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The Transitional Pain Service (TPS), a program pioneered at Toronto General Hospital, UHN, is taking an important step towards advancing continuity of care for patients dealing with complex pain and opioid use disorder.
The program is welcoming the first nurse practitioner (NP) to the team. Her role will be dedicated to supporting patients struggling with complex pain and addiction problems.
A nurse practitioner specialized in mental health and addictions, Kari Van Camp will focus on patients struggling with opioid use disorder within the institutional setting.
The goal of her novel role is to provide the hospital, patients and their families with the support needed to manage complex pain patients and those struggling with opioid addictions admitted via the emergency department and on the hospital wards.
"There is a public health crisis in the country and people are understandably concerned about using opioid medications," says Kari.
"Our first step is to educate patients that there is a time and place where, yes, you need these drugs and that there is a way to use them safely, weaning them off gradually."
To date the Transitional Pain Service has been an innovative service for perioperative care. However, increased demands related to patient care due to the opioid crisis have escalated significantly within the hospital.
Kari will help to guide and implement an institutional platform with respect to opioid stewardship and best practices for patients struggling with their pain and/or opioid misuse. Kari's role will be the first of its kind in the hospital setting.
The Transitional Pain Service currently implements opioid replacement therapies, physiotherapy, psychological support, mindful meditation, hypnosis, and acupuncture to perioperative patients.
With the new NP role, Kari aims to expand care for patients with opioid misuse disorder into the Emergency Department and onto the Internal Medicine wards at Toronto General (TG) and Princess Margaret Cancer Centre.
The Transitional Pain Service was launched in 2014. With Kari joining the program, the TPS can expand its patient care efforts beyond the perioperative clinical setting.
This will enable a more coordinated approach in their patient care as complex patients with pain and addiction issues flow through the institution. She will be able to follow-up with patients, understand their history and provide the best pain management and harm reduction strategies for patients struggling with pain and opioid misuse.
"As a Nurse Practitioner in the Transitional Pain Service, I'll become a consistent person on the wards and within the clinic who gets to know the patients in detail, so we can provide the care they need."
The need for specialized transitional care for UHN
While excessive use of opioids is often stigmatized as "addiction," Kari points out that many people who become dependant didn't have a drug-seeking behaviour. They were prescribed the medication in the first place because they were feeling pain, she says.
"Too many patients that start with acute pain tend not to get long-term support. They go home with a prescription of opioid medication and fall into a bad pattern, of relying on inappropriate mechanisms to cope with pain due to a lack of good information and appropriate education," Kari explains.
Surgical patients are a particularly vulnerable group. Studies show that as many as 30 per cent can develop chronic pain after surgery and are at increased risk for long-term opioid use.
"We created the Transitional Pain Service precisely to bridge that gap and to find a solution to break the pain cycle," says Dr. Hance Clarke, Medical Director of the Pain Research Unit at TG.
"Having Kari on the team will be a very important step for us to advance the program and provide a complete support service to patients struggling with opioid misuse beyond the perioperative setting.
"We have been struggling to meet the needs of the medicine wards and complex patients with pain and addiction as they flow through all areas of the hospital. This is a unique role UHN should be proud of as we lead institutional change not only at UHN, but worldwide."
Drawing from personal experience
Kari has a Master's of Science in community health nursing and Master's degree as both a Pediatric and Family Nurse Practitioner, along with certifications in mental health and addictions nursing, and over 20 years of professional experience.
But she also speaks from her personal experience in dealing with chronic pain and opioid use.
In September 2005, she suffered a lower back injury which resulted in a herniated disk. She was prescribed Oxycontin and was on that medication for eight months – after three months, pain is considered to be chronic.
Kari started to feel her body was becoming dependant and the medication was clouding her judgement. Without any specialized transitional pain service to be referred to at the time, she took matters into her own hands.
She developed a calendar to wean off the medication and looked for alternative treatments for her pain. In her case, the solution turned out to be acupuncture.
"There is no one solution that fits all, but I was able to find a mechanism that worked for me," Kari says. "This experience made me more conscious of treating people in pain, more understanding of my patients and of how subjective pain can be."
The Transitional Pain Service
Launched in June, 2014, the Transitional Pain Service is a world-first multidisciplinary pain program at TG, helping with pain control, monitoring and weaning patients off excessive amounts of opioid medications for pain.
In 2017, the group published
a study about some of the positive results achieved by the program.