National Pain Awareness Week

CPC Report Card on Pain

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Canadian Pain Coalition Report Card on Pain: Initial Report
S.R. Fashler1,2, L. Cooper1, L.C. Burns2, S. Razavi2, L. Goldberg2, E. Oosenbrug2, & J. Katz1,2
1Canadian Pain Coalition and 2York University

Canadian Pain Coalition Report Card on Pain: Initial Report

Summary:

One in five Canadians currently suffer from chronic pain, a debilitating condition that can be difficult to treat. For this reason, healthcare providers recommend specialized pain clinics that focus on several aspects of the pain experience as the gold standard for treatment. In this report, we provide an overview of pain clinics in Canada, addressing how accessible they are, where they are located, which medical professionals provide care, and what services are offered. Given that only one pain clinic exists for every 51,600 sufferers of chronic pain, there is an urgent need to improve access to pain clinics in Canada.

Introduction:

Approximately 20% of Canadians suffer from chronic pain, creating a substantial burden on the individual and their family, health care system, and economy.1 Chronic pain conditions vary considerably in their etiology but it is generally agreed they all involve a complex combination of biological, psychological, social, and cultural factors. Due to this complexity, pain clinics that offer a wide array of interventions targeting multiple dimensions of pain are considered to be "the gold standard" for treating chronic pain.2 However, little is currently known about Canadian pain centres: who works at them, what kinds of chronic pain conditions do they treat, how many people do they serve, and what treatments do they offer? The aim of this first phase of the Report Card on Pain is to review published literature evaluating multidisciplinary pain centres across Canada in order to determine, among other things, the professional disciplines involved, availability to the public, and services offered.

Methods:

A broad, systematic search of the literature published up until September 2014 was conducted using MEDLINE, PsycINFO, and CINAHL. Articles were selected if they used a survey or questionnaire to evaluate pain management centers anywhere in the world. Of the 1674 unique articles identified by the search strategy, 25 satisfied our criterion. Of these, three were surveys of Canadian pain centres.3-5

Results:

Two of the three articles comprised Canada-wide surveys3,4 while the other focused on services available in the province of Québec.5 Both articles by Peng et al.3,4 used the same survey, although they reported on different populations: the first study4 evaluated clinics that exclusively treated children whereas the second3 evaluated clinics that treated either exclusively adults or both adults and children. The reports revealed important differences in the approach used to evaluate pain clinics: for example, one study did not define what exactly constituted a pain clinic5 and each study used a different search strategy to identify pain clinics. 3-5 The disparate search strategies identified 5 Canada-wide children's chronic pain clinics,4 120 Canada-wide adult chronic pain clinics,3 and 50 chronic pain clinics in Québec.5 Mean clinic wait times varied from four weeks4 to nine months or more.5 Among the most commonly treated pain conditions were low back pain, neuropathic pain, headache pain, abdominal pain, complex regional pain syndrome, neck pain, and fibromyalgia. A wide variety of health care professionals reported working in pain clinics, most prominently general practitioners, anesthesiologists, psychologists, nurses, physiotherapists, psychiatrists, and physiatrists. Common interventional treatments included pharmacotherapy, epidural injections, stellate ganglion blocks, peripheral nerve blocks, and trigger point injections. The most commonly reported physical interventions were physiotherapy, hydrotherapy, exercise program, and transcutaneous nerve stimulation. Psychological treatments included individual and group psychotherapy, relaxation training, imagery, and biofeedback. In terms of availability, Peng3 reported that nation-wide, there is only one pain clinic per 258,000 people living in Canada. Given that approximately 20% of Canadians have chronic pain,1 this suggests there might be as few as one pain clinic for every 51,600 individuals living with pain in Canada.

Conclusion:

We identified only three studies that surveyed chronic pain centres in Canada, the most recent conducted seven years ago. We therefore do not know with certainty the current state of affairs with respect to many factors, including the professional composition, availability and locations of chronic pain clinics across Canada. However, the estimate that there is one chronic pain centre for every 51,600 Canadians with chronic pain is a stark reminder of the huge unmet need for accessible pain treatment centres across Canada. The results of this systematic review indicate that we need updated data regarding the availability of, and ongoing need for, pain centres across Canada as well as information from Canadians with chronic pain about the chronic pain treatment resources to which they currently have access, and their needs for accessible, effective treatments.

  1. Boulanger A, Clark AJ, Squire P, Cui E, Horbay GL. Chronic pain in Canada: Have we improved our management of chronic noncancer pain? Pain Res Manag 2007; 12: 39–47.
  2. Ospina M, Harstal C. Multidisciplinary Pain Programs for Chronic Pain: Evidence from systematic reviews. Alberta Heritage Foundation for Medical Research - Health Technology Assessment, Alberta, Canada, 2003: 1-48.
  3. Peng P, Choiniere M, Dion D, Intrater H, LeFort S, Lynch M, ... Veillette Y. Challenges in accessing multidisciplinary pain treatment facilities in Canada. Can J Anaesth 2007; 54(12): 977-984.
  4. Peng P, Stinson J, Choiniere M, Dion D, Intrater H, LeFort S, ... Veillette Y. Dedicated multidisciplinary pain management centres for children in Canada: the current status. Can J Anaesth 2007; 54(12): 985-991.
  5. Veillette Y, Dion D, Altier N, Choiniere M. The treatment of chronic pain in Québec: a study of hospital-based services offered within anesthesia departments. Can J Anaesth 2005; 52(6): 600-606.

Nov. 2, 2014