“I am exhausted and hopeless.”
This is just one of the many discouraging statements I hear regularly from clients who contact Pain BC’s Pain Support Line to seek advice, resources or even just a listening ear. As a Pain Support Line volunteer, I often hear from people with pain that they feel despair for many reasons, but particularly due to the invisibility of chronic pain. “There is no gushing blood or missing limbs to warrant emergency attention from our society,” one caller told me.
Chronic pain often impacts a person's quality of life and self-esteem. As a volunteer, I don’t claim to be a clinical expert in pain but I have spent considerable time listening to people’s stories, concerns and fears. Despite the uniqueness and complexity of each lived experience, I have discovered that many callers face common obstacles and share similar frustrations. Two such obstacles are frequent topics of discussion during phone conversations with clients: prescribing changes and a shortage of family doctors in British Columbia.
As a Pain Support Line volunteer, it is my duty to provide a safe space for people to talk about and express their pain, while also researching resources that are both relevant and beneficial. I have had many rewarding experiences that successfully fulfilled these duties, where I felt I had improved a person’s day by giving them the hope and resources they needed to take control of or better manage their pain. Yet, a significant number of clients inquire about available GPs.
In 2017, British Columbia was among the worst provinces in Canada when it came to residents lacking a primary health care provider, with 18.2% of patients not having a primary care provider – a number 2.9% above the national average. All Pain Support Line volunteers are familiar with how this interaction typically plays out: A client explains their struggle to find a family physician, we listen attentively and then assure them that we will do our best to find someone in their area. Throughout this interaction, we are well aware of the challenge we’re up against. We often call doctors’ offices for hours at a time, only to be left empty-handed. Finding a clinic currently accepting patients can be likened to finding a parking spot in a bustling parking lot. If a volunteer team, with numerous resources at our disposal, has trouble finding available clinics, how can a person who lives with daily chronic pain be expected to find the long-term care they need to improve their quality of life?
The task of finding reliable, long-term care has been made even more difficult due to the deadly overdose crisis. There is no doubt that overdose remains a national crisis in our country. Unfortunately, this has had significant impact on people with pain who previously relied on opioids for pain management. Many are now having their medications tapered or discontinued completely due to the stricter guidelines. Even if an individual has only ever used opioids as prescribed, they often face the stigmatization of being “potential” drug-seekers. They are treated with suspicion; their stories are doubted. Without opioids as a treatment option, where can these people turn? Specialized pain clinics are promising options but have long waitlists. The 2018 report by the BC Coroners Service on opioid overdose deaths between 2016 and 2017 stated that 45% (389/872 cases) of overdose deaths involved people who had previously contacted health services for pain-related issues. While many other factors, such as poverty, trauma and mental illness must be acknowledged, I believe it is at least worth considering this statistic as a cry for help by those in pain, by those who sought out help from our health care system but saw no other option but to turn towards illicit drugs out of desperation.
The questions I have laid out are not simple, and certainly not ones that can be solved overnight. However, the future gives me hope, despite the concerns of the present. Awareness is spreading with pain management workshops and support groups are beginning to extend into rural areas of BC, and there are a growing number of online resources. Even BC’s Opioid Prescribing Guidelines have been revisited to better protect people living with chronic pain. Of all the recent developments, I am most excited about Pain BC’s Project ECHO, a virtual learning community aimed at supporting health care providers with complex pain cases with the intent of improving care. I look forward to passing on these developments to the clients of the Pain Support Line to give them hope and – perhaps more importantly – to help increase their trust in our province’s health care system.
Tejas Phaterpekar, Pain Support Line volunteer