More needs to be done to treat chronic pain

August 04, 2016

When it comes to government funding announcements, one issued on July 18 managed to fly under the radar screen, receiving little media attention, with no mention in newspapers, radio or television.

Perhaps this was because it was an insignificant amount of money. Indeed, with a provincial health budget of $18 billion, awarding a mere $50,000 doesn't exactly stop the presses.

For thousands of British Columbians however, there is something quietly satisfying in the announcement from Health Minister Terry Lake: "$50,000 for Pain B.C. summit with focus on strategy for treating chronic pain," read the headline of this press release. This is not a lot of money. But as a physician dealing with patients in chronic pain every day, I found it an encouraging sign that perhaps the province is awakening to issues surrounding this invisible illness. As many as one in five British Columbians struggle daily with chronic pain.

For many of my patients, this is manifest as migraine headaches. Migraine is one of the most common diseases in the world, more prevalent than diabetes and asthma combined, and the direct and indirect cost of migraine in Canada has been estimated at more than $700 million annually. Particularly incapacitating is chronic migraine, which is a throbbing, debilitating headache that can last 15 or more days a month. Can you imagine living with a painful headache most of your life?

Yet in British Columbia, about 30,000 patients suffer with chronic migraine. These patients require significantly more healthcare resources, with frequent visits to emergency departments, primary-care doctors and pain clinics, sometimes culminating in hospitalization. All of this suffering costs us, the taxpaying funders of our health-care system, tens of millions of dollars a year.

Unfortunately, patients are often misdiagnosed as having migraine, and at other times can be inappropriately treated with prescription narcotic painkillers. This is a dangerous and slippery road that can be counter-productive. Further, many chronic pain sufferers in B.C. are addicted to prescription narcotics such as Oxy-Contin, a common and unfortunate scenario that, rather than curing the pain of migraine, actually makes the headaches worse. These so-called "medication-induced headaches" make effective treatment more problematic. Fortunately, through education, careful diagnosis and proper treatment, there is a brighter future for afflicted patients. For chronicmigraine patients, relief does not come in a pill bottle, but from specific and highly effective treatments such as Botox injections, administered by trained neurologists with a comprehensive knowledge of the disease process. Botox, or botulinum toxin, is the only Health Canada-approved treatment for the prevention of headache in adults with chronic migraine. The treatment works by interrupting certain pain pathways involving the nerve cells associated with migraines. For appropriately selected migraine patients, this one treatment can bring welcome relief of pain and disability for several months. With this treatment, patients will enter my office in pain, and leave with a smile.

The injections significantly reduce the frequency, severity and duration of headaches for months at a time with minimal side-effects, and allow patients to resume lives less burdened by debilitating pain. For a physician, that is worth a million dollars. Unfortunately, this treatment is not currently publicly funded in B.C. as it is in Alberta, Ontario and Quebec. There are concerns the treatment is too expensive; yet what is the cost of painkiller overuse, unwarranted visits to hospitals and, most importantly, unchecked disability? Consider also the reduction in quality of life, loss of economic productivity and so on.

That said, we can surely do more in B.C. to assist people living with chronic pain. We can reduce suffering, improve patient outcomes and, I hope, reduce health-care spending. The government's $50,000 in funding won't solve all these problems, but it is a symbolic start to an important conversation on reducing the stigma of chronic pain, employing better diagnostic and therapeutic techniques to treat pain, and extending proper supports to doctors and patients engaged in this condition.

And that must be a good thing for all of us.

Dr. James Scott is a neurologist practising in Victoria. See the original article here: 

Times Colonist Logo

Times Colonist (Victoria)

Dr. James Scott