Chronic pain patients fear side effects of opioid abuse clampdown

Terry Bremner is starting to wonder if anyone is listening.

For the majority of Bremner's 55 years, he's been in pain. At nine, he developed hip problems that would require nine surgeries and four total replacements through the years. A car accident in 1995 added more challenges.

In learning to cope with chronic pain, Bremner, president of the Chronic Pain Association of Canada, has had a front row seat for the serpentine path patients must often navigate as they seek treatment to live normal lives.

He worries attempts to curb opioid addiction will add another challenge.

Changes to prescription guidelines

As provinces across the country try to deal with people becoming addicted to powerful painkillers, regulatory bodies for doctors, such as the College of Physicians and Surgeons of Nova Scotia, are adopting American guidelines that call for a reduction in the total daily dose for chronic pain management by more than half.

Bremner said these changes are making it more difficult for chronic pain patients to get treatment they need and, in some cases, to find a doctor willing to treat them at all.

"There's more people that are probably dying from not being treated properly for their pain than patients who are affected by the overdose [of pain medication]."

He's disappointed a meeting last week to discuss the drug abuse problem didn't include representatives from the chronic pain community.

Battling a crisis

Dr. Gus Grant, registrar of the college, agrees there is a need for more education, training and awareness about pain management as well as more non-medicine resources for treatment.

And while Grant said doctors must work with legacy patients to ensure they are getting the help they need and it's happening in a balanced way, they also have a responsibility to address the number of deaths related to opioids.

"Many of these patients, many of these deaths, have in some way flowed through doctors' offices," he said. "We're in the middle of a crisis, a crisis of a scale that I don't think is still fully appreciated."

Differing views

Not everyone thinks the college's approach is the best way to do things.

Dr. Roman Jovey, an Ontario doctor who specializes in pain management, wrote to the Ontario college in July to express concern that the American dosage guidelines "will harm legitimate patients with chronic pain who might benefit from the careful prescribing of opioids."

Jovey's letter, which was signed by more than 30 other doctors and medical professionals, calls for more consultation with experts in the field before changes are implemented and advises a number of steps to improve the system while waiting for an update to Canadian guidelines, due next year.

Grant, who is familiar with the letter, said he disagrees with Jovey and thinks the new regulations have the necessary nuance built in while encouraging doctors to recognize "that the evidence of functional benefit is lacking."

"Patients who are maintained at these high doses are doing so without really good evidence to support that their lives are better," said Grant.

A lack of support for patients

Bremner and his group aren't saying medication is the only answer. He does regulartherapy in a swimming pool and is a major proponent of peer support groups.

But many therapies aren't covered without benefits, and that's something Bremner said many chronic pain sufferers don't have.

The provincial system, meanwhile, has a growing wait list.

In the province's central health zone, 1,266 patients are on a two-year-long waitlist for pain management services. Elsewhere in the province the wait ranges from three months to two.

Those wait times and the fact a majority of doctors have little training in pain management add further challenges for chronic pain patients.

Possible future problems

In the absence of other supports and better education, Bremner worries about what will happen to patients who are on established regimes that are working for them.

Next week is National Pain Awareness Week and a talk in Halifax on Tuesday will ask the question: is the war on opioids hurting people with pain?

Until his group can get access to the decision-making table, Bremner worries well-intentioned policies to address what is a growing problem could inadvertently create problems of a different kind.

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