CURAC/ARUCC Health Bulletin #19 on Chronic Pain

Chronic Pain in Adults: Challenges in Understanding and Care

Bulletin #19 of the CURAC/ARUCC Health Care Policy Committee focusses on chronic pain not caused by cancer. When pain persists for three months or longer, it is defined as chronic.

Chronic pain is commonplace. It is estimated that one in five people live with chronic pain, rising to one in three 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 difficult to interpret.

Additional problem areas include lack of knowledge of safe and effective treatments and lack of training and education for health professionals and patients. We make insufficient use of non-opioid analgesics and other biomedical and psychosocial therapies. There are also problems with insurance coverage and attention to the needs of caregivers.

The Bulletin provides a review of types of chronic 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 of the Canadian Pain Task Force 2019 report 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. We recommend the website, Oxford Pain Internet Site, as a resource to learn more about these interventions.

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.

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. This work has begun and an action plan has been published in the Canadian Pain Task Force’s 2021 Report.

Please visit the full version of Bulletin #19 here.