September is International Pain Awareness month. This month we highlight the importance of a multidisciplinary and individualized approach to pain management.

What is Chronic Pain?

Chronic pain is pain that continues or recurs for more than three months. Chronic pain may be either primary (not attributed to another diagnosis) or secondary (a symptom of an underlying health condition). Although it may be seen as a symptom, the World Health Organization recognizes chronic pain as a disease in its own right in the eleventh version of the International Statistical Classification of Diseases and Related Health Problems, which came into effect in 2022.

Why is it Important?

The Canadian Pain Task Force describes chronic pain as “a public health emergency in need of action.” As of 2019, an estimated 7.6 million people across Canada – one in five Canadians – were living with chronic pain. As a result of population growth and aging, that number is expected to reach as many as 9 million Canadians by 2030 – an increase of 17.5 percent.

Chronic pain negatively affects patients’ lives in many ways:

• decreased

quality of life

;
• Reduced productivity;
• Exacerbation of chronic disease;
• Worsening mental health (e.g., depression and anxiety, increased risk of suicidal ideation and suicide).

Chronic pain also has a significant economic impact. Health Canada estimates that in 2019 alone, the combined direct and indirect cost of chronic pain was between $38.2 and $40.3 billion. In 2030, that number is estimated to grow to between $52 and $55 billion – a total increase of 36.2 percent from 2019.

Finally, the COVID-19 pandemic has led to increased pain and disability for people living with chronic pain, and has created disruptions in healthcare that have reduced access to support and treatments that help to maintain their quality of life.

Management of Chronic Pain

Evidence and clinical experience suggest that any approach to management of chronic pain should be individual, multimodal, and multidisciplinary.

An Individual Experience

Pain is subjective and multidimensional, incorporating sensory, emotional and cognitive components: where the pain is felt in the body, and the intensity of that sensation; the unpleasantness of the experience; and how a person interprets and reacts to the pain (for example, with fear or anxiety). Pain is also highly personal, influenced by a myriad of factors unique to each person. Pain is thus a profoundly individual experience. There is no “one size fits all” solution to management of chronic pain; instead, treatment should be tailored to each patient’s particular needs, experience, and circumstances.

Multimodal Intervention

Chronic pain is complex; a single intervention is rarely enough to reduce patients’ suffering and improve their quality of life. Instead, it is best addressed by a multimodal approach that takes into account the various aspects of the patient’s experience of chronic pain: physical, cognitive, psychological, and behavioural.

Treatments for chronic pain range from traditional and non-traditional pharmacotherapy through physiotherapy and psychological support to interventions such as intrathecal therapy, neurostimulation and radiofrequency ablation. Complementary and alternative medicine may also play a role.

A Multidisciplinary Team

The diverse facets of chronic pain suggest that patients should be treated by a multidisciplinary team. Patients are more likely to receive an accurate diagnosis and to benefit from interventions tailored to their particular needs. Such a team usually includes three physicians (for example, a primary care physician, an anesthesiologist or pain specialist, and a psychiatrist) and several other healthcare providers. The members of the larger team will vary according to the patient’s particular health condition and circumstances, and may include specialists, pharmacists, physiotherapists, dietitians, complementary therapists, occupational therapists and medical social workers.

The benefits of this approach include diagnosis of pain at an early stage, a wide range of treatments, the opportunity for the patient to discuss interventions with appropriate healthcare providers, and continuity of care. Research has consistently shown that multidisciplinary pain treatment leads to reduced pain intensity. Other benefits of this approach include improvement in physical function, quality of life, emotional stress, and behavioural outcomes.

Chronic pain in primary care

While the evidence shows that multidisciplinary pain clinics are clinically and economically effective, waiting lists are long (up to 18 months). As a result, primary care clinicians may find themselves taking on a lead role in pain care for patients with chronic pain.

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