Thank you, Madam Chair and committee, for inviting the Canadian Pain Coalition to speak about the issues of pain facing all Canadians and older people in Canada, and for, in your way, recognizing that chronic pain is a disease.
One in five Canadians live with under-diagnosed, under-managed, and unrelenting daily pain. Children are not spared and prevalence increases with age. I am a person who has lived with persistent pain for 25 years since I sustained a back injury in a preventable office accident.
In my role as president of the Canadian Pain Coalition, people describe their pain to me like this: “It burns, it stabs, it throbs. It's like an electric shock going down my arm! It makes me feel so alone. My mother is afraid of falling because of the pain and eats alone in her room. The pain never stops—I'm going to lose my mind, and for a while you know I thought I almost would.” Chronic pain is so pervasive that it almost takes on an identity of its own.
People affected with pain ask, “Why don't people believe me when I say I have pain? How long is this going to last? Why can't they just fix it? How will I support my family? Will I ever be able to play with my granddaughter?”
Pain affects every aspect of a person's life. It impacts our ability to lead happy and healthy work, family, social, and personal lives. Pain is isolating and it's depressing. It is demoralizing, disabling, dehumanizing, and deadly. Research shows that there is double the risk of suicide as compared to those individuals who do not have chronic pain. You might be interested to know that the average cost for people like me who live with chronic pain is over $17,000 per year for out-of-pocket costs. This includes costs for medications and health care that are not covered by our health policies. The psychological, emotional, and relationship costs to individuals and their families cannot be measured.
It is hard enough for adults to endure the assault of this constant pain; however, the impact on our children and older Canadians is devastating.
As we age, we experience a progressive generalized impairment of function, resulting in the loss of adaptive response to stress and in a growing risk of developing diseases. Life's schedules and obstacles that we were once able to handle become increasingly challenging. Our voices gradually become silenced.
Most health conditions associated with aging carry a substantial burden of pain. Common chronic conditions include musculoskeletal diseases like arthritis, degenerative spine conditions, shingles, cancer, fibromyalgia, post-stroke pain syndromes, and diabetic peripheral neuropathy.
The overall prevalence estimates for pain range from approximately 25% to 65% of community-dwelling seniors and up to 80% of older Canadians living in long-term care facilities. Thirty-two per cent of Canadians over the age of 85 live in those facilities. Despite its prevalence, pain is under-treated in our senior population.
Demographics show that in the year 2026, 20% of the Canadian population will be 65 years and older. If pain management practices remain unchanged, considerably more Canadians, including me, will suffer needless pain as seniors.
There are myths about pain that prevent Canadians from recognizing chronic pain as a health priority and a chronic disease in Canada. The first myth is that all pain is the same. It isn't.
Acute pain serves as the body's warning system that something is wrong and there is need to take action. It is temporary. Chronic pain lasts longer than three to six months, or in my case 25 years, or beyond the normal time of healing. Chronic pain serves no purpose and it is maladaptive. We know from research that poorly managed acute pain can turn to long-term pain. People suffer the shame of pain because they are judged as complainers, malingerers, and drug seekers. Misunderstandings about the nature of chronic pain lead to comparing a bothersome acute headache with intractable migraines that go on for days and weeks.
Another myth is that chronic pain is a symptom of a chronic disease but not a disease itself. Functional MRI research shows that chronic pain changes the nervous system, and it changes the brain. Once established, chronic pain has its own set of mechanisms, hence it should be recognized, as you have done, and treated actively as a disease.
The final myth is that chronic pain is something you need to live with. There is much that can be done to moderate our pain. A multidisciplinary approach is recognized as best practice standard of care for chronic pain. This includes a combined use of medications, physiotherapy, and occupational and cognitive behavioural therapies, to name a few, as well as complementary modalities like massage therapy. Canadians in general have limited access to this gold standard treatment. Why is that? It is because we lack community multidisciplinary care and the cost for out-of-pocket treatment is very high.
Seniors living on reduced income and with more limited mobility would be less able to afford, schedule, and attend pain treatment sessions in their communities. The person with pain must take an active role in their pain management through making educated, informed decisions about their pain care and by adopting an adaptive lifestyle that includes a healthy diet, sleep, hygiene, and also exercise. As a caregiver for both my mother and father, it became clear to me that being involved in health care decisions as well as the ability to adapt and to do personal care became more and more difficult with age and the severity of pain.
In addition to the myths that I have outlined, barriers specific to effective diagnosis and management for pain in older persons have been identified. These include the entrenched, misleading notion that having pain is natural in older persons; increased stoicism and fear of being labelled a complainer makes older people unwilling to report their pain; sensory and cognitive impairment, including dementia, reduces ability to report pain; the pain itself also disrupts cognition and behaviour; and overestimation of the risk of addiction to opioids also causes a barrier. The final barrier I would like to highlight for you is the fact that Canada's health care systems provide inadequate support.
The International Association for the Study of Pain, which is recognized throughout the world, states that the effective treatment of pain in adults of advanced age requires specialized knowledge and training in pain management. Canadian research shows that our health care professionals are receiving inadequate education. Our veterinarian students receive three times more pain education than our human health professionals and five times more hours than our medical students. There is currently no accreditation for pain in Canada. That's the bad news. The good news is that the Royal College of Physicians and Surgeons has recognized this gap and has created an accreditation. Those graduates will not be appearing on the scene for three to five years, so we wait.
The number of physicians trained and willing to work in long-term care facilities is declining. Fewer medical students say they are willing to take up a practice in long-term care. A smaller percentage are specializing in geriatrics. There is inadequate funding for pain research—