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January 1 2008

Pain progress comes slowly

" The stigma attached to chronic pain includes the attitude that people making this complaint are wimps, malingerers or fakers. . . . Even now, complains Mary Lynch, MD, one of Nova Scotia’s leading pain specialists, WCB policies on chronic pain lag behind medical science on such issues as sensory abnormalities, or nerve damage, which can cause pain to linger long after the injury appears to have healed. “As a clinician in the trenches treating the survivors of work-related injuries,” she wrote recently, “it has been a desperately sad process to witness.” . . . Court decisions in Nova Scotia, in 1993 and last month, put the force of the Canadian Charter of Rights and Freedoms behind the entitlement to compensation for chronic pain caused by a workplace injury. These decisions are expensive to employers, more than $200 million in total for some 7,400 claims opened for review. But the answer to high workers’ compensation insurance rates is better workplace safety, not the denial of fairness and justice."

The Cape Breton Post

Labour Minister Mark Parent said an odd thing in reaction to the recent Nova Scotia Court of Appeal decision opening the chance of compensation for work-related chronic pain originating 23 years ago and more. He welcomed the ruling, noting that the government had always favoured that interpretation. The Workers’ Compensation Board’s denial of claims that reached back earlier than April 17, 1985, was attributed to a “slight” discrepancy in wording between the law and WCB’s application of it.

This being the case, why was it necessary to go through yet another costly and protracted court case to have a judge declare what Parent claims was the government’s intention all along? But this is the way it goes with pain, a medical phenomenon freighted with more baggage than just about anything else that doctors are asked to treat. The phrase “painfully slow” must have originated with someone seeking help for chronic pain. Whether the issue is recognition of the problem in law or policy, acknowledgement of it by the medical profession, treatment of it though the health care system, compensation for it through workplace insurance, or appreciation of it in the community, change comes slowly for chronic pain.

The stigma attached to chronic pain includes the attitude that people making this complaint are wimps, malingerers or fakers. Doctors are warned to guard against patients displaying drug-seeking behaviour with complaints of pain. The belief that dubious claims for pain were driving up auto insurance rates led the Nova Scotia government to cap most payments of this sort at $2,500.

Neglect of pain owes much to the notion that it is a symptom of a condition and not a condition in itself. The doctor’s job is to fix the underlying problem so the pain will go away. There are two problems with this: sometimes the underlying condition can’t be fixed, and sometimes when the originating injury heals the pain persists.

Even now, complains Mary Lynch, MD, one of Nova Scotia’s leading pain specialists, WCB policies on chronic pain lag behind medical science on such issues as sensory abnormalities, or nerve damage, which can cause pain to linger long after the injury appears to have healed. “As a clinician in the trenches treating the survivors of work-related injuries,” she wrote recently, “it has been a desperately sad process to witness.”

Change is coming. Court decisions in Nova Scotia, in 1993 and last month, put the force of the Canadian Charter of Rights and Freedoms behind the entitlement to compensation for chronic pain caused by a workplace injury. These decisions are expensive to employers, more than $200 million in total for some 7,400 claims opened for review. But the answer to high workers’ compensation insurance rates is better workplace safety, not the denial of fairness and justice.

In recognition of the broader problem, Health Minister Chris d’Entremont announced in October that five new part-time pain clinics will be established in the province, along with enhancements to established services in Cape Breton and Halifax. The expansion will double the number of Nova Scotians getting treatment for chronic pain from the current 1,700 annually.

This is good progress. But those who’ve waged the long war know the fight for proper recognition of chronic pain is far from won.

Cape Breton Post

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