Dr. Ian Schokking says he runs into cases of unresolved pain every day in his Prince George, B.C., practice.

"At least on a daily basis in my office, and at least 10 per cent of patients in emergency and the after-hours clinic have pain issues. Many of them without regular follow-up, without a lot of support."

Despite the daily encounters, he says medical school did not prepare him to deal with the issue.

"Training in chronic pain in medical school was probably zip, almost none," Schokking says. "There was not any real focus on chronic pain, [it] wasn't really on anybody's radar."

He says he has really learned more about pain only in the last 10 years, but not in any real coordinated way.

60 doctors spearhead pain training

But the situation is changing. A new chronic pain medicine program developed by the Doctors of B.C., formerly known as the B.C. Medical Association, is now underway.

Sixty physicians from all over B.C. are wrapping up a course on the latest pain management research and techniques. The idea is these doctors will head back to their communities and train more than 500 other family doctors by the end of the year.

B.C. pain management - Dr. Ian Schokking - Prince George

Dr. Ian Schokking says he has already seen improvements in patient outcomes after applying new pain management knowledge he gained this year in his practice in Prince George, B.C. (CBC)

Dr. Michael Negraeff, a pain specialist at Vancouver General Hospital who helped develop the course, said the program's impact should be especially felt in smaller communities with no access to pain specialists. 

"Chronic pain is really an orphaned condition in medicine," Negraeff said.

Physicians are traditionally trained to look at pain as a symptom of something else, and not a problem in and of itself. 

A study published in 2009 in the journal Pain Research and Management even found that Canadian veterinary students received five times more training in pain management than Canadian medical students.

Negraeff said the new B.C. program is designed to give doctors skills and techniques to help patients right away.

"[It] might be how to teach a patient how to breathe properly because that will help calm their nervous system," Negraeff says.

B.C. pain management -  Dr. Michael Negraeff - Vancouver

Dr. Michael Negraeff is a pain specialist at Vancouver General Hospital and co-founder and chair of the board of Pain B.C. He helped design the province's the Pain Management Practice Support Program, an educational initiative to help educate B.C. physicians about current pain management best practices. (CBC)

"There are also more traditional approaches with how to use medications and various types of pain: neuropathic pain would have a different approach than pain from bone or joint disease."

But, he said, there needs to be an understanding that doctors may not be able to completely eliminate someone's pain. 

Negraeff said the real measure of pain management success won't be eliminating all of a patient's pain, but will be apparent as an improvement in quality of life.

"It is often the most important and sometimes the only thing you can do to help people," he said.

Program to expand to other health professionals

The training program launched last fall, and Schokking says he has already seen some impressive results with the tools he has learned.

"I have had 10 or 15 patients who have gotten off of the painkillers they were on for years with as-good-as or better functioning using alternative strategies," he said.

The non-profit advocacy group Pain B.C., which played a key role in lobbying for the new training program, is now working with the governing bodies of other health care professionals to create similar programs for them. 

B.C. pain management -  Maria Hudspith - Vancouver

Maria Hudspith is the executive director of Pain B.C., a non-profit organization created in 2008 to help patients and health-care providers with educational resources, peer support and tools to assess and manage pain. (CBC)

Maria Hudspith, Pain B.C.'s executive director, said training for pharmacists should begin in May and a number of physiotherapists should be able to begin a program in September. 

"In the long run, what we want to see are these interdisciplinary networks of providers," she said. 

"So we might be able to say, 'You know, in Salmon Arm we have three GP pain champions, we have a pharmacist pain expert,' ...so [we're] really trying to create these informal networks that can better support people living with pain."

As for reaching the health care experts of the future, Canada's Royal College of Physicians and Surgeons recently accredited a brand new pain medicine sub-specialty.

Medical schools across the country are now in the process trying to launch their programs, but the University of British Columbia says it has not secured funding for a pain medicine program. 

The province has yet to agree to step in and fund pain management training for B.C.'s medical students, but it is making increasing funding in chronic pain awareness for practicing healthcare professionals.

On Monday, the government of British Columbia announced a $1-million grant to support Pain B.C.'s programs, which includes online and in-person pain management consultations for patients and educational opportunities for doctors, pharmacists, nurses, and other health care workers.

The $1-million grant is in addition to a $1,255,000 investment the Ministry of Health had made to Pain B.C.'s doctors education program, which launches a new session today.


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