TPC: Toronto Poly Clinic

Multi-disciplinary Pain Management Program

Inter-disciplinary patient education, one way of helping pain patients in poverty

We are seeing increasing evidence of relationship between poverty with poor health and as a result poorer treatment outcome of many complex pain conditions(WHO report on Poverty and Health 2003). At the same time we are facing a worldwide economical crisis. Increasingly our patients are caught in vicious cycle of poverty and poor medical conditions. A review of the current literature of pain medicine demonstrates the importance of multi-disciplinary treatment for complex pain conditions (Multidisciplinary allocation of chronic pain treatment: Effects and cognitive-behavioural predictors of outcome , Samwell HJ Br J Health Psychol. 2008 Aug 20).

The inter-disciplinary mechanism of treatment is an excellent model where different medical, physical and psychological providers join efforts in a team to improve treatment outcome. Unfortunately most of these treatments are not covered by provincial health plans. As a result the access to a reasonable comprehensive treatment for an average patient of our six million Canadian pain community is very limited. Family doctors and pain practitioners are the main help line of this community with very limited resources. This crisis calls for many solutions including creativity. There is reasonable evidence available that PATIENT EDUCATION can improve the treatment outcomes (The verbal numeric pain scale: effects of patient education on self-reports of pain, Marco CA, Acad. Emerg. Med. 2006 August 13 (8) 553-9 . The New England Journal of Medicine A Comparison of Physical Therapy, Chiropractic Manipulation, and Provision of an Educational Booklet for the Treatment of Patients with Low Back Pain October 8th, 1998, Daniel C. Cherkin, Ph.D., Richard A. Deyo, M.D., M.P.H., Michele Battié, Ph.D., R.P.T., Janet Street, M.N., C.P.N.P., and William Barlow, Ph.D. )

If our patients are not able to afford exercise therapy, nutritional consultation or relaxation therapy, patient education may fill the gap. If community physicians have access to a comprehensive user friendly inter-disciplinary educational tool which can guide patients in exercise, nutrition and relaxation techniques, the outcome of their treatment can improve. Toronto Poly Clinic is developing an inter-disciplinary educational guide to assist the patients struggling with poverty. While our group of patients will benefit from this guide, we are facing a national problem on this issue. I use this opportunity to call upon all my colleagues who are interested in this issue as a national project. I hope we can develop a nationally standardized interdisciplinary patient guide. The ultimate standardized guide would be provided to our front line treatment providers free of charge who deal with patients in poverty first hand. This is a significant project requiring noticeable time and effort. Currently all the work being done on this project is pro-bono as there is no special funding for it. Fighting poverty is a noble tradition of our profession. My colleagues at the national scene who are interested in volunteering for this project can contact me at Toronto Poly Clinic:

Dr. Kevin ROD
5460 Yonge Street Unit 204
Toronto ON M2N6K7
Email: krod@tpclinic.com