The scary truth about our pain problem- Canadian Chatelaine article

The scary truth about our pain problem
““In Canada, pain is under-recognized and under-treated,” Lynch says. “And that’s all pain, whether it’s due to trauma, surgery, illness or disease. It includes pain in the community, in our hospitals and in our emergency rooms — it’s a huge problem.” And it’s a problem that has a lot to do with how easy it is to dismiss a condition we can’t see. A nationwide survey by the Canadian Pain Coalition found 53 percent of us don’t believe chronic pain exists. On the other hand, an Angus Reid Poll found 70 percent of us believe that there is intelligent life on other planets (and 54 percent think extraterrestrials have already paid us a visit). So…aliens from outer space? Sure. Chronic pain? No way.”

It makes one wonder if there is intelligent life on this planet.

“You’re also at a clinical disadvantage if you happen to be a woman. In one study, LaChapelle discovered health care professionals feel more anger and annoyance when female patients complain about pain, whereas men elicit greater sympathy. “The stereotype is that men are more stoic and stronger than women, so if they complain, it must be really bad.” You can see the outcome of these attitudes in pain treatment, too, she says, because men are more often prescribed pain medications, like opioids, while women are given psychological meds, like sedatives, for the same condition. This is especially irritating considering that new research from Stanford University found women feel pain more intensely than men (women’s pain levels are 20 percent higher overall). So basically the message is women feel it more but should complain about it less.”

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Yeah, I had wondered about this given my lack of treatment for FM. I had assumed they simply did not treat it. Then kept hearing about men who were on some heavy-duty opiates with it. Job difference I wondered? Then why no treatment for me? Not that I think that is the right solution anyway, painkillers that is, but no treatment at all seemed rather… sucky. Why had I been told I was ‘depressed’ before my diagnosis like I didn’t know what pain was or what depression was? This stereotype is slightly amusing though because while they may believe a man’s pain more often and treat what they are actually saying is a woman has an insane pain tolerance such that they don’t even need painkillers or treatment because they don’t even bother treating them when they have the exact same condition. They must believe a man cannot tolerate that immense amount of pain but a woman can. It is like this ironic reverse stereotype that because they don’t believe a woman’s pain they are actually suggesting they can cope better without treatment. But it is a horrible one in reality given women cannot even express their pain because when they do they are ‘complaining’ so they learn not to talk about it or to downplay it… and get no treatment when they express it and no treatment when they downplay it to not complain. I was told by a doctor when my migraines were chronic and not treated that I was very stoic… and I thought isn’t that how I’m supposed to be? None of you want me to make a fuss right? I have had to re-learn how to talk to doctors to express my level of pain in reality because of all those years of Not doing so because I didn’t want to complain or make a fuss or suggest that I couldn’t just take it…. because while I learned to cope with FM on my own in whatever way I could, I couldn’t do that with chronic migraines and I needed to express that when treatment didn’t work the pain was unbearable. Still, have trouble with that. Doctors teach us very well not to talk about pain honestly because they don’t want to hear it.

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“Why your doctor can’t help you
The first place people head when something’s hurting is to their doctor’s office. Unfortunately, pain isn’t easily pinpointed with a few medical tests. “The main tool we have to diagnose pain is history, meaning what patients tell us,” Lynch says. If you’re lucky, your doctor will be immune to prevailing stereotypes and will be well versed in pain management, but most aren’t. “People ask me, ‘How can this be? Aren’t health care professionals trained to treat pain?’” says Lynch. “The answer is no.” Medical students might get a few hours of pain education at most, and since pain questions seldom crop up on licensing exams, there’s little incentive to pay attention in class. In which case your only hope is to be immediately referred to one of the country’s scarce pain clinics (only 270 nationwide), since the longer pain goes untreated, the harder it is to fix. A more likely scenario: You’ll be bounced around to several doctors, told there’s no physical reason for your pain and that it’s all in your head, before your name finally gets tacked on the bottom of a one- to two-year wait-list to see a pain specialist.”

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I am very aware… now that doctors have no clue what to do with chronic pain and therefore often do nothing. Once I actually got my diagnosis of FM then that was that. No actual treatment, but at least I had a label. Yay for me. And they felt free to brush off my pain and other symptoms because it was just FM and nothing they could do anything about. Even with chronic migraines they were clueless because they can at some level comprehend migraines… have a few run of the mill ideas and general advice but that is that. Afterward, you go to a neuro and listen to them but when you see your doctor and say this pain is getting to me, I can’t function at work, I don’t think I should be driving… they have no solutions, offer nothing and do nothing. When it gets worse, still nothing. When you are frantic and desperate. Nothing. Like me, you may go on many short-term leaves from work but my doctor was averse to putting me on long-term leave as if that was extreme for just migraines. Just no comprehension and no help from that front when the pain is unbearable.

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“The road to pain relief
Part of the solution to addiction to opioids is educating doctors about how to properly prescribe them, as well as how to incorporate non-medical treatments into the mix, from using professional resources like physiotherapists to exploring strategies patients can try themselves, like tai chi. Gordon, for instance, is researching how listening to the right music can ease the relentless, diffuse pain of fibromyalgia. And in his spare time, he’s teaching other health care professionals about all the other treatment options out there. “The biggest goal is to download pain management to primary care physicians,” he says. “The problem is there are about 12,000 family doctors in Ontario, and we’ve maybe worked with 500 of them.” Some provinces have mentorship programs; others, like British Columbia, have hotlines so doctors can dial up a pain specialist whenever they’re overwhelmed and need help. “We don’t have that in Ontario, but I wish we did,” Gordon says.
With so much disparity in resources between provinces, Lynch wants to take things a step further, which is why she co-chaired Canada’s first national pain summit Ottawa last spring. She’s also leading the charge for the national pain strategy. (Australia was the first country to introduce one in 2009, and it led to millions of dollars being allocated to improving pain education and access to care.) Lynch says one of the biggest benefits of a national pain strategy would be to educate health care providers and generally raise awareness — she’s tired of hearing about people whose pain isn’t being taken seriously. “We need to teach Canadians that people with pain are not a bunch of wimps, malingerers or drug seekers,” she says. “They’re real people with a real disease that needs to be treated.”

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This is where a national strategy and more money for pain research might help most. Just last year, studies using functional magnetic resonance imaging identified how chronic pain shifts the landscape of the brain — scientists can actually see the decrease in brain matter and how brain activity is altered.
Better yet, a recent study shows treating pain effectively can reverse those changes. Using before-and-after brain scans, researchers at McGill University followed patients who received spinal injections or surgery to relieve chronic back pain. They discovered that six months after their pain was gone, patients had increased cortical thickness in areas of the brain related to pain reduction — and they have the pictures to prove it. That’s got to be better than a grainy image of a UFO captured on someone’s iPhone, right?
The facts:

  • Your risk for chronic pain may be in your genes. Researchers in Toronto and Montreal studied women after mastectomies and found those with a wonky pain receptor (P2X7) in a specific gene had more chronic pain — a discovery that may help scientists fight pain by targeting the problem protein.
  • One in 10 people who go to the hospital for a routine surgery winds up with chronic pain.”

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