Patients are treated at the MUHC - Alan Edwards Pain Management Unit (AEPMU) 5 days a week from 8:00 a.m. to 5:00 p.m. Our treatment is interdisciplinary, combining the efforts of AEPMU team members representing the disciplines of anaesthesia, dentistry, family medicine, geriatrics, nursing, physiatry, physiotherapy, psychology, rheumatology and chiropractic, with psychiatrists, neurologists, orthopaedists and a neurosurgeon available for consultation. Both chronic and acute (postoperative) pain are managed by members of the AEPMU team.
New referrals are triaged by a team of three staff members: the medical director, a nurse and a psychologist. Please see Referral information for more information.
Assessment and treatments
The patient's first visit is usually with a physician but a group session to review a video about the AEPMU and respond to patient questions about the unit takes place one to two weeks before this visit. Because chronic pain often results in psychosocial problems that exacerbate suffering, many patients are seen for evaluation by an AEPMU psychologist. The overall treatment plan is tailor-made for each patient. During the course of treatment, the plan may be adjusted, depending on the patient's response to treatments. The duration of treatment at the AEPMU depends on the nature of the pain problem, type of treatment and response to treatment. In general, patients do not remain with us indefinitely. The objective is to provide a reasonable trial of appropriate treatments for the patient's problem, and then send him or her back to the family physician for continued care. The patient’s family/referring physician is always welcome to contact us after his/her patient has been discharged from our care.
Types of treatments
Treatments available at the AEPMU include pharmacological (including withdrawal of ineffective or problematic medications), interventional procedures, physiotherapy, relaxation training and hypnosis, short-term psychotherapy, life-style counseling, rehabilitation and a multidisciplinary Pain Management Group. There is strong emphasis on the combined efforts of the treatment team together with active collaboration from patients.
Interventional procedures are performed at the clinic or in an operating theatre, depending on the type of procedure. IV lidocaine infusions are an example of interventional treatments done at the clinic for patients suffering from neuropathic or mixed somatic/neuropathic pain. More sophisticated procedures like selective nerve root blocks, radiofrequency nerve ablations, etc., are done in the operating suite. There are specialty clinics for patients with wide-spread body pain (fibromyalgia), visceral pain, patients who might be candidates for rehabilitation programs and for geriatric patients. Patients may be referred out for treatments such as acupuncture, aquatherapy, or longer-term psychotherapy, not available at the AEPMU.
Geriatric Pain Clinic
The prevalence of chronic pain increases as we age. In addition, older patients often suffer from several diseases and take multiple medications. Consequently, the management of their pain is often challenging and benefits from the experience of a team with expertise in both geriatrics and pain medicine. The MUHC Geriatric Pain Clinic, established in 2004, is innovative and unique, being one of the few geriatric pain clinics in the world. In addition to providing care for patients, it also serves as a training environment for students of all disciplines. The clinic specializes in the treatment of pain in older persons, and is composed of a multidisciplinary team including a geriatrician with expertise in pain management (Dr. David Lussier), a nurse coordinator (Guylaine Bachand), a physical therapist (Denise Haché) and a psychologist (Dr. Marie-Josée Rivard). It offers consultative services for the assessment and management of pain. Patients can be referred by their family physician or by other specialists, via the MUHC AEPMU. After interdisciplinary evaluation, a treatment plan is discussed with the patient, including pharmacological approaches (pain medications), individualized home exercises, and referral to the appropriate community services (e.g. CLSC, geriatric day hospital, anesthesiologist for invasive pain-relieving interventions).
Consults for acute pain
Our obligation to patients in active treatment with us also extends to their visits to the Emergency Room or inpatient admissions. Our patients should advise the clinicians in the Emergency Room or on the inpatient ward that they are known to the AEPMU. Nursing and anaesthesia staff affiliated with our unit will then be brought in to assist with pain management issues.