Chronic Pain in Adults: Challenges in Understanding and Care (May 2021)

Bulletin No. 19 of the CURAC/ARUCC Health Care Policy Committee reviews the need for a multi-disciplinary or biopsychosocial approach to the treatment and management of chronic pain. 

Persistent pain is a serious problem that affects many Canadians.  In 2020, the Canadian Pain Task Force estimated that one in five people live with chronic pain, rising to one in four in seniors and up to 80% in care facilities, which often leads to significant decline in quality of life.  Because pain assessment tends to be difficult, reports of chronic pain may be downplayed undiagnosed or ignored and therefore left untreated. There are no known biomarkers for pain and self-reports and nonverbal measures can be hard to interpret.

Problem areas include lack of knowledge of safe and effective treatments and lack of training and education for health professionals and patients.  There are also problems with insurance coverage and attention to the needs of caregivers.

The Bulletin provides a review of types of pain and an overview of the biopsychosocial model. Psychological and socio-cultural factors interact with brain processes to influence health and illness.  Attention is often directed at biological features at the expense of the psychological and socio-cultural dimensions. Complex chronic pain requires a multi-modal approach that includes life-style issues, including continuing engagement in life activities and appropriate exercises.  Pain-relief exercises are available on YouTube. Table 1 in the bulletin provides a summary of interventions for the treatment and management of chronic pain. Opioids and over the counter analgesics are important tools if properly managed.

The Canadian Pain Task Force’s 2020 Report concludes that the health system remains ill-equipped to manage pain and that it should support biopsychosocial approaches and timely access to care. Pain management is a critical element of palliative care. Canada needs a national pain strategy. We need to transform the way health services work together and transform the way health professionals and the broader community understand and deal with pain.

For a fuller discussion, including a review of forms of intervention and associated problem areas, see Bulletin 19 on this website (https://curac.ca/wp-content/uploads/Bulletins/B19e-Chronic-Pain-in-Adults.pdf )