The Decibel - What a bad back tells us about Canada’s chronic pain problem

Episode Date: December 14, 2023

One in five Canadians suffer from chronic pain. According to one estimate, in 2019 the direct and indirect costs of chronic pain totalled $40-billion. And yet, the affliction is poorly understood and accessing treatment through the health care system can be tedious and frustrating.Lara Pingue is an editor at The Globe. In 2018 her life changed when a sneeze sent her spiralling into the world of chronic pain. On her years-long journey, she’s dealt first-hand with the health care system, she’s tried multitudes of treatments to help alleviate her pain and she’s learned about the research currently being done to figure out this mysterious affliction. She’s on the show to explain her experience and what her bad back taught her about the world of chronic pain.Questions? Comments? Ideas? E-mail us at [e-mail]

It was an ordinary morning. It was August 2018, so it was almost five years ago. And I had had like a bit of a nagging back pain before, so this certainly wasn't out of nowhere. Lara Ping Wei is an editor at The Globe. And in 2018, a simple sneeze changed her life. And I was just making breakfast in my kitchen. It was an ordinary morning and I sneezed and it was electric, this pain in my lower back. And I looked around thinking, like, did I just get hit with something? Because I couldn't believe that this pain had come from within my own body. That's how kind of shocking it was. That sneeze was the beginning of Laura's chronic pain, something that affects one in five Canadians.

But Laura thought her pain would eventually go away. So in 2018, she carried on with her day. You know, I did what a busy mom who was on her way to visit her mother four hours away in the summer would do. I took some Advil and I hope for the best. And I thought, surely this can't last. I had no way of knowing that this was the beginning of something, right? And so I thought, okay, I'm going to be uncomfortable for this car ride. But then as the weekend progressed, the pain started traveling. And so it started, went into my hip and then down my leg. And then it was just, you know, it wasn't,

it wasn't abating. It was amplifying. And I thought, this isn't great. And I remember I was going on a work trip in a couple of weeks and I thought, oh, this will be great for me because I'll get to rest. I won't have to be a parent for three days. And what really happened was I was stuck on a plane and I thought, I can't get up. I need to stretch. I need to stand. Sitting hurts. And that's when it kind of got serious for me. I thought, this isn't normal. I have to go see my doctor. For years, Laura tried treatment upon treatment to try and alleviate her pain, and almost none of it worked. According to one estimate,

the total direct and indirect costs of chronic pain was around $40 billion in 2019. And yet, even with that cost and so many people dealing with the condition, why it happens remains poorly understood. So today on the show, Laura tells us what it's like trying to access care for chronic pain and about research that could offer hope for those with this affliction. I'm Maina Karaman-Wilms, and this is The Decibel from The Globe and Mail. Laura, thank you so much for being here. Thanks for having me.

Laura, what was your life like before that sneeze? I think I was like a typical, pretty active mother of two children. I had been a runner all through my 20s. I had dabbled in yoga and Pilates virtually all my adult life. I was an on and off gym goer. And at the time of the sneeze, I actually was a card holding gym membership person. And I was really actively working on my core and doing all those things you think you should be doing in your early 40s. So I was doing that. I also walked a lot. I

live about two kilometers away from the GO train. I would do that walk twice a day. I was going into the office every day. This is pre-pandemic. So I was an active, healthy person. And then with that sneeze, I guess, did those things change? Yeah, absolutely. So suddenly walking to the train station, getting on the subway, things like that started hurting. I remember sitting near the exit in trains because I wanted to be able to pop up anytime. I didn't want to be hemmed in because, again, sitting hurt. So things started slowly kind of chipping away. I was running with a friend twice a week in my neighborhood, and I had to stop doing that, obviously. So I guess when did you realize that you were dealing with something more here,

that you were dealing, I guess, with chronic pain? You know, I still have a problem with the word chronic pain, and I actually didn't think of myself as somebody with chronic pain until years into this, when I was talking to a coworker about writing this story about back pain. And she said something about, well, you know, when it becomes chronic, and I said, oh, you said the C word. And I hate that. I don't love that word. My eyes kind of glaze over at that term. It feels clinical and sterile, and it doesn't sound very specific. And it's hard to quantify. So that was kind of my first thing.

Oh, yeah, like I fit that definition. The definition of chronic pain is pain lasting more than three months. And that was certainly the reality I was living in. Okay. Okay. So chronic pain is technically pain that's lasting more than three months. And that was certainly the reality I was living in. Okay. Okay. So chronic pain is technically pain that's lasting more than three months. So if this is something that's not going away after that, that's what you're dealing with then. So if you think about going to your doctor for something like acute pain, so you hit your knee,

you stubbed your toe and you need stitches, that's acute pain that's going to last less than seven days. I kind of think of it as like something's on fire, whereas product pain is much more almost insidious. And it's like embers burning, slow burn, not a fire. And some definitions kind of go even a step further and say that the source of the pain is actually resolved. And so you still live with pain, even though there's no material thing you can point to in your body as being the problem. So pain is one of these things, though, it's hard to always know because it's invisible in a lot of ways, right? So I guess, you know, how did you handle it day to day when you were feeling that? I, you know, I didn't want to give it too much attention. And I don't like telling people because I don't want to be defined by it. But, you know, in meetings at work, it was certainly

impossible to hide because I couldn't sit through meetings. So I would pop up and walk around. And I remember a coworker saying to me, he noticed that I was uncomfortable and he had dealt with shoulder pain before. And he said to me, you know, you won't always feel this way. And at first I thought, okay, buddy, you don't know what I'm going through. And I appreciate, you know, your input here. But really, I took that and it carried me because knowing that you won't always feel this way or believing that can really go a long way when you're suffering. Did you find out what was actually causing your pain, like the root of all of this? Yeah, it was a herniation for years when I had sneezed it fully herniated, which is kind of ruptured, right? And it gets dislodged and it hits your nerve.

And so you have something hitting your sciatic nerve and that's what causes pain. So what did you try to do to relieve it? What did you try? What did I do? Well, I started with the usual suspects. So I took over-the-counter pain meds. Advil liquid gel is kind of the OG pain reliever for me, even more so than prescription meds. And I did take prescription meds.

I was taking 9 to 12 a day when things were really bad. So I went off that. I had an epidural steroidal injection, which is when they put a needle right into your spine. And it's basically a cortisone or anti-inflammatory. And it's meant to just kind of give you some relief. I had that done twice. The first time it really did work. For about three months, it wears off. That's the problem.

I did Pilates. I did yoga. I did chiropractic. I did acupuncture. I did the gym. I stopped doing the gym. I did long walks, short walks, no walks. And then I did surgery. And so I had a disectomy where they take the disc that is offending, that is kind of ruptured and hitting your nerve, and they remove it. So technically speaking, nothing would be impeding that nerve and causing pain. What can happen though, and I think what did happen with me, is scar tissue grew back. And that also causes pain.

So the surgery didn't really actually relieve it then? I think statistically speaking, my surgery would be counted as a success. I mean, nothing bad happened. It didn't make it worse. I didn't die on the operating table. I recovered. I went back to work after seven weeks. But I didn't really feel better.

I couldn't sit for eight hours still. And so I wouldn't personally classify that as success. How did it feel to go through all of that kind of looking for an answer? Well, it's exhausting and it's expensive, right? And I'm lucky that I have kind of the means to do some of those things, to go to the Cleveland Clinic for like 100 bucks for half an hour, which is, you know, a great physiotherapy place. And they're actually the ones who referred

me to a pain specialist. And I'm also lucky that I live in Toronto where all these things are at my fingertips, even though there are wait times for those for sure. The fact of the matter is I have access that not everybody does have. So Laura, you wrote about the situation for the Globe and it got a ton of responses. You got emails, comments, like hundreds of people responded to this. So I guess why do you think this story resonates with so many people? Well, I think it's because everybody hurts or has hurt at some point in their lives. And a lot of people have back pain, maybe not back pain like this, but who has reached their 40s without a tinge or kind of wincing when they got up. And so it's almost universal, right?

But I was also struck by a podcast that I had listened to, and it was starring somebody named Dr. Rachel Zofna. She's an American pain psychologist. And she said, pain is everybody's problem. Everybody is a pain patient. And I thought, oh oh God, that's really dark, right? And she said, she contextualized it. She said, pain is the ultimate human condition. Everybody feels pain and it's coming for everyone. And I thought, well, that's certainly true in my

experience. And so, you know, why can't we get this right? If so many people are going to experience this in some way, shape or form, we should be paying attention to it. I remember thinking to myself, one way to describe pain like this is it makes me kind of feral. It makes me the worst version of myself. I mean, it sounds like this was a really difficult, a lot of this was really difficult to go through. I guess, is there something that sticks out as, you know, something particularly you remember then that's really, was really frustrating? Oh, there was tons of parenting moments that were really frustrating, like not being able to kind of wrestle with your kids and pick them up and swing them around and, you know, chase after them. But my youngest son, Sam, was in his battery-powered Jeep. And he had discovered the faster gear,

and he started taking off down the street. We live in a suburb, and it was a quiet street. But, you know, there were cars around, and I didn't want him to get that far away from me. And so I tried to catch up with him, and he couldn't hear me. And I ended up screaming at him. And he finally stopped. And it struck me that if something bad were to happen, I couldn't prevent it because I physically couldn't move fast enough. And that's a really tough pill to swallow if you're a parent. When your number one job is keeping your offspring alive and that's taken, that's threatened, that's tough. We'll be back after this message. OK, so after all of this happened, you went looking for some answers, really. So tell us what you found. Where does where does pain come from? And on a physical level, like how does it work? When I started investigating this with

like kind of a reporter's eye, I talked to Dr. Karen Davis. She's at the Crumble Institute here in Toronto, and she's been studying pain for 40 years. And she said, pain is in the brain. And that is something that I don't think we think about, right? We have pain in the knee, we touch the knee, we have pain in the back, we touch the knee we have pain in the back we touch the back the hip the head but pain is registered in the brain and that means that pain is subjective it is the same way you would you would say maybe i don't like olives but you know somebody else loves them the good news about the brain is it's neuroplastic. And that means the brain can change. And if the brain can change, then pain can change. And that is what gives us all hope, I think, about cracking the code of chronic pain. Is there a way to measure pain? Like we just talked about

kind of the one to 10 scale, but is there a way that we use? It's funny because nobody has ever in all the specialists and doctors and practitioners that I've dealt with in five years, nobody has ever asked me to measure my pain on a scale. And I think maybe for the reasons we just talked about, and that is, well, what does a 10 really mean? Right? Certainly doctors will say, does this hurt? Does this hurt? Does this hurt? You know, I'll be like, eh, you know you know, or I can't bend. I can't I can't touch my toes. I can't flex my foot up in a certain way. Those kinds of things.

Do we have any idea about like things that maybe make someone more prone to pain, like why someone might get chronic pain and another person might not? Right. Well, we do know what predisposes somebody to chronic pain, but we don't know why somebody with similar backgrounds may experience it while others don't. So if you are depressed, if you have trauma in your life, you're more likely to experience chronic pain. If you have parents who had chronic pain, you're more likely to have chronic pain or problems processing pain. In order to understand what's going on when someone feels pain, what are researchers looking at right now? So right now, Dr. Davis at the Kreml Institute, one of her kind of big

projects is mapping the brain for biomarkers of pain. What she's looking at is MRIs of brains, and she's trying to map out markers in the brain that would indicate a possible treatment. So if somebody looked at my brain and said, oh, you know, here's a marker, here's a marker, here's a marker, that means that Laura is more susceptible to responding to, say, physiotherapy or a certain drug so that hypothetically one day somebody like me could go into a pain specialist. They could take a map of my brain and say, we're going to take you down this very specific treatment path because your brain indicates that you'll respond to that. And you could skip like months and years and untold amount of money, you know, and all these different therapies and all these like surgeries. And you could have this kind of streamlined approach to treating pain. Yeah. So that's the dream. Yeah. Because it sounds like when you're describing your journey of trying to deal

with this, right, it's kind of trial and error, right? It is. This or that and see what works. And so this is kind of a different way to think about it. And another thing pain specialists will tell you is that it's biopsychosocial. And so you're treating kind of three things at once. You're treating the biological problem, the psychological problem, and the social problem. So that is to say that a lot of things contribute to pain. And so if you're not sleeping well, if you're stressed, that's going to contribute to your pain.

So pain is in the brain, yes, but your brain is taking in information from not just your body, but from other parts, right? Like from your mood levels, your sleep levels, things like that. That is not to say if you're stressed out, you're going to have pain. It's to say that these things that we don't think about or acknowledge impact your pain. It's to say that these things that we don't think about or acknowledge impact your pain. Yeah. How is chronic pain really treated now, though, I guess? I think it depends on who you see. So if you have a GP who is trained to treat acute pain, that's how they'll treat you. They'll give you a painkiller and away you go, right? If they know of a specialist, maybe they'll refer you to a pain specialist. And I think in that case, you'd have a much

higher level of success because they'll be looking at the biopsychosocial profile, right? And they'll be taking into account all those factors that could be contributing to your pain. And sometimes it is just in your body. Sometimes it is like, you know, nerve pain that can be treated surgically or with medicine. But there is so often something else at play there. Laura, this is just something I'm wondering about, because, you know, we know that women's pain in particular is often not believed, right? There have been studies about gender bias and pain assessment. So I guess I'm just wondering, how does that fit into this conversation? So the Canadian Pain Task Force issued a report a couple of years ago looking at all the people who are vulnerable to pain.

And they found that women, racialized people, and seniors are more likely to have a bad outcome with chronic pain. Also, if you live in a rural area in Canada, you have to consider access, right? How easy it is for you to get specialized care. It's so interesting because we're talking about how this is kind of misunderstood and diagnosed differently by different health care providers. But like, isn't pain such a huge part of health care, right? Like that's often why you go to the doctor. Something is hurting, right? Especially back pain.

It is staggering how many people go to see their GP for back pain, right? So why is pain so misunderstood? Because people don't understand the brain. The brain is a big mystery, I think. And also because the way it's taught in medical school. So that's changing now. But you know, there's that famous stat that veterinarians have better training in pain management than medical doctors dealing with humans. And that is true. It's changing. But doctors are trained to put out fires, right? And I think of chronic pain as kind of smoldering embers, you know, not this big blaze, right? And so it demands a different kind of treatment that not all doctors are prepared for. And think about

how overwhelmed our healthcare system is. Think about what our family doctors are dealing with right now. How can we expect them to have all the answers? So for people suffering from pain, chronic pain in particular in Canada, what are the hurdles for them to get treatment today? Wait times, for sure. And also, if you think, for instance, something like physiotherapy or massage therapy or acupuncture is going to work for you, that's all out of pocket, right? You have to pay for that. And it's time consuming. If you work shift work and you don't have sick days, think about kind of the personal cost that that takes. So there are certainly a lot of

barriers for everyday Canadians. I guess what could we do to make things better? Is there stuff in the system that we can change? What have experts told you about that? It's like anything, I think the more you know. So if we talk about it, right, and that is starting to happen. There's like these portals for pain online and it's being taught in medical schools and things like that. That's not going to help you if you have a doctor who's been practicing for 45 years or 30 years or 25 years, right? They're not new medical grads. But I do think that is changing.

And also the WHO is now calling chronic pain a disease, right? So it's being recognized, I think, in a way now that maybe it wasn't before. Yes, it is a medical condition in and of itself that can be divorced from an actual physical ailment or something, right? You can say, I have chronic pain, and that's it. End of story. We talked about your pain for quite a while now, but how are you doing now?

So much better. Certainly nowhere near the day of the sneeze. Although I have to say just recently I must have done something and I've kind of had a little bit of a setback, like a little bit of a flare in my back pain. I'm wearing running shoes right now. And that's always a telltale sign that I'm not feeling awesome. But I've learned that health is a delicate condition and it can be snatched from you at any moment. And so that's been a big lesson. Laura, thank you so much for being here today. Thanks for having me. That's it for today. I'm Maina Karaman-Wells. Our producers are Madeline

White, Cheryl Sutherland and Rachel Levy-McLaughlin David Crosby edits the show Adrian Chung is our senior producer and Angela Pachenza is our executive editor Thanks so much for listening and I'll talk to you tomorrow