Anesthesiology and Pain Medicine

Our mandate is to provide optimal acute pain relief and comfort for children, guided by the following principles:

1. Safe and Effective Pain Relief: Through consultative support, we aim to provide expert advice and best-practice pain relief to infants, children and youth with complex acute pain, while minimizing side effects from treatment.
2. Multi-modal approach: We promote various techniques to manage pain from a 3P approach (pharmacotherapy/ modalities, psychoeducation/ relaxation strategies, physical strategies).
3. Patient Advocacy for Pain Control:We increase patient and family empowerment by encouraging active participation in care decisions and reinforce their right to ask for timely pain intervention and facilitate ongoing dialogue with care providers.
4. Optimizing Acute Pain Care Access: We strive to rapidly intervene to provide timely pain assessment and intervention for both inpatients and outpatients in need of specialized acute pain interventions.
5. Chronic Pain Prevention: We optimize acute pain management since reduce the risk of chronic pain development.
6. Leading Acute Pain Education: We develop and deliver evidence-based pain education to CHEO nurses, allied health professionals, and physicians through bedside coaching, didactic rounds, and in-services. We also equip patients and families with resources and real-time coaching to foster safe and confident pain self-management.

CHEO has also been instrumental in the development of pain assessment tools in children, which are widely used around the world.

Children and their families are introduced to the post-surgery pain management options in the Pre-Anesthesia Clinic. The Acute Pain Service (APS) operates 24 hours a day, 7 days a week at CHEO and cares for children after painful surgical procedures as well as for patients with complex acute pain problems that are not associated with surgery. It is staffed by dedicated pain physicians, anesthesia residents and nurse practitioners.

The Acute Pain Service uses a wide range of pain management techniques. We use several medications together, such as Tylenol and Advil to prevent and treat pain. Other oral medications are added when needed. Intravenous morphine or morphine-like analgesics are delivered by continuous infusions, intermittent boluses or Patient Controlled Analgesia (PCA) methods. Regional anesthesia techniques such as epidurals and nerve blocks are also monitored, cared for and followed by the APS. Standard protocols of these pain practices are in place to ensure optimal pain control, safety and continuous quality improvement. 

How to use Patient Controlled Analgesia (PCA) to control pain

PCA is one method used to control pain after surgery or a painful medical condition. This method allows the patient to have some control of their pain management. Your health care provider will arrange for this modality if they feel it would be beneficial to your care.

Pamphlets

• Patient Controlled Analgesia (PCA)
• Epidural
• Sucrose

Pamphlets

• Continuous nerve block at home

Video

Our team values the integration of both pharmacological and non-pharmacological approaches.

Psychological

We know that pain is real for all patients and that pain is often invisible. When pain lasts for a long time, it can be difficult to continue going to school, complete homework, spend time with friends and family, and participate in enjoyable activities.

Thoughts and feelings are very powerful when it comes to managing pain. It is a normal reaction to feel worried, frustrated, angry, or upset when experiencing pain, and when pain keeps you from participating in regular activities. It is often helpful to work with a psychologist and other mental health providers  to learn new skills and strategies on how to cope with managing chronic pain, and any associated feelings and reactions.

Using evidence-based Cognitive Behavioural Therapy (CBT), Acceptance and Commitment Therapy (ACT), and various relaxation and mindfulness techniques, our psychologists help children and youth:

• Learn about stress management
• Modify negative thoughts
• Process emotions
• Increase problem solving and goal setting skills
• Restore function to their lives
• Find acceptance and take action

For more information

• Frequently used therapies and mindfulness
• Information on anxiety

Family and School Support

We know that chronic pain affects the whole family. We also know that parental engagement has an effect on the outcome of each patient’s pain management journey. The more engaged parents are with our program, the more their children and youth know their parents are on their team and supportive of trying out new skills and strategies in managing their pain.

Our social worker provides family support and education, as well as school support and liaison services. Parents are encouraged to connect with the social worker should they have any questions regarding parenting a child with chronic pain or for any need for additional support or resources.

If you are having difficulty at school due to pain or the need for extra school support is identified by our interdisciplinary team, our social worker will work with you and your school to help with your identified needs.

Physical

Movement and the right amount and type of exercise are key to managing chronic pain. A physiotherapist is a great resource for managing your pain and increasing your level of physical activity. Having an assessment done by a physiotherapist is an important step. Your physiotherapist can help guide you as you adjust your activity levels.

Things to remember:

• Start slow and little by little increase your activity level. You may need to adjust current activities to meet your needs.
• How you physically feel, also affects how you feel emotionally; if you have not been physically active and your body is deconditioned, your pain will increase which will affect many aspects of your life
• Regular physical activity as outlined by your physiotherapist will not worsen your pain, but will actually increase your level of physical functioning which in return can decrease the amount of pain you feel

Occupational Balance and Pacing

Chronic pain often means our function has decreased and our every day activities or “occupations” are unbalanced. Our occupational therapist is here to help you regain better occupational balance through a variety of hands-on methods.

While it is tempting to go all out or over-exert yourself when your pain is low and you’re feeling good, sometimes this will make you feel even worse for days or weeks afterward. This can cause further loss in function. Learning how to pace yourself is an important aspect of pain management. Pacing means slowly increasing your time and level of activity in a planned and controlled way.

Pharmacological (Medications)

• There is no single medication that works for everyone, and sometimes medications do not take the pain away entirely. The chronic pain team will work with you to try to find medications that reduce your pain so that you can participate more fully in your daily activities and physical functioning.
• It can take up to 4-6 weeks to know whether a particular medication will work for you, and often more than one medication will need to be tried. During this process it is important to take your medications regularly.
• It is important to let each member of your extended health care team know about the medications you are taking, and to tell them if you start something new or stop taking a medication. When medications are prescribed by different providers or care teams, it is important that you use only one pharmacy to ensure the combination of medications remains safe for you. It is a good idea to bring all of your medications to your medical appointments to make sure your medication records are kept up to date.
• Remember to ask questions if you are unsure about something, and to report any side effects that concern you. Some side effects may decrease over time, but if side effects are interfering with your daily functioning or becoming too bothersome, the medication may need to be changed. Do not stop taking your medications or change the dosing regimen without first consulting with the chronic pain team.
• Remember that when you go to your follow up appointments, the team will want to know how well your medications are working for you and if you have any concerns about taking them. Medications that are not helpful for your pain or are causing side effects will be reassessed by the team to determine if they should be continued.

What to Expect

Every patient’s journey through our program begins in the same place: a referral to our program. Here is what to expect as your start the process.

Intake session

Patients and their parents attend this two hour session to learn more about the Chronic Pain Service with other families awaiting services, and complete our intake package while confirming previously acquired details.

You will be able to accept or decline intake to the Chronic Pain Service following this session

Initial appointment

Patients and their parents meet with our interdisciplinary team for a full assessment. The team will create a custom plan of care and present it to you at the end of the appointment with suggestions for what pathways will best suit your needs.

Please bring all medications to your initial appointment

Individual and group services

Patients who are already engaged in community services may require consultative services by our health care professionals with their community providers. Some patients may require individual and group services provided by CHEO which will be better outlined during the initial assessment.

Please remember to give 48 hours notice for all appointment cancellations

Follow-up

Patients and families are expected to attend follow-up clinics quarterly to check-in with the interdisciplinary team as to their progress and next steps.

Please bring all medications to your follow-up appointment

Discharge

As patients engage and progress through our program, learn how to apply pain management techniques, increase their function and decrease their pain, the team will discuss how to transfer your care to the community

Resources