What is chronic pain?
“Chronic pain” is a generally defined as constant or intermittent pain that persists for longer than three to six months after initial onset. It extends well beyond the normal time expected for healing of tissue, and is distinct from what we call “acute pain” in that it is no longer behaving like the defensive warning system that helps to protect our bodies from harm. In fact, in chronic pain patients, changes to the structure, chemistry and function of their nervous systems at the cellular level cause the ‘symptom’ of pain to evolve into a disease in its own right.
How is chronic pain different from a “normal” (acute) pain response?
In the early stages it may not be easy to make this distinction. However, over time clear patterns emerge that are common to most patients with chronic pain:
- Pain persists for longer than 3-6 months, or longer than the predicted time for tissue healing after injury;
- Pain is often disproportionate to an initial triggering event (injury, trauma) in both scope and duration, or may not have an obvious triggering event at all;
- Pain is felt in a part of the body unrelated to an initial triggering event;
- The pain does not respond very well to over-the-counter pain medications;
- The pain may be felt with a combination of sensations, including numbness, tingling, burning, and ‘pins and needles’;
- Visible changes may also occur, such as swelling or colour changes in an affected limb, and;
- The pain may be intermittent or constant; it may be associated with certain movements or activities, or may be completely unpredictable. This is in contrast to an episode of acute pain, which is generally constant and predictable, but generally lessens over time from the initial triggering event.
How common is chronic pain?
Studies from around the world demonstrate that approximately 20% of the general population suffers from chronic pain. A Canadian pain study (2002/2003) found that chronic pain occurs in between 17% to 35% of Canadians, with rising incidence as our population ages.
What causes chronic pain in some, but not others, given similar/same circumstances?
Chronic pain is considered a ‘biopsychosocial’ illness with a complex mix of biological, genetic, psychological and social factors all contributing to its make-up. A genetically vulnerable individual with certain psychological traits who suffers a particular physical injury may be more likely to enter the ‘chronic pain spiral.’ However, we still cannot predict with any certainty which patient with acute pain will go on to become part of the 20 – 30% that research shows will develop chronic pain.
Does chronic pain involve increased sensitivity to touch?
It can. In some types of chronic pain (i.e. neuropathic pain) the chemical and physical rewiring of the central nervous system can result in commonplace contacts (such as pricking with a pin or brushing the skin with a soft brush) to be experienced as very painful by the patient.
Can chronic pain have psychological causes?
True “psychogenic” pain is quite rare and requires a very experienced pain psychiatrist to diagnose. Much more frequently, there are psychological factors that complicate or exacerbate the experience of the patient with most chronic illnesses – including chronic pain. Therefore, part of the assessment and treatment of patients with chronic pain often involves addressing psychological factors (i.e. pain-related fear or avoidance behaviours).
However, while it is clear that psychological factors contribute to the experience of chronic pain, it is a mistake to confuse them with the cause of the diagnosis. Chronic pain is real, and scientific evidence clearly exists to show it is not simply a figment of the patients’ minds.
Why are so many chronic pain patients misdiagnosed or under treated?
Understanding about chronic pain is still evolving in Canadian society, and more to the point, within our healthcare community. Medical training even today does not sufficiently equip most healthcare professionals to truly understand chronic pain as a multidimensional problem with no single root cause. While much more is now known about chronic pain from scientific, clinical, and societal perspectives, there is a clear lack of broad transmission of this knowledge. This is why CPM is supporting initiatives to increase education and awareness about chronic pain among medical professionals, patients, and the general public at risk for developing chronic pain.
Are all patients with chronic pain who take pain medications at risk for addiction?
No. Addiction is a complex “biopsychosocial” process, including significant psychological and behavioral factors, as well as genetic and environmental ones. In true addiction, affected individuals begin to use drugs in a manner that has negative impacts on their lives, rather than medically beneficial ones. Addiction is characterized by the “4Cs”:
- Loss of Control;
- Compulsive use;
- Craving, and;
- Consequences (or use despite harm).
Addiction is thought to occur in patients with chronic pain in the same proportion as the general population (approximately 7-10%). Consequently, while it’s true that a patient with risk factors for addiction could develop addictive behaviors when prescribed an opioid medication for pain, it’s also true that someone with no risk factors is very unlikely to develop addiction to prescribed opioids even in high doses. This is why it is so important for physicians to proactively do addiction risk screening as part of the comprehensive assessment process of chronic pain patients.
Addiction is often mistakenly confused with “physical dependence”, which is the process where the body begins to adapt to the regular use of a specific medication – this adaptation is termed as developing ‘tolerance’ to the drug. This is a physiological process, and is not the same as addiction.
However, in order to safely discontinue a drug upon which a patient has developed a physical dependence (and avoid the physiological response of ‘withdrawal’), the dose must be gradually reduced or ‘weaned’ from use over a period of time. Once this weaning process is completed, the patient does not display drug-seeking behaviours or the ill effects associated with addiction.
How much does chronic pain costs the healthcare system and society as a whole?
Chronic pain has been called a “silent epidemic” by a leading expert in the field. The National Health Population Survey 1996-1997 estimated that chronic pain costs the economy approximately $14,744 per affected person per year. However, this fails to consider the greater cost (in lost wages, productivity, social welfare costs, and quality of life) of those patients who receive no treatment or inadequate treatment.
The International Association for the Study of Pain (IASP) estimates the true social cost of chronic pain to be equivalent to that of cancer or cardiovascular disease. This is supported by additional international research which showed, for example, that in Denmark chronic pain patients lost twice as many work days and were 7 times more likely to quit their job for health reasons than the general population. They also had twice as much contact with healthcare professionals and made 25% more use of healthcare resources.
A recent U.S. study calculated that painful conditions cost the U.S. economy an estimated $60 billion per year in health care costs and lost productivity. An application of the generally accepted “10%” rule would translate this to an approximate $6 billion annual cost to the Canadian economy. As our population ages and the incidence of chronic pain in the general population rises as projected, the costs will increase dramatically.
How do I obtain treatment at CPM Centres for Pain Management?
All referrals must be made by your family physician or a nurse practitioner.
CPM Centres for Pain Management provide a multi-disciplinary approach to the treatment of chronic pain.
We work carefully with each patient and the referring physician/nurse practitioner to develop an individual and comprehensive treatment plan that will produce the best possible results.
Due to the many complex pre-disposing conditions that exacerbate chronic pain as well as requirements for follow-on care, patients are accepted for consultation and treatment at one of the CPM Centres only on referral from their family physician or a nurse practitioner. As a pre-condition of referral, the family physician/nurse practitioner must sign the referral form indicating that it is their intention to resume caring for their patient once their treatment regime in completed.
What types of chronic pain conditions are treated?
Our CPM physicians treat referred patients who suffer from non-cancer chronic pain, including:
- Arthritis and musculoskeletal pain;
- Back pain;
- Motor vehicle or work related injuries;
- Chronic headaches;
- Sports injuries;
- Shoulder and arm pain;
- Head and neck pain;
- Whiplash related injuries;
- Post-surgical pain syndromes;
- Myofascial pain;
- Neuropathic pain;
- Cervicogenic headache;
- Complex Regional Pain Syndrome (CRPS);
- Trigeminal neuralgia;
- Diabetic neuropathic pain, and;
- Post-shingles neuropathic pain.
Are the treatments offered by CPM covered under OHIP?
All CPM Centres for Pain Management patient treatments are covered under OHIP. Exceptions include for botox injections for migraines, viscosupplementation injections, pain medication/narcotics and rehabilitation services (exception for physiotherapy for those who are aged 65 or over, 19 or younger, post-hospital admission, and those who are on Ontario Disability Support Program or Ontario Works).
What can I expect once my referral is sent into CPM?
Once your family physician or a nurse practitioner has sent our completed referral form to our Central Intake department, your referral will be triaged. Once triaged, you will be in the queue for booking. The clinic staff will contact you directly to book your Pre-Assessment appointment with one of our nurses. The wait times for appointments vary per clinic location and can be found here. Once you have been seen for a Pre-Assessment appointment, you will be matched with an appropriate CPM Physician and will be booked with that doctor for a Consult appointment.
What should I bring to my appointment?
For your Pre-Assessment appointment, please bring your health card and a list of any medications you are taking, including over-the-counter medications. When the clinic calls you to book your Pre-Assessment appointment, they will send you a link to our online questionnaire. Please complete the questionnaire in full before your appointment. Please note, you are expected to bring your health card to every appointment at CPM.
What is the Chronic Pain Self-Management Program?
The longer that someone suffers from chronic pain, the more that pain can affect both physical and emotional health. CPM Centres for Pain Management conducts a FREE 6 Week – 12 hour group-based patient program that was developed by researchers at Stanford University in California and customized to meet the needs of chronic pain. The CPM Chronic pain self-management program is a psychoeducational, cognitive behavioral program which helps patients better understand the chronic pain process and teaches non-medicated coping strategies and goal setting.
Subjects covered include:
1) Techniques to deal with problems such as frustration, fatigue, pain and isolation,
2) Appropriate exercise for maintaining and improving strength, flexibility, and endurance,
3) Appropriate use of medications,
4) Communicating effectively with family, friends, and health professionals,
5) Nutrition, and,
6) How to evaluate new treatments.
It is the process in which the program is taught that makes it effective. Classes are highly participative, where mutual support and success build the participants’ confidence in their ability to manage their health and maintain active and fulfilling lives.
Where are the CPM Centres for Pain Management located?
For a complete list of CPM Centres for Pain Management Locations, click here
What patient resources are available?
Moulin, Clark, Speechley, Morley-Forster, “Chronic Pain in Canada”, Pain and Research Management 2002
International Association for the Study of Pain, Breivik H, Ventafridda V., Collett B., The Pain in Europe Survey, detailed results and analysis, Euro J Pain 2004