The Human Cost of Closing Pain Clinics: A Cry for Compassion and Change

Pain. It’s a universal feeling that everyone has experienced to some degree. We can all recall a time in our lives when we felt pain - sharp, searing, burning, aching, throbbing - a nervous system response indicating an injury and inciting us to prevent or limit further harm. It is a natural sensation, and important for our survival and safety.?

However, there are some of us for whom these natural sensations of pain become impaired, perhaps through injury to the nervous system, congenital defects, or the aftermath of surgery, and require medical and therapeutic interventions to override the pain.?

This is the case for more than 8 million Canadians who live with chronic pain disabilities, myself included. When I was 18 years old, I started experiencing numbness and tingling in my legs, leading to the discovery of a fractured disc and herniation in my lumbar spine and ultimately resulting in emergency surgery in the summer before my first year of university. Since then, I have had to learn how to manage the heightened and often debilitating level of nerve pain I experience daily. Through years of trial and error, I have found that by far the most effective treatment in lessening the degree of pain I feel and significantly minimizing my use of opioids is the weekly nerve-blocking injections I receive at my local pain clinic. Thanks to these treatments, I have been able to graduate from university, socialize with friends and family, work a full-time job, and perform weekly tasks such as groceries, cleaning, laundry, etc. which allow me to continue to maintain a certain quality of life.

These weekly nerve blockers I receive are the closest thing to magic I have ever experienced, but as anyone with chronic pain knows, this is not a cure to the pain - just one part of the continuous journey of pain management that helps us live with less discomfort.?

This year, the College of Physicians and Surgeons of Ontario (CPSO) has been working to enforce stricter regulations and standards on the medical practice of pain management for out-of-hospital clinics, specifically regarding nerve blockers for adults with chronic pain. These new regulations include the requirement that all out-of-hospital clinics providing these services must use ultrasound guidance when administering nerve blocks - a process that is much more technical and, in many cases, requires the costly and time-consuming retraining of physicians to obtain this skill. We are currently in a transitional period allowing for adjustments in the operational practice of these clinics, coming to an end on September 3, 2023. At this point, enforcement of this new standard will officially begin.?

Unfortunately, with these new regulations comes the threat of the closure of many pain intervention clinics across Ontario that cannot afford to stay open once these new standards are enforced, putting the future of pain management care for chronic pain patients at risk.?

In a survey conducted by the CPSO throughout 2022 in preparation for these newly enforceable regulations, significant discontent was shared by physicians and members of the public, both of whom expressed their fears and concerns about the new standards of pain intervention treatment being enforced at local, out-of-hospital community clinics. What this will mean for patients if they close is still uncertain.?

With a number of pain clinics closing their doors, and the scope of pain management care being narrowed and limited by these new standards and regulations, there is a widespread fear that chronic pain sufferers will lose their quality of life, be unable to work, and will endure chronic pain on a daily basis, without any reprieve other than turning to drugs such as opioids. Those suffering from chronic pain may need to either turn to anesthesiologists in hospitals for continued care, or be beholden to opioids and other medications that can be highly addictive and harmful.

There are considerable problems with defaulting to in-hospital care for pain intervention treatments, starting with the extreme wait times for specialized care, which can be upwards of six months cross-Canada. The healthcare system in Ontario is already overwhelmed, and it makes no sense to move millions of people with chronic pain into hospital care, which will only bottleneck the system even more. The reality of triage is that those with chronic pain will not be a priority when there are countless surgeries requiring attention, which will result in myself and countless other people being stripped of professional pain relief and being herded into a hospital system that cannot cope.

In anticipation of the projected and expected closure of local community pain clinics across Ontario, many doctors are referring their patients to hospitals for cortisone and epidural injections that can last up to three months at a time.

While the longer pain relief of these pain care treatments appears on a surface level to be a logical and effective replacement for more regular pain care injections at local community clinics, frequent use of these care options can cause up to a 30% increased risk in bone fractures of the spine. This is a risk that patients will need to evaluate for themselves. Do they choose to continue receiving pain intervention care that can allow them to live and function in society, at work, and in their homes with a decreased degree of pain in favour of the increased risk of spinal fractures? Or do they forgo the risk of further injury in favour of a heightened level of daily pain and discomfort that may limit both their physical mobility and cognitive functionality?

Additionally, and beyond the scope of lengthened wait times and reduced quality of care, there are financial factors that must be included in consideration of the negative repercussions and the fall-out of defaulting to in-hospital pain intervention care. The Canadian healthcare system is already in crisis mode, faced with staffing shortages, overflowing emergency rooms, severe budget constraints, and shortages in medical supplies. These problems will only be worsened by the closure of community pain clinics, and increased traffic of patients to hospitals which will balloon wait-times, and exacerbate the level of pressure placed on our already struggling health system.

In the long term, this could have a devastating economic ripple effect as more people need to be on Employment Insurance and long-term disability leave and require extended support from the Workplace Safety and Insurance Board if they cannot find regular, frequent and consistent relief for their pain management. The full extent of what these repercussions could mean for the labour market and human capital at workplaces if millions of people with disability, currently holding down jobs, are unable to work due to lack of effective pain care is not yet known.?

These additional risks to people suffering from chronic pain and the fear of decreased quality of pain intervention care are compounding factors adding to the mental health disorders that we are already 35-45% more prone to, including chronic stress, depression, anxiety, and substance use. The disability of chronic pain is oftentimes invisible, and with this invisibility comes the reality that our struggles and suffering are very often overlooked, both by the medical community and larger society.?

In a broader context, the strain placed on an already challenged healthcare system coupled with the heightened mental and physical health vulnerabilities of chronic pain sufferers underscores the urgency of a comprehensive, empathetic approach to addressing this often invisible struggle. As we navigate these changes, it's imperative to remember that each individual's story is unique, deserving of compassion, understanding, and the pursuit of solutions that prioritize both physical and emotional well-being.

My story is one of many, and my voice echoes the concern and fear of the entire chronic pain community. Our lives are real, our well-being matters, and our access to healthcare that appropriately and effectively meets our needs and supports our quality of life is vitally important. I urge you to join our fight to bring public attention to this issue. We need pain clinics to remain open as a means of treating people with chronic pain, in line with the Hippocratic oath “to prescribe only beneficial treatments; to refrain from causing harm or hurt; and to live an exemplary personal and professional life.”

Petition against closing pain clinics in Ontario