Left to right: Ben Fair, Director, Special Projects; Pavlina Napastiuk, Social Worker; Nashina Ali, Administrative Assistant; Barb Eddy, Nurse Practitioner; Esther Eidse, Manager, DCHC; Will Bateman, Physiotherapist
For some people who experience chronic pain, particularly those who face social and economic barriers in Vancouver's Downtown Eastside (DTES), for-pay services such as counselling and physiotherapy are simply not within reach. In an effort to break down these barriers and offer an integrated and collaborative approach appealing to both care providers and their clients, a team of passionate VCH frontline workers and community partners have come together to form the DTES Chronic Pain Service.
The DTES Chronic Pain Service — which launched early this year and serves clients of Vancouver Community Primary Care — offers drug-free options for chronic pain management. The pilot project was created in response to the opioid crisis, when the redesign of the Downtown Eastside Second Generation Strategy identified the need for overdose emergency response, with teams recognizing chronic pain as a contributor to substance use.
“The need was identified years ago," says Ben Fair, Special Projects Director. “There was a significant gap in care in the DTES. [Pain] services were not prevalent in peoples' lives."
Operated by VCH and in partnership with Pain BC, the clinic is funded through the BC/Canada Emergency Treatment Fund. The program is enmeshed within VC Primary Care teams and is a time-limited service available to referred clients from Heatley, Pender, Downtown Community Health Centre (DCHC), Sheway, Raven Song and Three Bridges Community Health Centres.
The program consists of a small but mighty team that includes counsellor Pavlina Napastiuk, nurse practitioner Barb Eddy, physiotherapist Will Bateman (a first for VCH Primary Care) and administrative assistant Nashina Ali. They offer clinics such as the Gentle Movement and Relaxation Class, myoActivation needling therapy and Making Sense of Pain (MSOP) – a group therapy pilot project within the program.
The clinics serve clients who experience persistent or chronic pain and have been previously assessed by a care provider in the community, many of whom have associated mental health or addiction issues. The programs are offered as a means for clients to learn how to manage their pain without the use of opioids or any pain medication.
“What is pain?" asks Bateman, who works directly with clients to educate them on the physiological complexities of pain and offer self-management strategies. He acknowledges that the benefits of understanding pain are not just physical, and that the emotional component needs to be addressed.
“The kind of pain we see can include chronic back and shoulder pain, osteoarthritis, fibromyalgia, complex regional pain syndrome – as well as lived trauma," he says. “We need to shift our approach in primary care to provide a culturally better understanding of how pain works so that it is managed better at the outset."
“There are multiple ways to cope with the experience of pain," says Napastiuk, who works with clients in the group therapy program. “[Clients] learn in group that there is not one go-to solution to improve their relationship with pain. We give them tools that can help empower them more."
Photo right: Will Bateman and his client Kim Williams.
The program has already seen spectacular results, with a referral increase of 299% from March to June 2019. With an engagement of around 200 clients per month, the team is expected to gain even more popularity as news of their services spreads across the community.
“The need has been unmet for a long time," says Eddy, NP. “Teams across VCH are hungry for this kind of service."
She says the ideal future state for the team would be to expand their services across VCH to address the demand of referrals from care providers. For her, the link between community partners and primary care clinics is imperative, and that providing education to colleagues in the community will help to maintain empathy and awareness around treatment options for clients.
“On-site in the community health centres is where the best care is provided," she says. “It's where the connections happen."
Eddy and the team provide Lunch and Learns across Vancouver CHCs to spread awareness of the DTES Pain Clinic Service programs and provide tools for care providers. Eddy recalls a conversation with a practitioner in the community that truly highlighted the benefits of pain clinic services and what the team works toward every day.
“How great it felt to have a place to send a person. Validating a person's pain experience was therapeutic itself."
Read the Media Release