Development and expansion of a pediatric transitional pain service to prevent complex chronic pain

Lisa Isaac; Brittany N Rosenbloom; Jennifer Tyrrell; Danielle A Ruskin; Kathryn A Birnie

doi:10.3389/fpain.2023.1173675

Development and expansion of a pediatric transitional pain service to prevent complex chronic pain

Front Pain Res (Lausanne). 2023 Nov 2:4:1173675. doi: 10.3389/fpain.2023.1173675. eCollection 2023.

Authors

Lisa Isaac^{1

2}, Brittany N Rosenbloom³, Jennifer Tyrrell^{1

4}, Danielle A Ruskin⁵, Kathryn A Birnie^{6

7}

Affiliations

¹ Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, ON, Canada.
² Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
³ Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada.
⁴ Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.
⁵ Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada.
⁶ Department of Anesthesiology, Perioperative and Pain Medicine, University of Calgary, Calgary, AB, Canada.
⁷ Alberta Children's Hospital Research Institute, Calgary, AB, Canada.

Abstract

The prevention of chronic pain is a key priority in North America and around the world. A novel pediatric Transitional Pain Service (pTPS) at the Hospital for Sick Children was established to address four main areas of need, which the authors will describe in more detail: (1) provide comprehensive multi-modal pain management and prevention techniques to children at-risk for the development of chronic pain, (2) provide opioid stewardship for children at-risk for chronic pain and their families at home after discharge, (3) facilitate continuity of pain care for children across transitions between inpatient and outpatient care settings, and (4) support caregivers to manage their child's pain at home. The pTPS works with healthcare providers, patients, and their families to address these areas of need and improve quality of life. Furthermore the service fills the gap between inpatient acute pain services and outpatient chronic pain services (accessible only once pain has persisted for >3 months). In pediatric patients who experience pain in hospital and who have been prescribed opioids, discharge to home or rehabilitation may represent a vulnerable time in which pain may persist and during which analgesic requirements may change. This offers an important opportunity to address and prevent the development of chronic pain, and to monitor opioids while ensuring alternative pain therapy is available. The authors will outline risk factors for persistent postsurgical pain, the development and implementation of a pTPS, present initial clinical outcomes andsuggest areas for future research in this evolving area of care.

Keywords: chronic pain prevention; chronic postsurgical pain; opioid stewardship; pediatrics; persistent pain; transitional pain service.

Grants and funding

The Pediatric Transitional Pain Service would like to acknowledge the support of the Department of Anesthesia and Pain Medicine for its financial and service support, and Perioperative Services at The Hospital for Sick Children for operational support. BNR was funded by CiHR Banting Postdoctoral Fellowship, Pain in Child Health Louise and Alan Edwards Postdoctoral Award, and Restracomp.