The following blog is contributed by Jim Parker. Jim has long represented injured workers in their compensation claims. In this blog, Jim draws on his recent experiences – both professional and personal – to highlight the changing chronic pain (CP) landscape in B.C.
For all of my 30 plus years as a representative for injured workers, WCB policy for chronic Pain (CP) has been a matter of considerable attention and controversy. In 2003, Supreme Court of Canada cases struck down provisions in other jurisdictions that denied workers compensation benefits to workers suffering from chronic pain.1 Ever since then the Workers’ Compensation Chronic Pain policy in BC has been a patched together mess that is inconsistent with other Workers’ Compensation policies.
These problematic CP policies have often been accompanied by problematic treatments. I have worked with many people that developed CP as a result of work-related injuries. My anecdotal experience is that some workers have suffered terribly with CP. Many of those that suffered worst were back injury claims. Surgeries were too often and sometimes inappropriately used as treatments for back injuries and some of the most troubling cases had multiple failed back surgeries. Two workers that I had represented died from mismanaged CP injuries. Medications, particularly opiate pain killers were all too often the default treatment for pain. While the outcomes for workers with CP has improved over the years, this is mostly as a result of small incremental improvements in medical treatment and have little to do with the WCB.
As a result of these experiences, I took to exploring some of the advances in the medical aspects of chronic pain outside the strange world of compensation policy. I have come to realize that there is a very robust medical and scientific community doing ground-breaking work about chronic pain. I believe there is a lot to be learned from this progress in the medical area that would benefit the compensation policy field.
Much of this progress is due to the work of pain associations at the national and international levels; the best known are the International Association for the Study of Pain (IASP) Association for the Study of Pain (IASP) and the Canadian Pain Society (CPS), which is affiliated with the IASP.
Several years ago, the IASP developed new comprehensive diagnostic criteria for CP and now, their rigorously tested CP criteria has been adopted by the International Classification of Diseases (ICD) (11th edition). The new ICD codes provide a scientific pathway to effective CP assessments and treatments.
With the new ICD definitions, medical advances in this area are proceeding at a remarkable place. In Canada, the Canadian Pain Society (CPS) was the catalyst for the formation of a federal Canadian Pain Task Force (CPTF), which was mandated to create an Action Plan for Canada. CPS also holds remarkable Annual Scientific Meetings (ASMs) to provide details of current work to the medical/research communities as well as the lived experiences of those suffering from CP. I took the opportunities to attend the CPS ASM in 2021 which was held virtually and 2022 ASM which was in person in Montreal.
At the April 2021 ASM we heard from the federal Minister of Health Patty Hajdu about the work of the national Canadian Pain Task Force (CPTF) and the CPTF’s Action Plan, soon to be released. The CPTF Action Plan provides clear and positive direction to address CP.
One of the CPTF co-chairs, Maria Hudspeth, is also the Executive Director of Pain BC. It is hard to say enough about the high quality work done by Ms. Hudspeth and Pain BC, much of which is detailed on its website.
The May 2022 CPS ASM was even more remarkable. It was a wonderful opportunity to attend a conference in person after nearly two years of only virtual events. There were numerous presentations of new developments in treatment and research. The program and abstracts are still available on the CPS website listed above for those that may want to do some additional research. The current science as regularly explained provide detailed definitions, assessments and treatments for a diverse variety of CP conditions.
Two examples from the 2022 CPS ASM are insights in pain management in pre-term neonatal infants and the problem of pain in patients with dementia. I found it absolutely compelling that different groups had found effective way to identify and address pain issues with premature babies and dementia patients. It is easy to see there are huge challenges in identifying and treating pain problems with these populations. If solutions can be found to address pain in individuals from these groups, who are at different ends of the age spectrum and who cannot readily communicate their experience with pain, surely a lot more can be done for injured workers’ experience of pain.
With all of these things going on it is hard not to get infused with optimism about the opportunities to improve what has been a dismal situation for workers suffering from work related CP.
But when I put all of this in the context of WCB policy, I am taken aback at how out of sync their CP policy is with these medical and scientific developments. The unfortunate reality is that despite WCB CP policy changes having been considered for years, nothing has changed. And while the BC WCB system uses ICD diagnostic codes for almost every other condition, it does not use the new ICD codes for chronic pain. The WCB policy simply defines CP as injuries that have taken longer than expected to recover and when “disproportionate pain” is accepted, it is not further defined and is rarely treated. I do remain hopeful that we will get there. The overwhelming scientific and medical evidence should make the needed changes inevitable. Eventually, I hope.
The 2022 conference took on an even greater personal meaning for me. Just before the conference, I found I would need surgery which I had scheduled for the week after I returned. So just after the 2022 CPS ASM I had the opportunity to view how the medical system treats pain from the perspective of a patient. (While it is unfortunate that I needed surgery the results were positive.) Post-surgical pain is one of the most significant causes of CP. In the workers’ compensation system, it is probably the second leading cause of CP behind musculoskeletal injury. I was impressed by how much attention was paid to the amount of pain I experienced after my surgery and the attention that was paid to control and treatment.
A key principle in modern medical care is patient-based care. Listening to the patient and accepting the patient’s information of their condition. On almost every interaction with a nurse or physician I was asked about the degree of pain I was experiencing, and attention was paid to appropriately treating/managing the pain. This certainly contrasted with how workers I represent have communicated to me how pain on their WCB injury is addressed. Reading through claim files and talking with workers my impression is that WCB still treats CP quite dismissively. The dismissiveness and lack of consideration for CP is a major aggravating factors for workers with WCB CP.
There was certainly no dismissiveness on the attention to potential pain issues with my surgery. There was a nurse liaison that met with me in hospital and spoke with me after discharge. I answered several questionnaires on my condition and effectiveness of treatment. Fortunately, I did not have any problems with recovery. If I had I am confident they would have been promptly and effectively addressed. Again, I contrast this with the often-dismissive treatment of workers on WCB claim that have pain issues.
My view on the solution for CP is to apply the science and recommendations that have been made and proven effective for CP outside the WCB system. The directions are clear in the recommendations of the Canadian Pain Task Force. We should get on with the job and bring WCB CP policy up with the times.2
- Nova Scotia (WCB) v. Martin and Laseur (2003) 2 SCR 504. ↩︎
- In the last two WCB Annual Reports the Board has pointed out two major concerns; chronic pain and mental disorder claims. Both of these areas have been identified as special concerns particularly for costs. It is my firmly held belief that these are both manageable problems, although I have only addressed the CP issue here. ↩︎