Canadian Pain Task Force and External Advisory Panel Joint Meeting: April 8-9, and April 30 2020

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• April 8, 2020, 11:00-13:00 EDT
• April 8, 2020, 14:00-16:00 EDT
• April 9, 2020, 11:00-13:00 EDT
• April 30, 2020, 13:00-14:00 EDT

April 8, 2020, 11:00-13:00 EDT

Via videoconference

Meeting Summary

Objectives

• Celebrate what we have accomplished collectively
• Discuss revised work plans including roles, responsibilities, and timelines for the remainder of this phase of the Task Force mandate
• Provide opportunity for sharing information about new initiatives to study or address impacts of COVID-19 pandemic on Canadians living with pain

Participants

Introductory Remarks and Celebrating CPTF Accomplishments – Presentation

• The Task Force Co-Chairs welcomed participants and provided an overview of meeting objectives
• The Co-Chairs went on to describe accomplishments since the inception of the Task Force, including recruitment of the Task Force and Panel, development of the phase I report on the current state of chronic pain in Canada, implementing several regional workshops and discussions with over 400 stakeholders from across Canada, and implementing an online national consultation.
• Several intangible accomplishments were also noted including raising awareness, engaging Canadians, enabling networks and discussions, and providing a voice for those least likely to be heard.

Phase II Work Planning – Presentation

• The Secretariat provided an overview of priority areas for the Task Force until the end of Phase II, including continued engagement, completion of consultations and evidence-gathering, drafting the Phase II report, and building communications related to resources for people living with pain.
• Due to the COVID-19 pandemic and its impact on governments and Canadians, the release of the Phase II report has been extended from June 2020 to Fall 2020. 

COVID-19 and Pain – Open Discussion

• Task Force and Panel members spoke to the impact of COVID-19 on people living with pain and emphasized the importance of continuing to engage and support partners.
• Members spoke to the health threat COVID-19 poses to vulnerable populations including people living with pain, Indigenous Peoples, and people who use drugs. These groups already experience poor access to healthcare, significantly higher rates of communicable and non-communicable diseases, lack of access to essential services, and other challenges. Task Force and Panel members also discussed the current Hydroxychloroquine drug shortages and the impacts on people living with rheumatic diseases.
• Members spoke of the various initiatives taking place across the country (i.e., surveys, studies, information and resources specifically for people in pain), which are being implemented during the pandemic. Members noted their appreciation for the innovation and strengthened interprovincial and interdisciplinary collaboration during this time.
• Members discussed the importance of continuing care, including support groups where possible through virtual / on-line sessions. However, it was also noted for those who need interventional pain practice, virtual sessions are insufficient.
• The Task Force will consider establishing an informal working group to respond to COVID-19 specific matters. The Secretariat also discussed ongoing efforts to share resources with its partners and to strengthen the Task Force's web presence.

April 8, 2020, 14:00-16:00 EDT

Via videoconference

Meeting Summary

Objectives

• Discussion with Health Canada leadership on expectations for the next Task Force report and activities
• Discuss progress and Task Force / EAP feedback on the key inputs for the Task Force report:
• What we have heard through stakeholder workshops
• Response to the online public consultation to date

Participants

Discussion with the Associate Assistant Deputy Minister (AADM) of the Controlled Substances and Cannabis Branch, Health Canada

• The AADM highlighted the success of the Task Force in raising the profile of pain nationally. He acknowledged the numerous accomplishments achieved by the Task Force in the past year and also acknowledged the Task Force's success in elevating pain as an important issue that is supported by senior leadership at Health Canada.
• The AADM addressed the many different health crises, which are being compounded by the COVID-19 pandemic and how they can impact people living with pain. The AADM also spoke to activities and actions underway at Health Canada within the Controlled Substances and Cannabis Branch to address the COVID-19 pandemic. 
• Members discussed extending the timeline for the release of the Phase II report, as well as the remainder of the mandate in the context of COVID-19 and associated delays.

What We Have Heard Through Stakeholder Workshops

• Task Force Co-Chairs presented to members an overview of the Phase II engagement process and common themes heard at Task Force regional stakeholder workshops.
• CPTF and EAP members held an open dialogue to further reflect on what they heard during the workshops across Canada (e.g., regional variance of best practices and elements of an improved approach to the prevention, diagnosis, and management of pain).
• Members expressed the workshops were a success and specifically noted the importance and success of including people with lived and living experience of pain in the discussions.
• Members suggested ideas of possible improvements for future Task Force workshops.

Canadian Pain Task Force Online Consultation

• The Secretariat provided an overview of responses received as of April 3, 2020, including demographic variance. The Secretariat also spoke to preliminary common themes within the online consultation responses gathered thus far.
• The Task Force will extend the online consultation to May 29, 2020, in light of the ongoing COVID-19 pandemic to allow more time for Canadians to provide their responses. Members noted pre- and post-COVID-19 sampling may be different and should be considered.
• Members noted a need to continue engagement with stakeholders to ensure representation of different socio-economic backgrounds, ethnicities, and Indigenous communities.
• The Secretariat will develop a forward plan for re-promotion of the online consultation. Task Force and Panel members will continue to distribute and promote the online consultation through their various networks.

April 9, 2020, 11:00-13:00 EDT

Via videoconference

Meeting Summary

Objectives

• Discuss progress and Task Force / EAP feedback on the key inputs for the Task Force report
• Provide opportunity for all participants to share information about new initiatives to better understand, prevent, and manage pain in Canada

Participants

Drug Safety and Effectiveness Network Rapid Evidence Reviews

• Representatives from the Drug Safety and Effectiveness Network (DSEN) shared an overview of two rapid evidence reviews related to (1) managing chronic pain, mental illness, and substance use and (2) preventing the transition of acute pain to chronic pain.
• DSEN representatives discussed the study criteria including the methods (i.e., protocols, literature searches, screening, and extraction) of the two reviews and discussed how these criteria ensured the accuracy of data collection. DSEN representatives also shared preliminary results of the two rapid evidence reviews (i.e., number of publications included in reviews, overview of excluded reviews, and generalized findings).
• DSEN representatives provided an overview of the limitations of both rapid evidence reviews and suggested future review considerations.
• Task Force and Panel members engaged in an open dialogue with DSEN members and agreed to continue this work by broadening the inclusion criteria.

The Economic Burden of Chronic Pain in Canada

• The Policy, Research, Economics, and Analytics unit (PREA) at Health Canada prepared a status update and next steps presentation on the ongoing estimate of the economic cost of chronic pain in Canada. 
• PREA presented an overview of the current work, methodology, limitations, and status, as well as requested the Task Force provide recommendations to key questions.
• Members had an opportunity to provide feedback and comments to the presentation provided by PREA. Comments regarding scope of data collection, methodology, federal populations, and limitations were provided. 

April 30, 2020, 13:00-14:00 EDT

Via videoconference

Meeting Summary

Objectives

• Discuss Task Force mandate in lieu of COVID19 and extension of phase II
• Confirm forward meeting planning and our approach to phase II report development

Participants

Task Force mandate

• Due to the ongoing COVID-19 situation, during the discussion with AADM on April 8 there was mention of the need to extend the second and third phase of the CPTF mandate beyond the current plan of finishing in December 2021; however, the discussion was cut short due to timing. This meeting continued the discussion between the Task Force, Advisory Panel, and the Secretariat on mandate expansion and extension scenarios.
• Task Force and Panel members were in consensus about the approved extension of the phase II report to Fall 2020, and were open to further expanding the mandate to better support the creation and implementation of a formal national pain strategy or other strategic policy work as well as extending timelines to match such an expansion. Several concerns were raised about extending timelines beyond December 2021 without an expanded mandate or clear rationale, including lose of momentum gained.
• Members agreed to further develop a knowledge translation and mobilization plan for phase III and to revisit needs and timelines based on the activities outlined in that plan.

Forward meeting planning and approach to Phase II report development

• Members discussed the importance of integrating learning from COVID-19 into the phase II report in some manner, including discussion of virtual care and innovative service delivery models (e.g., Stepped Care 2.0) being put in place in response to the pandemic and their relevance for chronic pain care.
• Members also noted the health care system could be radically transformed due to the ongoing COVID-19 situation, and that we must reflect on best practices, gaps, and strategies with potential future changes in mind.
• The Task Force and Panel agreed to meet again in June and September to discuss the online consultation and other evidence-gathering and engagement results. More frequent meetings will help to create the phase II report in a manner that ensures the findings accurately capture what was heard from consultations with Canadians, while also aligning with changes to the health care landscape.