A growing crisis behind closed doors
In Canada, chronic pain is a quietly growing crisis. It currently affects nearly 8 million people—one in five Canadians—and as our population ages, this number is expected to rise by 17.5% by 2030.
But the damage isn’t just physical; the connection between chronic pain and poor mental health outcomes has been extensively documented. Because it leaves no visible scar, chronic pain remains an ‘invisible illness’ and more often than not, individuals with chronic pain feel as though no one believes them, and may not understand how it affects their life. This skepticism fuels a mental health catastrophe: 40% of adults living with chronic pain struggle with depression or anxiety, and the risk of suicidal ideation is increased. Beyond the clinical symptoms, these individuals are battling a profound sense of isolation, effectively silenced by a system that often treats their pain as a mystery rather than a disease.
The multi-billion dollar cost of pain
Chronic pain isn’t just a patient problem—it’s a system-wide crisis. This escalating epidemic is not only a patient care challenge, but has resulted in an economic and operational crisis for our healthcare system.
Managing chronic pain is extremely costly. In Canada, the total direct and indirect cost of chronic pain in 2019 was between $38.2–$40.3 billion. On average it’s 51% more costly than treating patients without chronic pain, including dealing with diabetes, heart disease and cancer. Most notably these costs were associated with more physician and hospital visits. These expenses are just going to continue rising and are expected to increase by 40% and exceed $55 billion annually by 2030 as more people suffer and as pain severity and activity limitations increase.
The power of interdisciplinary care
Our understanding of pain has grown in recent years, and we now know it's not just “tissue damage,” we can understand it through a biopsychosocial model, and explains the complex interplay of how biological, social and psychological factors all impact the experience of chronic pain.
Because pain lives at the interplay of these forces, a single-track approach often fails.
Pain is a complex and multifactorial disease, and as such requires care from an interdisciplinary team, where physicians, physiotherapists, psychologists, social workers and other health care professionals work together to treat the whole person.
Collaboration between general practitioners and specialists is vital to helping individuals manage their pain. By referring to fellowship trained physicians for image-guided pain interventions, we can work together to improve patient outcomes and reduce the burden associated with this disease.
Specialists-led clinics act as an important point of contact for individuals with chronic pain. Their knowledge is crucial to getting the diagnosis right the first time. This prevents patients from cycling through unnecessary and ineffective medical treatments and medications.
The recent technological advancements in this area have allowed for more precise treatments, and better outcomes. The use of technology like fluoroscopy (X-ray) or ultrasound to guide needles directly to the source of the pain improves patients’ outcomes, as compared to blind injections. These procedures are often minimally invasive and done as day-surgeries, allowing patients to return back to their daily lives much faster.
What to look for in a pain clinic
When looking for places to refer patients, there are a few important things to consider.
You want to make sure the clinics prioritize interdisciplinary care, and prioritize functional goals, such as return to work and improvement in quality of life.
Make sure the clinics are led by physicians who have subspecialty training and expertise in Pain Medicine.
Another important thing is to steer patients towards clinics that have image-guided facilities such as fluoroscopy and ultrasound.
You want to ensure these clinics are confident in their care, and able to demonstrate that patients are improving, and keeping you in the loop with long-term management plans, rather than just procedures being performed.
In the span of 10 years, we have seen a rise in the number of pain injections being performed in Ontario. The number has tripled from 1 million in 2010, to just over 3 million in 2019. This rise may be seen because more people are experiencing chronic pain, but also because patients are returning for repeat injections, multiple times a year, and possibly landmark based injections. You want to avoid clinics where this seems to be happening. Especially where patients don’t seem to be getting better, seem to be going in for weekly or frequent injections, that don’t have image-guided facilities, or are only prioritizing pain scores and frequent injections, rather than functional outcomes.
Dr. Zameer Pirani is the principal co-founder of Afiya Spine & Pain Institute with locations in both Toronto and Hamilton, Ont.
Lee-Ran Goodman is a medical student aspiring to a career in Physiatry and Pain Medicine.