“Stay restless and continue to hunt.” How the Department of Anesthesiology & Pain Medicine continues to redefine pain medicine.

January 2023 will mark three years since the Department of Anesthesiology & Pain Medicine changed its name from the Department of Anesthesia.

For Department Chair, Dr. Beverley Orser, the name change was necessary to recognize the rapidly evolving role of pain medicine in the specialty and in health care in general. The popular notion of anesthesiologists working solely in the operating rooms was markedly outdated. The remarkable work and research being done by pain physicians to help patients with acute and chronic pain were not being adequately recognized and celebrated.

The new name better reflected the department’s current clinical operations, research, and educational activities.

“Over the years, we’ve seen a fundamental shift in attitudes towards pain across the board,” said Orser. “Pain used to be an expected and accepted outcome after surgery. Fortunately, that mindset has changed. The suffering can be intense, and we now know that pain can be substantially reduced by proper treatments. Mitigating pain impacts the patient’s overall quality of life.”

Central to the department’s collective vision was finding new ways to support its exceptionally talented community of innovators with the resources needed to find better solutions to treat acute and chronic pain. It was also essential to properly prepare the next generation of pain medicine leaders. Research, education, and pain care for the adult and pediatric populations became the pillars around which many faculty centred their efforts.

“Our wonderful department is committed to ensuring that we provide care, but we also constantly look for novel ways to deliver better care,” added Orser. “We have a culture of relentless innovation that constantly drives us to look for new solutions.

Preparing future pain medicine practitioners

Historically, training in pain management was only possible through non-accredited fellowships. The content of the training programs depended on the knowledge and experience of individual educators at each institution. However, in 2016 the University of Toronto established a pain medicine subspecialty residency program. This transformation resulted in a shift towards a standardized and accredited multidisciplinary pain medicine training program.

“We are already seeing the impact of our graduates,” said Director of the Pain Medicine Subspecialty Residency Program, Dr. John Hanlon. “I’m filled with pride when I hear their success stories and witness them taking on leadership roles.

“Some graduates have started new clinics, while others are leading important committees in regulatory bodies, and becoming faculty of our program in order to give back and train the next generation of pain physicians.”

A future of possibilities 

Learners accepted into the highly competitive pain medicine residency program are aware of the significance and complexity of their work. Critically, educators expose learners throughout their training to the many key stakeholders from various fields who contribute to pain management.

“Pain medicine is a medical issue, but also a social issue with but also a societal issue, imbued with equity, psychological and socioeconomic aspects,” said Resident, Dr. Edward Zhang. “We work closely with pain education nurses, physiotherapists, chiropractors, and pharmacists. We all have a role to play.”

Patient impact and care are also crucial to shaping a learner’s experience, as Resident, Dr. Aaron Kirschner experienced during his time in the program.

“I had a patient in his 80s with crippling back and leg pain from spinal stenosis. I asked him what he hoped for from his treatment and he told me he wanted to dance at his granddaughter’s wedding.

“We could significantly ease his pain through medical and interventional treatment, so he got his wish. He was so grateful and told me how much it meant to dance and enjoy the evening with his family,” said Kirschner.

Another resident, Dr. Hasan Behbehani had a similar experience. “I’ll always remember a patient we saw at the longitudinal clinic, who came back extremely pleased with the management plan we suggested and implemented. Her pain did not go away completely but it was manageable, and she was so happy with her progress.” 

After graduation, practitioners continue to push their limits. Graduates, including Dr. Ehtesham Baig, have used their training to help pain patients by using both medical and interventional treatment modalities. Dr. Baig hopes practitioners will continue to innovate and find solutions to barriers to care.

“I hope that the future of pain medicine involves patient-centred multidisciplinary access for patients with ongoing chronic pain conditions,” said Dr. Baig. “Right now, patients living in major cities have access to specific expertise that people who live in smaller communities do not. Virtual care is one way to bridge this gap. I hope that is explored more in the future.”

Dr. Orser reiterated those sentiments. “We have developed a culture of continuous improvement, whether it be through teaching, learning, strengthening government relations or sharing knowledge,” added Orser. “I know we will continue to extend our reach and have an even greater impact on our communities.”