The Centre of Excellence’s mission is to foster a national network of interdisciplinary pain management centres using research and evidence-based strategies to improve care for CAF Veterans and their families. One of the keys to accomplishing this pan-Canadian strategy is to firmly establish ourselves as an educational resource for supporters or potential supporters in a way that facilitates a healthy exchange of knowledge over the latest research on chronic pain or by bringing to light some of the important voices in the Canadian chronic pain research community.
Though the COVID-19 pandemic has certainly changed the dynamics of in-person events, the Centre of Excellence is committed to continuously providing CAF Veterans and their families with these very opportunities to learn about pain management therapies they can apply in their everyday lives. This is why we hosted the Veteran and Family Well-Being Series: A Person-Centered, Evidence-Based Approach to Chronic Pain. These symposiums feature presentations from respected researchers from Canada and the U.S. discussing the evolution of pain management and current best practices in evidence-based interdisciplinary care. While each presenter brings with them their own area of expertise, a reoccurring theme throughout the symposium series, and one that we place profound importance on, is the idea of prioritizing the overall quality of life of a Veteran and their families using a holistic and multidisciplinary approach to help guide their chronic pain management programs.
Here is a summary of our four symposiums:
Our first virtual symposium focused on a patient-centred approach to pain management and featured two researchers from the Veterans Health Administration, Friedhelm Sandbrink MD and Benjamin Kligler MD MPH. This symposium also included the Centre of Excellence’s Dr. Jason Busse who discussed his latest research on the effectiveness of cannabis in the management of chronic pain which will be published in the British Medical Journal in Winter 2020.
Dr. Sandbrink began by introducing what is called the ‘Biopsychosocial Model of Pain Management’ which places an emphasis on both improving function for Veterans with chronic pain but also on improving quality of life in general. Key to the efficacy of this model is that it is guided by an individualized, patient-centered care with a strong and trusting patient-physician relationship that uses a non-pharmacological approach such as yoga, acupuncture, nerve blocks, and so on. This is especially important because as Dr. Busse explained in a recent blog post, Canada is the world’s second highest per-capita consumer of opioids which has contributed to increased rates of misuse, dependence, and addiction. Moving away from the prescribing of opioids following an acute injury, or at the very least by encouraging clinicians to limit opioid prescriptions to 7 days or less, we can move towards a more sustainable, long-term healthcare approach that is grounded on alternative forms of treatment – instead of viewing opioids as a first resort.
Building off of Dr. Sandbrink’s presentation on the ‘Biopsychosocial Model of Pain Management’, Dr. Kligler began his segment by discussing the ‘Whole Health’ approach to care, which is how VA offers the Biopsychosocial model across its facilities and treatment programs. According to Dr. Kligler, ‘Whole Health’ is “an approach to health care that empowers and equips people to take charge of their health and well-being, and live their life to the fullest”. At its core is the idea that we’re moving beyond disease-oriented care to a model in which healthcare is also helping to promote health and well-being to Veterans and their families. The Whole Health approach is premised on the notion that the Veteran is at the centre of the system of health care and the physician’s job is to empower them either by encouraging them to make their well-being the primary focus, facilitating ways in which Veterans can expand their social relationships and surroundings, or by promoting an optimal, nutritious diet, among others.
The second in our series of educational symposiums featured Chester “Trip” Buckenmaier III, MD, Colonel, U.S. Army (Ret’d) who is the Program Director and Principal Investigator for the United States Department of Defense (DOD) Uniformed Services University’s (USU) Defense & Veterans Center for Integrative Pain Management (DVCIPM). This symposium also featured Dr. Brenda Lau, the Founder and Medical Director of CHANGEpain, an interdisciplinary pain clinic in Vancouver, British Columbia.
Dr. Buckenmaier’s presentation focused on how new pain management strategies have been explored to address the needs of service members in the last two decades, specifically to make way for a more holistic, multidisciplinary, and multimodal approach aiming to move away from opioids as a form of treatment for chronic pain in Veterans. He explained how the emphasis is really about shifting towards a model in which improving the overall quality of life is paramount to ensure Veterans and their families are progressing towards a future in which they can manage their chronic pain and live a functional life.
In the second presentation, Dr. Lau explained how, due to the COVID-19 pandemic, pain management clinics across the country, including CHANGEpain, piloted virtual care programs to provide care for Veterans because of the increasing barriers they were facing trying to access care. She noted that in some respects such as accessibility for patients, breadth of content and data, increased staff engagement, and the high number of patients reached, the shift towards virtual care in this unprecedented time has been positive and could be applied to deliver care in remote locations. Dr. Lau also noted that there are some downsides with a pain clinic providing virtual care programs, such as the organizational challenges pain management centres face, the barriers for online care effectiveness, and how to effectively monitor and evaluate the success of the program.
Our third symposium involved the U.S. Department of Defense’s (DOD) Dr. Diane Flynn, Dr. Patricia Poulin from The Ottawa Hospital, and McGill University’s Regina Visca. The theme for this event centred around the Stepped Care Model, a personalized pain management program based on the individual patient’s needs and responses to different types of pain management therapies.
In her presentation, Dr. Poulin explained how under the Stepped Care framework, there are two major umbrellas: progressive vs. matching/stratified model. The progressive, or the Stepped Care 2.0 is a mix of both - a flexible method that seeks to address the patient’s needs in which the goals are to eliminate wait times, ensure all patients feel welcome, provide adaptable and flexible treatments, giving patients choice, and to empower those living with chronic pain.
Regina Visca discussed how the Stepped Care Model encourages a multidisciplinary approach using one or more of five treatment modalities: medications, restorative therapies, interventional procedures, behavioural health approaches, complementary & integrative health.
Finally, the DOD’s Dr. Flynn explained how one should think of the Stepped Care Model like layers to an onion with the outer layer being described as self-management as the foundation of pain management, the first level seeking care in the patient-centred medical home, the second level as secondary consultations, and the third level as pain management clinics.
In our final symposium, Dr. Friedhelm Sandbrink and Dr. Benjamin Kligler from the Veterans Health Administration returned to share their findings and the initial outcomes from the Whole Health Project as well as Dr. Eleni Hapidou from the Michael G. DeGroote Pain Clinic who presented the results from her study published in the Canadian Journal of Pain in August 2020.
Dr. Kligler noted how Veterans who used Whole Health services reported greater improvements in engagement in healthcare & self-care as well as in perceived stress indicating improvements in overall well-being. Additionally, Dr. Kligler found that Veterans who participated in Whole Health at a substantial level, saw a 3.5x decrease in opioid usage compared to those who did not participate. For his part, Dr. Sandbrink found there was a clear, year-over-year association between the increase in the utilization of non-pharmacologic treatments compared to patient-level initiation of long-term opioid therapy in the subsequent year.
Dr. Hapidou shared the results of her study which concluded there was ample evidence for the effectiveness of interdisciplinary pain management programs in addressing chronic pain, while also noting that the unique facets of pain experience among Veterans aided clinicians in offering better-informed approaches to pain management.
We would like to thank all the presenters and their respective organizations for agreeing to participate in our first two parts of the Veteran and Family Well-Being Series. Adapting to the world around us as it temporarily shifts to more virtual platforms is critical to staying connected with our supporters. Being able to share some of these educational resources and insights from some of the leading minds on how chronic pain affects Veterans and their families reinforces for us the benefit of the Chronic Pain Centre of Excellence.