Pain Management Program - Services
Medical management of chronic pain can include the use of medications as well as injections. Our pain clinic physicians, nurses, and pharmacy support can help guide what options may be best for you. Medications and injections should not be used as the only treatment option for your pain. The best approach to receiving benefit from them is to use the pain relief they can provide to help you engage in other therapies such as exercise or counselling, combining the treatments in multidisciplinary approach. View our approach to treating chronic pain.
Medications and injections also have important limitations that the team can address with you. A realistic expectation for their benefit is a drop in your pain intensity by 20 per cent to 30 per cent. In fact, these options may not always be what is recommended, and the pain clinic team may even suggest that they are reduced or stopped if you are already receiving them. In some cases, stopping certain medical therapies may result in an improvement in your quality of life by reducing side effects of medications or injections that are not helpful.
Our team will give careful consideration and advice regarding the appropriate medical treatment options with your input.
Some of your individual sessions and all of group sessions and workshops, including Pain 101 and our Pain Management Group are delivered virtually. Learn more about virtual care and how to prepare for your virtual care session.
Fluoroscopy/X-Ray guided injection
Ultrasound guided injections
Pain medications represent just one part of the overall pain management strategy. Unlike antibiotics to treat pneumonia, pain medications will not cure pain or take away all the pain. Pain medications are intended to help you better manage your pain and to improve your quality of life and function. There are several different types of medications used in the management of chronic pain and the type of medication that is selected will depend on your specific type of pain (e.g., nerve pain vs. mechanical/myofascial pain vs. mixed pain). Some of the more commonly used pain medications are listed below:
- Non-steroidal anti-inflammatory drugs (NSAIDs) [e.g. ibuprofen, naproxen, meloxicam, celecoxib]
- Gabapentinoids [e.g., Gabapentin, Pregabalin]
- Tricyclic antidepressants (TCAs) [e.g., Amitriptyline, Nortriptyline]
- Serotonin-norepinephrine reuptake inhibitors (SNRIs) [Duloxetine, Venlafaxine]
- Opioids [Morphine, Oxycodone, Hydromorphone, Fentanyl patch, Methadone]
- ‘Opioid-like’ medications [e.g., Tramadol (immediate release), Tramadol (extended release), Tapentadol (immediate release), Tapentadol (extended release)]
- Cannabinoids [e.g., Nabilone, medical cannabis products]
- Botulinum toxin:
- Abobotulinumtoxin A (Dysport®) for cervical dystonia/spasmodic torticollis
- Abobotulinumtoxin A (Dysport®) for upper and lower limb spasticity
- Incobotulinumtoxin A (Xeomin®) for cervical dystonia/spasmodic torticollis
- Incobotulinumtoxin A (Xeomin®) for upper limb spasticity
- Onabotulinumtoxin A (Botox®) for cervical dystonia/spasmodic torticollis
- Onabotulinumtoxin A (Botox®) for chronic migraine headache prevention
- Onabotulinumtoxin A (Botox®) for upper and lower limb spasticity
Patients enrolled in the Pain Management Group program are exposed to a Pain Medication 101 education session where the various pain management medications are discussed in detail.
The following medication education webinars are intended to help patients to better understand the role of drug therapy in chronic pain conditions that are commonly managed at our clinic:
- Chronic low back pain and tips for medication management (hosted live on June 11, 2020)
- Neuropathic pain medication management tips (hosted live on Aug. 27, 2020)
- A guide to preventing shingles-related pain (hosted live on June 17, 2021)
- Fibromyalgia Medication Considerations (hosted live on June 16, 2022)
Sometimes, we will also incorporate medications to treat mood, anxiety, and sleep troubles into your pain management regimen because of how intertwined these conditions are with chronic pain.
- Depression Medication Treatment Concepts (hosted live on Jan. 18, 2022)
- Depression Medications: An Overview of the Options (hosted live on Jan. 20, 2022)
The following patient education booklets from RxFiles provide an excellent overview of some commonly encountered drug therapy topics in the chronic pain population:
- Opioid Patient Booklet – a booklet for people who may benefit from reducing or stopping their opioid
- Buprenorphine-Naloxone Patient Booklet – a booklet for people taking opioids for chronic pain
- Cannabis Patient Booklet – a booklet for people thinking about starting medical cannabis
- Anxiety/Benzodiazepine Patient Booklet – a booklet for people who take a benzodiazepine regularly for anxiety
- Sleeping Pills Patient Booklet – a booklet for people who may benefit from reducing or stopping their sleeping pill
- Alcohol Patient Booklet – a booklet for people who are considering quitting or drinking less alcohol
- Antidepressant Medication Booklet – a booklet for people wondering how long they should take their antidepressant
- Medication Overuse Headache Booklet – a booklet for people who may be overusing painkillers to treat their migraines
Allied Health Treatments
Our allied health team includes nurses, occupational therapists, physiotherapists, psychologists, a social worker and a clinical pharmacist. Together, we offer a variety of patient education and treatment services. Attending Pain 101 is the first step for all new patients. You may request a referral to the following services during your Pain 101 session. All services are covered by OHIP.
Pain Self-Management Resources
- OCPN Chronic Pain Self-Management Adult Resource
- Living Healthy Champlain Archived Self-Management Webinars
- Online Self-Management Program Archived Webinars
- Pain 101 Self-Management Resource List
- Understanding and Managing Anxiety Info Sheet
- Living with worry and anxiety amidst global uncertainty by Dr. Matthew Whalley and Dr. Hardeep Kaur
- Tolerance for uncertainty: A COVID-19 workbook by Dr. Sachiko Nagasawa
- Preventing and Treating Depression Info Sheet
- Gardening When You Have Chronic Pain
- Dr. Andrea Furlan's YouTube Channel: Let's Talk About Pain
We recognize some of our patient have limited access to the internet and computers. Various public libraries across Southwestern Ontario have borrowing initiatives underway to assist people with WiFi, laptop and tablet services. This poster on accessing the internet with library resources summarizes some of these services and may be worth further consideration if you have limited internet/computer access and are looking for ways to address this barrier.
Many things affect your pain and the effectiveness of treatments. Sessions address common challenges such as financial stress & income support programs, drug benefits, family stress, explaining your pain, smoking, weight gain, insomnia and sexual dysfunction. We provide tips, self-help materials and links to community resources. Check the schedule to see what's coming up:
Living with financial stress, a lack of medication coverage, disability application processes, and/or trying to find supports in the community can all complicate pain management. Register for a workshop to explore solutions and options. Individual support is available as needed. Medication coverage webinar
Pain Management Group
Are you struggling to manage your pain? Would you like to improve your quality of life? This treatment group teaches coping strategies to reduce symptoms of pain, stress, frustration and depression. You will learn how to avoid triggers and increase participation in work, household and social activities without increasing your pain. We help you to accept the circumstances that cannot be changed and find ways to rebuild a meaningful life. Group meets weekly for 10 weeks. We will schedule an allied health assessment and work with you to develop your treatment plan. Due to high demand, there may be a waitlist. You will be scheduled at the earliest possible time.
Depression Treatment Group
Living with chronic pain can be emotionally draining and the risk of depression is high, which can worsen your pain and affect your coping efforts. This group teaches you new coping skills to boost your mood and help you to enjoy life again. Group meets weekly for 10 weeks. Due to high demand, there may be a waitlist. You will be scheduled at the earliest possible time.
If you have attended one of our Pain Management or Depression Treatment Groups, it is important to understand that “falling off the wagon” with new coping skills is normal. Group booster sessions help past participants cope with common challenges that worsen pain, such as low mood, perfectionism, communication difficulties etc. These two-hour sessions are open to patients who have completed one of our treatment groups.
View the 2023 Virtual booster session schedule.
Chronic pain is often referred to as a “family issue” because it affects all members of the family – not just the person who is in pain. In this group, we offer patients and families a place to learn and talk about chronic pain, and to understand the impact chronic pain has on relationships. Due to space restrictions, we ask that patients bring one family member only.
Occupational therapists (OTs) help patients manage pain, increase activity tolerance, and find new ways to perform self-care, homemaking, leisure or work activities. OTs provide education on activity pacing, posture, modifying activities, joint protection strategies, sleep management and assistive devices. OT can also provide splints, orthotics and hand therapy.
Did you know pharmacists work in a variety of healthcare settings (e.g., drugstores, in hospitals caring for admitted patients, outpatient hospital clinics, family health teams, etc.) and as a result may have different clinical areas of focus/specialization? We have a clinical pharmacist at our Pain Management Program who works with the rest of the pain clinic team members, your family practitioner, your community pharmacist, and all other healthcare providers involved in your care so that we can help you get the most out of your medications.
Some of the services by our Pain Management Program pharmacist include:
- Helping collect a medication history/figure out what medications have been tried in the past
- Sorting out medication allergies/intolerances
- Clarifying goals of medication therapy and monitoring points
- Making recommendations about starting, stopping or changing medications, for instance:
- designing opioid tapering regimens
- providing guidance when switching from one opioid to another
- helping find the best medication dose if your kidneys or liver aren’t working well
- helping find a medication regimen that makes you less drowsy and causes fewer falls
- designing a regimen that involves fewer pills and fewer administration times
- coming up with medication regimens that are more cost-friendly
- Making recommendations around how to manage medication side effects, minimize drug interactions, prevent opioid overdoses, properly store medications, and navigate drug coverage plans.
- Helping support you in taking your medications as prescribed; this may involve arranging for blister packaging by the community pharmacy
- Conducting pain medication assessments for women considering pregnancy or breastfeeding
- Providing one-to-one and group-based medication education for patients
- Answering drug information questions from patients and healthcare providers
Sometimes our pharmacist will meet with patients in person at the pain clinic or speak with them on the telephone. In other cases, however, our pharmacist may be involved in the ‘behind-the-scenes’ work to support the doctors, nurses, and allied health team members at our pain clinic and you may not actually meet with or speak to our pharmacist. If you have questions about how your medications work, how to take them properly, or how to reduce side effects feel free to ask for a consultation with our pharmacist.
Social Work / Psychology
Are you experiencing grief, depression, anxiety or stress related to chronic pain? Our psychologists provide assessments, group therapy and individual treatment (limited). Our social worker provides short-term counselling, and facilitates access to mental health services, addictions treatment, family counseling, and other services.
Physiotherapists (PTs) help you improve your strength, function, and mobility. PTs also assist with posture and body mechanics, balance, exercise tolerance and pain management. Individualized exercise programs will be prescribed, and we can find the right community exercise program for you.