Posted February 5, 2009
Life Science

Paradigm shift needed in way chronic pain is managed: McMaster scientist
by Suzanne Morrison

Hamilton - More than 600,000 people in Ontario suffer from chronic pain - back pain, osteoarthritis, painful diabetic neuropathy, persistent pain following shingles, neuropathic pain following accidents and much more. While the pain may be debilitating one moment, gone the next, for most people the pain is constant, never ending.

Health care professionals tend to be bereft when faced with the medical need to ease the pain, as tools are lacking to accurately diagnose the severity of the pain, and tools are limited in terms of easing the pain. Some prescribe medicine, but for many sufferers the pain remains undertreated or untreated. Caregivers often believe that nothing more can be done. So, chronic pain suffers endure their pain in silence day and night while exasperated family and friends keep reminding them they "look normal."

James L. Henry, scientific director of the Michael G. DeGroote Institute for Pain Research and Care at McMaster University, calls it an "invisible epidemic."

In a paper in a recent issue of Pain Research Management, the official journal of the Canadian Pain Society, Henry stressed the need for a paradigm shift in the way chronic pain is managed.

"It is now critical to accelerate the capture of benefits from research for Canadians through improved health, more effective and responsive services and products, and a strengthened health care system to bring about health reform and health care reform across Canada as it pertains to the one in five Canadians living with chronic, disabling pain," he wrote.

The first step, he said, is "to recognize pain as a disease." He argues chronic pain has been assigned a "secondary role." For example, when a patient says their knee hurts, their doctor focuses on joint disease rather than finding a means to treat their chronic pain.

"The important first step is to recognize pain as a chronic disease and then develop strategies based on pain management principles," Henry said.

Rather than the current acute care approach, Henry believes patients would derive more benefit if chronic pain is seen, and treated, as a bio-psycho-social health issue.

"It's one thing to treat pain, it's another to cope with pain," he said. "Some patients benefit greatly from counseling programs. We need to focus on treatment outcomes, such as quality of life and life habits, and whether or not chronic pain patients are able to regain social interactions with others."

The emphasis in Henry's paper on the need to change the way the health care system manages chronic pain was strongly endorsed by Dr. Mary E. Lynch, president-elect of the Canadian Pain Society, and director of research of the Pain Management Unit, Queen Elizabeth 11 Health Sciences Centre, in Halifax.

"He argues persuasively that a chronic disease management model is the direction we must take," she said in an editorial in the journal. Lynch added new initiatives for change by the Canadian Pain Society "will only be successful on a national level if we adopt the approach presented by Henry - namely, system-wide strategic action."

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