Patients and their families living with chronic conditions are forced to deal with difficult situations. The pain management journey is different for everyone, and that means that different tools and strategies are needed to help treat and manage a patient’s pain and improve their quality of life. When chronic pain and addiction coincide, finding the right treatment can be complex and challenging for both the healthcare provider and patient.
In 2017, the Pain Clinic at the Dartmouth General Hospital closed leaving a significant number of patients on opioid therapy for chronic pain without a physician. In partnership with the North End Community Health Centre, Pain and Addictions Albro Lake (PAAL) opened to provide care and treatment to patients living with pain and substance use disorder.
Vicky Mills, Health Services Manager at the Pain Clinic of the Pain Management unit at the QEII Health Sciences Centre, said the goal of PAAL is to help patients navigate a complicated system with appropriate supports and guidance while focusing on managing their pain and substance use disorders with harm reduction strategies at the forefront of our care.
“Many of the people coming into the clinic feel very stigmatized by the healthcare system due to their substance use,” said Mills. “It is really important to us to establish a safe place where patients can come and be treated equitably and not be judged or stigmatized.”
Chronic pain is defined as pain that persists for over three months. It can occur without a known cause, after an injury has healed, or after a condition has been treated. As a community-based clinic, PAAL primarily serves patients with pain and an active addiction or history of addiction; prescribed opioids for complex pain management problems, are transitioning from inpatient to outpatient care, or those with no primary care provider or prescriber.
Since opening in May 2021, PAAL has completed 1800 visits. The pain clinic treats patients for many different persistent pain problems, that stem from multifactorial causes, such as but not limited to, injuries, and a range of illnesses, including fibromyalgia, Ehlers Danlos syndrome, connective tissue disorders, osteoarthritis and more.
Prior to the opening of PAAL, individuals with comorbid disease of pain and addiction were waiting up to a year or more to be seen by a physician specializing in chronic pain and substance use disorder. Individuals with chronic pain and substance use disorder are triaged as needing urgent care but frequently fall through the cracks of the system. By placing accessible care in an area of identified need, patients can now be seen quite quickly and the whole health care system benefits from this. The wait is now less than six months at PAAL which helps to relieve some pressures from the wait list at the pain clinic at the QEII.
PAAL also provides harm reduction information and techniques such as overdose prevention information, intervention in case of overdose (i.e., take home Naloxone kits), safe injection techniques, opioid agonist therapy (modified to treat both pain and addiction), community resources, wound care assessments and supportive counselling for patients during challenging times.
In addition to chronic pain and substance use disorders, the population that the clinic serves often deals with multifocal societal issues, including homelessness and unemployment.
“We want to try to get their pain managed so that they can try to find a job and stable shelter. We want patients to be able to have a quality of life,” said Mills.
PAAL receives patient referrals from community partners, including various homeless shelters and Direction 180. The clinic has taken a unique approach to health care and allows patients to self-refer for access to care. A nurse will interview the patient, collaboratively discuss this with a physician, and if eligible to receive treatment at the clinic, they are given an appointment based on a triage system of their needs and current condition.
“The clinic was established in an area of Dartmouth that was identified as a high-needs location. The location itself is also accessible and located along major bus routes. We also share the space with The Nova Scotia Brotherhood, Housing First, and Adsum House,” explained Mills.
Treatment of patients at the clinic is very complex and requires a team approach. PAAL is a collaborative, inter-disciplinary clinic with three Primary Care physicians specializing in addictions, nurses, and psychiatrists. Medical learners and residents also train at the clinic, gaining valuable experience from physicians bringing crucial services and support to people who are stigmatized by the health care system.
Physicians like Dr. John Fraser.
Dr. Fraser has spent over forty years working as a Family Physician at the North End Community Health Centre. As an expert in the areas of addiction and chronic pain, he is also the past Medical Director at Direction 180 and has provided consulting services at the QEII’s Pain Management Unit since 2008. Dr. Fraser recently retired after a long career devoted to helping those from many marginalized communities.
“PAAL is a dream come true for me. Historically, people living with chronic pain and addiction have been marginalized and underserved. PAAL is helping to close that gap,” said Dr. Fraser. “It is the result of collaboration on many fronts, including primary care and tertiary care, housing and health, administration, clinicians, and, most importantly, interprofessional collaboration in providing patient care. It has been a great privilege to be part of the team that developed this exciting and essential program.”
“Our clinic prioritizes and incorporates harm reduction in all of our care”, explained Elizabeth LeDrew So, Registered Nurse (RN) at PAAL. “Many of our patients come to us using street sourced substances to help treat their chronic pain, and when we help them find the correct regimen of medication and adjunctive therapy, their risk of overdose death from the toxic street-sourced drug supply significantly decreases.”
“After our patients meet with us for the first time and they realize we see, hear, and value their concerns, you can see a sign of relief in their eyes,” said LeDrew So. “After they see us on a more continual basis, and they start to feel their pain and addictions are being well managed, patients start creating goals for their future, and it’s truly remarkable to see what people are capable of achieving if they’re provided with the appropriate tools and support,” explained LeDrew So.
PAAL has helped many individuals with the tools and support to adequately control their pain and manage their addictions. LeDrew So said the most rewarding part of her job is seeing that the clinic has provided the appropriate supports to allow patients to be happy, healthy, and thriving.