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Transitional Pain Service
- Location:
- 525 University Avenue, Suite 925
- Phone:
- 416-813-6975
About the Clinic
The Transitional Pain Service (pedTPS) provides extended pain management care to children, teens and their families who are recently discharged from the hospital or in preparation for, or following painful procedures, such as surgery.
Opioid stewardship plays an important role within the Transitional Pain service. Safe opioid prescribing, monitoring, dose adjustment, side effect management and weaning are part of the care provided with the Service.
Pre-appointment Instructions
Important pre-appointment instructions:
If your child is eligible for a Telehealth (or GuestLink) appointment please ensure internet connection is tested and working properly before your clinic appointment. Please call OTN Help Desk: 1-855-654-0888 if you have any questions or issues with the connection.
Directions:
The Transitional Pain Clinic is located at 525 University Avenue, Suite 925. The building is located on the southeast corner of University Avenue and Elm Street, directly across from SickKids main building.
What to Expect During Your Visit
The length of the clinic appointment will depend on whether your child is a new patient scheduled for an initial appointment or coming in for a follow-up appointment. The length may also vary depending on the complexity of your child’s pain. An initial appointment is scheduled for 1 hour and a follow-up appointment is scheduled for 30 minutes. We try our best to remain on time so that other children and families don’t need to wait too long.
At your initial clinic appointment, you will meet with an Anesthesiologist (a doctor specialized in pain management) and Advanced Practice Nurse. SickKids is a teaching hospital so there may be other health-care professionals present during the appointment. If this occurs you will be notified prior to beginning your clinic appointment.
The appointment with the Transitional Pain Service team will involve an assessment of your child’s pain and discussion about how it impacts life on a daily basis. For initial appointments, we will ask both you and your child to describe the impact of the pain. Some of the topics we will talk about may include:
- The history of the pain problem
- How the pain is affecting sleep, mood, and ability to physically participate in activities such as walking and going to school
- What you and your child are currently doing to manage the pain
- What medications your child may be taking or may have taken
- What physical exercises your child is doing
- What coping strategies are helpful or unhelpful
- Other medical information e.g. other conditions, allergies.
The doctor may also perform a physical examination.
At the end of the appointment the team will discuss with you and your child their findings and their suggestions for treatment.
We encourage you to ask questions and give feedback about the pain management plan. At the end of the appointment, you will be given a summary of the pain management plan to take home. A copy of this plan will also be sent to your family doctor.
If any referrals or follow-up appointments are needed, the clinic coordinator will be available to assist you with scheduling an appointment.
Dr. Lisa Isaac
Medical Director
Dr. Lisa Isaac is a paediatric anesthesiologist who began her role at SickKids after a paediatric anesthesia and intensive care fellowship at the Montreal Children's Hospital and McGill University. She works as an anesthesiologist in the operating room, and as a pain specialist in the chronic pain clinic and the acute pain service. Dr. Isaac established the first transitional pain service for children at SickKids in 2012. As assistant professor at the University of Toronto, her research interests include the transition from acute to chronic pain, and pharmacological management of pain with a special focus on opioid and non-opioid management and opioid minimization.
Dr. Naiyu Sun
Staff Anesthesiologist
Dr. Naiyi Sun is a staff anesthesiologist and pain physician who completed her medical training at Stanford University School of Medicine, obtained her anesthesia residency and paediatric anesthesia fellowship training at Stanford University, before coming to SickKids. Her clinical focus is on the management of chronic and transitional pain in children. Her research focus include transition of acute to chronic pain and use of opioids for pain treatment in children.
Jennifer Tyrrell
Clinical Nurse Specialist
Jennifer is a Clinical Nurse Specialist who provides education, support and comprehensive coordination of care to children and their families who are experiencing acute pain at home following discharge. Jennifer obtained her undergraduate and graduate degrees from the University of Toronto. Jennifer's academic and research interests includes the prevention of chronic pain, opioid stewardship and quality improvement.
Susan Lawless
Clinic Administrative Coordinator
Susan joined SickKids in 2001, and became a member of the pain program in 2010. Prior to joining the program Susan worked in many departments within the hospital including the Bone Marrow Transplant Unit, Oncology, Orthopaedics and the Craniofacial program.
Bryna Fernandes
Data Analyst
Bryna joined SickKids in 2017 and works as a Data Analyst in the Pain Program. Before joining the Pain Program, Bryna worked in various quality improvement roles at UHN. Bryna completed her Bachelor of Science in Kinesiology & Health Science from York University.
The Transitional Pain Service offers expertise in acute pain management out of hospital, opioid management, prevention of chronic pain, and patient support for the pediatric and adolescent population.
Pharmacological Management and Monitoring (opioids and other pain medication/adjuncts) after discharge for patients with ongoing pain needs:
- weaning
- titration
- safe ordering and dispensing
- prevention and management of side effects
- Determine who may be at risk for the development of complex, recurrent and/or or prolonged pain due to certain types of procedures (e.g. amputation, pectus repair, complex orthopedic surgeries)
- Determine who develops neuropathic pain (e.g. Post-surgical, chemotherapy induced)
Patient and family education concerning ambulatory pharmacological and non-pharmacological pain management including management of side effects/withdrawal, prevention of adverse events, pain assessment and safe prescription and management practices
Provide interventional pain management support for patients with advanced cancer pain in liaison with Haematology/Oncology, Paediatric Advanced Care Team and the Acute Pain Service.
- Children who are anxious or concerned about pain prior to an operative procedure.
- Children coming in to hospital for procedures who are concerned about or have high risk for significant or prolonged moderate to severe pain post procedure.
- Children who require opioid, benzodiazepine and/or adjunct pain medication titration/wean and ongoing management following discharge.
- Children who have identified acute onset neuropathic pain and require timely follow-up for assessment and management.
- Children with complex pain concerns being discharged from hospital and needing timely but short term pain management support.
- Children requiring assessment for advanced interventional pain techniques (eg. nerve blocks).
- Children who present in an outpatient clinic or Emergency that require follow up for a pain complaint but do not meet the criteria for chronic pain referral.
We do not see the following patients:
Children who have had recurrent or persistent pain for greater than 3 months, or who are suspected to have a diagnosis of complex regional pain syndrome (CRPS), please refer to the Chronic Pain Clinic.
Children who are suspected to have a diagnosis of complex regional pain syndrome (CRPS) please refer to chronic pain clinic (ACTIVE LINK)
All referrals must be submitted by a nurse practitioner or physician, using the SickKids referral process. If you would like your patient to be assessed while still admitted to hospital please place an inpatient referral and page Transitional Pain Service via locating. Otherwise please complete outpatient referral prior to discharge.
All referrals should include:
- Reason for referral
- Type, location, duration and descriptors of pain
- Current pain medications
- Relevant medical and surgical history
- Goal of transitional pain consult
Coming to a clinic appointment
It's important to come prepared and be on time for a clinic appointment. Visit Coming for Clinic Appointments to read appointment guidelines that are applicable for most clinical appointments at SickKids.
You’ll find information on how to prepare and what to bring, what to do if you/your child are sick before your appointment or you need to cancel, and important things to know about the SickKids philosophy.