Solving our pain problem
There is growing concern in the health care community about increasing incidents of prescription painkiller addiction and related deaths, and the significant toll it's taking on the health care system.
I'm not getting into a lengthy rant about what led us to this crisis. Much has already been written and said about the overprescription of opioids by medical doctors with little to no evidence of efficacy. Doctors have acknowledged the role they played in what observers are now calling a public health crisis.
"We've been over-prescribing and we need to reset this," Dr. Gordon Wallace, managing director of the Canadian Medical Protective Association, told The Canadian Press in a recent interview.
Acceptance is the first step in the addiction recovery program. Ironically, the medical profession and the whole health-care system hierarchy would do well to heed this recommendation if a more sustainable and effective approach to solving the country's pain problems is to be achieved. Accept that we have a pain problem and that the solution requires a comprehensive, integrative and multidisciplinary approach.
While there is very little evidence about the effectiveness of opioids in long-term pain treatment, there is growing data that points to a coordinated, interprofessional approach to chronic pain management. The College of Physicians and Surgeons of Ontario recognized this in its 2010 report, "Avoiding Abuse, Achieving a Balance: Tackling the Opioid Public Health Crisis," in which it cited the insufficient training of medical doctors in pain and addiction management, and the need for "strong linkages" between family physicians and other health care providers for interprofessional care to be effective.
That report was released six years ago. The opioid abuse crisis has now reached critical level and public spending on programs for treatment of prescription painkiller and opioid addiction reached nearly a billion dollars in 2014 alone, The Globe and Mail reports.
This topic is expected to be on the agenda of the Canadian Medical Association's annual conference in Vancouver this week. That's well and good, but real change will happen when there is genuine effort toward inclusiveness – where all health-care disciplines with respective, evidence-based expertise in chronic pain treatment and management as well as addiction management are brought to the table. Understanding each health discipline's role in the pain management paradigm will be a big step in the right direction.
The power of interprofessional health care is being demonstrated everyday in certain segments of health care. One recent example is the Ontario Primary Care Low Back Pain Pilot project, which established a program for a team-based, multidisciplinary approach to treatment and management of low back pain. Health practitioners and patients who were involved with the pilot project have reported positive outcomes. It is an eye-opening experience for some of the health practitioners as they begin to understand the role allied health disciplines play in pain management and witness the power of patient-centred, collaborative model of care.
Merely reducing the number of opioid prescription is not going to solve this emerging health care crisis. The fact remains that one in five Canadian adults suffer from chronic pain and they want their health experts to alleviate their suffering and restore function. Our health-care professionals must work collectively and in concert toward effective, sustainable and evidence-based treatment protocols that include both pharmacological and non-pharmacological approaches, exercise and self-care regimens.
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