Chronic Pain Service

What is chronic pain?

Pain is normal. It is processed in the brain, and it protects you and alerts your brain that tissues are under threat. However, there are two types of pain.

Chronic pain:

• Usually presents for more than 3 months.
• The tissues are healed but the alarm signal continues to go off.
  • This is not helpful because there is no longer any tissue damage.
• For some there was no significant injury or illness, the pain just started on its own.
• Chronic pain is more complex than acute pain.
• Imaging (X-rays/MRIs etc.) cannot show us if there is something which causes pain. Pain is an output of the brain.
• Treatment of chronic pain does not focus on how the pain started or where it is. We focus on managing pain and getting patients back to functioning.

Acute pain

• Is the pain you feel when you break your arm, stub your toe, or touch a hot surface.
• It is an alarm signal that tells us there is injury to the body—its purpose is to get our attention.
• We deal with acute pain by resting, taking a break and taking pain medications.
• When the tissue heals, the pain goes away (alarm signal turns off) and we can go back to our usual activities.

Referral Process

Patients will be triaged based upon the information obtained in the request for consultation. It is imperative that we have an overview of current and past therapies including medications, copies of investigations and imaging and a functional assessment (including school attendance and impact upon ADL and family). Use the pain clinic referral form to make referral.

Inclusion criteria

• pain as primary issue
• Other significant/severe medical or mental health issues have either already been addressed or are concurrently being addressed by the appropriate professionals.
• Investigations to identify etiology of pain have been completed.
• Pain refractory to attempted management strategies (ex: commonly used analgesics, physical or psychological therapies), or therapies not available in community despite best efforts.
• Chronic pain impacts function (school attendance, sleep, mood, quality of life and/or family functioning); and
• Primary provider/referring physician agrees to collaborate in ongoing pain management follow-up including writing medication prescriptions when indicated and transition planning where possible.

Exclusion criteria

• no complete workup – diagnosis not complete
• basic pain management not tried before – possible consult (eConsult) on basic pain management
• “Headache” must be seen by Neurology or post “concussion clinic”
• Identified major psychiatric disorder as primary complaint not being treated or appropriate assessor.
• active Suicidal ideation