The Schroeder Pain Assessment and Rehabilitation Research Centre's system makes care more effective and efficient by allowing clinicians to narrow in on the treatment that will work best.
Doctors often treat pain with a generic approach: for example, they might advise everyone with chronic back to try the same thing first and then return to them if it doesn’t work and try something else. But there’s a better way, says Dr. Dinesh Kumbhare, director of the Toronto Rehabilitation Institute’s SPARC pain clinic and the Schroeder Chair in Pain Assessment and Rehabilitation.
“In the current model, the patient bounces from treatment to treatment based on what the family doctor thinks works in general,” says Dr. Kumbhare. In the SPARC clinic, the interdisciplinary team first works out a personalized treatment plan for pain by grouping people into subcategories based on the cause of their pain and looking at comorbidities at the same time.
This system makes care much more effective and efficient by allowing clinicians to narrow in on the treatment that will work the best right away instead of through trial and error. “Clinicians provide the treatment promptly, which is a better experience for the patient and the healthcare professional as well,” says Dr. Kumbhare.
It begins with longer assessments than standard doctors’ appointments, which include things like EMGs, ultrasounds, measuring the response to pressure using a pressure gauge, and looking at the person’s range of motion. Then, based on what’s needed, they’re sent to different members of its interdisciplinary team for treatment.
Someone who has pain that leads to depression, for example, might be treated by the group’s physician for their pain and a psychotherapist; someone who has back pain and is generally frail might work with the kinesiologist on their strength rather than stretching.
“This is something all pain clinics should do, based on where the literature is,” says Dr. Kumbhare. However, there is a significant lag between when evidence comes to light and when clinicians use it in their practice – one commonly cited study pegged it at 17 years. “There is usually a disconnect between what’s been published in the literature and its use, but we’re trying to be right on the forefront of implementing the latest evidence,” he says.
At SPARC, they’re more aligned with the research – perhaps because they’re also leading much of it. Dr. Kumbhare is also a scientist at the KITE Research Institute and a Professor and Clinician Scientist in the Department of Medicine at the University of Toronto. He’s authored more than 150 papers on pain.
And the clinic itself has a mandate to research clinical pain as well as treating it. SPARC analyzes the data that comes through its doors by tracking what’s working for patients with specific subsets of pain. Its team is also researching physiological markers for pain conditions, central sensitization, and biomarkers for chronic pain. Those results could lead to a test doctors would do on people with pain that would tell them what treatment will work best.
It’s all working towards a vision where pain management becomes as tailored as possible at SPARC and in other venues too. “Hopefully, it’s, ‘You have pain, it comes from this source, and this is what kind of care you can get,’” says Dr. Kumbhare. “The patient is assessed thoroughly and appropriately, the right care providers are working with them, and they are getting better faster.”