Back to Chronic pain management by rural and urban community pharmacists

chronic pain low back headaches neuropathyThe facts are sobering — the Public Health Agency of Canada estimates that 17% of Canadian adults live with some form of chronic pain. Such pain can lower a person’s quality of life and its effects often extend to families, society and the workplace. Chronic pain is estimated to cost Canadians $15 billion annually, of which $10 billion is borne by our healthcare system.

Chronic pain becomes more common as people get older and its prevalence will undoubtedly grow as Canada’s population ages. It is a complex problem, and treating it can be difficult because chronic pain has many causes, including injury, disease and disorders, that can interact to exacerbate its intensity and duration.

Many healthcare professionals treat chronic pain, but could the scope of practice of pharmacists — the most accessible healthcare professionals — be expanded to include its management?

This is precisely the question that Drs. Feng Chang, Tejal Patel and Beth Sproule of OPEN’s Chronic pain management by rural and urban community pharmacists project hope to answer.

“Pain is subjective,” explains Dr. Chang, a pharmacist and assistant professor at Waterloo’s School of Pharmacy.

“For a similar condition, one patient may require opioids for pain relief while another may be able to cope through meditation or over-the-counter drugs. But we know that many people see a pharmacist first for self-administered pain relief before visiting other healthcare professionals. Here, pharmacists are very much on the frontlines of patient care.”

OPEN’s chronic pain stakeholder workshop

To get a sense of the experiences patients have with chronic pain, how healthcare professionals are responding to them, and opportunities for community-based pharmacists, the research team invited chronic pain patients, patient advocates and healthcare providers to participate in a day-long exploratory workshop during the fall of 2013 at Waterloo’s School of Pharmacy.

Waterloo Wellington-Myalgic Encephalomyelitis AssociationAttendees began the day by giving presentations on their experiences with chronic pain. Afterward, attendees participated in small group discussions. Using a structured discussion method to identify problems and generate solutions known as the nominal group technique, the research team elucidated what participants saw as their most significant challenges with respect to chronic pain and the role community pharmacists could play to manage it.

With this baseline information, the research team has developed a survey that will be sent this spring to Ontario pharmacists in the community and those on family health teams to gauge their attitudes, perceptions and knowledge about chronic pain, particularly from headache disorders, low back problems and pain diabetic neuropathy.

“The survey findings will tell us what’s happening in pharmacy practice so we can progress to the next phase of the project — developing a specialized program for a new professional service pharmacists could provide to better manage their patients’ chronic pain,” Dr. Chang said.

The aim is to provide pharmacists with a tangible program they can incorporate into their clinical practices, with the goal of providing patients with better care and pain management.

“A lot of patients would benefit from a coordinated approach to pain management,” Dr. Chang said. “We know it’s not just about drugs and that chronic pain can be a lifelong challenge for many. Healthcare professionals need to understand patients’ personal stories and provide ongoing individualized support, a role pharmacists in the community could help fill.”

In total, workshop participants identified 69 items to consider, which were classified into 10 priority areas.

“Improved pharmacist education was ranked as the top opportunity to better manage chronic pain in patients, followed by improved recognition of the pharmacist as members of interdisciplinary healthcare teams and a need for improved communications among healthcare providers,” Dr. Chang said.



The Waterloo Wellington Myalgic Encephalomyelitis Association was one of the groups that attended and participated in the chronic pain stakeholder workshop (please click on the photo above to see their presentation).

After the event they sent Ayesha Khan a thank-you card for organizing the day’s activities.

  • Dear Ayesha,

    The new “OPEN” initiative was a wonderful workshop to be invited to participate in! It was fast-paced but very informative and interesting and we felt very valued as presenters and also for our contributions in the discussion groups.

    Kudos to all who worked hard to make it an enjoyable and educational experience for us and for to you personally for your patience in emailing back and forth with us! We wish you well in all your future endeavours.

    Many, many thanks!

    Ken, Ellen and Kitty (ME Association)