Dr. Hance Clarke, medical director of the pain research unit at Toronto General Hospital, believes doctors can do more to prevent patients from developing chronic and debilitating pain after surgery.
He heads a new program — one he says is a world-first — that helps patients manage severe post-surgical pain using a range of traditional and alternate therapies, including acupuncture, exercise, psychological techniques and non-opioid pain medications.
The program is unique in that it provides follow-up care for surgical patients after they are discharged from hospital.
“We do a good job of dealing with pain in hospital, but those regiments don’t continue beyond the hospital stay,” says Clarke, director of the new transitional pain service at Toronto General Hospital, a part of University Health Network.
Patients who have uncontrolled pain after surgery can sometimes wait up to 18 months to see a pain specialist, he says. During that wait, there is a risk that some patients will get addicted to prescription pain killers.
“After major surgery, 50 per cent of patients get sent home with a prescription for an opioid drug, and a percentage of those patients continue on those drugs long-term,” Clarke says. “And one of the reasons they stay on the drugs is because persistent pain from an operation gets in the way of life.”
The goal of Toronto General’s transitional pain service is to catch patients before their acute surgical pain turns chronic, becoming its own hard-to-treat disease.
Clarke says about 30 per cent of surgical patients are at risk of developing chronic pain, a shift that typically happens about three months after an operation.
“We need to treat people before we miss that window,” he says, noting the one-year pilot program, which launched in June, identifies patients at high-risk of developing chronic pain prior to their surgery.