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J Pain Res. 2015 Oct 12;8:695-702. doi: 10.2147/JPR.S91924. eCollection 2015.

The Toronto General Hospital Transitional Pain Service: development and implementation of a multidisciplinary program to prevent chronic postsurgical pain.

Author information

1
Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada ; Department of Psychology, York University, Toronto, ON, Canada ; Department of Anesthesia, University of Toronto, Toronto, ON, Canada.
2
Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada ; Department of Psychology, York University, Toronto, ON, Canada.
3
Department of Psychology, York University, Toronto, ON, Canada.
4
Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada ; Department of Anesthesia, University of Toronto, Toronto, ON, Canada.
5
Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
6
Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada ; Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada.
7
Palliative Care, University Health Network, University of Toronto, Toronto, ON, Canada ; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
8
Division of Thoracic Surgery, Toronto General Hospital, York University, Toronto, ON, Canada.
9
Division of Cardiovascular Surgery, Toronto General Hospital, York University, Toronto, ON, Canada.
10
Multiorgan Transplant Program, Toronto General Hospital, York University, Toronto, ON, Canada.
11
Division of Vascular Surgery, Toronto General Hospital, York University, Toronto, ON, Canada.
12
Division of General Surgery, Toronto General Hospital, York University, Toronto, ON, Canada.
13
Division of Plastic Surgery, Toronto General Hospital, York University, Toronto, ON, Canada.
14
Division of Otolaryngology - Head and Neck Surgery, Toronto General Hospital, York University, Toronto, ON, Canada.
15
Department of Kinesiology and Health Science, York University, Toronto, ON, Canada.
16
ManagingLife, Toronto, ON, Canada.

Abstract

Chronic postsurgical pain (CPSP), an often unanticipated result of necessary and even life-saving procedures, develops in 5-10% of patients one-year after major surgery. Substantial advances have been made in identifying patients at elevated risk of developing CPSP based on perioperative pain, opioid use, and negative affect, including depression, anxiety, pain catastrophizing, and posttraumatic stress disorder-like symptoms. The Transitional Pain Service (TPS) at Toronto General Hospital (TGH) is the first to comprehensively address the problem of CPSP at three stages: 1) preoperatively, 2) postoperatively in hospital, and 3) postoperatively in an outpatient setting for up to 6 months after surgery. Patients at high risk for CPSP are identified early and offered coordinated and comprehensive care by the multidisciplinary team consisting of pain physicians, advanced practice nurses, psychologists, and physiotherapists. Access to expert intervention through the Transitional Pain Service bypasses typically long wait times for surgical patients to be referred and seen in chronic pain clinics. This affords the opportunity to impact patients' pain trajectories, preventing the transition from acute to chronic pain, and reducing suffering, disability, and health care costs. In this report, we describe the workings of the Transitional Pain Service at Toronto General Hospital, including the clinical algorithm used to identify patients, and clinical services offered to patients as they transition through the stages of surgical recovery. We describe the role of the psychological treatment, which draws on innovations in Acceptance and Commitment Therapy that allow for brief and effective behavioral interventions to be applied transdiagnostically and preventatively. Finally, we describe our vision for future growth.

KEYWORDS:

Transitional Pain Service; chronic postsurgical pain; multidisciplinary treatment; opioid use; transition to chronic pain

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