One in every five Canadians experience chronic pain, and it is not uncommon for Vancouver physician, Dr. Ali Ghahary, to treat patients suffering from complex and chronic pain disorders. In the United States, that number is even higher, making chronic pain a major epidemic in the world today. Unfortunately, unlike conditions such as diabetes or cancer, chronic pain can be incredibly difficult to diagnose and treat.
Pain often has a purpose, and that is to protect our body from further injury and to also serve as a reminder that our body’s tissue has become damaged and needs to be protected. From a simple cut or scape, bump or bruise, we have all experienced pain. This is a specific type of pain known as acute pain, which normally does not require treatment or can be resolved with over-the-counter medications such as acetaminophen. Acute pain typically resolves itself quite quickly. Chronic pain, however, does not. It can last for several weeks, months or years, and it can be debilitating and detrimental to one’s health, leading to psychological problems such as depression and/or anxiety, which is often much worse in those with chronic pain.
A large number of individuals take opioids to treat chronic pain. However, in light of the recent (and growing) opioid crisis in Canada (with just 15 people dying from opioid-related overdoses in one week in Vancouver), McMaster University’s National Pain Centre has introduced new guidelines, and physicians like Dr. Ali Ghahary are taking a much stricter and multifaceted approach in the way chronic pain is managed.
Examples of opioids include oxycodone, morphine, hydromorphone, codeine and fentanyl. They come in many different forms such as tablets, capsules, syrups, nasal sprays, patches, suppositories, and are also injectable. Opioids come with many dangerous and oftentimes unpredictable side effects including extreme fatigue, nausea and vomiting, headaches/dizziness/confusion, breathing difficulty, skin itching, sweating, and constipation.
When opioids are taken, this results in artificial endorphins being created in the brain, causing the patient to feel good almost immediately. As a result of this process, opioids can become addictive and patients will rapidly develop a tolerance to the medication. As this tolerance increases, the effectiveness of the opioid wears off, causing the patient to want to take more medication to produce the same “good” feeling and pain relief, which can then lead to dependency and abuse of other illicit drugs. As such, opioid use is not recommended as first-line therapy for chronic pain. Typically, medications such as acetaminophen, NSAID’s, neurological-related medications (Gabapentin), as well as topical medications are often used as first-line treatment, though the type of treatment chosen is dependent on the type and severity of the pain. There is strong evidence that suggests the use of these types of non-opioid therapies can provide great relief, and they are also much safer for the patient.
For Dr. Ali Ghahary, it is important that patients living with chronic pain receive treatment that provides the best benefit to them. This also includes identifying any co-existing heath and mental health conditions, and actively engaging patients in their pain management and ensuring he explains all available options to them as well as seeing them for follow-up appointments if necessary. Dr. Ali Ghahary treats pain management as a joint effort by communicating with patient’s families as well as other healthcare professionals, as this can result in a better outcome for the patient moving forward.