Easing the Pain

How TAPMI is empowering patients to manage their chronic pain

One in five Canadians – or 8 million people – currently live with chronic pain. Chronic pain can affect a person’s life in many ways, often with physical, psychological and emotional impacts. That’s why the interdisciplinary team at the Toronto Academic Pain Management Institute (TAPMI) based at Women’s College Hospital have been collaborating with community stakeholders to create patient-centered chronic pain management resources and, most recently, a stepped model of care to help increase system capacity and provide a range of resources that meet patients where they are.

“The whole principle of the new stepped model is getting the right person to the right program at the right time, based on what their needs and preferences are at that time,” says Rachael Bosma, Research Lead, TAPMI. “It’s important to recognize, too, that we are all individuals with different stories and journeys, and we need different things. And sometimes, even if we may benefit from something clinically, we might not be ready or in a place in our journey to receive that care just yet. So, this approach is really about recognizing the need to meet people where they are and developing a personalized care plan for them.”

To achieve this goal, the TAPMI team mapped out their services from “low intensity” to “high intensity,” based on the clinical resources that patients feel they can use to meet their goals, allowing their healthcare providers to meet them where they are in their pain management journey. This enables the TAPMI interdisciplinary team to partner with the patient to empower them with self-management strategies and resources they can easily access themselves.

“Everything we do, we do collaboratively with patients based on what they feel they want and need at that time,” says Cara Stanley, Registered Practical Nurse, TAPMI. “Rather than patients coming in and having us tell them what to do to eliminate their pain, we really do focus on a self-management approach including lifestyle changes and resources that patients can commit to.”

Some examples of low intensity approaches would be self-management tools like the TAPMI website, which offers evidence-based educational resources for pain self-management; the new Power over Pain portal, offering a suite of resources for pain management including a self-assessment and tracker; Pain U online modules, and many other resources. These are tools the patients can access on their own without a referral from a clinician.

On the high intensity end of the scale, approaches would include therapeutic programs like Cognitive Behavioural Therapy or other interventions in a clinical setting.

Using this approach, the TAPMI team can empower patients to be active participants in every step of their care, helping to choose and identify the resources they need and are able to commit to. The stepped model also allows for more patients to access TAPMI resources, as the intake is spread out over the different intensities of services needed, allowing more patients to access different service streams. And on top of that, the team is hoping the approach will help referring providers better navigate this area of the health system as a central triage referral.

“TAPMI is the central hub of chronic pain management in Toronto, and so it’s a lot easier for referring providers to be able to refer patients directly to us and connect their patients with self-management resources while they wait,” says Dr. Tania Di Renna, Medical Director, TAPMI. “With streamlined and accessible resources – including a package of resources we will be offering healthcare providers – more patients will be able to access self-management tools tailored to their needs at every step of their chronic pain journey. This, in turn, can help alleviate pressures on the health system and decrease wait times for those who may need more intensive care.”

Going forward, the team is developing new standardized questionnaires and evaluation tools to gather metrics and feedback. Currently, patients who utilize any service from TAPMI are asked to participate in feedback surveys, but the goal is develop a system to measure the success of this new approach.

“We’ll be collecting feedback and different points in patients’ journeys, so we’re trying to be really intentional with the infrastructure of evaluation,” says Stanley. “So those tools are in development now and will hopefully be ready for use within the next year.”

TAPMI first opened five years ago and, at the time, the landscape for self-management of chronic pain was almost non-existent. In that short time, the team has developed numerous resources and self-management tools that are easily accessed by people across Ontario and Canada, helping to create broader access to chronic pain management where there once was a larger gap. Building on this progress, the team will continue to reassess patients’ needs and create avenues within the healthcare system for patients to access this care.

Power Over Pain

Living with chronic pain can have several serious impacts on a person’s life and waiting for care can add to that pain. That’s why the Toronto Academic Pain Management Institute (TAPMI) built the Power Over Pain Portal, an online platform designed with and for people living with chronic pain to provide rapid access self-management resources.

Read This StoryThe portal was developed out of a need for additional self-management resources for patients waiting to see a specialist. To address this gap in care, Bosma, along with the TAPMI team, began developing and curating online resources and interventions on the Power Over Pain Portal that people can access anytime and anywhere, without a referral to a pain clinic.

“There are a lot of great programs and materials out there, and this puts them in one place for people to access what they need, when they need it,” says Bosma. “The Power Over Pain Portal is one piece of the puzzle aimed at improving access to pain care in Canada.”

The portal, developed with seed funding from Health Canada, is a collaborative project with the bilingual portal for adults led by TAPMI, The Ottawa Hospital, and Memorial University and the youth portal led by Alberta Children’s Hospital and Toronto’s Hospital for Sick Children. Power Over Pain, which is free and available to youth and adults across Canada, brings together numerous evidence-based resources and acts as a hub for chronic pain self-management. The resources available in the portal are aimed at meeting people where they are, whether that’s wanting to learn about pain management through educational courses, engaging in peer-led programming and support or addressing substance use health and mental health.

When users create an account, they can complete a self-assessment to track their progress alongside the solutions or resources they are using to get a better understanding of what works best for them.

“The self-assessment and tracker in the portal are really helpful for providers to learn more about their patients and for patients and users of the portal to help understand their own pain and what factors influence their pain,” says Bosma. “This not only helps patients understand more about themselves and their experience with chronic pain, but also to communicate their experiences, symptoms and progress to healthcare providers or support teams.”