Chronic pain expert on the invisible disease of epidemic proportions

Chronic pain affects 10 to 20 per cent of Albertans — more than diabetes, major depression or lung disease.

The disease is estimated to cost the Canadian economy up to $60 billion a year in health-care costs and lost productivity. Yet there are no five-kilometre runs for chronic pain and no fundraisers for research into the often-misdiagnosed disease. 

This week, CBC Calgary is exploring this disease online and on-air. We start with an interview with Dr. Gay Wardell, a Medicine Hat-based anaesthesiologist who has treated more people with pain than anyone in the province. 

In May, the Chronic Pain Association of Canada presented Wardell with the Dr. Helen Hays Award for Excellence in Pain Management.

Q: What is chronic pain and how does it differ from acute pain?

Veterinarians get far more education on pain than physicians do.- Dr. Gay Wardell

A: Acute pain saves us from danger. Acute pain warns us, it nurtures us when we're injured and it goes away so we can function.

If that does not go away after the tissue heals, and when the pain goes on beyond the time of healing, the pain is no longer helpful, no longer useful, no longer nurturing, then it becomes chronic pain.

Chronic pain is useless pain.

Q: What causes chronic pain?

A: Almost all chronic pain is caused by the malfunction of the nervous system.

Nerves which are damaged and never recover completely and send signals back to that gray box inside our skull that knows nothing except what it gets from the outside.

For the first 10,000 years of civilization, pain was seen as a punishment from God. Then it was seen as a sign of psychological weakness.- Dr. Gay Wardell

If it gets signals from a malfunctioning nerve, a damaged nerve, it's going to — about one out of five times — convert that to a threat signal that says we are in pain and we can't stop that.

Chronic pain may start with an initial injury or there may be an ongoing cause of pain, as in foot pain caused by diabetes.

Some people suffer chronic pain without evidence of injury. Chronic pain is often divided into three categories — headache, neuromuscular skeletal (back pain, fibromyalgia, leg pain) and pelvic pain.

Q: How well do drugs work to combat chronic pain?

A: We do not have any effective drugs to treat chronic pain.

The brain is doing exactly what it's supposed to do. It's getting a signal that it doesn't like. Now if you then ask, 'How are we going to make the brain not respond?' — we can't block the signal otherwise we lose contact with the outside world.

We can't make the nerve new. There's only one thing we can do.

Chronic pain drugs make the brain stupid so it won't do what it's supposed to do. If it makes the brain too stupid, the side effects are so bad that people can't take it.

If it doesn't make the brain stupid enough, there's no benefit from the pain. So in reality, we don't have a drug to actually get rid of the signal that's causing the pain.

Q: How well are doctors educated to deal with pain?

A: Not very well. Out of the 117 accredited medical schools in North America, there are only five of those medical schools that have a credit course in pain.

Veterinarians get far more education on pain than physicians do.

The average physician only gets four to five hours of chronic pain training in their medical school. So at this point, the training is lacking.

Q: How have our attitudes towards pain changed over the years?

A: Pain is one of the most controversial things in society. For the first 10,000 years of civilization, pain was seen as a punishment from God.

Then it was seen as a sign of psychological weakness. During that time, pain was seen as something to be endured, something that would ultimately lead to salvation.

Now we are seeing a paradigm shift and starting to understand that this is a disease caused by problems in the nervous system. Sadly, we don't yet know how to fix the nerves.