Effective pain management requires teamwork

By Christa Jeney MD, CCFP

Pain affects all of us at some point in our lives and is the most common symptom for which Canadians seek medical assistance. It is estimated that 80 per cent of physician office visits are somehow related to the symptom of pain. Proper treatment of pain requires a team of pain specialists able to orchestrate medications, physical therapy and psychological support. St. Joseph’s Health Centre has recently adopted a multidisciplinary approach for the management of pain and has embarked on a mission to become a recognized centre of excellence in the management of pain in the Greater Toronto Area.

All of St. Joseph’s existing pain services are encouraged to work together through the hospital’s Pain Management Committee, which has the ongoing responsibility of improving the assessment and treatment of pain throughout the Health Centre. For example, the Ambulatory Pain Clinic has vital links within the hospital to other services that also deal with pain management. When patients are having difficulties with substance abuse and pain they are referred to the Addiction Medicine Service. Patients who have been diagnosed with a terminal illness are referred to the Palliative and Supportive Care Service team.

In response to the ever-increasing demand from patients in our community to help manage their pain, the St. Joseph’s Ambulatory Pain Clinic opened for business in January 2002. The clinic opened to a two-month waiting list through referrals from staff and community physicians alone. A multidisciplinary approach is utilized in the Pain Clinic. The clinic provides ambulatory patient care and education in the areas of acute and chronic disabling pain disorders. In addition to conventional medical interventions, the clinic offers complementary and alternative medicine interventions, such as acupuncture, that are evidence based.

Through the Ambulatory Pain Clinic and other initiatives in pain management, St. Joseph’s Health Centre will also be involved in clinical pain research.

Less than one per cent of pain patients using opiates develop addictive behaviour. The Addiction Medicine Service provides consultations to family physicians and specialists to help their patients with pain who are also dealing with substance abuse. The Addiction Medicine Service team works collaboratively with their colleagues in optimizing pain management while providing support to these patients.

The Palliative Care and Supportive Service program at St. Joseph’s was introduced in 1999 to provide for the needs of families in our community facing loss and experiencing grief. The palliative team consults with patients who are suffering from pain, both malignant and non-malignant (i.e. pain resulting from complications of diabetes) as patients approach or are in the terminal stages of their life.

The Pain Committee at St. Joseph’s has also recently developed comprehensive pain management standards that have earned the support of the Medical Advisory Committee and senior management. These standards are currently being implemented on the paediatric and general surgery floor.

In order to ensure that the new pain standards are met, the Pain Committee has committed to educating staff about pain assessment and intervention. As part of the educational initiative, St. Joseph’s Health Centre is hosting its first pain management conference Bringing it Back to the Bedside: The Art and Science of Pain Management on Saturday, April 13, 2002.

The title of the conference ties into the philosophy that is needed to provide compassionate and effective pain management. The “art” of pain management reflects the medical staff’s ability to integrate objective findings in the context of the human experience of pain. To be effective in the management of pain, the clinician, nurse or the allied health worker must also treat the patient equipped with the most up-to-date scientific knowledge in the context of the person and his/her environment: this is the art of pain management.

Experts in the field will be addressing such areas as the fundamentals of pain assessment, and the assessment and management of pain in the cognitively impaired patient. The conference has been planned to appeal to a wide spectrum of interests in pain management.

In striving to become a leader in pain management, St. Joseph’s Health Centre has recognized that it takes a team to provide effective care. Utilizing all of our resources and committing to continued pain management education for our caregivers, we are confident that our goal is within reach.

Bringing it Back to the Bedside: The Art and Science of Pain Management conference will be held on April 13, 2002 at the Boulevard Club in Toronto.

For more information about registration, please call St. Joseph’s Health Centre at 416-530-6036 or access our web site at www.stjoe.on.ca.