May 22, 2010, Kitchener, Ontario
Posted by: Robert Deutschmann, Personal Injury Lawyer
As reported in the Waterloo Region Record:
New guidelines for chronic pain management with medication
May 07, 2010
Waterloo region Record
WATERLOO REGION — A Kitchener advocate for people suffering with chronic pain is hopeful new Canadian guidelines for prescribing opioids will help more people get the care they need to live better.
“Right now in Canada, pain is grossly misunderstood,” said Lynn Cooper, president of the Canadian Pain Coalition.
Avoiding under-prescribing as well as the abuse of strong pain medications such as Percocet and OxyContin are the goals of new national guidelines about the use of opioids for chronic non-cancer pain published Monday in the Canadian Medical Association Journal as well as online and publicly accessible by a new national pain centre in Hamilton.
Cooper said there’s not enough education for doctors about chronic pain and, as a result, it’s undertreated. The public also has little knowledge, which means they don’t push for proper treatment to get pain under control.
“The guidelines, we hope, are going to be able to promote better interaction between patients and their health care provider,” said Cooper, who suffers from chronic pain after a back injury.
It’s important for both doctor and patient to consider the benefits and side-effects before starting opioid therapy because, she said, “this is not anything someone should take lightly.”
Cooper worries the guideline’s focus on addictions may cause some doctors to be more hesitant about prescribing opioids to their patients.
“There is enough fear,” she said.
Dr. Norm Buckley, director of the pain management centre at Hamilton General Hospital, agrees that many doctors have “opioid phobia” — the fear patients will become addicted or misuse the powerful medication, which can have deadly consequences.
But, at the same time, there’s been huge jump in the prescribed use of opioids in Canada — with a 50 per cent increase in prescriptions between 2000 and 2004. Canada is now the world’s third largest opioid consumer per capita, according to the paper.
The new guidelines, developed by a committee formed by the colleges of physicians and surgeons in provinces across Canada, take doctors step-by-step through assessing patients, determining the best medication and dosage and how to monitor the effectiveness as well as look for signs of misuse.
Clear directions will hopefully make family doctors more comfortable managing pain with opioids. Buckley said doctors unsure of opioid prescribing commonly refer patients to pain centres, including the Hamilton one where Waterloo Region residents are sent, and they’re put on lengthy wait lists — often stretching more than a year.
Pain expert Dr. Roman Jovey said people suffering with long-lasting pain who could benefit from opioids are overshadowed by fears of overdoses and addiction.
“Under-treated pain is a far bigger problem than the misuse of opiates,” said Jovey, medical director of the Centres for Pain Management with 10 locations across Canada primarily in the Toronto area.
“People with pain shouldn’t be the victims of our desire to stomp out the misuse of opiates.”
He was on the expert panel that reviewed the guidelines, which depend primarily on expert experience rather than scientific evidence because little exists.
“Pain is such a new discipline,” Jovey said. “Right now it’s more art than science.”
He said there are also few resources in the province — no multidisciplinary clinics, the few pain management centres that exist are overwhelmed, and the government doesn’t recognize chronic pain as a disease.
Posting the guidelines on a public website was the first big project of the new Michael G. DeGroote National Pain Centre at McMaster University, started early this year with a $1.5 million donation with the intention of identifying best practice guidelines and making them accessible.
Although chronic pain often starts from disease or injury, Buckley said, “sometimes the pain itself becomes the primary problem.”
Cooper wants to believe the new guidelines will provide better understanding of chronic pain and how to treat it to vastly improve the lives of those people burdened by long-lasting pain.
“We’re very hopeful that this is what’s going to happen — Canadians are going to get better care for their pain and their suffering is going to be reduced