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Prince Edward Island neuralgia

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					          Survey of Atlantic Pain Physician
                    Wait-Times




                                      Prepared for
                                     Action Atlantic
                                      October 2005
Action Atlantic is a non-profit group of physicians and patients working to improve care of people
with chronic pain.
                                                                                                     1
Table of Contents

Preamble ------------------------------------------------------------------------------------------------------------------- 3
Pain Physicians in Newfoundland -------------------------------------------------------------------------------------- 4
Pain Physicians in New Brunswick ------------------------------------------------------------------------------------ 6
New Brunswick (cont’d) ------------------------------------------------------------------------------------------------- 7
Pain Physicians in Nova Scotia ----------------------------------------------------------------------------------------- 8
Nova Scotia (cont’d) ----------------------------------------------------------------------------------------------------- 9
Pain Physicians in Prince Edward Island -----------------------------------------------------------------------------10
Illustration of Number of People Waiting ----------------------------------------------------------------------------11
Illustration of the Last 600 Referrals to the Pain Management Unit (CDHA) ----------------------------------11
Illustration of Population of Atlantic Provinces ---------------------------------------------------------------------12
Illustration of Wait-Times ----------------------------------------------------------------------------------------------12




                                                                                                                            2
Preamble

Chronic pain affects about 20% of Canadians at some point in their lives. Wait times at the QEII Pain
Management Unit vary from less than one week for patients with terminal cancer, to more than five years
for most chronic pain problems. Discussions with other pain practitioners revealed long waits were the
routine rather than the exception. We sought to determine if there were wide variations in wait times
showing a need for better coordination of care, or universal long wait times showing a need for better
allocation of resources overall.

We recognize that all physicians treat pain. This represents a telephone and email survey of the Doctors
involved in chronic pain as a specialty or significant portion of their practice. The palliative care staff,
rheumatology clinic, and physical medicine division in Halifax are not included in this survey. The wait
times for assessment and follow-up visit are as reported by the physician or their booking staff. Although
every effort was made to contact these doctors, not all physicians replied. There may be some physicians
missed in this survey, although we feel the list is very close to all inclusive.

The most accepted treatment for complex chronic pain is an interdisciplinary model addressing the
underlying illness but also resulting immobility, disability, and failure of coping skills. Other chronic or
sub-acute pains such as post-herpetic neuralgia of a herniated lumbar disc, may respond to unimodal
therapy. If first line treatment fails coordinated interdisciplinary care is needed. Some doctors provide
ongoing care over years or decades, such as nerve blocks that provide months of relief but need to be
repeated to maintain benefit. Others work in time limited programmes which aim to rehabilitate patients
over a 4-6 week period of intensive treatment but then discharge them. Time limited programmes may
tend to have shorter wait times but may not address needs of patients in subsequent years. Nerve block
centered practices may look after patients for a more representative portion of their chronic illness, but
may not emphasize functional restoration. Therefore the best approach is felt to be multidisciplinary care
tailored to patient need, and available before disability is permanent.

Unfortunately there are some clinics which are only or primarily open to patients with third party
insurance such as workers compensation. Others are restricted by type of pain, such as the Stan Cassidy
Centre in Fredericton, which is an excellent comprehensive programme but only for neuropathic not
musculoskeletal pain. Other practices represent physicians doing the best they can without psychology,
physiotherapy, and occupational therapy to restore function.

Conclusion:

Unfortunately, there is no clinic in Atlantic Canada which is accessible to any referred patient, involves
coordinated interdisciplinary care and rehabilitation, and is available in a timely manner. A national
shortage of anesthetists suggests no easy solution, other than increasing exposure of medical students to
pain and anesthesia as undergraduates. More continuing education on pain for front line family physicians
will be important, as will increased funding, resources and support from government for small, regional
pain clinics across the Atlantic Region. This will help the current problem from becoming a full-blown
crisis.


                                                                                                               3
Pain Physicians in Newfoundland


  Physician           Address           Number of   Wait-time      Wait-        Additional
                                        people on   for New        time for     Comments
                                        Wait-list   Referrals      Return
                                                                   Patients
                                                                                Patients are seen by
Dr. Michael    36 Roche St. St.             4-6       1-2 weeks        1 week   a rotation of
Bautista       John’s NF,                                                       anesthetists working
(anesthesia)   A1B 1L7                                                          in a pre-op
               (709) 777-5000                                                   assessment clinic.
                                                                                Short wait time but
                                                                                not always
                                                                                consistent care.

Dr. Chander    3 Paddington Place St.       50        4 months     2 months
Kamra          John’s NF, A1A 5A9
(anesthesia)   (709) 777-6541


Centre for     100 Forest Road          1 *WHSCC       1 month                  Sees mostly MCP &
                                                                                WHSCC patients.
Pain and       St. John's, NL            109 MCP     8-10 months                Patients are
Disability     A1A 1E5
                                                                                referred to an
Management (709) 777-7048
                                                                                inter-disciplinary
                                                                                team. The
                                                                                physicians see
                                                                                patients only after
                                                                                admission to the
                                                                                rehabilitation
                                                                                program.

Dr. Paul       P.O. Box 2005            100-150         1 year     Within 2     Sees 6-7 new
Woolfrey       Stn. Main NF,                                       weeks        patients/wk. In clinic
(physical      (709)634-3029                                                    4 days/wk, 1 of these
medicine                                                                        days does EMG
specialist)                                                                     studies.

*Workplace Health Safety & Compensation Commission

Dr. Phillip Beresford, Dr. James Hickey were contacted but no reply.

                                                                                                      4
5
Pain Physicians in New Brunswick

    Physician            Address         Number      Wait-time     Wait-time for          Additional
                                         of people   for New         Return               Comments
                                         on Wait-    Referrals      Patients
                                            list
                                                                                      Has not seen any
Dr. Farooque         155 Kierstead Dr.     380                                        new referrals in 1
                                                     18 months
Khan (anesthesia)    Miramichi, NB                                                    year.
                     E1V 6R9                                                          Clinic 2 days/week
                     (506) 622-5868
                                                                                      Sees mainly WCB
Dr. Jose Ledezma     106 Doncaster Dr.                                                & insurance
(family physician    Quispamsis, NB                  1-2 weeks                        patients.
                                            2                         8 weeks
with certification   E2E 1R2                                                          New patients do a 6
in pain              (506) 738-4364                                                   week multi-
management)                                                                           disciplinary
                                                                                      program.
                                                                                      Follow-up
                                                                                      appointment with
                                                                                      physician is 2
                                                                                      weeks after.
                                                                                      1 block wait-list
Dr. Susan Lee        58 Westminster        100         18-19                          1 clinic wait-list
                                                                    Appointments
(anesthesia)         Crt. St. John NB,               months for                       (pt. to see multi-
                                                                     made on an
                     E2K 4S3                         full-team                        disciplinary team).
                                                                   individual basis
Dr. Colin Davies     (506) 648-6861                                                   1 physician sees
(anesthesia)                                                                          patients with
                                                                                      pending litigation.
Dr. Phillip Reid                                                                      WCB patients
                                                                                      receive nerve
                                                                                      blocks only, 1 in
                                                                                      spring/summer and
                                                                                      1 in fall/winter.
Dr. Tom Evans        75 Albert St.                   1 month                          Clinic 3 days per
(anesthesia)         Moncton, NB            10       Pts pre-                         week.
                                                                       1 month
                     E1C 1B3                         approved                         Sees 3-4 new
                                                                     Long-term
                     (506) 382-6601                  for                              assessments per
                                                                    follow-up pts
                                                     treatment                        week.
                                            14       1.5 months
                                                     Pts for                          Intense structured
                                                     assessment                       rehab program only
                                                     & treatment                      open to pt.s with 3rd
                                            6        2 months                         party coverage
                                                     Pts for
                                                     assessment

                                                                                                         6
New Brunswick (cont’d)

Physician           Address         Number      Wait-time    Wait-time for          Additional
                                    of people   for New        Return               Comments
                                    on Wait-    Referrals     Patients
                                       list
Dr. Colleen   Stan Cassidy Center
O’Connell     for Rehabilitation                                               Sees patients with
(physical     180 Woodbridge St.                                               neurologic disorders
medicine      Fredericton, NB                                                  or injuries (ex MS,
specialist)   E3B 4R3                                                          SCI, nerve injuries).
              (506)452-5681                                                    Does not run pain
Dr. Leckey                                      6 months                       clinic, however
(physical                                                                      addresses entirety of
medicine                                                                       care including pain.
specialist)                                                                    Routinely sees
                                                                               patients for
Dr.                                                                            complicated pain
Milzcarek                                                                      issues who fit their
                                                                               mandate.

Dr. Richard George Dumont
Dumais       Hospital 330                                                      Has clinic 5 days/wk.
(anesthesia) University Ave.,                                                  Has a P/T physiatrist,
             Moncton, NB                                                       2x0.25 psychologists
Dr. Patrick E1C 2Z3                    800        4 years                      and 0.5 FTE
Giroux                                                                         physiotherapist. Will
(physical                                                                      soon be doing
medicine                                                                       percutaneous lumbar
specialist)                                                                    discectomy.
Dr. John     The Moncton Hospital
Crompton     South-East Health                                                 Has a physiotherapist
(anesthesia) Region                                                            2.5 days/wk & 0.5
             (506)-857-5458            568      3 months -   1 week –          psychologist.
Dr. Jamie                                       1 year       1 month
Penfold                                         (urgents)    (depending on
(anesthesia)                                                 treatment given
                                                4 years      & physician
                                                (regular)    scheduling)


Dr. Hirsto Laevski was contacted but no reply given.




                                                                                                   7
Pain Physicians in Nova Scotia

   Physician           Address         Number of        Wait-time for    Wait-time           Additional
                                       people on        New              for Return          Comments
                                       Wait-list        Referrals        Patients
Dr. Alex          46 Portland St.                                                         Has no regular
Finlayson         Dartmouth, NS             200                            1-2 months     OR/clinic
(anesthesia)      B2Y 1H4                                                                 schedule
                  465-8316
Dr. Rob           PO Box 458                                                              Accepting new
Patterson         Stn. Main                 180         11-13 months        Within 1      patients
(anesthesia)      Dartmouth, NS                                              week
                  B2Y 3Y5
                  832-0640
Dr. Allison       Hants                                                                   Clinic held once
Kelland           Community                 442           24 months         4 months      per week (Wed.)
(anesthesia)      Hospital, NS
                  792-2034
Dr. Henry         125 Lavinia St.                                                         27 patients left
Adamson           New                       Nil            3 months                       to be seen.
(anesthesia)      Glasgow,NS                                                              *No longer
                  B2H 1N7                                                                 accepting new
                  752-8311                                                                referrals.
Dr. Rob           C.B. Regional                                                           Sees 6-7 new
MacNeill          Hospital                  800           24 months         Within 1      patients/wk
(anesthesia)      1482 George St.                                            month        Does 6
                  Sydney, NS                                                              blocks/day @
                  B1P 1P3                                                                 10hrs/day
                  567-8183
Dr. Harry Pollett 4128 East Bay
(anesthesia)      Highway NS                200           6-8 months       3-4 months
                   B1J 1M8
                  794-2369

* Unable to see new patients due to the unavailability of OR time and anaesthesia. Currently there is 6.5
hrs of OR time every 2 weeks




                                                                                                             8
Nova Scotia (cont’d)

 Physician       Address        Number of   Wait-time for   Wait-time for       Additional
                                people on   New Referrals   Return Patients     Comments
                                Wait-list
Dr. Ian        Pain                                                           Clinic and
Beauprie       Management                                       4 months      Blocks held
(anesthesia)   Unit                                                           twice/wk. 1/2day
               5820                                                           clinic, 1/2day
               University                                                     blocks.
Dr. Ken        Ave. 4th Floor                                                 Clinic held
Chisholm       Dickson              1300+     60 months         4 months      once/wk and
(anesthesia)   Bldg.                                                          twice every 2nd
               Halifax, NS                                                    wk. Blocks held
               B3H 1V7                                                        1/2day twice/wk.
Dr. Gail       473-4130                                                       Clinic and
Gillespie                                                       3 months      Blocks held
(anesthesia)                                                                  twice/wk. 1/2day
                                                                              clinic, 1/2day
                                                                              blocks.
Dr. Allison                                                                   Clinic and
Kelland                                                         4 months      Blocks held once
(anesthesia)                                                                  every 2nd wk. ½
                                                                              Clinic, 1/2day
                                                                              Blocks.
Dr. Patricia                                                                  Clinic and
Livingston                                                      4 months      Blocks held
(anesthesia)                                                                  1day/wk. 1/2day
                                                                              Clinic, 1/2day
                                                                              Blocks.
Dr. Mary                                                                      Clinic held 11/2
Lynch                                                           6 months      days/wk.
(psychiatry)




                                                                                             9
Pain Physicians in Prince Edward Island

 Physician          Address         Number of   Wait-time      Wait-time          Additional
                                    people on   for New        for Return         Comments
                                    Wait-list   Referrals      Patients

Dr. George     22 St. Peter’s Rd.               No wait-list                   Sees mostly own
Carruthers     Charlottetown, PE                                                   patients
 (family       C1A 5N4
medicine)      (902) 894-7087
                                                                              Has not seen a new
 Dr. Steve     1020 Bracley Pt.        200       24 months      4-5 weeks    referral in 1-11/2 yrs
  Farmer       Rd. Charlottetown,                                           due to lack of facilities
(anesthesia)   PE                                                                and support.
               C1E 1Z3                                                       Sees patients that are
               (902)894-2230                                                  admitted to hospital
                                                                             for pain (i.e. cancer)




                                                                                                  10
Illustration of Number of People Waiting

               Number of people waiting in each province



                       3200
                                                            200



                     316                        1870


                             NS    PE    NB     NF                  TOTAL=5586




Illustration of the Last 600 Referrals to the Pain Management Unit
(CDHA)

             Breakdown of Last 600 Referrals to the Pain Management Unit




                                                              348




              152

                                   64             31   5



                        NF    NB   PE   outside CDHA       CDHA

                                                                                 11
Illustration of Population of Atlantic Provinces

                             Population of the Atlantic provinces



                                                              908007
                    512930




                                                                   135294
                                     729498


                                     NS    PE    NB      NF
         *Based on Statistics Canada, 2001 Census


Illustration of Wait-Times
                                  Average Wait-Times (months)


                    25                                         24
                                                    22
                                        20.5
                    20                                                      18.9
           MONTHS




                    15

                    10        9

                     5

                     0
                             NF       NB         NS           PE        AVG.
                                               PROVINCE




                                                                                   12

				
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