PAIN IN CANADA FACT SHEET

Pain is poorly managed in Canada

• Although we have the knowledge and technology, Canadians are left in pain after surgery, even in our top hospitals.
  
• Only 30% of ordered medication is given, 50% of patients are left in moderate to severe pain after surgery and the situation is not improving (Watt‐Watson, Stevens et al. 2004; Watt‐Watson, Choiniere et al. 2010).
• Growing evidence has identified that many common surgical procedures cause persistent post‐operative pain that becomes chronic  (Kehlet, Jensen et al. 2006).
• Pain is the most common reason for seeking health care and as a presenting complaint accounts for up to 78% of visits to the emergency department, recent research continues to document high pain intensity and suboptimal pain management in a large multicenter emergency department network in Canada and the United States (Todd, Ducharme et al. 2007).
• Uncontrolled pain compromises immune function, promotes tumor growth and compromises healing with increased morbidity
  
• and mortality following surgery (Liebeskind 1991).
• One in five Canadian adults suffer from chronic pain (Moulin, Clark et al. 2002; Schopflocher, Jovey et al. 2011) children are not spared with 15‐30% of children experiencing recurring or chronic pain  (Stanford, Chambers et al. 2008) and the prevalence increases with age (Hadjistavropoulos, Gibson et al. 2010)  
• Many cancer and HIV survivors have greater quantity of life but unfortunately a poor quality of life due to chronic pain conditions caused by the disease or the treatments that cause irreversible damage to nerves (Levy, Chwistek et al. 2008; Phillips, Cherry et al. 2010).
• Chronic pain is associated with the worst quality of life as compared with other chronic diseases such as chronic lung or heart disease (Choiniere, Dion et al. 2010).
• Based on US figures documenting that the cost of chronic pain in adults including health care expenses and lost productivity is $560‐$630 Billion annually it is estimated that the annual cost of chronic pain in Canada is at least $56‐60 Billion dollars    (Relieving Pain in America (2011)

• People living with pain have double the risk of suicide as compared with people without chronic pain (Tang and Crane 2006).  
  
• A recent review of opioid (narcotic) related deaths in Ontario, identified the tragic fact that pain medication related deaths in
  
• Ontario are increasing and that most of the people who died had been seen by a physician within 9‐11 days prior to death (emergency room visits and office visits respectively) and the final encounter with the physician involved a mental health or pain related diagnosis. In almost a quarter of the cases the coroner had determined that the manner of death was suicide (Dhalla, Mamdani et al. 2009).
• Veterinarian students receive 3X more pain education than human health professionals and 5X more hours than medical  students (Watt-Watson, McGillion et al. 2009). 
• Pain research is grossly under‐funded in Canada (Lynch, Schopflocher et al. 2009).
  
• Institute of Medicine (2011), Relieving Pain in America: A blueprint for transforming prevention,care, education and research. Washington DC, National Academies Press.
  

References

Choiniere, M., D. Dion, et al. (2010). "The Canadian STOP‐PAIN Project‐Part 1: Who are the patients on the wait lists of multidisciplinary pain treatment facilities? ." Can J
Anesth 57: 539‐548.
Dhalla, I. A., M. M. Mamdani, et al. (2009). "Prescribing of opioid analgesics and related mortality before and after the introduction of long‐acting oxycodone." CMAJ 181:
891‐896.
Hadjistavropoulos, T., S. Gibson, et al. (2010). Pain in older persons : a brief clinical guide. Chronic Pain Management: A Clinical Guide. M. E. Lynch, K. D. Craig and P. W. H.
Peng. Oxford, UK, Wiley‐Blackwell: 311‐318.
Kehlet, H., T. S. Jensen, et al. (2006). "Persistent postsurgical pain: risk factors and prevention." Lancet 367: 1618‐1625.
Levy, M. H., M. Chwistek, et al. (2008). "Management of chronic pain in cancer survivors." Cancer J 14(6): 401‐409.
Liebeskind, J. C. (1991). "Pain can kill." Pain 44: 3‐4.
Lynch, M. E., D. Schopflocher, et al. (2009). "Research funding for pain in Canada." Pain Res Manage 14: 113‐115.
Moulin, D., A. J. Clark, et al. (2002). "Chronic pain in Canada, prevalence, treatment, impact and the role of opioid analgesia." Pain Res Manage 7: 179‐184.
Phillips, T. J. C., C. L. Cherry, et al. (2010). "Painful HIV‐associated sensory neuropathy." Pain Clinical Updates XVIII (3): 1‐8.
Schopflocher, D., R. Jovey, et al. (2011). "The Burden of Pain in Canada." Pain Res Manage: In Press.
Stanford, E. A., C. T. Chambers, et al. (2008). "The frequency, trajectories and predictors of adolescent recurrent pain: A population based approach." Pain 138: 11‐21.
Tang, N. and C. Crane (2006). "Suicidality in chronic pain: review of the prevalence, risk factors and psychological links." Psychol Med 36: 575‐586.
Todd, K. H., J. Ducharme, et al. (2007). "Pain in the emergency department: results of the Pain and Emergency Medicine Initiative (PEMI) Multicentre Study." J Pain 8: 460‐
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Watt‐Watson, J., M. Choiniere, et al. (2010). "Prevalence, characteristics and risk factors of persistent post‐operative pain after cardiac surgery." World Congress on Pain
Montreal: Abstract.
Watt‐Watson, J., M. McGillion, et al. (2009). "A survey of pre‐licensure pain curricula in health science faculties in Canadian universities." Pain Res Manage 14: 439‐444.
Watt‐Watson, J., B. Stevens, et al. (2004). "Impact of preoperative education on pain outcomes after coronary artery bypass graft surgery." Pain 109: 73‐85.