize that we need to help the people suffering before the numbers are too great. And instead of cutting funding we should be identifying which areas need more grants and need more clinics with PROPERLY trained in treating pain.

A recent study looked into the level of funding research into pain conditions count in the grand scheme. This is what they found:

To determine the current level of research funding for pain in Canada, the Canadian Pain Society conducted a survey. Of 79 active researchers performing pain-related studies, 65 received funding
in the past five years amounting to a total of approximately $80.9 million. This is less than 1% of the total funding from the Canadian Institutes of Health Research and 0.25% of the total funding for health research.^16

Another statistic looks at the level of training and the number of doctors who are ignorant about prescribing or assessing.  They looked at the health care training compared to those who are involved in Veterinary care, and they found that “a survey of 10 major Canadian universities found that veterinary medicine students receive, on average, 87 hours of mandatory training in pain, versus 16 hours, on average, for medical students”.^17  There is also “inadequate funding for research (just one-quarter of one per cent cent of all federal dollars for health research in Canada go to pain). ^18
This needs to change.  We patients are made to feel like we have no control over our lives. A good doctor does exist, but they are hard to find.  Not to mention the cost.  Many Canadians seem to think that the healthcare system is completely free access. There are so many people trying to fight for our rights but we need help.  There are new organizations popping up- some of which are led by doctors who suffer from a chronic illness and some that are led just by fellow sufferers, and everywhere in between. Others are trying to qualify as a charity.  And one offers advocates to help people who have no one to help attend appointments to make sure we are not taken advantage of.
There is so much more to discuss and so much more to the fight against Chronic Pain. I hope that through this blog, you will be able to understand from a personal level from both the patients and the doctors willing to help, but you will also able to be informed with all the facts.  I will go on to discuss those groups and more links of course, to come. 

-S

Sources:

1)http://www.canadianpainsociety.ca/pdf/Sharon_Kirkey_Chronic_Pain_Series.pdf

2)http://www.canadianpainsociety.ca/pdf/news_chronic_pain.pdf

3)http://m.theglobeandmail.com/life/health-and-fitness/chronic-pain-patients-collateral-damage-

of-drug-abuse-policy/article551590/?service=mobile

4)http://www2.macleans.ca/2012/03/15/the-latest-opium-war/

5)http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2706647/pdf/prm14113.pdf


 

The wait times for people looking for a Pain doctor can reach up to three and a half years.^11

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