Chronic pain can present in many forms, from migraines to plantar fasciitis, and the number of people suffering from pain, currently one in five, is expected to increase. Websites and social-media platforms focused on pain can enhance chronic pain management for many people.[1] Past president of the American Academy of Pain Medicine, Dr Lynn Webster, put it best, “Complex problems require complex solutions.” Webster pointed out that, “In the USA in 2000, there were 1000 multidisciplinary programs. Today there are 200.” Incongruously, as the number of pain clinics in the USA has decreased, the annual number of opioid prescriptions for pain relief has increased.[2] 

In a policy statement released in July 2017, Doctors of BC called for improvements in chronic pain management.[3] Of note, the statement pushed for improved access to chronic pain specialist services, which currently can have wait times of up to 2 years. Family doctors can help patients while they wait, and since close to 90% of patients have some form of digital access,[1] they can access free pain websites such as those from Pain BC (www.painbc.ca [10]), Self-Management BC (www.selfmanagementbc.ca [11]), and Pain Improvement (www.painimprovement.com [12]), all of which are geared to augment office-based pain management. Such self-management programs have proven benefits.[4] 

Professor Patrick McGowan recognized 30 years ago that patients need to take charge of their own health. Expanding on programs studied at Stanford, he created the Self-Management BC program launched by the University of Victoria in 2002. McGowan, director of the program, “felt the need to lower the risk of patients having to face the crippling consequences of poorly managed chronic diseases.” McGowan estimates that between 3000 and 3500 people participate in the program every year, and that half of the patients are seeking improved pain control.

Having worked as a family doctor for over 30 years, I understand how easy it is to neglect certain aspects of chronic pain management. In a busy clinic, it is challenging to address the complex needs of patients suffering with chronic pain. I have learned that the most valuable resource can be the informed patient. Patients who are taught skills to cope with their symptoms are more likely to take charge of their own health.[5] 

Many physicians are not aware of Self-Management BC’s new telephone-based program aimed at supporting patients in their homes, the Health Coach Program, which thousands of patients with all types of chronic diseases have participated in. The program is supported by recruited volunteers who are given a 2-day training course and paired with patients. The volunteers call the patients once a week for 6 months to provide support.

I learned of this program from a patient who was referred to me by a chronic disease nurse in our community. The patient’s pain and anxiety had noticeably improved by the time I saw her, and she attributed the improvement to the support she received from her coach. 

Other self-management programs also exist (see Box). Charles Labun, coordinator of the Interior Self-Management Program, notes that the various Self-Management BC programs have been well received by patients in the province. The education and support provided increase patient readiness for change. Chronic pain requires a multimodal attack, and even if patients are unable to afford private services, like physiotherapy, massage, or chiropractic treatments, self-management programs augment office-based medical care. 

Family physicians and health care providers can reassure patients, once any serious pathology has been excluded, that accessing the available free programs could help them improve their pain. By improving pain control, it is possible to decrease the risk of substance abuse and improve the quality of the lives of families living with people suffering from chronic pain. 

When a patient presents with severe, even unbelievable pain, a trusting doctor-patient relationship is essential, as fear and anxiety increase pain. Patients are often terrified that their medications are going to be withdrawn or reduced. Recent evidence supports the finding that the vast majority of older patients with moderate to severe pain are undertreated,[6] and physicians are reluctant to prescribe opioids to patients who have addictions (or a history of addictions) even if they have moderate to severe chronic pain.[7] Dr Lynn Webster has highlighted the challenges physicians face with the opioid regulations: “We as physicians are forced to be the judge and law enforcement. . . . We are required to be in an adversarial role for our patients. This is the antithesis of healing and jeopardizes the doctor-patient relationship.” 

Instead, physicians can emphasize the need for partnership in their patients’ care. They are in the ideal position to stress the importance of self-management programs as part of a pain plan. As patient self-efficacy improves, opioids can be reduced or, when indicated, switched to safer options, like buprenorphine. Appropriate treatment reduces the risk of patients in chronic pain suffering because of undertreatment or turning to drugs available illegally.

BC offers a wide variety of invaluable tools. I have found the RACE phone line to be a readily accessible gold mine of information. The addictions specialist I spoke with has helped me transition patients from high doses of morphine and hydromorphone to buprenorphine. I have patients with addiction problems now coping so well with their pain that they are able to attend mental health and addiction counseling. The General Practice Services Committee’s Practice Support Program and website have also improved physicians’ abilities to manage pain. Pain BC provides education, support lines, and online physician and patient workshops. Self-Management BC has group meetings for patients, online workshops, and telephone coaching. The Divisions of Family Practice website includes a number of resources and division-created tools for pain management. The Northern Interior Rural Division of Family Practice, hoping to see more activation of these resources in areas of Northern BC and Williams Lake, has sponsored a program aimed at increasing awareness of the ways to help patients and families improve their quality of life. Painimprovement.com is geared toward patients who are not computer savvy. Podcasts and simple navigation choices help guide patients through a pain-management journey that will support resources provided by Pain BC and Self-Management BC. 

The battle against chronic pain has to be fought on all fronts. The complex problem of chronic pain and addiction is inadequately managed with medication alone. Physicians need not feel alone in this struggle. Until more multidisciplinary clinics are available, self-management resources can go a long way in cutting a path through the jungle of pain management. 

Chronic pain resources

Competing interests

None declared.

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This article has been peer reviewed.

References

1.    Ranney ML, Duarte C, Baird J, et al. Correlation of digital health use and chronic pain coping strategies. Mhealth 2016;2:35.

2.    Kamimura A, Panahi S, Rathi N, et al. Risks of opioid abuse among uninsured primary care patients utilizing a free clinic. J Ethn Subst Abuse. 2018, doi: 10.1080/15332640.2018.1456387.

3.    Doctors of BC. Policy statement. Improving chronic pain management. July 2017. Accessed 17 August 2018. www.doctorsofbc.ca/health-care-services-access-care/improving-chronic-pain-management [16].

4.    Nevedal DC, Wang C, Oberleitner L, et al. Effects of an individually tailored web-based chronic pain management program on pain severity, psychological health, and functioning. J Med Internet Res 2013;15:e201.

5.    Nicholas MK, Asghari A, Corbett M, et al. Is adherence to pain self-management strategies associated with improved pain, depression and disability in those with disabling chronic pain? Eur J Pain 2012;16:93-104.

6.    Guerriero F. Guidance on opioids prescribing for the management of persistent non-cancer pain among older adults. World J Clin Cases 2017;5:73-81.

7.    Baldacchino A, Gilchrist G, Fleming R, Bannister J. Guilty until proven innocent: A qualitative study of the management of chronic non-cancer pain among patients with a history of substance abuse. Addict Behav 2010;35:270-272.

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Dr Dercksen is a family physician working in rural BC. She is a graduate of the University of the Witwatersrand, South Africa, and a fellow of the College of Family Physicians of Canada.