The Chronic Pain Day Program at The Pain Centre, St. Paul’s Hospital, incorporates a multidimensional approach to the treatment of persons suffering from chronic pain by combining physical therapy, occupational therapy, counseling, and education in a group setting. Because pain is a physical, emotional, and psycho-social experience, impacting all aspects of life, it is essential to treat the “whole person”. A broad range of chronic pain conditions are seen at the program, including fibromyalgia, migraine headaches, complex regional pain syndrome, neuropathic pain, and chronic back pain.

The primary goal of the Chronic Pain Day Program is to assist patients to learn about their pain and to help them develop personal strategies for improved pain management. The goal of the Program is not to take away the pain. While attending the program, patients are introduced to a number of pain management strategies. These include a comprehensive, exercise program, relaxation, deep breathing, stress management, goal setting, pacing, and energy conservation techniques.

The Day Program staff is an interdisciplinary team comprised of a psychiatrist, psychologist, social worker, physiotherapist, occupational therapist, and registered nurse. However, the most important member of the team is the patient.

The Day Program is nonresidential. The Program is conducted in a group setting, with limited individual sessions available with the staff. Group size ranges from six to eight participants. Clients must be willing and able to participate in a group setting, as peer learning and mutual support are key components of improved pain management.

It is essential that patients are able to participate in the Day Program at a time when they are motivated to develop goals and can commit to achieving them. In order to maximize the benefits of the program, patients must be ready to dedicate the time and energy required to meet their goals.

The Day Program currently has two formats, which are offered over the course of the year. The frequency and order of these groups is determined by the patient’s energy levels and the needs of those waiting to attend the program.

Click on the to read more about format.

1. Half Day Program: 2 half days a week for 7 weeks

2. Modified Day Program: 3-5 hours per day, 3 days a week for 5 weeks

Admission Procedure and Criteria

A referral is made to the Day Program by one of our Pain Centre physicians. Upon receipt of the referral, one of the team members will contact the patient by telephone to discuss the referral. The patient will then be contacted by the program secretary to schedule an assessment in order to determine suitability for the Day Program.

Acceptance to the Day Program is determined by the team (psychiatrist, social worker, nurse, and physiotherapist) after the patient has attended the program assessment.

The primary areas assessed and considered for acceptance include:

• Stamina - the ability to participate and attend the program a minimum of 3 hours for the Half Day Program and 8 hours for the Full Day Program
• Medications - the patients’ current medication regime should provide adequate pain control without impairing cognition or physical ability
• Group readiness - this is a willingness to participate in psycho-educational groups, physiotherapy, and occupational therapy. Group readiness also includes emotional and psychological stability
• Active treatment - all relevant diagnostic investigations and medical treatments are complete and the patient has a final diagnosis
• Language - fluency in written and spoken English is required to participate in the group work

Every patient is assessed and evaluated on an individual and case-by-case basis. This ensures that this is the right program for the patient as well as optimum compatibility within the group setting.

What to Bring

Here’s what to bring to the Day Program Assessment:

• A list of current medications
• Running shoes and shorts for the physiotherapy component of the assessment
• Eye glasses, hearing aides, mobility aides (if used)
• Medication routinely taken during the day

What to bring to the Day Program:

• A list of all current medications
• Medications normally taken during the day
• Notepaper and pen
• Three ring binder
• Running shoes for physiotherapy
• Eye glasses, hearing aids, mobility aids (if used)
• Any cushions, support devices, mobility aides, normally used during the day
• A calendar or day timer to record appointments

Transportation and accommodation

The Day Program does not provide or arrange transportation or accommodation. A list of possible accommodations and parking areas are available upon request. The cost of transportation, accommodation, and parking is at the patients’ expense. Due to the limited parking, it is suggested that patients use public transit, if at all possible.

Day Program Team members

Nursing and Social Work

The nurse and social worker work as a team to facilitate the psycho-educational groups offered in the various day programs.

Topics covered in the content of the program include: relaxation strategies, relaxation training, meditation, sleep hygiene, nutrition, dealing with family and friends, developing a maintenance plan, and sexuality. Topics can be adjusted depending on the specific needs of any group.

Both of these professionals have experience in facilitating groups and in working with patients in individual sessions. Individual session times are available to discuss your unique concerns.

The social worker is also available to assist in family discussions around pain-related issues.

The nurse is available to provide education regarding medication issues in both group and on an individual basis. However, it is important to remember that the focus is on developing non-pharmacological approaches to pain management.

Psychiatry

The psychiatrist is available for consultations regarding pain management. Depending on the program the patient attends, the psychiatrist may meet with the patient individually to teach self hypnosis. This is an effective tool in the management of pain. The psychiatrist also leads group sessions on the Gate Control Theory of Pain and Stress management in some of the programs.

Physiotherapy

Physical activity is an integral part of the program. All patients participate in a comprehensive program with the physiotherapist. The education component includes posture, exercise goal setting, fitness habits, flare-up management, and maintaining motivation. On completion of the program, a comprehensive exercise program, along with a walking program, will have been developed for patients to continue at home or in the community.

Occupational Therapy (O.T.)

The occupational therapist works with the patients to achieve functional goals and to resume the roles and daily activities that may have been disrupted due to chronic pain. The O.T. facilitates groups on the practical approaches to pain management including management of time, pacing, energy conservation, seating and joint protection, and vocational planning. A back care group is also conducted in conjunction with the physiotherapist. As well, the occupational therapist will work with an individual to address specific challenges in the areas of self care, work, and leisure.

Psychologist

When a chronic pain condition develops, it has an impact on many areas of a persons life. Individuals often need to learn how to communicate to others about their pain and their changed capabilities. For example, a person who has always been independent may need to learn how to ask for help or to be able to say no to some requests.

The program’s psychologist conducts a series of group sessions addressing topics such as communication, assertiveness, and anger management. The exact content will depend on the needs of the individual groups.

The psychologist is also responsible for Program evaluation and the research questionnaires.