Barriers to treating chronic pain

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1 Barriers to treating chronic pain Dr Owen D Williamson FRCSC Pain Medicine Chair, Academic Pain Directors of Canada President, Pain Medicine Physicians of BC Society

2 Declaration of Interests None relevant to this presentation

3 The problem

4 Chronic pain in Canada 1 in 5 Canadians suffer from chronic pain 65% of community dwelling older adults have chronic pain 80% of older adults living in long term care facilities have chronic pain Pain is the most common reason for seeking health care Pain is the presenting complaint in up to 78% of ER visits Chronic pain is associated with the worst quality of life as compared with other chronic diseases such as chronic lung or heart disease The annual cost of chronic pain in Canada is at least CAD 37 billion (more than cancer, heart disease and HIV combined) Lynch ME. The need for a Canadian pain strategy. Pain Res Manag 2011;16(2):77 80

5 Chronic pain and workers 9.7% of Canadians have pain-related disabilities (70% of all disabilities) 22.2% 65 years have pain-related-disabilities Loss of education (47% of years fail to complete G12, cf 25%) Loss of employment (46% of years, cf 73.6%) 44.3% felt disadvantaged if employed (fewer hours worked, more job modifications) Loss of income $21400, cf $31200, worse for women Bizier C et al. Pain-related disabilities among Canadians aged 15 years and older, 2012 Statistics Canada Catalogue no X

6 Chronic pain and seniors Number of working aged Canadians (20-64 years) per senior ( 65 years) 2015: : Population (millions) Year Percentage aged 60+ years Population 60+ years Total population Percentage population 60+ years United Nations, Department of Economic and Social Affairs, Population Division (2015). World Population Ageing 2015 (ST/ESA/SER.A/390).

7 Barriers to the treatment of chronic pain chronic pain is not well understood by physicians, patients or the public the framing of chronic pain only in relation to the opioid crisis is not conducive to long-term solutions there are limitations in existing programs and services for effectively managing (and preventing) chronic pain gaps in health-system arrangements limit the reach and impact of chronic-pain programs and services Waddell K et al. Evidence brief: Developing a national pain strategy for Canada. Hamilton, Canada: McMaster Health Forum, 2017.

8 Lack of knowledge Acute pain is a symptom usually associated with tissue damage a warning signal Chronic pain is a neurological disease often not associated with tissue damage a disorder of signal generation and processing a faulty warning signal, but with often profound, and expensive, consequences

9 Lack of knowledge Chronic pain is real - it s not just in your head! reducing stigma The best decisions are made with the best information inform the public, manage expectations Choosing Wisely Canada pain recommendations are scattered in other specialties Public education programs are effective Buchbinder et al Spine 2005; 30(11):

10 Lack of timely access to safe, effective and affordable care Lack of access to pain drugs variations in coverage across provinces/territories Lack of (affordable) access to non-drug treatments physical and psychological therapies are generally not covered (50+% of direct costs) Lack of access to interdisciplinary care long wait times for few clinics Vulnerable populations are particularly affected young, old, First Nations, co-morbid mental health/addiction, regional and remote populations

11 Lack of timely access to safe, effective and affordable care Requires integration of services within and between provinces/territories integrated pain management services from community to tertiary care Canadian Pain Drug Formulary/Pharmaceutical Benefits Scheme Requires new and/or reallocation of human resources skills training workplace injury prevention, including among healthcare workers

12 Barriers to the treatment of chronic pain: the policy perspective No single organization in Canada is charged with coordinating the many facets of pain management Planning and care are fragmented, leading to an unnecessary duplication of effort and a waste of resources Opportunities to benefit from economies of scale are being lost There is no mechanism for coordinating action, sharing learning and distributing best practices to policy-makers, health professionals, patients and the community at large. Waddell K et al. Evidence brief: Developing a national pain strategy for Canada. Hamilton, Canada: McMaster Health Forum, 2017.

13 The beginning of the solution: The Canadian Pain Strategy

14 What can a Canadian pain strategy achieve? Better care improve community and primary care based chronic-pain management Better prevention/education reduce the emergence of chronic pain and its sequelae (including opioid-use problems) once it has emerged Better research/implementation rapid response to emerging challenges and solutions Better coordination create a Canadian Pain Taskforce Waddell K et al. Evidence brief: Developing a national pain strategy for Canada. Hamilton, Canada: McMaster Health Forum, 2017.

15 The roles of a Canadian Pain Taskforce To identify, engage and co-ordinate stakeholders in developing a Canadian Pain Strategy/Action Plan To promote awareness of the Canadian Pain Strategy and build policy support within Federal and Provincial Governments To achieve Federal and Provincial Government recognition of chronic pain as a chronic disease To identify and build the partnerships, frameworks and resources required to build capacity and deliver proposed outcomes To identify low-hanging fruit set up for success!

16 Can it work? NSW Pain Management Plan was a response to the 2010 Australian National Pain Strategy and the 2012 NSW Pain Management Taskforce s Report. NSW Government allocated $26 million and achieved: improved access to pain services improved patient outcomes pain disability mental health decreased use of opioids in pain clinic patients decreased health care utilisation data/assets/pdf_file/0011/357239/health-consult-aci-evaluation-of-pmp.pdf

17 The role of the Federal Government What are we looking for? We look for leadership and support within the mandates of federal government ministries We look for leadership in co-ordinating the federal and provincial/territorial response to the epidemic of chronic pain We look for financial/administrative support for a Canadian Pain Taskforce Where should we look?

18 Cost of pain: direct and indirect Direct hospital care expenditures physician care expenditures prescription drug expenditures formal caregiving (other healthcare professional expenditures # ) (OTC drug expenditures # ) Indirect lost production due to morbidity lost production due to premature mortality informal caregiving Public Health Agency of Canada # LaLonde L et al J Pain Res 2014; 7:

19 Cost of pain: direct and indirect An analysis of costs assists in the identification of relevant federal government ministries Direct costs (29-34 billion pa) Health Indirect costs (18-26 billion pa) Employment, Workforce Development and Labour Indigenous Services Youth Seniors Veterans Affairs

20 The ask Funding to establish and support a Canadian Pain Taskforce lead by Health Canada Facilitation of discussions with Ministers/senior officials of other relevant federal government ministries

21 Conclusions One in five people in Canada live with chronic pain Access to care is fragmented The status quo is not sustainable personally, provincially or nationally. The time is right for change A Canadian Pain Strategy offers a process to disrupt the status quo A Canadian Pain Taskforce is needed to co-ordinate the development of the Canadian Pain Strategy Improving the quality of life for people living with pain will improve the well-being of the Canada

22 Acknowledgements Prof Norm Buckley Chronic Pain Network Dr John Lavis McMaster Health Forum Prof Michael Cousins AO - painaustralia

23 @DrODWilliamson

Presentation to the Standing Committee on Health Chronic Diseases Related to Aging. October 17, 2011

THE CANADIAN CHIROPRACTIC ASSOCIATION Presentation to the Standing Committee on Health Chronic Diseases Related to Aging October 17, 2011 Prevention as a mean to manage or delay chronic diseases related