Chronic pain patients praise nerve blocks for freeing them from the shackles of pain

Seven years ago, Mississauga resident Tony Iaboni was diagnosed with a hereditary condition that led to repeated back injuries, causing two herniated discs, spinal stenosis and sciatica. He went from workers’ compensation to permanent disability.

“Imagine somebody taking an ice pick and jamming it through your spine. That’s the worst it gets … It’s constant pain. I can’t bend over. If I sit, it hurts. If I lay down, it hurts. There is no position where it doesn’t hurt,” he said. “It drives me nuts. I’ve been working full time since I was 13. It was kind of a big hit to find out everything’s genetic and there was nothing I could do about it.”

Iaboni started exploring pain treatments under the supervision of his family doctor. Standing 6’2” and weighing 260 lbs, Iaboni’s opioid dosage started high and kept increasing until his doctor referred him to the Centre for Pain Management (CPM) in Mississauga.

There, he was given weekly epidural injections — a painful procedure where you briefly lose feeling in your legs — but when he realized that the full cost wasn’t covered by his insurance, he switched to nerve block injections, which are covered by OHIP. Iaboni now gets 10 to 12 injections at his weekly visits — a treatment plan that exceeds the maximum billing currently allowed by OHIP.

That’s between 500 and 600 nerve blocks per year.

“The number and location of shots switches up depending on the pain. Sometimes, it’s from the neck right down to the tailbone. Sometimes it’s in my butt area. It depends on how bad the week was,” he said. “Sometimes I go for injections and I feel great afterwards. Other times, it feels like I’ve gone 10 rounds with Mike Tyson and all I want to do is come home and sleep.”

The owner of CPM clinics said it could not comment directly on Iaboni’s case but specified that “any nerve blocks provided above the 8/visit limit are not billed and the doctor receives no compensation.”

“It would be difficult to imagine that a patient would subject themselves to 10-12 injections per week, unless they saw some meaningful improvement in their daily life activities. The alternatives – long-term opioid use or frequent ER visits – are much worse,” wrote Grant Connelly.

The Star spoke to more than a dozen chronic pain patients. Some of them get weekly nerve blocks and others wait as long as three months between injections. All but one of them praised the treatment for freeing them from the debilitating shackles of chronic pain.

Some patients have returned to work, while others can go for walks for the first time in years.

“It’s not like I’m going to join my hockey league again. But I can put on skates and skate around with my daughter for 15 minutes,” said Steve Goscar, a Toronto chef who receives weekly pain injections. “It’s given me back my life.”

While some chronic pain patients interviewed by the Star have been able to wean themselves off opioids since starting nerve blocks, most remain on daily opioid regimes. Many combine pain medication with marijuana and injections and say stopping — or cutting back — any one of these three treatments would topple the delicate balance that allows them to manage their pain and live some semblance of a normal life.

Patients also described chronic pain’s mental toll. Pain can prevent you from working and keep you in bed all day; it can affect your relationships with family and friends; it can send you spiralling into the depths of depression.

“If you’ve got very severe pain, you’re going to become depressed. It affects you that way,” said Marvin Ross, a volunteer representative of the Chronic Pain Association of Canada (CPAC), a group of patients that organizes support groups and lobbies government.

One in five Canadians suffers from chronic pain. Two million sufferers have “intractable, high-impact chronic pain,” CPAC says.

Thousands of these patients, who had found a way to manage their pain, were thrown into turmoil in 2017 when — in response to the overdose epidemic — Health Canada released new opioid prescription guidelines, cutting many doses by as much as three-quarters.

The vast majority of those who had their dosages reduced reported a worse quality of life, more pain and worsened disability, according to a CPAC survey. More than one-third reported contemplating suicide and five per cent attempted to take their own life.

“I don’t think too many people would consider suicide if their pain was properly treated,” Ross said. “Many of them are in absolutely horrible condition. Maybe that’s why the needle mills are doing so well.”

Demand for nerve blocks and other pain treatments is overwhelming the healthcare system. One patient told the Star that she had to wait for three years to get into a hospital-based program that offers multidisciplinary care, the gold standard for pain management. It’s a more holistic approach that can include chiropractors, psychologists and social workers, typically only available in hospital, but sometimes offered at private clinics, too.

But wait lists are long. Two patients reported waiting more than a year to get into such a program. The wait time to get into a private clinic can be as short as two weeks.

Patients describe appointments in these clinics as short and efficient. They’re often in and out within half an hour.

“I think of it like stopping at Starbucks on the way to work. It’s that same effectiveness for me. A coffee helps some people in the morning. For me, I’m able to get the injections and I feel like I can have somewhat of a normal life,” said Goscar.

Not every patient is so enamoured with nerve blocks.

After throwing out his back in the shower nine years ago, Kristijan Stojakovic’s doctor referred him to the Pain Care Clinics (PCC) in Windsor after he was rejected as a candidate for surgery.

During his first and only appointment, Stojakovic says the doctor walked in and gave him a cursory examination before pulling out two pre-loaded syringes and giving him multiple shots in the back. His hands started shaking but the pain doctor reassured him that this was normal and continued until he had received 11 injections.

“My back went numb and so did my toes,” he said. “I’m like, ‘Oh my God, what the hell did I get myself into?’”

Stojakovic asked about side effects and was told there were none. He recalls the doctor saying: “By tonight you’ll be completely fine.”

Instead “it was three days of pain.”

On day one, he couldn’t walk. On day two, he could barely sit down. It was only on day three that he started feeling better.

“For me, it was a bunch of BS,” he said. “It seemed like a sales pitch: ‘Nothing else will help you. Only me.’”

“It’s not relief,” he said. “It’s not like, ‘Oh my God, the pain is gone.’ You’re literally numb.”

“This didn’t help at all. I don’t think it’s worth it. You’re two days out of commission and in three weeks, you go back and repeat the whole thing. Maybe it’s just me, but that’s not worth it. … It’s not a solution.”

PCC and its medical director, Dr. Hany Demian, declined to comment through a receptionist at their Mississauga location.



When Stojakovic cancelled his second appointment, the clinic “kept calling and calling,” he said. When he finally picked up, the receptionist told him he shouldn’t cancel because “this is the only thing that will help you,” he recalled.

In the four years since, Stojakovic says he takes pain killers but avoids opioids. He has learned to manage his pain with physiotherapy and lots of stretching.

“I do yoga,” he said “Keeping my muscles around the area strong, so my back doesn’t compensate.”

He has lost 30 pounds and while he does reaggravate his back from time to time, “it’s not as severe as it used to be.”

When told that some people get the shots every week for years on end — with one patient receiving 736 injections in a 12-month period, according to the Star’s analysis — Stojakovic was incredulous.

“That’s crazy,” he said.

Stojakovic is in the minority. Most patients are desperate for treatment. The pain, they say, is debilitating. Even with extremely-high nerve block regimens that are only available in Ontario, many patients are also on maximum dosages of opioids.

A health ministry analysis obtained by the Star shows that in the 2016/17 fiscal year, 61 per cent of patients who received nerve blocks were also prescribed opioids.

The patients who made the most visits to pain clinics received the most nerve blocks and the most opioids. Ten per cent of nerve block patients had 21 or more appointments that year and received a median of seven nerve blocks per visit. Opioids were dispensed to each of these patients 23.4 times during the year with a daily oral morphine equivalent of 2,058. That’s equal to taking 16 OxyContin 80 mg tablets — the highest strength formulation of the medication — every day.

Since 2017, when the new opioid guidelines forced many chronic pain patients to cut down their medication, billing for nerve blocks has increased. Now, with a government proposal to cut back injections as well, some patients are livid.

“The government here is hell bent on taking away anything that’s any good,” said Larry Sanger, who has had chronic pain since his hip replacement surgery more than 15 years ago.

“They’ve already cut my drugs in half and now they want to take these away and say, well, ‘we’re gonna let you have them four times a year.’ They’re no good at that interval.”

Sanger and his wife, Dee, both receive nerve block injections — he weekly, she bi-weekly. They say each time the province takes away a treatment, another one is proffered in its place. First it was nerve blocks when the opioids were cut back. Now it’s medical marijuana — which isn’t covered by the government — to make up for the proposed reduction in nerve blocks.

“Yes, they’ve given us cannabis. But nobody’s given any consideration to who is paying for it. It’s really expensive, especially CBD,” said Dee.

“CBD works,” interjects Larry.

“But it’s not covered. It’s expensive as hell. So you don’t get a whole lot of it,” said Dee.

Like many of the chronic pain sufferers who spoke to the Star, the Sangers expressed frustration at being penalized for the opioid overdose epidemic, which they say overwhelmingly affects recreational users, not pain sufferers.

“We’re not the abusers. People who are in a situation like this are not the opioid abusers. But we’re grouped in with the crisis they’re trying to stop on the street. And we’re taking a hit,” said Larry.

“I had a program worked out with my doctors that was working at the time. And all of a sudden the government stepped in and went, ‘Now we’re gonna roll you back.’ And it was literally half of what I was getting,” said Larry.

“That was when we started looking around and listening to all this stuff about nerve blocks,” he said.

“And, thankfully, they work,” added Dee.

Data analysis by Andrew Bailey

Marco Chown Oved

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