Tackling pain management in young patients

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Recognizing the importance of pain management in children, the Children’s Hospital of Eastern Ontario (CHEO) is tackling pain management in a coordinated fashion.

Following a Quality Improvement report that identified the need for improved pain management services at CHEO, a working group was appointed in March 2005 to develop a more comprehensive model of pain services.

In response to the working group’s report, a team that included a nurse, psychologist, physiotherapist, pharmacist and anesthesiologist carved time out from their respective schedules and began offering a chronic pain clinic in September 2007 as the first response phase of this initiative.

With many of the team members having encountered patients who could greatly benefit from a comprehensive approach to their chronic pain issues, the team set out to establish referral criteria.

With no dedicated funding in place to do so, and without knowing how many children might be in need of this service, they began offering this clinic one half-day per month with the objective of seeing two new patients, and two in follow-up, as a phased in approach to an integrated pain service at CHEO.

Children, up to age 18 years, who are experiencing debilitating pain and not responding to short-term treatment, and whose life was being impacted negatively were identified as those who could benefit greatly from this approach. Referring physicians at CHEO had indicated that in some cases, their patients (many of whom are adolescents) were withdrawing from their social circle, experiencing family difficulties, weren’t attending school any longer and were quitting their part-time jobs, due to the unrelenting pain they were experiencing.

The chronic pain clinic aims to bring together a number of specialties in order to treat these patients in a holistic way. To date, some of the referrals have included young patients who have chronic pain resulting from an injury, and others who are suffering from chronic illnesses.

The multidisciplinary approach is particularly effective in treating complex cases, where patients are accessing treatment from a number of different services. This approach allows for coordination between each member of the team, to better treat all of the patients’ symptoms.

The team meets in a fairly large, conference room, which can sometimes be intimidating at first for young people who may never have been in such a formal setting. They quickly warm up to the setting once they experience first-hand the benefits of having all the players in one room.

Fourteen-year old Marie-Soleil Plouffe was first seen by the team in December. To date, Marie-Soleil has had two consults with the team and clearly sees the benefits. The best thing about this approach, from her perspective, is having everyone in one room and not having to repeat her story, time and time again, to various practitioners. After the consult, there is individual care and follow-up with individual team members, which may include the physiotherapist, psychologist, or anesthetist for medication adjustment as required.

With such limited resources, CHEO’s chronic pain clinic is already building a waiting list for consults as more physicians begin to identify patients who can benefit from this new service. Additional resources are required in various areas, in order to grow this service and support the team’s approach. Building a referral pattern is what the team is focusing on presently, knowing full well that as referrals increase so too will wait times.

“We’ve got to start somewhere,” says Dr. Christine Lamontagne. “With chronic pain being such an issue in the adult sector, we need to begin addressing our adolescent patients’ needs in this area, before they transition over to the adult sector. We’ve had great feedback so far, and I’m confident that we can keep building this service in a coordinated way as needs become identified. For now, it feels great to offer this service to those who can really benefit from it.”