let's talk about chronic pain

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Let’s Talk About Chronic Pain in BC

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Page 1: Let's Talk About Chronic Pain

Let’s Talk About Chronic Pain in BC

Page 2: Let's Talk About Chronic Pain

Presenter Disclosure

Speaker’s Names: Maria Hudspith and Jen Hanson

Relationships with Commercial Interests:

•Grants: Pain BC has received unrestricted grants from Purdue Pharma as

well as from personal injury law firms; in 2016, this accounted for less than 4

% of our annual operating budget

•Honoraria: None

•Consulting fees: None

Page 3: Let's Talk About Chronic Pain

Managing Potential Bias

Pain BC is governed by a Sponsorship and Funding policy that:

•Prohibits representatives from industry from serving on our Board of Directors

or otherwise being involved in governance

•Prohibits commercial activities at any of our educational or public awareness

events

•Prevents industry or commercial influence in any aspect of our organization,

including communications and educational programs

Page 4: Let's Talk About Chronic Pain

Pain BC - Who We Are

• Collaborative NGO – comprised of patients, clinicians, researchers

and other supporters

• Mission: improving the lives of people in pain through empowerment,

education and innovation

• Partnerships are the cornerstone of our work – health authorities,

regulatory bodies, MoH, other NGOs, health professional

associations, business leaders

• Ministry of Health funding – Patients as Partners, Community Grants

Page 5: Let's Talk About Chronic Pain

Pain BC’s Strategic Plan 2015 - 2018

1. Promote prevention and early intervention in chronic pain and

pain-related disability

2. Educate, promote skill development and build hope and

confidence among people in pain and their families

3. Empower health care providers with the education, tools and

skills they need to improve the lives of people in pain

4. Facilitate planning, action, evaluation and innovation leading

to system change

5. Engage a cross-sectoral coalition to raise awareness of

chronic pain and reduce the stigma associated with it

6. Foster pain and pain-related disability research

Page 6: Let's Talk About Chronic Pain

What is Chronic Pain?

• Pain is an unpleasant sensory and emotional experience associated with

actual or potential tissue damage, or described in terms of such damage.

International Association for the Study of Pain (1979)

• May start with an acute pain experience (injury, illness or surgery) or

result from another condition (e.g., arthritis, diabetes, heart disease, HIV)

• Typically pain that lasts longer than 3 months

• “Software vs hardware” issue – the role of the brain and nervous system,

not just tissues or joints

• Some people “at risk” - emerging evidence on trauma, ”catastrophizing”

• A chronic condition in and of itself – not just a symptom of something else

• Highly personal and subjective - makes it difficult to measure “objectively”

Page 7: Let's Talk About Chronic Pain

What Does the Evidence Say?

• It affects 1 in 5 in the population (21.8 % of population in BC)

• It’s a biopsychosocial problem – requires a biopsychosocial

approach

• Prevention and early intervention are essential to improving

outcomes and limiting pain-related disability

• Improving function should be the primary goal – shift the

discourse on “pain killers”

• Self management is one of the gold standards – patients must be

supported to co-manage their condition

• Significant role for interdisciplinary care – needs to be

appropriately funded and coordinated

Page 8: Let's Talk About Chronic Pain

Karen’s Story

Page 9: Let's Talk About Chronic Pain

Impact on People and their Families

Page 10: Let's Talk About Chronic Pain

Breaking the Pain Spiral

Page 11: Let's Talk About Chronic Pain

Live Plan Be: www.liveplanbe.ca

Page 12: Let's Talk About Chronic Pain

About Live Plan Be

• Free, online tool for pain self-management

• Accessible to anyone with an internet connection (all devices)

• Evidence-based: latest research and resources

• Created by Pain BC in partnership with people in pain, health care providers

and funded by the BC Ministry of Health

• Launched in April, 2016, constantly updated with new resources

#eHealth

Page 13: Let's Talk About Chronic Pain

Key Content & Functionality

1. Manage my Pain

a) Self Assessments

b) Brief Action Planning

2. Pain Education

3. Real Stories

4. Discussion Forum

Page 14: Let's Talk About Chronic Pain

1. a) Manage My Pain: Self-Assessment

Page 15: Let's Talk About Chronic Pain

1. b) Manage My Pain: Brief Action Planning

Page 16: Let's Talk About Chronic Pain

2. Evidence-based Pain Education

Page 17: Let's Talk About Chronic Pain

3. Real Stories

Page 18: Let's Talk About Chronic Pain

4. Discussion Forum

Page 19: Let's Talk About Chronic Pain

Live Plan Be Help Videos

• Learn how to use Live Plan Be

• Find them on the homepage

Page 20: Let's Talk About Chronic Pain

Pain BC’s Connect for Health

• Call toll-free 1-844-430-0818

[email protected]

• Self-referral form

• Provider referral form

Page 21: Let's Talk About Chronic Pain

Pain BC’s Connect for Health

Issues that

can’t be

addressed in a

doctor’s visit

Providers or

caregivers can

refer others

too

Volunteers

conduct intake,

identify needs and

follow up with

individualized help

Personalized

help to access

services

outside the

medical system

People in pain

can call toll-free,

email or

complete

self-referral form

Completely

confidential

Page 22: Let's Talk About Chronic Pain

Impact of Pain on the Health Care System

• Pain is the most common reason for seeking health care

• 10 GP visits per year vs 3.8 national average

• 2 X hospital admissions

• More (and often unnecessary) medications and procedures

• 28% of ER visits due to chronic pain; response is often inadequate

and stigmatizing

Despite this investment, chronic pain is

associated with the worst quality of life

compared to other chronic diseases (Choiniere, Dion et al,

2010)

Page 23: Let's Talk About Chronic Pain

Chronic Pain and the Opioid Crisis – How Did We Get Here?

• Provider and patient expectations – “a pill for everything”

• Two decades of aggressive marketing of opioids for chronic, non

cancer pain

• Inadequate education for prescribers and patients

• Lack of knowledge translation – best evidence not informing care

• Lack of a “system of care” = over-reliance on the prescription pad

• Lack of robust monitoring systems

• Poor surveillance and lack of data

• Reduction in supply of prescribed opioids impacting supply chain in

the illicit drug market

Page 24: Let's Talk About Chronic Pain

The Pendulum Swing

• CPSBC Standards and Guidelines resulting in patients being denied

access to pharmacological pain care

• Only medical regulator in Canada to adopt legally binding standards

• Lack of guidance for physicians on safe weaning and different approaches

needed for different patient situations; patients suffering, losing ability to

function

• Conflation of medical opioid issue and illicit fentanyl issue

• New national guidelines announced end of January

• New opioid substitution guidelines announced in BC

Page 25: Let's Talk About Chronic Pain

Ministry Priorities and Chronic Pain

Seniors: Prevalence increases with age; as high as 65 % in community dwelling

seniors and 80 % of those in residential facilities; high numbers of “legacy patients”

among them

Mental Health and Substance Use: 4 X as likely to experience depression and

anxiety; 2 X as likely to commit suicide; evidence suggests between 8 to 12% of

people using opioids for pain will develop addiction – comparable to prevalence of

addiction in the general population; undertreated pain is a gateway to illicit drug use

Rural and Remote Communities: Few resources, travel barriers, suboptimal

outcomes for patients

Surgical Patients: Acute to chronic in 10 – 50 % of surgical patients (severe in 2-10

%); 9 % of patients on pain clinic waitlists are there for post-surgical chronic pain

Primary Care Homes: Estimated that 80 % of patients could be appropriately cared

for by primary care providers

Page 26: Let's Talk About Chronic Pain

Health Authority Pain Programs in BC

Island Health

2 hospital clinics (NRGH and RJH) 1

community clinic

VCH

St. Paul’s Pain Clinic

Fraser Health

Surrey Memorial Clinic

Northern Health

Implementing new regional pain strategy + Northern Partners in

Care pilot

Interior Health

Plan not yet implemented

Page 27: Let's Talk About Chronic Pain

Other Pain “Infrastructure” in BC

New Pain Medicine

Residency (UBC)

Private rehabilitation

clinics

Private pain clinics

Pain BC

GPSC Practice Support

Program for GPs

Self Management

BC

Page 28: Let's Talk About Chronic Pain

Provincial Strategy – Ontario

New provincial strategy for pain and addictions includes:

Modernizing opioid prescribing and monitoring (quality standards, training

for prescribers, patient education, monitoring of prescribing and overdoses,

delisting of high dose opioids, patch-for-patch program)

Investing ($17 M annually) in Pediatric and Adult Chronic Pain Clinical

Network – cut waitlists from 2-3 years to 6-8 weeks plus Project ECHO and

Transitional Pain Service to prevent post-surgical chronic pain

Enhancing addiction supports and harm reduction (access to Naloxone

and Suboxone, indigenous mental health and addiction supports, primary care

integration. May include supervised injection sites and other harm reduction

efforts)

Page 29: Let's Talk About Chronic Pain

Momentum for Action

• People in pain finding their voice

• Health care providers and administrators calling for action

• Consistent and increasing media attention

• CIHR Chronic Pain SPOR announced – March 2016

• BC Overdose Response and CPSBC Standards and Guidelines – Summer 2016

• CIHR National Pain Research Summit – September 2016

• National Opioid Summit – November 2016

• New National Opioid Guidelines – January 2017

• Provincial Pain Summit – February 2017

• Efforts to re-ignite a National Pain Strategy – led by Arthritis Society and Canadian Pain

Care Forum

• Significant effort and/or investment in some provinces

Page 30: Let's Talk About Chronic Pain

A Foundation to Build On…

Consensus emerging!

Chronic pain is key to all 5 Ministry priorities

Significant number and diversity of stakeholders already engaged

Some Health Authority programs to build on

Self management programs are available

Opioid crisis generating awareness and will…

Networks of clinicians with foundational training

Everyone has a role to play: policy makers, clinicians, patients and

families, administrators, researchers, NGOs

Page 31: Let's Talk About Chronic Pain

Questions, Comments, Reflections

Thank you!

Maria Hudspith, Executive Director, [email protected]

Jen Hanson, Director, Education and Engagement, [email protected]

Karen Hakansson, Member, Expert Patient Advisory Committee and

Education Volunteer, [email protected]