Pain Care in Canada
Notes from the Pacific Pain Forum 2025
Pain affects everyone, but not everyone has access to the same care—or outcomes. The more I learn, the more I realize how deeply pain care intersects with equity, trust, strategy, education, cultural safety, and system design. This reflection brings together insights from the Pacific Pain Forum and key voices across Canada who are reimagining and enacting what better pain care could look like.
Pain and Opioids
Are we getting better?
A
CMAJ study shared at the Pacific Pain Forum painted a sobering picture of how chronic pain, opioid use, and system design intersect:
- Between 2019 and 2021, opioid-related deaths more than doubled in Canada: 3,007 → 6,222 deaths (nearly 17 deaths per day)
- Years of life lost (YLL) also doubled, from 126,115 to 256,336
- Adults aged 30–39 were hit especially hard: Over 87,000 years of life lost—the equivalent of wiping out the full lifespan of ~2,500 people in their 30s
- In 2021, opioids were responsible for over 1 in 4 deaths among younger adults
- Pain-related issues cost Canada $40 billion in 2019 - That’s roughly $1,000 per person
My ramblings on this...
We know the data.
We’ve heard the stories. And yet—change is still slow.
That’s what puzzles me the most. Why is it that what seems most pressing feels most glacial...?
We have strong evidence, national task force reports, and promising models like TAPMI and Rapid Access Clinics.
And yet—system-wide change is still painfully slow. Even when real human lives are being lost, progress lags behind.
That’s the hardest part to sit with. We know what needs to change. But of course, knowing isn’t enough.
Why?
Not sure, but my guess is shifting systems means shifting power, politics, funding priorities, and perspectives. It means rethinking how we train clinicians, how we track outcomes, and how we define success in pain care.
It’s hard work. But it’s essential work. And forums like the Pacific Pain Forum remind me that momentum is building—we just need to keep pushing.
1 in 5 Canadians live with chronic pain—but
access isn’t equal. Indigenous Peoples (First Nations, Métis, and Inuit) are among those most affected, yet often receive the least compassionate care.
- Persistent stereotypes like "stoic," "high pain tolerance," "drug-seeking," or "frequent flyer" continue to harm and retraumatize.
- Many avoid healthcare services altogether out of fear of being dismissed, judged, or mistreated.
Here is a quote that really stuck with me from one of the presenters:
“Do you want to help some people—or all people?”
Give that quote some space to settle in for a moment ...
Cultural safety is the outcome of respectful, power-aware interactions. It’s how someone feels after a healthcare encounter.
- It requires cultural humility, continuous reflection, and a commitment to listening.
- In BC, the Cultural Safety and Humility Standard is now a recognized practice standard by the College of Physicians and Surgeons (CPSBC).
- "Two-Eyed Seeing" encourages us to bring together Indigenous and Western ways of knowing, side by side, with mutual respect.
- Providers, but importantly Indigenous patient's, are increasingly being asked to walk in both worlds.
Here are some other great resources I discovered at the Forum:
1.
Remembering Keegan: A BC First Nations Case Study Reflection
2. Health Equity Collaborative:
Believe Me: identifying barriers to health equity
With 39% of Canada’s population, Ontario is grappling with a massive pain burden. The Toronto Academic Pain Medicine Institute (
TAPMI) offers a glimpse of what coordinated care can look like:
- Triage systems led my registered nurses.
- Mandatory orientation and stepped care to manage access and expectations
- Power Over Pain Portal for adults and youth ("Don’t Google—Go Here") to get people timely access to care so they don't end up spiralling as they sit on the waitlist.
- Programs like ENDOPAIN for early endometriosis screening.
- A push to engage people while they wait instead of letting them fall through the cracks.
2.8 million Ontarian's live with chronic pain. TAPMI receives $30 million in funding—that’s just $10 per person. Yet they’re finding ways to stretch impact through smart design.
Pain BC continues to do incredible work in education, empowerment, and systems advocacy. But gaps remain:
- People reach out regularly needing simple things: referrals, prescriptions, clarity. I am sure you could think of a few ways to alleviate this burden now.
- There aren’t enough GPs to quarterback chronic pain care, and walk-in clinics may need to take on that role. Perhaps there is a role for NP's but what about Physio's?
- Payment models don’t support the type of care many people need.
At the Pacific Pain Forum, there was a bit of an update around core competencies for pain care. There was strong consensus around a few essentials:
- Entry-to-practice education that moves beyond "pain is complex" to practical, compassionate care.
- Shared standards across professions.
- A shift from focusing solely on pain intensity to tracking function, coping, and recovery.
What do you think should be part of every clinician’s pain toolkit?
A Patient's Wisdom
The patient panel was a highlight. Stories of being unseen were painful—but stories of being heard were powerful. One quote in particular stuck with me:
“The good physician treats the disease. The great physician treats the person who has the disease.”
That’s the bar. And the system we build should help us reach it.
Thanks to the presenters, patients, and program leaders who made the Pacific Pain Forum such a meaningful experience. Let’s keep building better together.
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Sean Overin, MPT, tDPT Registered Physiotherapist
