Chronic pain is a disease recognized by the World Health Organization since 2019, on a par with diabetes, but private insurers have not yet followed suit. Knowledge and science have evolved in this field, but Dr. Anne-Marie Pinard, head of the chronic pain clinic at the CHU de Québec, is not convinced that insurance companies are up to speed. Currently, the prevalence rate of this type of pain is around 25 per cent. It is expected to increase as cancer rates multiply and the population ages.
Dr. Pinard is holder of the Medisca Leadership Chair in Chronic Pain Education at Université Laval. She is one of the leading clinical experts in pain in Quebec. Given the difficulties that health professionals encounter with insurers regarding their patients with this disease, this anesthesiologist believes that people who work in insurance compensation should have basic training in chronic pain in order to better understand their clients’ condition.
Pain lasting more than three months
Pain becomes chronic when it lasts longer than three months. Percentage wise, it affects women slightly more than men. It can be associated with diseases such as arthritis and cancer, or it can simply occur for no known reason (idiopathic). The more chronic it becomes, says Dr. Pinard, and the longer it has been there, the more work needs to be done to unravel the pain circuits. Early intervention yields the best results. The goal with early management and treatment is to prevent the pain from becoming chronic.
Chronic pain can lead to severe limitations at work and in daily life, and in some cases result in complete disability. “I don't know what percentage of disability claims are related to a chronic pain issue, because I don’t have access to that data,” says Dr. Pinard, “but it must be pretty significant.”
In Quebec, pain clinics are jam packed. Unfortunately for the patients, there is no miracle pill or injection to ease their suffering. Scientists are tackling the problem, but have yet to find a solution. In 2022-2023, care mainly involves a series of complementary actions, treatments, medication, diet, physical exercise and psychology.
Pain that is hard to measure
Chronic pain is quite distinctive. One of the major problems, the anesthesiologist who has been working on this disease for 20 years points out, is that it is hard to measure. We are not necessarily able to demonstrate permanent physical damage in patients who say they feel pain. However, there are measurement tools that are used every day in pain clinics.
“I think insurers should realize the risk factors for developing chronic pain after an acute event are known. Even so, insurers don't consider these factors. If they did, it would pay off for them and their patients would benefit greatly,” Pinard explains.
For people with low back pain, a person who has previously had chronic pain is more likely to develop it again. A large proportion of cancer survivors will experience chronic pain due to treatment or surgery. In addition, chemotherapy can lead to neuropathy, a form of nerve damage that can be difficult to treat.
Dr. Pinard says that if insurers acted on the evidence stemming from large numbers of studies to initiate early multidisciplinary team treatment for patients with risk factors, perhaps fewer people would be on disability or more individuals would still be able to work part time.
Problems with disability
According to Dr. Pinard, insurers have no qualms about issuing payment or reimbursement for treatments such as physiotherapy. Yet the concept of disability is much more contentious. Because insurers do not consider pain to be a disease in itself, but rather a sign or symptom of another condition, health professionals are asked to prove where the pain is coming from. They should not have to do so. Things get more complicated, the anesthesiologist continues, when you get to the famous two-year mark, and extended disability insurance.
“It's normal to explain to insurers what has been tried, what works and what doesn't," she says. “Where I have a problem is when we have a patient whose only symptom is pain, and they tell you the MRI is normal and they don't recognize their condition. That's where it gets extremely complex to justify. Chronic pain is a disease in and of itself, and it’s high time that insurance companies recognize that.”
Provide insurers with chronic pain training
As a physician, Dr. Pinard also complains of how difficult it is to communicate with insurers in person. “They ask us to fill out forms,” she says, “but a piece of paper doesn't tell the whole story. I'd like to be able to talk to a human being in an insurance company to find out how it works because their world is not the world of health care, and my world is not the world of insurers.”
Dr. Pinard would also like to see more training in chronic pain for people in the insurance industry who disburse disability benefits. She points out that it would be feasible to develop training with insurance companies and is even willing to work with them to this end. “If people were trained to detect the risk factors for developing pain, it would make a real difference and it would pay off for everyone,” she says.
