Copyright 2004 Sharon Crawford

One in 10 Canadians suffers chronic pain. Their joints, back or feet ache; they have irritable bowel syndrome, fibromyalgia, carpal tunnel syndrome, migraines or whiplash. They pop Aspirin, NSAIDS and corticosteroids, but dislike side effects, no effects and the stress and depression of coping. Treatment now includes acupuncture, chiropractic adjustment, cognitive behaviour therapy, exercise, hypnosis, massage, relaxation, physiotherapy, and support groups.

What is chronic pain?

“Chronic pain is non-malignant pain that has been present for six months or more. Sufficient time has elapsed for healing to occur, but the pain continues for no apparent cause,” says Dr. Gil Faclier, director of the pain management program, Sunnybrook and Women’s College Health Sciences Centre, Toronto. “Pain is all subjective; there are no blood tests to measure the intensity of the pain.”

He divides chronic pain into categories:

1.                          Musculoskeletal, examples are whiplash, back injuries (falls, fractures) and arthritis.

2.                          Neuropathic. “If you damage a nerve it can affect you in any part of the body.” These include “shingles, nerve laceration, bullet wound to a nerve, previous surgery typically of the spine, and cancer.”

3.                          Headaches.

4.                          “Primary psychological/psychiatric disorders causing physical pain.”  Examples include anxiety and depression.

“Chronic pain from any cause eventually results in the development of secondary psychological issues, e.g. depression, anxiety, despair and a sense of hopelessness. It is therefore important to approach the patient holistically. We don’t look at curing chronic pain; we look at alleviating. You have to deal with pain on a biological, psychological and social level.”

The hospital’s pain program (by referral only) includes full assessment by a doctor, then referral to different “treatment modalities,” including injections, medications, cognitive behavioural therapy, mindfulness-based chronic pain therapy (a meditation form), acupuncture and massage therapy. “Access to all other specialties are available in the hospital,” says Dr. Faclier. 

“Cognitive therapy looks at emotions, cognition and behaviour and how they interact,” says Dr. Linda Gruson, Toronto psychologist in private practice. “How you think influences how you behave and how you feel.” She uses a “focused, active approach” and scrutinizes “how stress may trigger pain.” Clients keep logs about daily incidents and their accompanying feelings and thoughts. Gruson asks them, “How might you interpret this incident differently and what could you do differently?”

Gruson uses hypnosis, relaxation and meditation to prevent beginning migraines from developing. “If you can learn to relax, you can learn how to let go of tension in your mind and body.”

Health care facilities, such as O’Connor Rehab & Wellness Clinic in Toronto, use a “multi-disciplinary approach,” says Dr. Len Herman, chiropractor. “We see patients with acute and chronic injuries, or who have been involved in a car accident. We feel a team approach works best. Chiropractors are trained to detect and treat abnormal joint motion using adjustments/manipulations to alleviate tension on surrounding nerves and muscles. The goal is to enhance your body’s natural healing potential and wellness.”

“Acupuncture is a very safe and effective method of treating pain,” adds Andrea Basevitz, the clinic’s physiotherapist. Sterile disposable needles are “left in for approximately 15 minutes. Your body reacts to the needle and releases natural endorphins. Acupuncture can help ease symptoms of many conditions, including arthritis, carpal tunnel syndrome. It can compliment hands-on therapy, and traditional physiotherapy modalities, such as TENS (transcutaneous electrical nerve stimulation), interferential, ultrasound, and exercise.”

“When we have inflammation and pain, we tend to move around less causing our muscle mass to decrease,” says Fanaye McCalla, the clinic’s kinesiologist. She tailors exercises to the injury so the patients can gain back their strength and remain functional. Low back pain exercises focus on strengthening the abdominal muscles and keeping the spine in regular alignment. “Stretching exercises improve flexibility, lengthen the muscles, and helps prevent scar tissue.”

Many treatments will require extended health coverage because OHIP doesn’t include them (example, acupuncture and massage even in-hospital). The Ontario government is deregulating chiropractics and physiotherapy. Chronic pain support groups meet regularly in the GTA.