Re: Health outcomes of patients in the Complex Chronic Diseases Program

Issue: BCMJ, vol. 67, No. 9, November 2025, Page 310 Letters
By: Spencer Cleave, MD, CCFP Thea Gilks, MD, FRCPC Isaac Rodin, MD

We thank the authors for their illuminating article [BCMJ 2025;67:174-181]. We appreciate the dedication of the Complex Chronic Diseases Program (CCDP) to a group of patients who are stigmatized and profoundly underserved by our health care system. These patients suffer deeply, and their distress deserves compassion and appropriate care.

We disagree with the authors’ conclusion that the absence of meaningful clinical improvement in their study indicates that patients with fibromyalgia and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) have illnesses that are too “severe and persistent” to respond meaningfully to treatment. We believe the more urgent implication of this study is that these patients’ suffering was not ameliorated because the treatment provided by the CCDP does not address their complex psychosocial needs.

Patients with fibromyalgia and ME/CFS have a high proportion of childhood physical abuse, emotional neglect, and sexual trauma.[1,2] This trauma contributes to profound attachment disruptions and, when combined with the chronicity of their illness and the stigma they face, fosters deep epistemic mistrust toward the health care system. Establishment of a longitudinal, trusting relationship with a consistent care provider offers a supportive attachment, which is essential for these patients to engage in care and experience recovery.

The CCDP model, focused primarily on specialist consultations and other short-term interventions such as self-management, pacing, pharmacotherapy, and group medical visits, is thus fundamentally limited. The pursuit of these treatments is ineffective, as the authors conclude, and is, therefore, a disservice to our patients.

The treatment of complex chronic diseases necessitates individualized, holistic, long-term, and relationship-centred care. Primary care physicians are well positioned to provide this care, as is offered by the High Complexity Care Team in Victoria. Psychiatrists, who were strikingly absent from the interdisciplinary team members mentioned in this article, are also well positioned to provide this care, as is offered by the St. Paul’s Hospital Complex Pain Centre.

Treating complex chronic diseases requires systems that are willing to centre access to individualized, longitudinal, and whole-person care that is trauma informed. Programs like the CCDP are uniquely positioned to lead this charge, but only if they are willing to move beyond their short-term, consultative, and biological frame.
—Spencer Cleave, MD, CCFP
Medical Director, High Complexity Care Team
—Thea Gilks, MD, FRCPC
Psychiatrist, St. Paul’s Hospital Complex Pain Centre
—Isaac Rodin, MD
Psychiatry Resident, UBC
St. Paul’s Hospital Complex Pain Centre

This letter was submitted in response to “Health outcomes of patients in the Complex Chronic Diseases Program.”

Read the authors’ response in “Re: Health outcomes of patients in the Complex Chronic Diseases Program. Authors reply.”

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References

1.    Häuser W, Kosseva M, Üceyler N, et al. Emotional, physical, and sexual abuse in fibromyalgia syndrome: A systematic review with meta-analysis. Arthritis Care Res (Hoboken) 2011;63:808-820. https://doi.org/10.1002/acr.20328.

2.    Gardoki-Souto I, Redolar-Ripoll D, Fontana M, et al. Prevalence and characterization of psychological trauma in patients with fibromyalgia: A cross-sectional study. Pain Res Manag 2022:2022:2114451. https://doi.org/10.1155/2022/2114451.

Spencer Cleave, MD, CCFP, Thea Gilks, MD, FRCPC, Isaac Rodin, MD. Re: Health outcomes of patients in the Complex Chronic Diseases Program. BCMJ, Vol. 67, No. 9, November, 2025, Page(s) 310 - Letters.


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