let's talk about chronic pain
TRANSCRIPT
Let’s Talk About Chronic Pain in BC
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
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
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
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
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”
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
Karen’s Story
Impact on People and their Families
Breaking the Pain Spiral
Live Plan Be: www.liveplanbe.ca
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
Key Content & Functionality
1. Manage my Pain
a) Self Assessments
b) Brief Action Planning
2. Pain Education
3. Real Stories
4. Discussion Forum
1. a) Manage My Pain: Self-Assessment
1. b) Manage My Pain: Brief Action Planning
2. Evidence-based Pain Education
3. Real Stories
4. Discussion Forum
Live Plan Be Help Videos
• Learn how to use Live Plan Be
• Find them on the homepage
Pain BC’s Connect for Health
• Call toll-free 1-844-430-0818
• Self-referral form
• Provider referral form
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
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)
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
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
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
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
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
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)
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
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
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]