Chronic pain

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About chronic pain

Nearly 8 million Canadians live with chronic pain, which can have major impacts on a person’s:

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. The experience of pain is a unique and personal experience that can vary widely from person to person.

Acute pain

Acute pain is temporary and usually resolves as a person heals. It warns us that something is wrong and that something has caused or may cause damage to some part of our body.

Chronic pain

Chronic pain is pain that continues for longer than three months. Sometimes pain can continue:

While chronic pain is often invisible, the World Health Organization now recognizes it as a disease in and of itself and not just a symptom of something else. They categorize it into two distinct types.

Chronic primary pain

Chronic pain that exists despite complete tissue healing, or pain that has no identifiable cause. Examples include fibromyalgia, chronic pelvic pain, chronic musculoskeletal pain, and non-specific lower back pain.

Chronic secondary pain

Chronic pain that occurs in association with underlying diseases or issues. Examples include cancer treatment, post-surgical pain, and rheumatoid arthritis.

People most impacted by chronic pain

People with chronic pain often face a range of challenges, including stigma. Pain is largely subjective, and an invisible condition. People can often feel isolated and have trouble with others not believing their pain is real. This can lead to trouble accessing health services and a lack of treatment and support, which can negatively impact:

People facing discrimination and marginalization are often more likely to have chronic pain and to have more severe pain. Groups more likely to report chronic pain include:

Children and youth with chronic pain have unique needs. Lack of pain treatment and support can affect their development, lead to problems in school, and cause them problems later on in life.

People who work in the trades are also more likely to experience pain, work when in pain, and experience more severe pain.

Treatments and therapies

Our experience of pain is influenced by:

We should understand and treat chronic pain with these factors in mind. Research shows that treatment options are most effective when used in combination, and as part of a pain management plan.

There is a range of therapies designed to help with pain management and improve cognitive, psychological, social and physical function. People with chronic pain must be empowered to choose and use strategies based on their own needs. This lets them best treat or manage their pain.

Pharmaceuticals

Medications and substances that have a physiological effect, such as:

  • nonsteroidal anti-inflammatory drugs
  • acetaminophen
  • opioids
  • cannabinoids
  • anticonvulsants
  • antidepressants
  • muscle relaxants

Psychological interventions

Interventions that aim to change thoughts, emotions, or behaviours, such as:

  • cognitive behavioural therapy
  • acceptance and commitment therapy
  • support groups
  • education sessions
  • individual and group psychotherapy
  • mindfulness-based interventions
  • problem adaptation therapy for pain (PATH)

Physical and rehabilitation interventions

A process that enables people to reach or maintain optimal physical function, such as:

  • exercise, movement, and physical activity
  • activity modification
  • Yoga and Tai Chi
  • graded motor imagery
  • graded activity participation and exposure

Medical devices or interventional pain procedures

Procedures or applications of medical devices that can treat or manage pain, such as:

  • dental splint
  • low-level laser therapy
  • shock wave therapy
  • deep brain stimulation
  • spinal cord stimulation
  • transcutaneous electrical nerve stimulation (TENS)
  • nerve blocks, steroid injections, trigger point injections, or prolotherapy

Practitioner administered or manual therapy

Therapeutic activities administered by a health professional, such as:

  • acupuncture
  • massage therapy
  • physical therapies
  • spinal mobilization
  • spinal manipulation
  • osteopathic treatments

Self-management

Individual-led strategies focused on coping mechanisms or cognitive and behavioural factors, such as:

  • meditation
  • support groups
  • dietary practices
  • pain neuroscience education
  • relaxation and breathing exercises
  • life skills and self-efficacy programs

Canadian Pain Task Force and the Government of Canada’s role

We recognize the impacts and challenges faced by Canadians with chronic pain. We established the Canadian Pain Task Force to provide advice and guidance on how to prevent and manage chronic pain. The Task Force has delivered three reports to Health Canada over its three year mandate:

These reports highlight current research and where future research is still needed.

Untreated pain and substance use

Substance use is complex and driven by a number of factors that are unique to each person. The Government of Canada’s approach to substance use issues has been comprehensive, collaborative, compassionate and evidence-based, guided by our federal drug strategy – the Canadian Drugs and Substances Strategy. It includes four key pillars – prevention, treatment, harm reduction, and enforcement.

The Government of Canada recognizes the close links between people who live with pain, substance use and the overdose crisis. The overdose crisis is one of the most significant and complex public health threats in Canada in decades. Many people who use substances, including opioids also live with untreated chronic pain. People who use substances and their families often point to the lack of appropriate care for pain. This is a factor contributing to their substance use and a possible barrier to their successful treatment and path to recovery.

Opioids are medications that are sometimes prescribed to treat pain. As with all medications, opioids have benefits and risks, and sometimes potentially serious side effects. Taking too large a dose of opioids can cause breathing to stop, which can lead to death. That is why it is important to talk to your health care provider and take medications as prescribed. Naloxone can temporarily reverse an overdose. Naloxone kits are available without a prescription at pharmacies in Canada. Visit About Opioids to learn more.

The opioid overdose crisis is very complex, and untreated pain is a contributing factor. Some other factors that have contributed to the crisis are:

COVID-19

For many people with pre-existing chronic pain, the COVID-19 pandemic has led to stress, social isolation, increased pain and disability, and negative impacts on pre-existing mental health conditions. Disruptions in health care and services have reduced access to supports and therapies that people with chronic pain need to maintain quality of life. Canadians with chronic pain may need additional supports during COVID-19.

Impacts of chronic pain on the economy

Chronic pain has a tremendous impact on the economy. According to Health Canada analyses, the total direct and indirect cost of chronic pain in 2019 was $38.3 to $40.4 billion. Direct costs were between $15.1 and $17.2 billion, which represents over 10% of total combined health expenditures on:

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