When treating chronic pain, both patient and physician need support
Dr. Cathy Scrimshaw understands all too well the complexity of the opioid crisis and the worries it brings.
“When I got my first MD Snapshot prescribing report from CPSA and saw my prescribing percentile, I was nervous,” shares Dr. Scrimshaw. “I think a lot of doctors feel that way, they see that number and feel like they’re being reprimanded. But once I looked deeper into the report and saw the whole picture, I began to see it as the resource it is. It helps keep me accountable, so I am aware of the doses my patients are on and cognizant of whether or not we need to look at getting it down. I can also see whether my patients have received prescriptions from other doctors and flag their chart to discuss this with them.”
Dr. Scrimshaw is a community physician from Pincher Creek with an interest in addiction and chronic pain. She knows providing care for people who use opioids is complex and says taking time to develop trust is key to helping these patients effectively manage their conditions.
“If a patient feels like you’re going to take away their medication, they won’t be receptive to what you have to say,” Dr. Scrimshaw cautions. “Establish a strong relationship. Talk to your patients with an open mind. Reassure them that you don’t want to take away their medication if the dosage is appropriate and they’re functioning well. Review their history and to see if all avenues of pain management have been explored. If you have concerns, tell them why and ask if they would consider tapering, or maybe trying a new treatment. Make sure they know about the risks of continued opioid use and give them some resources to review. Then ask them to come back to discuss next steps.
“Chronic pain is complex but ultimately, it’s just like treating any chronic illness,” says Dr. Scrimshaw. “Communication with our patients is critical. And there are many resources available for physicians who need some extra help with these cases.”
In addition to her work with patients, Dr. Scrimshaw is the lead of the Alberta College of Family Physicians’ Collaborative Mentorship Network for Chronic Pain and Addiction. The network, based on a model first introduced in Ontario, focuses on medical mentoring-connecting physicians who have expertise and experience in chronic pain and addiction with other physicians who are developing their skills and need support.
“Any physician can sign up as either a mentor or a mentee,” says Dr. Scrimshaw. “Currently, we have 22 mentors working with one or two physicians each, giving advice and resources on providing care for people with chronic pain and addiction. An online discussion board where doctors will be able to go for help is currently being developed and we’re always scheduling workshops and educational events across Alberta. We’ve received great feedback from these events, attendees see them as a safe place where they can bring forward scenarios and ask questions.”
When treating chronic pain, Dr. Scrimshaw encourages physicians to work together, with interdisciplinary teams if possible, to share information and support each other.
“You’re not alone,” says Dr. Scrimshaw, echoing what physicians often tell patients who are struggling. “There are so many resources available to help us help our patients. Don’t be afraid to reach out for help.”
For support with treating chronic pain, check out the ACFP’s Collaborative Mentorship Network website.
If you have questions or concerns about safe prescribing, visit CPSA’s Physician Prescribing Practices website.
To access the University of Calgary’s new opioid course, The Wise Prescribing and Deprescribing: Opioid Skills for the Frontline Clinician, visit their Continuing Medical Education & Professional Development website.
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