I read with interest Dr Ladouceur’s editorial, “Opioid dependence,” in the April issue of Canadian Family Physician.1 Being on the “front line” of medicine with my “attached patients” and in complementary walk-in care, I am very much aware of the difficulties in providing balanced care to those with chronic nonmalignant pain. The most onerous aspect is the solitude one experiences, with the regulatory college on one side looking over your shoulder, the rare community physician willing to care for such patients on another side, and then the patient in front of you needing the assistance with pain. When you seek to access support or wisdom in what you are trying to achieve in your management plan, there is such an incredible paucity of resources. Expert colleagues in this area have such extensive waiting lists (anywhere between 1 and 2 years, if lucky) as they rightfully struggle with their heroic workloads (which speaks volumes about how few are willing to pick up the challenges), such that they are forced to simply advise in a brief format on what direction to take. The workload quickly returns to the primary care physician to “test” whether the suggestions work or determine if the replies are helpful. The longer-term care remains to be the single dilemma of that primary care physician. Other “multidisciplinary team members” whose presence and input are so often advised to be part of the standard approach for the management of such complex patients are in reality rare as hen’s teeth. I would be very interested in the views of others on this point.
Footnotes
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Competing interests
None declared
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