Karen Goddard’s bout with chronic pain began five years ago, after slipping on ice and breaking her left ankle on her way to work one morning. One bolt, two plates and 12 screws were put in the ankle to stabilize it. The injury left Goddard, who also has rheumatoid arthritis, in constant agony, taking multiple medications, and unable to work. For years, she suffered through the pain.
During a regular visit to Rouge Valley Ajax and Pickering’s (RVAP) fracture clinic, her physician noticed discolouration in her foot due to poor circulation. This, combined with Goddard’s immense pain in her ankle, indicated that something was wrong.
She was soon referred to Rouge Valley anesthesiologist Dr. Kevin Smith’s Pain Clinic, located in RVAP ambulatory care unit (ACU). There, he diagnosed her with Complex Regional Pain Syndrome – or CRPS. This chronic disease is characterized by severe pain, swelling, and changes in the skin. CRPS typically worsens over time.
“When you break an ankle, the pain is excruciating. But with the CRPS it made it even worse,” explains the 49-year-old mother of four.
Under Dr. Smith’s care, Goddard began receiving several treatments, including new medications and sympathetic nerve blocks and eventually intravenous (IV) lidocaine infusions for the ankle pain and discolouration. It didn’t take long before the CRPS resolved and she could feel an improvement in her pain. She continues to return to the clinic, however, every two months to receive pain-relieving intravenous infusions of lidocaine for leftover nerve (“neuropathic”) pain, which are covered under OHIP.
“The treatments have been excellent for me. Overall, I think Dr. Smith is wonderful. He gave me my life back. He really cares about his patients,” says Goddard.
Goddard’s story is one of many seen at RVAP’s Pain Clinic. The outpatient clinic, led by Dr. Smith, was founded over 20 years ago by Dr. Magdi Gaid, an anesthesiologist at RVAP, and Dr. Kirit Patel, division head of the department of anesthesia at RVAP. Last year almost 300 new patients were seen in consultation at the clinic, and close to 600 specialized interventional pain procedures were performed.
A high proportion of the patients Dr. Smith sees in the clinic are elderly, often over 70 years of age, suffering mostly from back pain, whether from arthritis or spinal stenosis. At Rouge Valley, he is also called on to help patients with poorly controlled pain following surgery, or patients admitted to the hospital but bedridden due to chronic pain.
The Rouge Valley Pain Clinic focuses largely on the use of evidence-based diagnostic and long-acting therapeutic injections, referred to as interventional pain management. Its goal is to help patients better manage their pain so that they can remain active in their everyday lives, rather than being restricted by chronic pain.
Some patients are easier to diagnose than others, while others require diagnostic testing to properly identify the area of concern. Once the patient is diagnosed, Dr. Smith determines the best treatment for the patient. Treatments such as epidural steroid injections for pinched nerves and herniated discs, radiofrequency neurotomy for arthritic or strained neck and back pain, and IV lidocaine infusions for neuropathic pain are just some of the options available. Most can be done in the ACU, while others are done in a surgical recovery room. For many patients, the injections work so well that they may only need to return to the clinic for treatments a few times a year. Many hospitalized patients who are bedridden before treatment, he adds, are able to recover relatively quickly and return home shortly thereafter.
“It’s not about curing patients. It’s about enabling them, with adequate pain management, so that they don’t remain in the hospital for what could otherwise be outpatient care. Our goal is to keep them walking, ambulatory and independent as much as possible,” Dr. Smith explains.
The effects of pain
Dr. Smith explains, “Many people suffer from chronic pain. It’s an area that’s not given as much attention, and therefore, a huge cost to the health care system. It’s not yet a well understood area of healthcare, and many patients don’t receive care until it’s too late.”
According to the March 2011 edition of the Canadian Pain Society’s medical journal, Pain Research and Management, “Chronic pain costs more than cancer, heart disease and HIV combined. Estimates place direct health care costs to greater than $6 billion a year and productivity costs related to job losses and sick days to $37 billion per year.”
Living with chronic pain doesn’t only have a strong physical impact; it can also affect the patient’s mental health. “Chronic pain can consume an individual’s life in most aspects, sometimes rendering them disabled. If it’s not treated, it can lead to anxiety, depression, sleep disorders, and increasing difficulty in leading a productive life,” says Dr. Smith. “Every aspect of one’s life is affected when chronic pain is poorly treated or not treated.”
The hospital’s Acute Pain Service will also care for patients with chronic pain receiving surgery at RVAP. This will help to ensure that their surgical pain is being managed, and their chronic pain needs are also addressed.
Many of the services, including injections, are covered under OHIP. Patients looking for a consultation with Dr. Smith can contact the Pain Clinic office directly at 905-427-3900. Referral forms can be faxed to 905-427-7090.