Lack of recognition and awareness of the magnitude of chronic pain problem; cost (human and monetary); and knowledge of how to diagnose and manage CNCP (by all providers).
Lack of treatment modalities and services because effective CNCP programs/services are not readily available or accessible; effective drugs or nondrug modalities also are not available or accessible; lack of directory of services and programs that do exist.
Lack of oversight, standardization, and education, namely, lack of unified policy for CNCP; lack of standards for pain programs/clinics; inadequate education and training in CNCP within the undergraduate curricula, postgraduate programs, and continuing health education for practicing professionals; and lack of accreditation for health care providers to deliver CNCP care.
Lack of systematic treatment for populations, including all Ontarians, as well as most vulnerable people such as aboriginals, immigrants, elderly in long-term care, addicts with chronic pain, and the military.
Lack of prevention services, specifically, lack of strategies to minimize transition from acute to chronic pain management; lack of self-management programs; and no funding of effective vaccine shown to prevent/reduce incidence of shingles/postherpetic neuralgia.
Lack of accountability with no organized system able to measure outcomes or conduct research.
Scarcity of chronic pain care delivery at the level of primary care resulting from a lack of supportive services for primary health care providers in managing chronic pain; guidelines/care pathways for chronic pain; availability of stepped-up comprehensive continuum of care for patients with chronic pain from primary care up to the tertiary care level; ongoing mentoring and continuing education to primary health care providers; and chronic pain management within integrated models of care at the primary health care provider level.
Financial considerations, such as absence of remuneration specifically for managing patients with chronic pain at both a primary and specialty care level (i.e., no fee code for chronic pain care); lack of remuneration for team-based care involving allied health professionals, who are widely used by the public and important for multidisciplinary management; providing funds for treatment modalities that are shown to be ineffective while there is no funding for treatments that have been shown to work.
