It is painful to be a Canadian

Stephen Yeates has lived an odyssey of pain.  Over the past eight years the 53-year-old family man has deteriorated from a robust director and cinematographer for TV commercials to someone who can leave his home for only a few hours at a time.

Suffering from the fallout of degenerative disc disease, he hasn't worked for four years. His search for relief has taken him to Buffalo for an MRI and to Germany for a $50,000 back operation that gave him two artificial discs  And when the bank-breaking surgery offered no relief, he kept searching.

Now, after trying many different drugs (becoming addicted in the process) and therapies, plus self-medication, he's on a waiting list to have a device implanted in his spinal cord, a last try at easing his pain. It's not the first time he's had to wait for treatment.

"I recall asking for an appointment at the London Health Sciences Centre in October 2004, and they said they could see me in November. I was thrilled. But they meant November 2005," he says  His story of delays in getting treatment and failed attempts at alleviating his suffering is a familiar one in this country, pain experts say.

"Wait times for treatment at pain facilities are too long," says Dr. Mary Lynch, president-elect of the Canadian Pain Society. And she says that with longer wait times, patients can go downhill quickly. Chronic pain left untreated gets worse. The Dalhousie University professor is shocked that so many Canadians are left to suffer.

Lynch says there are two major contributing factors  Not enough treatment facilities in Canada, which lengthens wait times  And health care practitioners who are not adequately trained in pain management techniques.

Yeates says, "I spent years trying to find out what was wrong. I saw lots of different doctors and every new appointment started with a set of X-rays.  He's visited physiotherapists, chiropractors and acupuncturists. "I've tried nerve blocks but they weren't effective," he says. "I lost weight, hoping that would help."

In the very beginning he relied on Tylenol and, he admits, alcohol, though he has since stopped drinking  And there were drugs. He took OxyContin for two years but became addicted  "You have to be very disciplined. You have the pills in your hand and you want to take more. I consider myself a balanced person. I stuck to the allowed dosage."

Earlier this year he tried Sativex, a cannabinoid that's sprayed into the mouth. "But it didn't work for me," he says. Yeates credits his wife of 20 years and his two teenaged children for getting him through the agony of the past few years.

Now being treated at Mount Sinai Hospital's Wasser Pain Management Centre, Yeates is off OxyContin and on a combination of methadone and Lyrica (marketed to treat nerve pain caused by diabetes or shingles) and Tylenol  "My only hope is to get on a list for a spinal cord stimulator," he says, "But that will take time."

The wireless electrical device is implanted and operates by remote control, Yeates explains. "There are leads attached to the nerves on the spine which can block the pain signal  "This is a way to get me off the drugs," he says  Yeates says he understands how celebrities such as Rush Limbaugh can get hooked on painkillers.

Chronic pain can be a killer, the Canadian Pain Society says. Last year, a society task force report said, "studies ... show that chronic pain doubles the risk of death by suicide and that uncontrolled pain compromises immune function, promotes tumour growth and can slow healing with an associated increase in morbidity following surgery."

In its list of recommendations, made public under the title Wait Times for Access to Pain Treatment in Canada – A Sore Point for Sufferers, the task force suggested that six months should be the maximum wait time to protect the quality of life and psychological well-being of pain sufferers.

Dr. Philip Peng is an anesthesiologist and director of research at the Wasser Pain Management Centre. In his recently completed survey on access to multidisciplinary pain treatment in Canada, he estimates "there are only 120 such facilities available – equivalent to one in 258,000 population."

His survey revealed a shocking truth: "The wait time was more than one year in approximately one-third of the public multidisciplinary pain treatment facilities and could be as long as five years."

The median wait time at public facilities was 12 times longer than at private clinics, he says. While people relying on public facilities will wait about six months, you can get an appointment at a private clinic in about two weeks  Desperate for relief, Canadians in pain who cannot get help are treating themselves.

Peng's research tells him that people in pain want fast relief. "At least 80 per cent of people who finally get into an appropriate multidisciplinary pain management centre will have tried non-prescription, anti-inflammatory drugs like Advil, herbal medicines and marijuana," he says.

The dearth of treatment facilities is made worse by the fact that too many clinicians – nurses, doctors and other health-care professionals – are not receiving adequate training in pain management.

According to University of Western Ontario pain specialist Dr. Dwight Moulin, too many doctors are woefully untrained in diagnosis and treatment of pain. As well, these doctors are often reluctant to prescribe powerful opioids because they worry about addiction and impaired breathing. But research has indicated that addiction rarely becomes a problem for patients who use their medications as prescribed  The anxiety has been dubbed "opiophobia."

"For doctors, the use of strong painkillers is very time-consuming. You have to spend considerably more time with the patient," he says. Though he suggests medical teaching institutions are finally starting to appreciate the importance of training new physicians in pain management, he laments, "it will take years to filter down to people in practice."

Dr. Judy Watt-Watson, at the University of Toronto's faculty of nursing, has participated in a survey of the curricula at medical teaching facilities across Canada for the Canadian Pain Society. The study, which also reviewed veterinary teaching colleges, revealed that easing pain in pets is a primary concern, while institutions that train clinicians to treat people virtually ignore the subject.

Pain specialists wonder if all this untreated and undertreated pain is encouraging sufferers to go beyond herbal remedies, anti-inflammatories and smoking pot  More worrisome, however, is the looming possibility that suffering patients will turn to more potent painkillers in their search for comfort  While there is a reported increase in the number of people turning to painkillers to get high, most prescription painkiller abuse develops rather innocently.

After an injury or operation, for example, painkillers are prescribed. If the pain persists, sufferers may take matters into their own hands, by elevating doses and mixing painkillers with antidepressants or alcohol to increase the effect  In the U.S., Science Daily reports, "Once hooked, patients may doctor shop to get multiple prescriptions to painkillers, forge prescriptions, order painkillers from websites that don't require prescriptions or take a road trip to Mexico to supply their habits."

A recent study reveals that in the U.S., the amount of five major painkillers sold at retail (over the counter or by prescription) rose 90 per cent between 1997 and 2005. That includes codeine, morphine, oxycodone, hydrocodone and meperidine (also known as Demerol)  In Canada, the market is growing, as well. The estimated number of prescriptions filled for analgesics rose from just over 16 million in 2002 to nearly 20 million between September 2006 and August 2007.

The U.N.-affiliated International Narcotics Control Board stated earlier this year, "Abuse of prescription drugs is about to exceed the use of illicit street narcotics worldwide, and the shift has spawned a lethal new trade – counterfeit painkillers, sedatives and other medicines, potent enough to kill.  It's a prescription for disaster, Lynch worries: greater access to and availability of potent analgesics and a health-care system that's not prepared to handle the pain.  Canada may be ahead of many countries in the quality and accesability to health-care but we are still far from perfect.

By: David Graham