Multidisciplinary Transitional Pain Service for the Veteran Population

Buys, Michael J.

doi:10.12788/fp.0053

Cited by 12 publications

(20 citation statements)

References 19 publications

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“…Opioid tapering must always be accompanied by patient education and respectful support from the healthcare team [ 104 , 109 ]. Transitional pain services or other perioperative pain management specialist consultation is recommended for opioid-tolerant or otherwise high-risk patients by current guidelines and is supported by implementation reports [ 15 , 18 , 111 , 112 , 113 , 114 ]. Current institutional expertise and resources limit availability of such services at many centers, representing an important area for future investment by health-systems and institutions.…”

Section: Pain Management and Opioid Stewardship Across The Periopementioning

confidence: 99%

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

et al. 2021

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Surgical procedures are key drivers of pain development and opioid utilization globally. Various organizations have generated guidance on postoperative pain management, enhanced recovery strategies, multimodal analgesic and anesthetic techniques, and postoperative opioid prescribing. Still, comprehensive integration of these recommendations into standard practice at the institutional level remains elusive, and persistent postoperative pain and opioid use pose significant societal burdens. The multitude of guidance publications, many different healthcare providers involved in executing them, evolution of surgical technique, and complexities of perioperative care transitions all represent challenges to process improvement. This review seeks to summarize and integrate key recommendations into a “roadmap” for institutional adoption of perioperative analgesic and opioid optimization strategies. We present a brief review of applicable statistics and definitions as impetus for prioritizing both analgesia and opioid exposure in surgical quality improvement. We then review recommended modalities at each phase of perioperative care. We showcase the value of interprofessional collaboration in implementing and sustaining perioperative performance measures related to pain management and analgesic exposure, including those from the patient perspective. Surgery centers across the globe should adopt an integrated, collaborative approach to the twin goals of optimal pain management and opioid stewardship across the care continuum.

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Section: Pain Management and Opioid Stewardship Across The Periopementioning

confidence: 99%

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

et al. 2021

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“…The educational strategies comprised seven studies on strategies aimed at providing patient information on the adequate use of opioids ( n = 6) [ 5 , 50 , 51 , 53 , 100 , 107 ] or aimed as a reminder to professionals on opioid prescribing guidelines ( n = 1) [ 52 ]. The multimodal strategies included eight studies testing strategies on multiple analgesic regimens or a combination of pharmacological and non-pharmacological strategies [ 56 – 58 , 68 , 84 , 101 , 108 , 110 ] and a transitional pain service [ 133 ]. Finally, five studies focused on the effect of surgical techniques (e.g., different surgical approaches [ 59 – 61 , 111 ]) or inpatient vs. outpatient surgery [ 112 ]; two on an alternative pain management strategy (i.e., acupuncture) [ 54 , 55 ], and three on a psychological strategy (i.e., Acceptance and Commitment Therapy [ 95 ], motivational interviewing [ 114 ] or mindfulness [ 113 ].…”

Section: Resultsmentioning

confidence: 99%

Strategies aimed at preventing long-term opioid use in trauma and orthopaedic surgery: a scoping review

Côté

Bérubé

Moore

et al. 2022

BMC Musculoskelet Disord

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Background Long-term opioid use, which may have significant individual and societal impacts, has been documented in up to 20% of patients after trauma or orthopaedic surgery. The objectives of this scoping review were to systematically map the research on strategies aiming to prevent chronic opioid use in these populations and to identify knowledge gaps in this area. Methods This scoping review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist. We searched seven databases and websites of relevant organizations. Selected studies and guidelines were published between January 2008 and September 2021. Preventive strategies were categorized as: system-based, pharmacological, educational, multimodal, and others. We summarized findings using measures of central tendency and frequency along with p-values. We also reported the level of evidence and the strength of recommendations presented in clinical guidelines. Results A total of 391 studies met the inclusion criteria after initial screening from which 66 studies and 20 guidelines were selected. Studies mainly focused on orthopaedic surgery (62,1%), trauma (30.3%) and spine surgery (7.6%). Among system-based strategies, hospital-based individualized opioid tapering protocols, and regulation initiatives limiting the prescription of opioids were associated with statistically significant decreases in morphine equivalent doses (MEDs) at 1 to 3 months following trauma and orthopaedic surgery. Among pharmacological strategies, only the use of non-steroidal anti-inflammatory drugs and beta blockers led to a significant reduction in MEDs up to 12 months after orthopaedic surgery. Most studies on educational strategies, multimodal strategies and psychological strategies were associated with significant reductions in MEDs beyond 1 month. The majority of recommendations from clinical practice guidelines were of low level of evidence. Conclusions This scoping review advances knowledge on existing strategies to prevent long-term opioid use in trauma and orthopaedic surgery patients. We observed that system-based, educational, multimodal and psychological strategies are the most promising. Future research should focus on determining which strategies should be implemented particularly in trauma patients at high risk for long-term use, testing those that can promote a judicious prescription of opioids while preventing an illicit use, and evaluating their effects on relevant patient-reported and social outcomes.

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“…Beginning in January 2018, a TPS was implemented at our institution. This program has been described in depth in previous reports 12 13. Patients enrolled in TPS attended a preoperative class on available pharmacologic and non-pharmacologic pain-control therapies, including opioids.…”

Section: Methodsmentioning

confidence: 99%

Postoperative opioid prescribing, use and pain trends following general surgery procedures: a retrospective cohort study among veterans comparing non-opioid versus chronic opioid users

Bleicher

Brooke

Bayless

et al. 2022

Reg Anesth Pain Med

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IntroductionUnderstanding postoperative opioid use patterns among different populations is key to developing opioid stewardship programs.MethodsWe performed a retrospective cohort study on opioid prescribing, use, and pain after general surgery procedures for patients cared for by a transitional pain service at a veterans administration hospital. Discharge opioid prescription quantity, 90-day opioid prescription, and patient reported outcome pain measures were compared between chronic opioid users and non-opioid users (NOU). Additionally, 90-day total opioid use was evaluated for NOU.ResultsOf 257 patients, 34 (13%) were on chronic opioid therapy, over 50% had a mental health disorder, and 29% had a history and/or presence of a substance use disorder. NOU were prescribed a median (IQR) of 10 (7, 12) tablets at discharge, while chronic opioid users were prescribed 6 (0, 12) tablets (p<0.001). 90-day opioid prescription (not including baseline opioid prescription for chronic users) was 10 (7, 15) and 6 (0, 12) tablets, respectively (p=0.001). There were no differences in changes in pain intensity or pain interference scores during recovery between groups. Median 90-day opioid use post discharge for NOU was 4 (0, 10) pills.DiscussionNon-opioid and chronic opioid users required very few opioid pills following surgery, and patients on chronic opioid therapy quickly returned to their baseline opioid use after a small opioid prescription at discharge. There was no difference in pain recovery between groups. Opioid prescribing guidelines should include patients on chronic opioid therapy and could consider recommending a more conservative prescribing approach.

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Multidisciplinary Transitional Pain Service for the Veteran Population

Cited by 12 publications

References 19 publications

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

Strategies aimed at preventing long-term opioid use in trauma and orthopaedic surgery: a scoping review

Postoperative opioid prescribing, use and pain trends following general surgery procedures: a retrospective cohort study among veterans comparing non-opioid versus chronic opioid users

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