Canadian Pain Task Force Report: March 2021

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An action plan for pain in Canada

Table of contents

Opening remarks

The Canadian Pain Task Force (CPTF) was established in 2019 to provide advice to guide the federal government toward an improved approach for the prevention and management of chronic pain, a diagnosis affecting nearly 8 million people living in Canada. The Task Force was asked to assess the current state of pain, resulting in our first report, and to identify best practices and an improved approach to care, education and awareness, research and related infrastructure, and health system monitoring, resulting in our second report. In December 2020, the Task Force mandate was strengthened and accelerated to provide recommendations on priority actions. These actions are meant to ensure that people with pain are recognized and supported and that pain is understood, prevented, and effectively treated across Canada.

The strengthening of the Task Force mandate reflects the urgency to take action on pain. The turbulent events over 2020 have laid bare the significant impacts of systemic inequity on the health of people in Canada. The COVID-19 pandemic, racial injustice, growing income inequity, and the opioid overdose crisis have exposed many shortcomings in our society and in the health system. They have also created an unprecedented opportunity for broad system reform.

The recommendations presented in this Action Plan build on system improvement efforts underway in federal, provincial, territorial, and regional jurisdictions. The Plan lays out specific and targeted actions necessary to improve outcomes for people living with chronic pain and to reduce its impact on families, communities, and society. Recommendations are clustered around six primary goals:

  1. Enable coordination, collaboration, and leadership across Canada
  2. Improve access to timely, equitable, and patient-centred pain care
  3. Increase awareness, education, and specialized training in pain
  4. Support pain research and strengthen related infrastructure
  5. Monitor population health and health system quality
  6. Ensure equitable approaches for populations disproportionately impacted by pain

Addressing chronic pain requires multiple and diverse approaches to change, from policy and regulation to changes in programs, practices, and attitudes. It will require broad engagement and depend on perseverance, collaboration, commitment, leadership, and resources. While presenting this action plan is a critical milestone, we recognize it is but one step in a longer journey. We have a lot to build on: advocacy and peer support, established and emerging networks, clinical experts, world-renowned researchers, and growing awareness among the public and policy makers. Together, we will work to create a better future for all people living with and impacted by pain.

With sincere gratitude,

The Canadian Pain Task Force

Fiona Campbell, Co-Chair
Maria Hudspith, Co-Chair
Manon Choinière
Hani El-Gabalawy
Jacques Laliberté
Michael Sangster
Jaris Swidrovich
Linda Wilhelm

Background and context

The Canadian Pain Task Force

The Canadian Pain Task Force (CPTF) was established to provide advice and information to guide Health Canada toward an improved approach to the prevention and management of chronic pain in Canada. It is comprised of people personally impacted by chronic pain, Indigenous Peoples, researchers, educators, and health professionals with expertise across many disciplines in the field of pain. An External Advisory Panel provides additional subject-matter guidance and further broadens this expertise.

Phase I Report

In June 2019, the Task Force submitted its first report to Health Canada – Chronic Pain in Canada: Laying a Foundation for Action. The report highlighted significant gaps in access to timely and appropriate pain care; education, training, and awareness for patients, the public, and health care professionals; research and related infrastructure; and chronic pain surveillance and health system quality monitoring.

Phase II Report

Between July 2019 and August 2020, the Task Force conducted national consultations with over 2000 stakeholders (representing a sampling of the wide spectrum of opinions regarding chronic pain) and reviewed evidence to identify best and leading practices, areas for action, and elements of an improved approach to better understand, prevent, and manage chronic pain in Canada. The results of this engagement and evidence synthesis, including the voices of people living with pain, were summarized in Working Together to Better Understand, Prevent and Manage Chronic Pain: What We Heard.  

Phase III Goals

In January 2021, the mandate of the CPTF was strengthened and accelerated to provide recommendations on priority actions with a focus on ensuring people with pain are recognized and supported and that pain is understood, prevented, and effectively treated across Canada. This final CPTF report provides an Action Plan consisting of recommendations across six goals:

  1. Enable coordination, collaboration, and leadership across Canada
  2. Improve access to timely, equitable, and person-centred pain care
  3. Increase awareness, education, and specialized training for pain
  4. Support pain research and strength related infrastructure
  5. Monitor population health and health system quality
  6. Ensure equitable approaches for populations disproportionately impacted by pain

These six goals represent a national consensus, echoing international agreement, on the key areas for action that will transform how pain is understood and treated. An overview of the evidence underpinning these goals can be found in the CPTF’s first two reports.

Pain in Canada: A Public Health emergency in need of action

Chronic pain is a disease in its own right

The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage”. For most people, pain is temporary and serves as a warning that something is wrong, that something has caused or may cause damage to some part of our body. This is acute pain, which usually resolves as we heal.

When pain persists for longer than 3 months, it is defined as chronic. The World Health Organization (WHO) in its 11th revision of the International Classification of Diseases (ICD-11) includes chronic pain as a diagnosis in its own right, further categorizing chronic primary pain and chronic secondary pain. Chronic primary pain refers to pain that exists despite complete tissue healing, or pain that has no identifiable cause. Chronic secondary pain occurs in association with underlying diseases (e.g., rheumatoid arthritis).

Biological, psychological, spiritual, environmental, and social factors influence our experience of pain. Chronic pain, like other chronic diseases, is best understood within a biopsychosocial framework, and its treatment should integrate pharmacological, physical, psychological, spiritual, self-management, and other approaches, as appropriate.

Nearly 8 million people in Canada live with chronic pain

It is a critical time for action on pain in Canada. An estimated 7.6 million, or one in five people (across the lifespan), live with chronic painFootnote 1, many of whom report it adversely affecting some or most daily activities. Pain impacts all demographics in Canada, although not equally. One in five children and youth experience ongoing pain, which can have affects across the life course. It is even more common as we age, with approximately one in three people over 65 experiencing chronic pain. As Canada’s population ages, the prevalence of chronic pain and its impacts are expected to grow.

Like many other chronic conditions, chronic pain disproportionately affects seniors, people living in poverty, people living with mental health and substance use disorders, people working in the trades and transportation industry, Veterans, Indigenous Peoples, certain ethnic and racialized communities, sexually and gender diverse persons, those who have experienced past trauma or violence, persons with disabilities, and women. Such disparities demonstrate the importance of addressing equity as a cornerstone of Canada’s response to chronic pain.   

Untreated pain results in poor outcomes for individuals, families, and communities

Pain impacts people’s ability to work, attend school, and participate in family and community life. Chronic pain often accompanies other physical and mental health conditions, from sickle cell disease, arthritis and diabetes to post-traumatic stress disorder, depression, and anxiety. Chronic pain is largely invisible, and those affected often feel disbelieved and stigmatized. Living with chronic pain can take a tremendous toll on sleep, physical functioning, mental health, and social relationships. Children with pain have unique needs and when their pain goes unmanaged, it is associated with poor academic, social, and developmental outcomes, including higher rates of chronic pain, substance use, and mental health issues in adulthood. The lack of specialized pain services, the lack of effective treatment for some chronically painful conditions, long wait times, barriers to access for care, and the scarcity of health professionals trained in pain management exacerbate hopelessness for people who live with pain.

“My pain has had a significant impact on my life. It impacts my ability to get out of bed, get ready, go to school, go to work, exercise, and spend time with my friends and loved ones. Pain causes me to compromise on every aspect of my life.”

Person living with pain

Chronic pain is taking a massive economic toll

Chronic pain also has a tremendous impact on the economy. According to Health Canada’s analyses, the total direct (health care) and indirect (lost productionFootnote 2) cost of chronic pain in 2019 was $38.2 - $40.3 billion. Direct costs (expenditures for physician’s services, prescription drugs, and hospital inpatient and outpatient care) were between $15.1 and $17.2 billion, representing over 10% of total combined health expenditures for these costs.

Preliminary analysis by Health CanadaFootnote 3 estimates the total number of individuals living with chronic pain will increase by 17.5% from 2019 to 2030 due to population growth and agingFootnote 4. Preliminary projections indicate as many as 8.3 million Canadians may live with chronic pain by 2025 and as many as 9.0 million by 2030. By 2030, the estimated direct costs will rise to $20.5 - $23.4 billion and indirect costs to $31.5 billion. This results in a total cost increase of 36.2% during this period ($52 - $55 billion).

Despite the substantial cost, people living with pain in Canada continue to face tremendous barriers to care, employment supports, and other services.

Chronic pain and its impacts can be reduced

A substantial proportion of people develop chronic pain following injury (e.g., at work or home, through sports or motor vehicle accidents) or surgery. Various risk factors contribute to the development of chronic pain, providing a substantial opportunity to intervene early, to prevent pain from becoming intractable, and to mitigate its many impacts.

Preliminary analysis by Health Canada estimates a 1% annual reduction in the number of Canadians living with chronic pain could yield an average annual saving of $165.2 - $188.5 million (2020 CAD) in direct costs, and an average annual saving of $232.6 million (2020 CAD) in indirect costs between 2020 to 2030. The estimated present value of cumulative savings in direct and indirect cost is $3.5 - $3.7 billion (2020 CAD) over the 10-year periodFootnote 5.

Various strategies can reduce the likelihood that pain will persist over time: improving surgical techniques, preventing and managing injury and trauma, optimizing pain management in the peri-operative period, and intervening early with multi-modal, biopsychosocial approaches to address risks for chronicity and comorbidities. Many existing strategies, including those focused on primary prevention of chronic disease through improved nutrition, healthier built environments, improved sleep, increased physical activity, and supports for mental health and resiliency could also potentially reduce the occurrence and severity of chronic pain and improve function. 

Preliminary analysis by Health Canada estimates that a 3% to 5% annual improvement in functionalityFootnote 6 and related improvements in production (i.e., unemployment and absenteeism), among individuals living with activity-limiting chronic pain could result in an average annual saving of $132.4 million to $217.4 million (2020 CAD) in indirect costs between 2020 and 2030. The estimated present value of cumulative savings in indirect costs is in the range of $1.2 to $1.9 billion (2020 CAD)Footnote 7 over the 10-year period.

Investment in pain prevention and management has the potential to not only improve outcomes for Canadians but also deliver sizable savings

"It may surprise people to learn that pain itself is not the biggest factor affecting my life but the by-product of the pain – financial insecurity. Most significant was having to leave the workforce long before retirement age. At the time of my highest earning potential, I was forced to stop working because of unremitting chronic pain."

Person living with pain

Untreated chronic pain is connected to the opioid overdose crisis

A large proportion of people who use substances also live with untreated chronic pain. People who use substances and their families often point to the lack of appropriate pain care as a contributor to their substance use and an impediment to successful treatment and recovery. The substance use system is also poorly connected to other systems (e.g., primary care, tertiary multidisciplinary pain treatment clinics); this lack of coordination can further complicate access to care and exacerbate substance use-related harms. Numerous factors have contributed to a significant increase in opioid-related harms and deaths over the last two decades; increase in opioid prescribing, particularly for people at risk of substance use disorder, lack of access to non-opioid options to treat pain, widespread market availability of opioids, the introduction of potent illicit synthetic opioids (e.g., fentanyl), and association between high doses and risk of death as well as broader socio-economic drivers of substance use (e.g., racial injustice, poverty, trauma).

Efforts to address opioid-related harms have led to serious and unintended consequences for some people living with chronic pain, including unmanaged pain, increased stigma, reduced access to care for people who use opioids for pain relief, and preventable deaths. This has led some people to obtain illicit drugs to self-medicate, putting them at serious risk of overdose. Despite widespread decreased opioid prescribing, and investments in a continuum of harm reduction, treatment, and prevention initiatives, there are record high numbers of overdose deaths in Canada. We must urgently address untreated pain as a driver of this crisis.

Pain and its impacts are exacerbated by the COVID-19 pandemic

For many people with pre-existing chronic pain, the COVID-19 pandemic has led to stress, social isolation, exacerbation of concurrent mental health conditions, reduced opportunities to maintain physical functioning, and increased pain and disability. The pandemic-related disruptions in health care and services have reduced access to supports and therapies that people living with pain rely on to maintain quality of life. Elective surgeries and procedures to alleviate pain have been postponed, resulting in prolonged pain and reduced ability to function. Such challenges have contributed to increased reliance on prescription medications, including opioids, and increased use of other substances.

As the COVID-19 pandemic continues, and the effects of public health measures are felt over the longer term, people who live with pain are increasingly vulnerable to harm. People who live with chronic conditions – many of which are associated with chronic pain – have been shown to experience worse outcomes from COVID-19 infection. There is also the potential for the pandemic to result in large numbers of new cases of complex chronic pain over time due to not only these noted challenges but also post-viral complications among those who were infected. 

There is an emerging consensus about what works and what is needed for meaningful change

Many people living with pain, health care professionals, researchers, policy makers, and non-governmental organizations have been contributing to a movement for action on pain in Canada. Innovative treatments and clinical models, proven educational approaches, novel support programs, and world-renowned research ready for real-world implementation already exist across the country. Through the CPTF’s assessment and consultation phases, it is clear that there is consensus on both the gaps and the remedies. What is needed now is national policy, coordination, and resources to amplify, build, and accelerate this work, and to address current gaps and inequities.

The opportunity for integrating pain into system reform and health in all policies

Large-scale and complex societal problems such as the COVID-19 pandemic, racial injustice, poverty, and the overdose crisis have exposed many shortcomings in the health system. They have also resulted in fast-tracking of meaningful solutions and created an unprecedented opportunity for broad system reform. People in Canada have witnessed accelerated changes in health care that have improved access, safety, and efficiency for some services. Rapid mobilization of virtual care, access to expanded income supports, improved access to prescription medications and pharmaceutical alternatives to toxic drugs, expanded access to mental health services, and enhanced self-management tools and resources are a few of the many changes that will contribute to improved health. Such change will also have secondary benefits, improving assessment, prevention, and management of chronic pain for millions of Canadians.

The Action Plan and recommendations presented in this report leverage such health system expansion and improvement activities underway in federal, provincial, territorial, and regional jurisdictions. This Plan lays out specific and targeted actions necessary to improve outcomes for people living with chronic pain in Canada and to reduce its impact on families, communities, and society. It provides an ideal opportunity for federal, provincial, territorial, Indigenous, and other leaders to champion and dedicate resources to take action on chronic pain.

The action plan for pain

Addressing chronic pain requires multiple and diverse approaches to change. National strategies conventionally articulate top-down approaches through policy and regulation. Although these levers are tremendously powerful, policy change – on its own – will not realize the overarching outcome of the Action Plan: improved prevention and quality of life for people living with pain and fewer impacts on individuals, families, community, and society. Shifting outcomes also requires culture change – changing peoples’ attitudes, judgements, and ways of being.

Building from the extensive evidence reviews and consultations informing the work of the CPTF reports to date, this Plan recommends a wide range of actions to ensure people with pain in Canada are recognized and supported and that pain is understood, prevented, and effectively treated. The roles and influence of many actors are noted; governments, provincial and regional health authorities, educational institutions, non-profit organizations, and other stakeholder groups will need to consider how best to make strategic and targeted choices on specific activities, mindful of their respective mandates and levers for action.

Equity lens

Overlapping biological, psychological, social, environmental, cultural, historical, and other factors not only influence how pain is experienced, but also impact who develops chronic pain in the first place and how it is treated. Addressing systemic inequities must be a central, integrated pillar of Canada’s efforts to understand, prevent, and treat pain; the Task Force has applied this lens to the following recommendations.

Figure 1: An Action Plan for Pain in Canada

An Action Plan for Pain in Canada
Figure 1 - Text Description

Concentric circles showing the interplay between the action plan goals and the outcome. The centre circle is the outcome:

  • Prevention of chronic pain, improved quality of life for people living with pain, and fewer associated impacts on individuals, families, community, and society.

Moving outwards, the next concentric circle is divided into four quadrants:

  1. Improve access to timely, equitable, and person-centred pain care
  2. Increase awareness, education, and specialized training for pain
  3. Support pain research and strength related infrastructure
  4. Monitor population health and health system quality

The four quadrants are surrounded by two more concentric circles, the goals of:

  1. Ensure equitable approaches for populations disproportionately impacted by pain
  2. Enable coordination, collaboration, and leadership across Canada

The types of stakeholders and partners make up the outer layer.

Concentric circles showing the action plan outcome supported by four central goals, with overarching goals of equity, coordination, and stakeholder involvement.

This figure depicts the Canadian Pain Task Force Action Plan for pain in Canada. At its centre is the overall outcome the action plan hopes to achieve. This outcome will be enabled with a focus on four main goals related to improving access, education, research, and surveillance as well as foundational goals underpinning all recommendations that include attention to equity for different populations and coordination, collaboration, and leadership across Canada.

Outcome: Prevention of chronic pain, improved quality of life for people living with pain, and fewer associated impacts on individuals, families, community, and society.

Goal #1 - Pain is recognized as a public health priority and coordination of action across jurisdictions spurs collaboration, leadership, and support to ensure a consistent approach to pain throughout Canada

Chronic pain is a complex problem that currently exists everywhere and yet belongs nowhere. It is highly prevalent, drives utilization across virtually every domain of health care, and has significant impacts in many other systems. Despite this, chronic pain remains an issue without an institutional home or a champion accountable to drive improvement.

“We urgently need an [action plan] embraced by policymakers, health professionals, and patients to provide effective pain management services for all Canadians who need them.”

Person living with pain

This Action Plan outlines specific policy and program recommendations for federal, provincial, and territorial governments and calls others – from federal agencies to Pan-Canadian Health Organizations – to act within their jurisdictions and spheres of influence. Engaging a diverse network, with a range of skills, perspectives, resources, and tools, is necessary when tackling large-scale and societal problems. Many organizations and stakeholders have a role to play but coordination is required to foster collaboration, reduce duplication of effort, and ensure results are achieved over time.

Over the last decade, people living with chronic pain have begun to mobilize in communities (both geographic and online) across Canada and internationally, non-profit organizations have been formed, networks of pain researchers have been created, and clinicians and educators have come together to change practice. This momentum represents a tremendous opportunity; harnessing the power of this movement will be key to success and is necessary for achieving each of the ensuing goals.

Recommended actions:

Goal #2 - People have equitable and consistent access to a continuum of timely, evidence-informed, and person-centred pain care and supports across jurisdictions

Pain – whether acute or chronic – must be appropriately treated and/or managed. Knowledge of risk factors that drive acute pain to become chronic are emerging, presenting an opportunity to both mitigate risk and enhance protective factors. Timely access to evidenced-informed strategies to prevent the transition from acute to chronic pain will help substantially reduce prevalence of chronic pain in Canada.

People in Canada currently have inconsistent and insufficient access to pain services in primary care, and wait too long for speciality services. Evidence points to the need for access to a broad spectrum of options matched to the unique needs of each individual, including self-management, primary care, wellness-oriented programming, community-based care, specialized services, and interprofessional care.

Recommended actions:

System reform and innovative person-centred pathways and models of care

Regulatory measures and reforms

Tax and fiscal measures

National standards and guidance

Virtual treatment, self-management, and peer supports

Goal #3 - People living with pain and health professionals have the knowledge, skills, and educational supports to appropriately assess and manage pain based on population needs. The broader community understands pain as a legitimate, biopsychosocial condition and stigma is reduced

Despite a wealth of knowledge on different aspects of chronic pain, it is still not well understood by many and remains stigmatized and invalidated, contributing to poor outcomes for people who live with pain. Legitimizing pain – in the health care system, in workplaces and schools, and in society more broadly – is essential to combating stigma and improving quality of life for Canadians with chronic pain.

“My personal vision is that the awareness about chronic pain takes on the same level of awareness that conditions such as mental health and breast cancer have received.”

Person living with pain

People living with pain need knowledge of pain science and evidence-informed treatments and supports to enable them to improve their quality of life. Innovative self-management programs exist but they require support to scale and to be tailored for diverse populations and contexts. 

Pain education for health professionals is inadequate, with significant knowledge gaps in both pre- and post-licensure contexts. There are pockets of excellence across the country in health professional education and training, although there is work to be done to scale these and to integrate trauma and violence-informed approaches and cultural relevance and safety.

Recommended actions:

Public education and awareness

Health system organization and delivery of care

Pre-licensure education and training

Post-licensure education and continuing professional development

Goal #4 - Pain research and related infrastructure enables discovery, catalyzes innovation, and results in the translation of knowledge into real world impact

There have been recent significant investments in pain research and knowledge mobilization in Canada. Our country is home to many internationally renowned pain researchers and boasts a strong pain research community. However, many knowledge gaps persist and strategies to spark discovery and foster innovation are needed.

Research and advocacy-based funders, organizations, and networks, some collaborating with people living with chronic pain, have worked to define directions for a national research agenda. Further investment is required to support and accelerate basic science, clinical trials, research in social determinants, and evaluation of health services in the area of pain, and to ensure knowledge is mobilized to change practice and policy.

Recommended actions:

Engagement of people living with pain

Coordinated and collaborative opportunities specific to pain research

Invest in research infrastructure to enable precision and personalized care

Invest in strategic research priorities

Build future research capacity

Goal #5 - Data enables effective monitoring of pain and facilitates improvement of health system quality

Due to the lack of surveillance infrastructure, governments, researchers, and health care professionals do not have enough information about chronic pain (e.g., mechanisms, manifestations, management), the unique challenges and needs of people living with pain, and the capacity of respective health care systems to respond to these needs. Taking action on pain must be enabled by improved, consistent, and sustained national data collection on the prevalence, course, and impact of chronic pain in Canada. There is also a need to monitor the impact of interventions intended to improve health outcomes for people living with pain and health system performance.

Canada’s public health surveillance system offers turn-key opportunities to integrate questions on pain into existing surveys as well as building new tools to enhance our understanding. These data will help to create health profiles at federal, provincial, territorial, and regional levels, identify populations at-risk, monitor changes over time, and enable big data approaches and evidence-informed policy, programming, and investments to ensure all Canadians living with or at-risk of chronic pain achieve the best outcomes possible.

Recommended actions:

National indicators and reporting

Novel approaches to monitoring pain

Novel collaborations and data sources

Populations disproportionately impacted by chronic pain

Goal #6 - There is improved and equitable access to services for populations disproportionately impacted by pain

The prevalence of chronic pain in Canada is not equitably distributed. Occurrence of disease, severity of illness, and barriers to care are higher in populations affected by social inequities, racism, poverty, violence, trauma, and other experiences of marginalization. Various intersecting forms of discrimination may also lead to compounded challenges in receiving care and outcomes. An equity-oriented and trauma and violence-informed approach will be essential to understand, prevent, and treat pain.

"Many marginalized groups, in particular people of colour, Indigenous people and women, have their pain outright dismissed by the public and medical professionals. People of colour and Indigenous people are often regarded as 'drug seekers' and women are regarded as being 'dramatic'. These barriers not only prevent people from getting proper care but also prevent them from seeking help in the first place, due to negative experiences and shame."

Person living with pain

First Nations, Inuit, Métis Peoples

Racialized Peoples

People who use substances

People with mental illness


Persons with disabilities

Children and youth



People who are sexually and gender diverse

People who are incarcerated


Conclusion and next steps

Chronic pain is ubiquitous. It is a serious public health emergency impacting people across Canada, their families, the health system, and society. There is an urgent need to address pain in Canada. The Action Plan for Pain in Canada is a critical step towards laying a strong foundation for change, and provides a blueprint to advance an improved approach to the prevention and management of chronic pain.

National leadership, supported by resources, is needed now to put these recommendations into action.  Health Canada and the Government of Canada must lead the way, in partnership with Provinces and Territories and with all levels of government. It does not stop there. A range of other actors working inside and outside of the health system, from peer advocates, non-governmental organizations, academic institutions, insurers, and others, must step forward in order to enable positive and lasting change.

Together, we must act to build, amplify and accelerate activities, coordinate responses, and address gaps and inequities. Investing in these priority actions will ensure people with pain are recognized and supported, and that pain is understood, prevented, and effectively treated across Canada.

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