Dr. Judith Nicholls
Dr. Judith Nicholls, Anesthesia Fellow at the Transitional Pain Clinic, Toronto General Hospital, says her experience at UHN has given her the vision and skills to fill a gap in the pain services available in the Caribbean. (Photo: UHN)

As Dr. Judith Nicholls' year-long fellowship at Toronto General Hospital's (TGH) Transitional Pain Program nears an end, she jokes that she better hurry in booking her flight back home to Barbados.

But she certainly won't just be relaxing on the beaches when she returns.

Instead, Dr. Nicholls will be taking everything she learned at UHN to spearhead the opening of the Caribbean's first multi-disciplinary pain clinic in Bridgetown, Barbados. She says the clinic will include a variety of services, including ones for chronic pain, opioid addiction, psychosocial therapy and physiotherapy.

"There's a dire need for pain services in the Caribbean, and not many people are willing to invest their time and energy in it," Dr. Nicholls says. "My vision is that it will eventually be a referral centre for the rest of the Caribbean."

While the Caribbean does not have as extreme of an opioid crisis as Canada does, there's still a significant population with sickle cell disease and chronic pain where more treatment options are necessary, according to Nicholls.

TGH pain clinic leading by example as 'global first'

Near the end of her residency at the University of the West Indies in 2013, Dr. Nicholls says she had her eyes set to do her anesthesia fellowship at TGH's Transitional Pain Program after learning about Dr. Hance Clarke's work during a visit to Toronto two years ago.

What started as a one-year pilot program in 2014 now boasts an established team of physicians, psychologists, acupuncturists, and other specialists who help post-surgical patients wean off of addictive opioids while still managing their chronic pain.

"I was really impressed with the fact that the program is a global first in the field, and I found it exciting to be able to make very meaningful changes in the way that we practice main management," Dr. Nicholls says.​

Led by Dr. Clarke, Medical Director of the Pain Research Unit and Director of The Transitional Pain Service in the Anesthesia Department and Pain Management at TGH, the program emphasizes the practice of psychological therapy when treating complex pain patients.

Therapy sessions that include acceptance commitment therapy (ACT), mindfulness and deep relaxation exercises are led by the team's clinical psychologist, Dr. Aliza Weinrib.

Learning to accept their pain and mentally cope

Dr. Nicholls says patients who are engaged in psychosocial therapies and interventions tend to have better outcomes in weaning their opioids than patients who aren't – these patients learn ways to accept their pain and mentally cope with it day to day.

 "We've built an entire program revolving around psychological intervention and it's fantastic to see the potential of the work we're doing here reaching a greater international scale," says Dr. Clarke.

He says out of about 450 patients the pain program has treated since it opened, one in five patients are completely off of the opioids they were once dependent on after surgery.

"When I came to UHN and saw the different possibilities, it truly opened my eyes to opportunities where my new expertise could create an impactful change in the approach to pain management back home," Nicholls says.

She says he hopes to have the basic structure of her clinic completed by 2018, but it won't end there – Nicholls also has plans to start an Annual Pain Day in Barbados in partnership with UHN, as well as developing a comprehensive pain curriculum for the University of the West Indies.

"It will be demanding, but I have very grand ambitions and I'm excited to see what I can achieve," she says. ​

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