Joint Meeting of the Canadian Pain Task Force and External Advisory Panel: May 1-2, 2019

Diefenbaker Building, 111 Sussex, Library Room, Ottawa, Ontario

Meeting Summary

Meeting Objectives

• Engage with members of federal government departments to discuss federal roles, interests, and potential opportunities in the area of chronic pain
• Confirm outline and obtain input on key questions, messages, and content to be addressed in the first report on the state of chronic pain in Canada
• Initiate planning to engage other external and provincial/territorial stakeholders to inform the work of the Task Force

Day 1 – Engaging Government Departments and Discussing the Report Outline

Introductory Remarks

Eric Costen, Associate Assistant Deputy Minister, Controlled Substances and Cannabis Branch (CSCB), provided opening remarks and welcomed meeting participants. Mr. Costen highlighted the important role that external advisory bodies play in helping governments to work through complex and challenging policy problems as well as the value of consensus among a diversity of perspectives for compelling action. He challenged members to reflect on what success will look like.

Dr. Fiona Campbell and Maria Hudspith, Co-Chairs, Canadian Pain Task Force, provided an overview of the Task Force impetus and mandate, the diversity of perspectives represented on the External Advisory Panel, the importance of engaging stakeholders beyond the Task Force and Panel in this important work and, and the meeting objectives and ground rules.

Roundtable Introductions and Expectations

Task Force and Panel members introduced themselves, noting their unique perspectives and expectations for the collective work of the Task Force. Members emphasized the importance of interdisciplinary approaches to treatment, including the voices of people living with pain, and the role that continued research and education will play. Expectations revolved around building awareness and respect, validating the experience of those living with pain, and working toward the ultimate goal of improving access to pain prevention and management.

Roundtable with Federal Government Departments

Task Force and Panel members participated in a roundtable with officials from several government departments discussing roles, interests, and opportunities with respect to chronic pain and the mandate of the Task Force. The following is a summary of the discussion from various government representatives:

• Opioid Response Team, Health Canada – Jennifer Novak, Executive Director, ORT discussed the drug overdose crisis, recent federal actions to address the crisis, how the chronic pain perspective has been integrated into these discussions, and next steps for the department.
• Health Products Food Branch, Health Canada – Dr. Supriya Sharma, Chief Medical Officer, HPFB discussed the role of HPFB in approving and monitoring of clinical trials, approving health products for use, and undertaking important surveillance functions. She noted recent changes to labelling and risk communication around opioids, the marketing and advertising of opioids, and classification of certain opioid products.
• Public Health Agency of Canada – Stephanie Priest, Executive Director, Mental Health and Wellbeing Division provided an overview of public health functions and activities with particular emphasis on preventing disease and injuries, promoting good physical and mental health, and providing information to support informed decision-making.
• Canadian Institute for Health Research – Dr. Karim Khan, Scientific Director, Institute of Musculoskeletal Health and Arthritis discussed the role of CIHR, its unique model for health research, and CIHR investments in chronic pain.
• Indigenous Services Canada – Dr. Patricia Wiebe, Senior Medical Advisor, Office of the Medical Officer of Public Health, presented on the restructuring of the First Nations and Inuit Health Branch and Indigenous Services Canada and changes to better support community-led action on the social determinants of health and self-determined approaches.
• Veterans Affairs Canada – Nathan Svenson, Director of Research and Dr. Alexandra Heber, Chief of Psychiatry, spoke to the prevalence of chronic conditions in veteran communities and the recently announced funding to create a Centre for Excellence on Chronic Pain Research.
• Correctional Services Canada – Harold Boudreau, Director, Pharmacy, Health Technology, and Health Services, briefly spoke to pain management within the federal correctional system and challenges associated with the stigma.
• Statistics Canada – Anie Marcil, Section Chief, discussed recent statistics related to chronic pain in Canada and information collected through the Canadian Community Health Survey.
• Economic and Social Development Canada – Joëlle Bastien, Senior Policy Analyst, Seniors and Pensions Policy Secretariat, reiterated government commitments to seniors, families and caregivers, poverty and homelessness, and accessibility, noting high-level activities that could be relevant.

Discussion of Task Force Report High-Level Narrative 

Andrew Taylor presented the initial draft outline and approach for the first report of the Task Force, followed by a general roundtable discussion with all members. Members emphasized the report should be able to guide us in creating tangible next steps for Phase II of the Task Force’s work and noted the need for alignment with communications and engagement planning. Additional points of discussion focused on:

• Engaging those experiencing and affected by pain.
• Chronic pain as a common and impactful public health priority and a disease in its own right.
• Economic impacts of chronic pain and potential cost savings.
• Challenges associated with diagnosing pain.
• Challenges associated with providing care and matching services and resource intensity based on complexity and needs.
• Evidence and knowledge translation gaps related to opioid use, concurrent substance use disorder, and overdose deaths.

Small Group Work on Task Force Report Priority Topics

Task Force and Panel members broke out into groups based on the main sections and areas of inquiry of the report. Through a range of facilitated activities, each group discussed key messages, content, considerations, and literature for their assigned topic. After their initial discussions, each group circulated to explore new topics to review and build on the previous groups’ work. The following is a listing of the main areas of discussion:

Defining and explaining pain, its prevalence and impact, and priority populations

• Unifying language and framework for pain.
• Taking a lifespan approach.
• Emphasizing the factors that contribute to pain.
• Recognizing the reality and lived experience of pain.
• Discussing goals and outcomes that are meaningful for patients and providers.

Introducing how pain is prevented and management and treatment options

• Having better prevention and treatment of acute pain will prevent pain from becoming chronic.
• Respecting the role that social, psychological, and physical interventions play in prevention and management.
• Discussing the various challenges impacting accessibility and availability of services.
• Acknowledging the importance of a stepped and guided approach to care.
• Acknowledging and respecting diverse forms of knowledge.
• Acknowledging stigma, stress, and emotions associated with pain.

Understanding the drug overdose crisis and pain management

• Framing pain management as a “wicked problem” (a problem that is complex, involving multiple opinions and possible causes, interconnected dynamics, incomplete or contradictory knowledge, and severe negative consequences for society if not addressed properly) requiring availability of and access to a variety of tools including opioids.
• Discussing stigma in all its forms and how it affects management of pain.
• Sharing decision-making and responsibility for pain management between health professionals and patients.
• Educating health professionals on pain management options.
• Acknowledging realities of people living with pain and the health professionals helping them to manage their pain.
• Exploring how to improve knowledge around opioid use.

Describing the current strategies, policies, and actions being implemented

• Learning from the successes and failures of other strategies.
• Mapping out what is going on and building from existing strengths and work.
• Engaging key stakeholders and patients early and in a meaningful way.
• Unifying different approaches to pain across Canada.

Building education and awareness activities

• Building awareness of pain among the general public through:
  • Exploring pain education activities and leveraging existing tools.
  • Addressing common myths.
• Improving pain education for health professionals through:
  • Addressing the need to reduce stigma, discrimination, and other negative factors impacting care and compassion.
  • Discussing standard curriculum and approaches.

Closing Remarks

Dr. Fiona Campbell and Maria Hudspith, Co-Chairs, Canadian Pain Task Force, provided closing remarks and reflections on the discussion from Day 1. They thanked everyone for their participation and noted the important contributions people were making.

Day 2 – Discussing the Report Outline and Planning for an Engagement Strategy

Introductory Remarks

Dr. Fiona Campbell and Maria Hudspith, Co-Chairs, Canadian Pain Task Force, reiterated the meeting objectives and ground rules.

Revisiting Task Force Report Content and Messaging 

Andrew Taylor presented a summary from the working group discussions on Day 1 and opened up a roundtable on further reflections. Members noted the need to distinguish between a general vision for improving chronic pain management and providing commentary on the current state of the field. Discussion subsequently involved further considerations:

• Distinguishing pain as a disease and acknowledging contributing factors.
• Noting challenges related to availability and accessibility and discussing a stepped and tailored approach to care.
• Recognizing the range of opioid uses, concurrent conditions, and challenges around prescription guidelines.
• Exploring the value of general and targeted approaches to building awareness around pain.

Stakeholder Mapping and Engagement Strategy Planning

Task Force and Panel members were presented with an initial table of stakeholder groups and subsequently undertook a brainstorming roundtable on groups, sequencing, and engagement strategies to inform more formal consultations and evidence-gathering.

Closing Remarks

Dr. Fiona Campbell and Maria Hudspith, Co-Chairs, Canadian Pain Task Force, provided closing remarks and reflections thanking everyone for their participation. Andrea Currie, Canadian Pain Task Force Secretariat, provided an overview of next steps including developing a summary of the meeting, and a calendar of events. The Task Force and Panel will be engaged during May and June to develop and review the Phase 1 report and will meet via teleconference twice in June to help to finalize the content prior to submission. The next joint meeting of the Task Force and Panel will be in September 2019 where members will discuss engagement and evidence-gathering.

Appendix A: Agenda

May 1 and 2, 2019

Meeting Objectives

• Engage with members of federal government departments to discuss federal roles, interests and potential opportunities in the area of chronic pain;
• Confirm outline and obtain input on key questions, messages, and content to be addressed in the first report on the state of chronic pain in Canada; and,
• Initiate planning to engage other external and provincial/territorial stakeholders to inform the work of the Task Force.

Day 1 – Task Force and External Advisory Panel Joint Meeting

8:30-9:00 1. Introductions

• Introductory remarks by Eric Costen, Associate Assistant Deputy Minister, Controlled Substances and Cannabis Branch, Health Canada; and,
• Task Force Co-Chairs to provide background and context related to the creation of the Task Force, note key themes of inquiry and review meeting agenda and objectives.

9:00-9:30 2. Roundtable introductions of CPTF and External Advisory Panel (Task Force Co-Chairs)

• Each member to introduce themselves by discussing the unique perspective they bring and their expectations for the collective work of the Task Force and Panel.

9:30-10:15 3.  Roundtable with Federal Government Departments (Secretariat to chair)

• Departmental officials to describe roles, interests, and opportunities with respect to chronic pain and the mandate of the Task Force.

(10 min per presenter followed by Q & A)

10:15-10:30 Break

10:30-12:00 3. Roundtable with Federal Government Departments Continued (Secretariat to chair)

• Departmental officials to describe roles, interests, and opportunities with respect to chronic pain and the mandate of the Task Force.

(10 min per presenter followed by Q & A)

12:00-13:00 Lunch in cafeteria

13:00-13:15 4. Introduce First Task Force Report (Secretariat to chair)

• Review objectives and agenda for remainder of joint meeting; and,
• Task Force Secretariat to present draft outline and approach for review and comment.

13:15-14:00 5. Discuss Outline for First Task Force Report (Secretariat to chair)

• Task Force and Panel members to discuss general report structure and goals; and,
• The group will reach general agreement on the main section headings and overarching areas of inquiry.

14:00-15:00 6. Small Group Work – Discuss Content for First Task Force Report (Co-Chairs and table facilitators to chair)

• Task Force and Panel members to be broken out into groups based on the main sections and areas of inquiry of the report;
• Each group to discuss key messages, content, considerations, and literature for their assigned section/area (30 mins); and,
• Each group will then circulate to a new section/area to review and build on the previous group(s) work.

15:00-15:15 Break

15:15-16:15 6. Small Group Work – Task Force Report Cont. (Co-Chairs and table facilitators to chair)

• Each group to discuss key messages, content, considerations, and literature for their assigned section/area (30 mins); and,
• Each group will then circulate to a new section/area to review and build on the previous group(s) work.

16:15-16:30 7. Closing Remarks

• Task Force Co-Chairs to provide reflections on the day’s discussion.

Day 2 – Task Force and External Advisory Panel Joint Meeting

8:30-8:45 1. Introductions and Welcome (Task Force Co-Chairs)

• Introduction and opening remarks; and,
• Goals for Day 2.

8:45-10:00 2. Roundtable – Discuss Content for First Task Force Report (Secretariat to chair)

• Secretariat to provide an overview of the key points raised in the small group work from Day 1; and,
• Task Force and Panel members to continue to reflect on the key messages, content, considerations, and literature for the report as a whole.

10:00-10:30 Break

10:30-11:30 3. Stakeholder Mapping and Engagement Strategy Planning (Maria Hudspith to chair)

• Task Force and Panel members to start to brainstorm on key areas of inquiry, stakeholder groups, and engagement mechanisms that will help to inform the Phase 2 engagement and consultation strategy.

11:30-12:00 4. Closing Remarks

• Secretariat to confirm summary of action items; and,
• Task Force Co-Chairs to provide reflections on the day’s discussion.

12:00-13:00 Lunch in cafeteria

Appendix B: Participant List

Canadian Pain Task Force (Task Force)

• Dr. Fiona Campbell, Co-chair
• Maria Hudspith, Co-chair
• Melissa Anderson
• Dr. Manon Choinière
• Dr. Hani El-Gabalawy
• Jacques Laliberté
• Dr. Jaris Swidrovich
• Linda Wilhelm

External Advisory Panel (Panel)

• Dr. Norm Buckley
• Dr. Christine Chambers
• Dr. David Lussier
• Justina Marianayagam
• Dr. Laura Murphy
• Dean Penney
• Dr. John Pereira
• Dr. Patricia Poulin
• Kathy Reid
• Michael Sangster

Panel Regrets

• Friederike Ballantyne
• Anshu Gupta
• Jennifer Harris
• Dr. Gilles Lavigne
• Pamela Schacht
• Dr. Colleen Varcoe

Secretariat

• Andrea Currie, Executive Secretary
• Andrew Taylor, Senior Policy Advisor
• Gisèle Jean, Senior Program Officer
• Megan Wyszynski, Program Officer
• Esther Stewart, Project Officer

Additional support to Secretariat generously provided by:

• Elaine Chan, Public Health Officer, PHAC
• Fabienne Glauser, Policy Analyst, Centre for Surveillance and Applied Research, PHAC

Health Canada (HC)

• Eric Costen, Associate Assistant Deputy Minister, Controlled Substances and Cannabis Branch (CSCB)
• Jennifer Novak, Executive Director, Opioid Response Team, CSCB
• Dr. Supriya Sharma, Chief Medical Advisor, Health Products and Food Branch (HPFB)
• Alejandra Valenzuela, Scientific Reviewer, HPFB

Public Health Agency of Canada (PHAC)

• Dr. James Taylor, Chief Dental Officer
• Stephanie Priest, Executive Director, Mental Health and Wellbeing Division

Indigenous Services Canada (ISC)

• Dr. Patricia Wiebe, Senior Medical Advisor, Office of the Medical Officer of Public Health
• Lindsay Croxall, Senior Policy Analyst, Mental Wellness

Canadian Institutes of Health Research (CIHR)

• Dr. Karim Khan, Scientific Director
• Tushar Shakya, Project Lead
• Mallika Auplish, Senior Briefing & Correspondence Analyst

Veterans’ Affairs Canada (VAC)

• Nathan Svenson, Director
• Dr. Alexandra Heber, Chief Psychiatrist

Statistics Canada

• Anie Marcil, Section Chief

Employment Services and Development Canada (ESDC)

• Joëlle Bastien, Senior Policy Analyst

Correctional Service Canada (CSC)

• Harold Boudreau, Director, Pharmacy & Health Technology