Findings, and possible solutions to treat chronic pain

Photo: Jeff Pachoud Agence France-Presse
Patients have consulted up to 23 health professionals when they are knocking at the door of the pain Clinic, according to a study published in the journal “pain Research and Management”.

Assistance to physicians, research projects, bonds for CIUSSS : initiatives make the surface a little everywhere in Quebec to improve the care of chronic pain, but much remains to be done. Tour of the horizon.


Advice for physicians : The Centre, chronic pain of the CHUM, a reference in the field in Québec, offers all the weeks of distance training courses for family doctors, nurses and other first responders. “We present the case of anonymous one of the participants, and I write the recommendations,” says Aline Boulanger, anesthetist and director of the Centre of expertise for chronic pain of the CHUM. “The advantage is that everyone can learn from everyone. “Practical sessions are also planned.


The Centre also offers the service of “expert Opinion” to answer the questions of the professionals. “It is a telephone line that the doctor can use to get information. A medical record is open and our recommendations are sent to the doctor. It is neither more nor less than a telephone consultation. “The catch is that many doctors are unaware of even its existence, grants-t-it. “We could take more. “


Obligation to act : In Quebec, the CIUSSS are responsible for the centres of treatment of chronic pain. The ministry has obliged each of them to develop by 2018 in service in the treatment of pain. However, with the approach of the maturity date, several CISSS and CIUSSS do not always, noted Aline Boulanger. “There are centres which have set up regional clinics. […] Others are at the development stage, but there is one where he did almost nothing happened. “Even if progress is slow, Ms. Baker noted that three years ago, Three Rivers was the only region to offer a service outside of Montreal. There are a few around now.


Training of doctors : Many experts deplore the short time allowed for the treatment of pain in the general training of general practitioners. “In the curriculum of medical studies, there is little or no courses specifically devoted to pain,” notes Dr. Dropinski, who himself specialized in this field in Europe. In the wake of the crisis of opioids, the Federation of faculties of medicine announced in November that it intended to propose a new curriculum giving more space to the treatment of pain and to prescribe opioids more safely “.


The research : The research on the treatment of pain is in full swing in Quebec. Manon Choinière, for example, seeks to determine what factors are causing lower back pain chronic. “Patients who tend to be more anxious are more at risk and, therefore, you can intervene on the plan of the anxiety. You can use the psychotherapy and self-management techniques. “Very mobilized, the quebec milieu of the research held its first congress on chronic pain in November last year and, for the third time, the city of Montebello will host the next summer School north american of the pain, where will be presented the advances in the treatment of chronic ailments.


The australian example : Australia has, in 2011, a national Strategy for the fight against chronic pain. With the addition of pain clinics in the region, the average waiting time is passed, from one to two years, to approximately two months. These changes have resulted in a significant reduction of opioid consumption.


Psychological support : In the opinion of most stakeholders, there is still much to do to get a follow-up in psychology. According to Muriel Marois, it is necessary to prioritize patients on the waiting lists whose pain endures. Their physicians should direct them to support groups, she said, so that they can acquire techniques for the management of pain. The offer in psychology in the public system should be improved, she believes. Dr. Aline Boulanger also believes that the services in rehabilitation and psychology remain ” not easily accessible to patients.”