Canadian Pain Task Force and External Advisory Panel Joint Meeting: September 9 to 10, 2020

Canadian Pain Task Force Meeting:
September 9, 2020, 11:00-12:30 and 15:00-16:30 EST;
September 10, 2020, 11:00-12:30 and 14:00-15:30 EST

Via videoconference

Objectives

• Review Phase II report and discuss needed revisions.
• Engage in detailed feedback and dialogue related to main messaging and content.
• Outline next steps for finalizing the report prior to submission.

Participants

Task Force: Fiona Campbell, Maria Hudspith, Manon Choinière, Hani El-Gabalawy, Jacques Laliberté, Michael Sangster, Jaris Swidrovich, Linda Wilhelm

EAP: Norm Buckley, Christine Chambers, Chloe Crosschild, Jennifer Harris, Gilles Lavigne, David Lussier, Laura Murphy, Steven Passmore, Dean Penney, John Pereira, Patricia Poulin, Kathleen Reid, Colleen Varcoe, Gerald Zamponi

Regrets: Anshu Gupta, Justina Marianayagam

Secretariat: Dhilal Alhaboob, Baies Haqani, Pamela Rizzo, Nyree Schreiber, Andrew Taylor, Megan Wyszynski, Lindsey Yessick

Guests: Gisèle Carriere, Alan Diener,Olga Milliken, Barbara Sérandour

September 9, 2020

Opening remarks

• Eric Costen, Associate Assistant Deputy Minister for the Controlled Substances and Cannabis Branch, provided an introduction thanking members for their dedication and encouraging their continued efforts in finalizing the Phase II report.
• The Secretariat outlined the meeting objectives and agenda and proceeded to present the current status of the Phase II consultation process and resulting draft report.
• Members discussed the role of clinical best practices in the Phase II report and confirmed the broader definition of best practices used to guide the consultation process and report writing.

Breakout room and large group discussion: Overall impressions of the draft report

• In small groups, participants discussed their overall impressions of the report, and noted specific areas of strengths and needed improvements.
• Overall, participants felt the draft report was comprehensive, had a good balance of discussion across key issues, and was representative of the various consultation inputs including workshops, focused discussions, online consultation, and evidence-gathering activities.
• Members felt the Executive Summary was essential and suggested additional ideas for summary components. They also noted the importance of having a separate section on Indigenous Peoples, yet felt it was important to incorporate various content on different ways of knowing, social determinants of health, and population-based reflections throughout all sections of the report.
• Members discussed a range of potential improvements including:
• Editing for brevity and clarity, consolidating different sections where necessary.
• Revising sub-titles to more clearly articulate key points.
• Reducing simple listings of best practices and instead focusing on the details, principles, and ideas involved in the practices most identified by stakeholders.
• Expanding content on elements of an improved approach and being more specific and concrete about potential future strategies.
• Recognizing the challenges facing smaller provinces and territories and how federal actions can support and build capacity.

Breakout room and large group discussion: Research and related infrastructure

• In small pre-assigned groups, Task Force and Advisory Panel members provided feedback and discussed strategies for improving the research section of the draft report. Members then reported back key points and continued the discussion as a large group.
• Main points of discussion included:
• Providing more concrete direction to funding agencies about how pain could be better managed and discussing the need for leadership to bring all aspects together.
• Emphasizing the need to explore and better understand what has been achieved by research networks and investments.
• Stressing the need to better understand the research funding submission process and to collect statistics on the number of pain-related submissions and the outcomes of those submissions.
• Emphasizing the need for collaboration among institutions, jurisdictions, and disciplines.
• Discussing the importance of common, uniform set of measures/minimum data standards and building capacity and infrastructure for evaluation of innovative care solutions and real-world practice.

Breakout room and large group discussion: Surveillance and quality monitoring

• In small pre-assigned groups, Task Force and Advisory Panel members provided feedback and discussed strategies for improving the surveillance section of the draft report. Members then reported back key points and continued the discussion as a large group.
• Main points of discussion included:
• Providing a clear definition of surveillance and why surveillance efforts are important to improve care, address stigma, and build awareness.
• Describing the role of different data stewards (e.g., Stats Can) in supporting national surveillance, standardization, and minimum requirements for pain indicators.
• Acknowledging the existence of available data and current projects exploring data linkage and analysis; while incomplete there are currently data that can be used to estimate the prevalence of pain.
• Clarifying the economic costing work as a separate exercise during consultations and acknowledging its limitations. 
• Discussing the need for better coordination between pain researchers, Stats Can, Health Canada, and others to help build a surveillance system for pain.

Breakout room and large group discussion: Awareness, education, and specialized training

• In small pre-assigned groups, Task Force and Advisory Panel members provided feedback and discussed strategies for improving the education section of the draft report. Members then reported back key points and continued the discussion as a large group.
• Main points of discussion included:
• Strengthening tone, language, and detail provided.
• Conveying the notion that all individuals involved in the pain landscape should be trained on fundamental pain concepts and strengthening discussion on public awareness.
• Streamlining discussion of best practices with a focus on principles.
• Providing more detailed discussion of Indigenous knowledge systems and practices, as well as other knowledge systems and practices.
• Acknowledging the importance of having a variety of education modalities.
• Including more detail on anti-racism approaches, culturally sensitive and trauma and violence informed care, and the social determinants of health.

September 10, 2020

Breakout room and large group discussion: Access to care

• In small pre-assigned groups, Task Force and Advisory Panel members provided feedback and discussed strategies for improving the access section of the draft report. Members then reported back key points and continued the discussion as a large group.
• Main points of discussion included:
• Integrating content of Indigenous knowledge systems and practices and different ways of knowing as well as the cultural and financial barriers that impede this sort of care.
• Clarifying discussions on differing expectations between patients and health professionals.
• Discussing the health system as ill-equipped to manage pain.
• Building out discussion on virtual care options and alternatives to providing care.
• Incorporating patient-centred language.

Large group discussion: Indigenous Peoples

• In large group discussion, Task Force and Advisory Panel members provided feedback and discussed strategies for improving the Indigenous Peoples section of the draft report.
• Members agreed to keep a distinct section on Indigenous Peoples but to also integrate key points on different knowledge systems and practices within other sections.
• Members also suggested acknowledging the diversity of different First Nations, Inuit, and Métis peoples, language barriers surrounding the concept of pain, and the importance of cultural safety and anti-racism training and approaches.  

Large group discussion: The COVID-19 pandemic

• In large group discussion, Task Force and Advisory Panel members provided feedback and discussed strategies for improving discussion on the impact of COVID-19 on people living with pain.
• Members noted how the COVID-19 pandemic has hindered research and surveillance efforts in addition to negative impacts on provision of care.
• Members discussed how relevant solutions/promising practices for improving care during the COVID-19 pandemic are also relevant for more long-term health system restructuring and could positively benefit people living with pain.
• Discussion concluded with additional considerations including concerns over the development of post-viral pain and the importance of improved surveillance and epidemiological study in this regard.

Large group discussion: Inequity, violence, and trauma

• In large group discussion, Task Force and Advisory Panel members provided feedback and discussed strategies for improving discussion on population-based disparities, violence, and trauma.
• Members suggested strengthening discussion of the structural and ongoing nature of violence and trauma, situations of complex trauma, and the intersections of trauma, violence, chronic pain, and substance use. They also noted that many people in Canada living with pain are often dealing with multiple forms of trauma and violence, which can complicate care and recovery.

Large group discussion: Phase III planning

• Task Force and Advisory Panel members discussed potential ideas for goals and activities to guide Phase III of the Task Force mandate. Members agreed that the final Task Force report should focus on strategies for improving approaches to pain in Canada and offer concrete actions.
• Phase III will also involve collaborating with stakeholders to share and disseminate the findings of the first two Task Force reports, allowing for more engagement and communication on improved approaches.

Next steps and follow-up items

• Task Force and Advisory Panel members will provide more detailed and specific feedback to the Secretariat, who will then revise and build out the report as needed.
• The Secretariat will reach out to individuals directly for input as required.
• A revised version of the report will be sent to all Task Force members for final sign-off.
• The Secretariat will further refine the preliminary outreach plan for Phase III and present to the Task Force and Advisory Panel at a future meeting.