Background & Aims

The Transitional Pain Service (TPS) at Toronto General Hospital is a multidisciplinary treatment team that works to prevent chronic postsurgical pain (CPSP) and the development of persistent opioid use after surgery. This service, focused on pain-specialty medical care and pain psychology, is effective in managing pain and reducing opioid dependence. There is both a desire and a need for this treatment approach to spread to other institutions and regions. However, the scarcity of specialized pain psychologists is a major barrier to program delivery. Acceptance and Commitment Therapy (ACT) is an evidence-based psychology intervention used at the TPS that is effective in reducing patients’ risk of CPSP and opioid use. To increase access to this intervention, the aim of the current project is to develop a fully self-guided digital intervention program for postsurgical pain management, Advancing Online Psychology Tools for the Transitional Pain Service (ADOPT-TPS).

Methods

The self-guided ADOPT-TPS intervention was modeled on a one-time 3-hour ACT group workshop already in use at the TPS. This intervention uses the ACT Matrix, a tool for evaluation of coping strategies and enhancing quality of life. Components include 1) Psychoeducation on ACT, pain, and opioid use; 2) Introducing the ACT Matrix; 3) Evaluating avoidance behaviors; 4) Strategies to “make room” for pain; and 5) Flexible persistence in meaningful activities (e.g., physical rehabilitation). We employed the digital health application platform, Manage My Pain (MMP), to design an interactive intervention that incorporated the features of the group workshop in a self-paced fashion. Development of the intervention program followed the Agile software development method, where a series of development “sprints” was punctuated by qualitative evaluation of the usability of the program by a variety of stakeholders, including TPS patients, clinicians, and staff.

Results

The ADOPT-TPS intervention was designed and implemented on the MMP platform as four distinct parts completed in sequence. Each part includes several didactic modules interspersed with interactive reflection exercises and concluded by a mindfulness exercise and an optional learning check. Each part is designed to be completed in about 20 min and contains text, audio, and video components. Users can easily access the digital intervention program on a web browser or a dedicated app. Employment of the existing MMP platform, specifically designed to support users in managing pain, facilitated the development process by incorporating previously-tested navigation features geared towards this user population. Stakeholder input was incorporated throughout the development process using “think-aloud” interviews to quickly identify problems with navigation, content, and flow, followed by retrospective semi-structured interviews to evaluate the experience of using the intervention program.

Conclusions

This scalable, digital self-guided intervention is easily implementable at other health institutions that wish to develop a Transitional Pain Service to address postsurgical pain and opioid use but do not have specialized pain psychologists on staff. Further testing in a randomized control trial will evaluate its effectiveness as a substitute to a psychologist-led group workshop.

References

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Clarke H, Azargive S, Montbriand J, et al. Opioid weaning and pain management in postsurgical patients at the Toronto General Hospital Transitional Pain Service. Canadian Journal of Pain. 2018;2(1):236-247.

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Presenting Author

Anna M. Lomanowska

Poster Authors

Anna Lomanowska

PhD

University Health Network

Lead Author

Kristina Axenova

York University

Lead Author

Tahir Janmohamed

Lead Author

Molly McCarthy

Ph.D.

Toronto General Hospital

Lead Author

Joel Katz

PhD

York University

Lead Author

Hance Clarke

MD

University Health Network, University of Toronto

Lead Author

Max Slepian

Toronto General Hospital, University Health Network

Lead Author

Topics

  • Access to Care