The Toronto General Hospital Transitional Pain Service: development and implementation of a multidisciplinary program to prevent chronic postsurgical pain.
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.
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.
Joel
J
Katz
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.
Aliza
A
Weinrib
Department of Psychology, York University, Toronto, ON, Canada.
Samantha R
SR
Fashler
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.
Rita
R
Katznelzon
Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
Bansi R
BR
Shah
Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
Salima Sj
SS
Ladak
Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
Jiao
J
Jiang
Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
Qing
Q
Li
Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
Kayla
K
McMillan
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.
Daniel
D
Santa Mina
Palliative Care, University Health Network, University of Toronto, Toronto, ON, Canada ; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
Kirsten
K
Wentlandt
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.
Karen
K
McRae
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.
Diana
D
Tamir
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.
Sheldon
S
Lyn
Division of Thoracic Surgery, Toronto General Hospital, York University, Toronto, ON, Canada.
Marc
M
de Perrot
Division of Cardiovascular Surgery, Toronto General Hospital, York University, Toronto, ON, Canada.
Vivek
V
Rao
Multiorgan Transplant Program, Toronto General Hospital, York University, Toronto, ON, Canada.
David
D
Grant
Division of Vascular Surgery, Toronto General Hospital, York University, Toronto, ON, Canada.
Graham
G
Roche-Nagle
Division of General Surgery, Toronto General Hospital, York University, Toronto, ON, Canada.
Sean P
SP
Cleary
Division of Plastic Surgery, Toronto General Hospital, York University, Toronto, ON, Canada.
Stefan Op
SO
Hofer
Division of Otolaryngology - Head and Neck Surgery, Toronto General Hospital, York University, Toronto, ON, Canada.
Ralph
R
Gilbert
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.
Duminda
D
Wijeysundera
Department of Kinesiology and Health Science, York University, Toronto, ON, Canada.
Paul
P
Ritvo
ManagingLife, Toronto, ON, Canada.
Tahir
T
Janmohamed
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.
Gerald
G
O'Leary
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.
Hance
H
Clarke
Transitional Pain Service; chronic postsurgical pain; multidisciplinary treatment; opioid use; transition to chronic pain