Fraser Northwest physicians prepare to improve chronic pain care

With National Pain Awareness week approaching in November, the complexity of chronic pain management amidst a shortage of family doctors is understandably top of mind for patients living with this diagnosis. The Chronic Pain Project Team saw the need for a multidisciplinary approach to improve the quality and coordination of care.

From its inception in 2019, the Project team focused on addressing the primary issue they noticed during the expression-of-interest stage: a lack of understanding around what resources are available for chronic pain patients. By leveraging events, newsletters, Pathways, and meetings, the team compiled and shared resources with physicians in the region, spanning from the Fraser Health Authority’s Pain Hub to the BC ECHO for Chronic Pain, and others. Together with a specialized sub-committee working group, the Team developed the Chronic Pain Care Pathway —a tool focusing on key treatment guidelines and recommendations, while highlighting free-to-low-cost resources.

This tragic need for better resources was illustrated by patient voices. One patient described that they became “the CEO of my health care” due to a lack of capacity from local family physicians, and that they had to drive over an hour for help with their chronic pain only to be seen by an ER who “just thought I wanted drugs.” Another patient—who had been on the same medication for a decade—was shocked when her new family physician changed her prescription, a decision they attribute to the stigma and misinformation surrounding the prescription of opioids.

Another perspective came from a retiring family doctor who had managed a couple of patients with complex situations and was concerned for their care after leaving practice. The new-to-practice replacement physician was uncomfortable prescribing opioids—as are most new-to-practice physicians—due to fears of scrutiny from the College combined with a lack of knowledge, skills, and support to manage complex chronic pain patients. The Project team seized this opportunity to trial the Collaborative Model to Opioid Prescribing for Chronic Pain Patients. In this model, an anesthesiologist, psychiatrist, and an addiction medicine physician saw each patient to ensure there was a coordinated plan to recommend to the family doctor—the final goal being to reduce opioid dosages within the College guidelines, supporting the family physician, and improving the patient’s quality of life. The expanded efforts led to this model evolving into its own Shared Care project.

"Chronic pain is one of the most challenging situations my patients and I have had to manage, particularly when dual diagnoses involving mental health and opioids are involved,” explains Dr Huy Nguyen, family physician leading the Project. “I am hopeful that the algorithm we created will ensure that effective treatments for common chronic pain conditions have been explored, while we continue to explore a promising multidisciplinary approach to support family doctors in caring for the patients who have the most complex and difficult to manage pain conditions."

This project will leverage the group’s broad stakeholder engagement to continue moving forward for regional, and potentially provincial, uptake. There are ongoing conversations with Pain BC and the Provincial Health Services Authority Pain Care BC network to sustain the Chronic Pain Care Pathways resource at a provincial level. Through sustained efforts, education, and sharing of the resources developed, the team expects the quality of care for patients living with chronic pain will improve along with the confidence, knowledge, and skills of their family physicians.