This guide is to assist practitioners to navigate the referral process for the Get up and Go Persistent Pediatric Pain Service at Holland Bloorview Kids Rehabilitation Hospital. Our program focuses on functional rehabilitation, not pain reduction. Referrals will be considered from clinics working with chronic pain populations.
Indications for Referral:
Referrals are assessed and prioritized for children and youth aged 12 – 181 with persistent pain, and who meet all the following criteria:
- Pain has an impact on some aspects of life including self-care, sleep, mobility, school attendance, leisure activities, family life, social relationships and/or mood
- Reasonable treatments have been tried with insufficient success despite appropriate client/family engagement; or there is extremely limited timely access to treatments
- Referral team believes that an intensive approach will result in expedited return to function
Typical diagnoses may include:
- CRPS (complex regional pain syndrome)
- Chronic widespread MSK pain
- Chronic neuropathic pain
- Recurrent gastrointestinal pain/discomfort
- Chronic daily headache
- Post-concussion symptoms
- Ehlers Danlos Syndrome/significant hypermobility
Inclusion Criteria:
- Client and family have consented to the referral
- Any indicated investigations for pain condition have been completed and there are no outstanding investigations
- The client has been sufficiently assessed by the referring clinic with respect to mental health and family functioning, physical functioning and pharmacotherapy, including:
- Recent psychosocial assessment (at least one individual assessment by psychologists, social worker and/or psychiatrist)
- Recent detailed physical assessment
- Client and family are willing and able to engage in all therapeutic modalities in Get Up and Go Persistent Pain Service, including physical therapy and talk therapy in both an individual and group setting
- Client is on a stable dose of all prescribed medications
- Referring clinic and/or primary care provider accepts follow up care post-discharge, including follow up of discharge recommendations and referrals as appropriate
- Demonstrated readiness for the program, as reflected by:
- Client and family have historically engaged well with all services they were offered
- Client and family are willing to engage in all aspects of 3Ps approach (pharmacotherapy, psychotherapy, physiotherapy) and are willing to spend the time and effort engaging in treatment
- Client and family are focused on rehabilitation and have clear functional goals; no longer searching for alternate medical diagnoses or testing
Exclusion Criteria:
- Clients who require medication changes in the 4 weeks prior to the admission or over the 4 week admission (e.g. no high-dose opioid weaning or titrating antidepressants)
- Clients who have unstable medical conditions (e.g. acute injury or illness)
- Clients who have unstable mental health conditions that would likely hinder participation or pose a safety risk (e.g. psychosis, mania, suicidal behaviours, unmonitored substance use, untreated/unprocessed PTSD, personality disorder, active eating disorder)
- Clients with significant cognitive impairments
- Clients who do not have follow up support after discharge (arranged prior to admission)
- Significant family dysfunction which would likely hinder the ability for the client/family to participate fully in the program
Get Up and Go Persistent Pain Service will require:
- Completion of the referral form
- Accompanying documents where appropriate (e.g. psychological assessments, psychoeducational assessment, psychiatric reports, physiotherapy assessment report, school IEP, school report card). Please include relevant consultation notes from subspecialty providers for all active issues.
Note: Referrals will not be triaged until all accompanying documents are received. Following discharge from the Get Up and Go Persistent Pain Service, the referring physician/provider will receive a written report with recommendations for ongoing management. A follow up appointment post-discharge should be made by the referring clinic or provider(s).
1 Referrals welcomed from ages 12 – 19th birthday. Younger patients may be considered on an individual basis.
