18 April 2019

Dear Premier Ford and Minister Elliott,

As an Ontario doctor, I recognize that bold steps are needed to ensure that our healthcare system can deliver efficient and effective care for years to come. As a doctor who has focused on treating chronic pain, I know how life-changing this care can be.

The Appropriateness Working Group has recommended restricting patients’ access to nerve block procedures because they are considered to be of unproven benefit. This is a serious error based on flawed thinking that will have dire consequences for all Ontarians. You cannot allow this to happen.

While many studies have shown that a single treatment can effectively treat pain for several days, there are no studies measuring its success over the long-term. Despite this, thousands of Ontarians across the province rely on these treatments to function and, in some cases, to survive. These treatments allow my patients to work. To be students, parents and spouses. To be effective caregivers, teachers, doctors and nurses.

Without these treatments, many of my patients will not be able to keep their jobs. They will not find pain relief anywhere else, especially now that the opioid crisis has turned doctors into reluctant prescribers. Some will look for painkillers on the streets, and some will have accidental overdoses and die. All of my patients will suffer, and some will probably choose to end their lives.

At my clinic, we have invested in technology to help us deliver better care. Our clinical charts are data forms that our patients and staff complete at every visit using tablet PCs. This data tells us that over the past 12 months, our patients received 3253 injection treatments. These treatments gave them real pain relief for over 7 days, allowing them to exercise, interact with spouses and children, fulfill duties at work and home, and helped them to cope.

As a doctor who uses integrative medicine, I also recommend acupuncture, mindfulness, nutrition and other methods to help me treat my patients’ pain. The success stories I have seen with these therapies over the past 13 years of practice have shown me the limits of evidence-based medicine. While all doctors agree that proven treatments should be used first, our duty to our patients forces us to explore therapies that are less proven when they don’t work. For patients with pain, the goal should be to help them suffer less and live better lives.

I strongly urge you not to restrict access to injection treatments for chronic pain. While some may call them unproven, those of us who provide them – and those who receive them – have no doubt that they work. My colleagues have told the media that these changes will close every pain clinic in Ontario virtually overnight, and I must say it is hard to disagree. The impact on our patients will be catastrophic. Lives will be ruined, and lives will be lost.

I believe in an efficient and sustainable healthcare system, but cutting pain care is not the solution. Our patients are some of the most vulnerable in Ontario, and many of them they are barely surviving as it is. If you must cut, for their sake, cut somewhere else.


Richard Nahas MD