When Jeanine McDonald heard a pop in her low back as she bent down to pick up a lid from a box, she had no idea she’d ruptured a disc and would wait three months for surgery. Then a second disc ruptured and left her in more debilitating chronic pain, the kind that millions of Canadians live with daily.
In McDonald’s case, a condition called cauda equina syndrome, involving a bundle of spinal-cord nerves, causes severe neuropathic pain in her lower legs and feet, forcing her to wear leg braces and forearm crutches so she can walk.
Her neurosurgeon told her there’s no known reason why the two discs ruptured three years apart, in 2005 and 2008, leaving her able to work only one day a week for a non-profit organization helping families of special-needs kids.
“There’s super sharp pins-and-needles type of pain and what I call fire feet, which is a burning type of pain that happens,” McDonald said. “And there’s what I refer to as Charlie horses on steroids. You have to find humour in it or you just lose your mind.”
McDonald spent two years in search of a specialist who prescribed her current cocktail of medications including opioids so she could function. She also gets treatment from a physiatrist, a doctor who specializes in conditions including those affecting the spinal cord, and counts on support from a patient-advocacy and health professionals’ group called PainBC.
It’s considered the most patient-focused group in the country among several organizations that are pushing for a national pain strategy, which would see the federal government establish a framework for provinces and territories to deliver programs addressing awareness, education for health professionals, early access to care and research.
Dr. Fiona Campbell, president-elect of the Canadian Pain Society consisting of clinicians, patients and educators, said groups involved in chronic-pain initiatives, including in British Columbia, Ontario, Quebec, Saskatchewan, Alberta and Nova Scotia, want better services for acute pain as well, before people develop chronic pain, which changes the central nervous system and could affect mental health.
The society announced a national pain strategy at a summit in Ottawa in 2012 but the federal government did not adopt it.
“We’re now at what one might call a tipping point, where the ducks are aligning,” said Campbell, an anesthesiologist and co-director of the Pain Centre at the Hospital for Sick Children in Toronto.
“There’s more of an appetite and awareness about pain, which has probably arisen related to the opioid crisis, which is not the same as saying all people with chronic pain are taking opioids or affected by the opioid crisis. It just means it’s become more sentient in the public mind.”
Dr. Norman Buckley, scientific director of the Michael G. DeGroote Institute for Pain Research and Care at McMaster University, also heads the Chronic Pain Network through a five-year funding arrangement with the Canadian Institutes of Health Research. He said the aim is to train researchers and translate that knowledge into policy action.
“Guys come in, they sit in my office and cry because they can’t pick up their grandchildren,” Buckley said of patients with back pain, one of the most common chronic-pain conditions, along with arthritis.
While groups including PainBC and SaskPain are working to get provincial funding for multidisciplinary pain clinics, Quebec leads the country with a strategy that incorporates care as well as research.
Jacques Laliberte, immediate past president of the Quebec Association of Chronic Pain Patients, said that in 2010, the province established centres of expertise at hospitals linked with four of its universities before creating regional centres to provide chronic-pain services.
“Our main activity right now is to have support groups throughout the province of Quebec and we have about 17 of them,” said Laliberte, who nearly broke his neck in a snowboarding accident in 2003 before taking on the role of leading the association he helped form at the urging of a doctor.
More regional centres are needed in Quebec, Laliberte said, adding: “We’re still striving to get chronic pain understood by decision makers.”
In Ontario, the provincial government enhanced funding in 2016 for its current 18 multidisciplinary clinics as part of a pain management plan that includes a strategy to prevent opioid addiction. It also expanded training for primary care providers via case-based learning and video-conferencing sessions to manage chronic pain, the province’s Health Ministry said in a statement.
“A data-driven national pain strategy would help inform ministry work in Ontario,” it says.
Dr. Owen Williamson, president of the Pain Medicine Physicians of B.C. Society, said chronic pain affects one in five Canadians, many of whom develop anxiety and depression.
“There’s more disability associated with chronic pain than with hypertension, diabetes, HIV and even cancer,” he said.
“It’s a $60-billion drain a year on our economy,” said Williamson of visits to doctors’ offices, emergency-room and surgeries.
Williamson, who treats patients at a clinic in Surrey as part of a team of health-care providers including physiotherapists, psychologists and social workers, said Australia has led the way with its national pain strategy.
“For example, in New South Wales, they’ve shown greater access to pain management services, pain and disability outcomes are better, the use of opioids has been reduced, deaths through suicide are reduced and there’s been a reduced impact of the cost of managing pain.”
Canada needs “political champions” in order to create its own pain strategy, he said.
Health Canada has not committed to any action. It said in a statement it’s aware of “recent calls for a national pain strategy, including those proposed by the Chronic Pain Network and the Canadian Pain Society, and understands the importance of a responsible approach to pain management for Canadians.”