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Survey of chronic pain practice by anesthesiologists in Canada

[Enquête sur la pratique en douleur chronique des anesthésiologistes du Canada]

From the Department of Anesthesiology and Pain Management, University Health Network and Mount Sinai Hospital, Wasser Pain Management Center, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.

Address correspondence to: Dr. Philip Peng, Department of Anesthesiology and Pain Management, EC 2-046 Toronto Western Hospital, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada. Phone: 416-603-5118; Fax: 416-603-6494; E-mail: Philip.peng{at}uhn.on.ca

Purpose: To describe the pattern of chronic pain practice (CPP) among anesthesiologists in Canada.

Methods: Following hospital Ethics Committee approval, a detailed postal questionnaire was sent to all active members of the Canadian Anesthesiologists’ Society. A second mailing was conducted two months later.

Results: The overall response rate was 53%. While 38% of responding anesthesiologists were involved in CPP, in the majority of cases, this accounted for less than 20% of their clinical time. Thirty percent of those involved in CPP had previous training in pain management. The types of CPP included nerve blocks (84%) and pharmacological treatment (60%) in non-cancer pain (85%) and cancer pain (50%) patients. Ten percent and 28% of anesthesiologists were involved in research and teaching respectively while 26% were affiliated with a multidisciplinary clinic. The healthcare professions that anesthesiologists had access to or were directly working with in their practice were as follows: acupuncture (18%), nursing (36%), psychology (28%), psychiatry (35%) and physiotherapy (58%). Epidural steroid injection was the most commonly practiced intervention (82%). This was followed by trigger point injection (70%), stellate ganglion block (61%), occipital nerve block (60%) and lumbar sympathetic block (50%). Practice of interventional procedures was highly diverse.

Seventy percent of anesthesiologists prescribed opioids as part of their CPP. However, half of them never incorporated an opioid agreement with patients. Opioids were most commonly used in the sustained release form.

Conclusion: Approximately one-third of anesthesiologists surveyed incorporate chronic pain in their practice and their pattern of practice is widely diversified.

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