Pain Management Program - Services

Medical Treatments

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.

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.

Fluoroscopy/X-Ray guided injection
  •  Facet joint steroid injection 
  •  Epidural steroid injection 
  •  Sacroiliac joint steroid injection 
  •  Radiofrequency ablation/nerve burn
Ultrasound guided injections
  • Stellate ganglion nerve injection 
  • Bursa injection 
  • Trigger point injections
  • Sacroiliac joint steroid injection 
  • Nerve block
Pharmacotherapy

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:

  1. Non-steroidal anti-inflammatory drugs (NSAIDs) [e.g. ibuprofen, naproxen, meloxicam, celecoxib]
  2. Gabapentinoids [e.g., gabapentin, pregabalin]
  3. Tricyclic antidepressants (TCAs) [e.g., amitriptyline, nortriptyline]
  4. Serotonin-norepinephrine reuptake inhibitors (SNRIs) [duloxetine, venlafaxine]
  5. Opioids [morphine, oxycodone, hydromorphone, fentanyl patch, methadone]
  6. ‘Opioid-like’ medications [e.g., tramadol, tapentadol]
  7. Cannabinoids [e.g., nabilone, medical cannabis products]
  8. Topiramate
  9. Botulinum toxin

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.
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.  
 

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 Management 101 is the first step for all new patients.  You may request a referral to the following services during your Pain Management 101 session.   All services are covered by OHIP.

Pain Clinic Allied Health Fact Sheet

Patient Attendance Policy for Physiotherapy, Occupational Therapy, Psychology and Social Work 

Pain Self-Management Resources
Workshops

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:

2021 Pain Management and Rheumatology Program Allied Health Workshop Schedule

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Social Work

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. 

Booster Sessions

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 2021 Virtual booster session schedule

Family Group

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 Therapy

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. 

Pharmacist Consult

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.

Physiotherapy

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.