About Chronic Pain?
Chronic Pain is defined as any pain lasting longer than three months, which is the duration required for tissue healing after any injury. Long after the tissue heals, the perception of pain becomes a disease in itself.
A patient’s pain experience is not straightforward, but can be influenced by a number of psychosocial, environmental and physical factors. Evidence tells us that there is no single approach for managing all these factors. Patients are often frustrated by this, as there is no single cure for chronic pain.
This is why an interdisciplinary approach is currently the best practice management for chronic pain.
The TAPMI interdisciplinary approach to chronic pain management can address all the influencing factors in a patient’s perception of their pain.
A TAPMI care plan — that is evidence based and tailored to the patients' individual needs is selected, and includes participation from a variety of specialists as the most effective way to reduce chronic pain and improve function.
The care plan can include:
- Patient Education
- Psychological interventions
- Physical Therapy
- Medical Therapies
- Medication Review by Pharmacist
- Interventional Therapies
- Social Work
- Advice or treatment for patients with substance use disorder
TAPMI offers state of the art interventional therapies such as ultrasound or fluoroscopic guided nerve blocks and radiofrequency ablation.
Who is TAPMI?
Toronto Academic Pain Medicine Institute (TAPMI) is a comprehensive virtual network of pain management services in downtown Toronto. It is a partnership whereby all academic pain management hospitals — Centre for Addiction and Mental Health, Sinai Health System, St. Michael’s Hospital, University Health Network and Women’s College Hospital — work together to provide seamless care for Ontario’s chronic pain patients via a centralized referral network.
TAPMI is uniquely positioned to offer patients a wide variety of interdisciplinary provider options including (but not limited to) physiotherapy, medical treatments, cognitive behavioural therapy, chiropractic services, occupational therapy that are fully funded by OHIP.
To ensure patients get to the right place the first time we are developing a simplified intake and triage process. Referrals are triaged by nursing staff at TAPMI central intake and your patients can expect to receive treatment at any of the five TAPMI hospitals depending on their plan of care. The TAPMI healthcare practitioners communicate about each case to ensure patients are receiving the best care possible and the healthcare practitioner is aware of the care plan.
TAPMI is the only comprehensive interdisciplinary, fully funded academic pain program serving as the hub for chronic pain care in Toronto.
- Provide access to an interdisciplinary team of health care professionals who are experts in treating chronic pain.
- Changing the model of care to ensure that patients see chronic pain experts as quickly as possible.
- Provide the patient with information to assist them in developing care goals and understand their role in managing their pain.
- Provide support to healthcare practitioners on chronic pain management.
- Provide education to a full spectrum of clinical students.
- Develop an integrated research agenda including long-term outcomes studies to evaluate the impact of services provided.
- Conduct research across the 5 partner hospitals to improve patient care.
- Collaborate with other pain centers in Ontario to maximize resources and ensure no duplication of efforts.
The TAPMI Partners
The treatment and management of pain is complex and requires a wide range of programs and services to help those in pain function. The hub is created through sharing a interdisciplinary team (including nursing, pharmacy, physical therapy, psychology, and social work) with all TAPMI programs listed below.
The Hub is also managing the central referral process to ensure patients get to the right healthcare practitioner the first time.
Centre for Addiction and Mental Health CAMH’s Interprofessional Pain and Addiction Recovery Clinic (IPARC) contributes its expertise in managing a wide-range of chronic pain conditions in individuals who may have a substance use disorder, aberrant drug related behaviours and /or mental health issues. The program focuses on promoting function and empowering self-management in patients.
Wasser Pain Management Centre, Mount Sinai Hospital The Wasser Pain Management Centre offers specialty programs including the management of widespread pain and neuropathic pain. The Wasser also offers unique programming for craniofacial pain and chronic headaches as well as pelvic, genital, and abdominal pain programs for both men and women.
St. Michael’s Hospital St. Michael’s Hospital offers services from its interventional pain program through the department of Anesthesia.
University Health Network The Chronic Integrated Pain Program (CIPP) at UHN offers expertise across Anesthesia and Physiatry to support patients with widespread pain, neuropathic pain as well as unique programming for seniors with cognitive impairment or affective disorders where diagnosis becomes less clear and management more individualized.
Women’s College Hospital Women’s College Hospital has expertise in interventional pain management. In addition, the TAPMI hub is located at WCH and will be responsible for coordinating central intake and triage as well as providing inter-disciplinary health services including nursing, pharmacy, physiotherapy, psychology and social work for TAPMI patients.
- Inflammatory Bowel Disease
- Irritable Bowel Syndrome
- Inflammatory Bowel Disease
- Cervicogenic Headache
- Cluster Headache
- Occipital Neuralgia
- Migraine Tension Type Headache
- Temporomandibular Joint Disorder
- Deep Gluteal Pain (ie Piriformis Syndrome)
- Degenerative Disc Disease
- Facet Arthropathy
- Sacro-iliac Joint Pain
- Spinal Stenosis
- Whiplash-associated Disorder
- Complex Regional Pain Syndrome
- Multiple Sclerosis
- Painful Diabetic Neuropathy
- Phantom limb pain
- Post-traumatic or compression-related
- Rheumatoid Arthritis
- Shingles and Postherpetic Neuralgia
- Traumatic Nerve Injury
- Trigeminal Neuralgia and Atypical Facial Pain
- Chronic Pelvic Pain in Men
- Interstitial Cystitis
- Vulvodynia or Pudenda Neuralgia
Widespread Pain Disorders
- Fibromyalgia or Widespread Pain
- Myofascial pain syndrome
- Cancer Pain (cancer survivor)
- Cancer Pain (palliative)
- Cardiac Pain Conditions
- Rheumatological Condition i.e. Systemic Lupus Erythematous
- Traumatic Brain Injury
Referring your patients
In the TAPMI model, healthcare practitioners play an active role in the treatment of their patients. The TAPMI team will provide assessment and a care plan for your patients' chronic pain problem. In some cases, treatment may be initiated by TAPMI, however, once stabilized (6– 24 months) the patient will be returned to you for ongoing care, including pharmacotherapy, with our continued support.
TAPMI physicians and nurse practitioners will not take over prescribing opioids.
Consider a referral to TAPMI when:
Patient has persistent pain beyond 3 months that is not responding to current treatment, and is showing evidence of:
- Declining physical functioning
- Increasing psychological stress
- Absence from work or multiple emergency facility utilizations for pain management
- You would like guidance on patient opioid use, withdrawal or weaning.
Consider early (less than 6 months from start of symptoms) referrals for patients with:
- Suspected Complex Regional Pain Syndrome
- Acute intervertebral disc herniation with radiculopathy
- Post herpetic neuralgia
- Aberrant opioid use
- Palliative (expected length of survival less than 3 months) patients with poorly controlled pain.
How to make a referral to TAPMI:
Print off referral form and fax to TAPMI Central Intake at 416-323-2666.
If you have questions about your patient’s referral please call:
- Your patient’s referral will be assessed by nursing at TAPMI Central Intake and sent to the appropriate site with the next available appointment.
- Your patient will be contacted directly with an appointment by the site and then you will be notified via fax once an appointment has been booked.
Following up on your referral
If you have questions about your patient’s referral please contact TAPMI Central Intake at 416-323-6269.
Your patient will be contacted directly by the site their first appointment is booked at. We will also notify you via fax.