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

• DOI: 10.2147/jpr.s91924
• Publication Date: 2015-10-15T00:47:25Z
• Authors: Joel Katz; Aliza Weinrib; Samantha Fashler; Rita Katznelson; Bansi Shah; Salima Ladak; Jiao Jiang; Qing Li; Kayla McMillan; Daniel Santa Mina; Kirsten Wendtlandt; Karen McRae; Diana Tamir; Sheldon Lyn; Marc de Perrot; Vivek Rao; David Grant; Graham Roche-Nagle; Sean Cleary; Stefan Hofer; Ralph Gilbert; Duminda Wijeysundera; Paul Ritvo; Tahir Janmohamed; Gerald O'Leary; Hance Clarke
• Keywords: Pain catastrophizing; Transitional care; Depression

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