Transitional Pain Medicine: novel pharmacological treatments for the management of moderate to severe postsurgical pain

Clarke, Hance

doi:10.1586/17512433.2016.1129896

Cited by 30 publications

(23 citation statements)

References 30 publications

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“…More research is needed to evaluate the efficacy of various alternative strategies [43]. Recent development of transitional pain service models involving a team of physicians, nurse practitioners, pharmacists, physical therapists, and psychologists could be a valuable asset to reduce the risk of opioid overuse/ misuse targeting high-risk patients who undergo mastectomy [44,45].…”

Section: Discussionmentioning

confidence: 99%

Prolonged Opioid Use After Surgery for Early-Stage Breast Cancer

Shen

Thornton

et al. 2020

The Oncologist

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Introduction. This study examined the patterns of prolonged opioid use and the factors associated with higher risk of prolonged opioid use among opioid-naïve workingage patients with early-stage breast cancer. Methods. Using MarketScan data, the study identified 23,440 opioid-naïve patients who received surgery for breast cancer between January 2000 and December 2014 and filled at least one opioid prescription attributable to surgery. Prolonged opioid use was defined as one or more prescriptions for opioids within 90 to 180 days after surgery and defined extra-prolonged opioid use as one or more opioid prescriptions between 181 and 365 days after surgery. Multivariable logistic regressions were performed to ascertain factors associated with prolonged and extraprolonged use of opioids. Findings. Of the 23,440 patients, 4,233 (18%) had prolonged opioid use, and 2,052 (9%) had extra-prolonged opioid use. Patients who received mastectomy plus reconstruction had the highest rate of prolonged opioid use (38%) followed by mastectomy alone (15%). A multivariable logistic regression confirmed that patients with mastectomy and reconstruction had the highest odds ratio of prolonged opioid use compared to lumpectomy and whole breast irradiation (adjusted odds ratio, 5.6; 95% confidence interval, 5.1-6.1). Mean daily opioid dose was consistently high without any obvious dosage reduction among patients with opioid use. Interpretation. This large observational study showed a high rate of prolonged opioid use among patients who received surgery for early-stage breast cancer and found significant difference in prolonged opioid use by treatment type. The Oncologist 2020;25:e1574-e1582 Implications for Practice: This large observational study found a high rate of prolonged opioid use among working-age patients with early-stage breast cancer who received curative surgery, especially among patients who received mastectomy. Among patients with opioid use, the mean daily opioid dose was consistently high without any obvious dosage tapering. This study highlights the need to emphasize appropriate opioid therapy and potential dosage reduction or discontinuation among patients with early-stage breast cancer who received surgical interventions.

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Section: Discussionmentioning

confidence: 99%

Prolonged Opioid Use After Surgery for Early-Stage Breast Cancer

Shen

Thornton

et al. 2020

The Oncologist

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“…Indeed, several meta-analyses of the broad surgical literature have yielded conflicting results. An initial systematic review of 11 trials (8 studying gabapentin, 3 pregabalin) showed promising results: 38,40 four of the gabapentin trials found reductions in the incidence of pain two or more months post-surgery, while all three of the pregabalin trials did so. A subset of these studies (six gabapentin trials, two pregabalin trials) had sufficient data to support a meta-analysis, which showed a moderate reduction in the risk of chronic pain for gabapentin (OR = 0.52, 95% CI = 0.27—0.98, p = 0.04) and a larger reduction for pregabalin (OR = 0.09, 95% CI = 0.02—0.79, p = 0.007).…”

Section: Pre-emptive Analgesiamentioning

confidence: 99%

Persistent Post-Mastectomy Pain: Risk Factors and Current Approaches to Treatment

Tait

Zoberi

Ferguson

et al. 2018

The Journal of Pain

133

121

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Persistent Post-Mastectomy Pain (PPMP) is a common condition that can follow surgeries for breast cancer, the most common cancer in women. Because of the frequency of PPMP and its potential severity, it has received increasing research attention. This manuscript reviews the recent research literature, beginning with a brief history and then relevant medical, surgical, demographic, and psychosocial risk factors. Subsequently, social, psychological, and functional sequelae that have been linked to PPMPS are considered, as is research on current pharmacological, psychological, and rehabilitative approaches to treatment. The review concludes with a discussion of directions for future research and treatment that might reduce the incidence and impact of PPMP on breast cancer survivors. PERSPECTIVE: This article describes current research literature involving mechanisms, risks, and treatments related to persistent post-mastectomy pain. Implications of research findings also are discussed for pre- and post-surgical approaches to pain management, current treatments, and promising research directions.

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“…An enthusiastic and promising novelty in this field is the development and implementation of a Transitional Pain Service, a multidisciplinary program aimed at preventing and managing CPSP, which offers simultaneous psychological and pharmacological interventions. 20,23,42,49 Psychological interventions have the power to impact supraspinal mechanisms involving higher pain centers, 62 influencing endogenous modulation of pain, thereby improving endogenous analgesia, similarly to mechanisms underlying pharmacological analgesia. 34,45,46,83 For example, cognitive-behavioral therapy has been related to changes in brain limbic activity, which has been implicated in improvement of anxiety and potentiation of descending modulatory inhibition of pain.…”

Section: Practical and Clinical Implicationsmentioning

confidence: 99%

Psychological factors predict an unfavorable pain trajectory after hysterectomy: a prospective cohort study on chronic postsurgical pain

Pinto

McIntyre

Araújo‐Soares

et al. 2018

Pain

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Chronic postsurgical pain (CPSP) is a well-recognized potential complication with negative personal, social, and health care consequences. However, limited data exist on CPSP and on the course of pain over time after hysterectomy. Using data from a prospective cohort study on a consecutive sample assessed at 4 time points, presurgery (T1), 48 hours (T2), 4 months (T3), and 5 years postsurgery (T4), we sought to examine women's PSP trajectories using assessments of pain at T3 and T4. In addition, this study aimed to investigate presurgical and postsurgical risk factors associated with an unfavourable pain trajectory (PT). Based on pain data collected at T3 and T4, 3 distinct trajectories of PSP emerged: no CPSP (PT1; n = 88), prolonged PSP (PT2; n = 53), and CPSP (PT3; n = 29). Moreover, reported CPSP prevalence at 5 years was 17.1%. Multinomial logistic regression models controlling for age, presurgical pain, and type of hysterectomy tested for baseline and acute postsurgical predictive variables. Membership in PT2 and PT3 was predicted by presurgical anxiety (odds ratio [OR] = 1.131, P = 0.015; OR = 1.175, P = 0.009, respectively), emotional representation of the surgical disease (OR = 1.155, P = 0.034; OR = 1.213, P = 0.020, respectively), and pain catastrophizing (OR = 1.079, P = 0.043; OR = 1.143, P = 0.001, respectively). Furthermore, acute PSP intensity and frequency determined membership of women in PT3 (OR = 1.211, P = 0.033; OR = 3.000, P = 0.029, respectively), and postsurgical anxiety (OR = 1.182, P = 0.026) also played a key predictive role. This study identified factors that can be easily screened before and after surgery and are amenable to change through carefully designed timely and tailored interventions for women at risk of an unfavorable PSP trajectory posthysterectomy.

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Transitional Pain Medicine: novel pharmacological treatments for the management of moderate to severe postsurgical pain

Cited by 30 publications

References 30 publications

Prolonged Opioid Use After Surgery for Early-Stage Breast Cancer

Prolonged Opioid Use After Surgery for Early-Stage Breast Cancer

Persistent Post-Mastectomy Pain: Risk Factors and Current Approaches to Treatment

Psychological factors predict an unfavorable pain trajectory after hysterectomy: a prospective cohort study on chronic postsurgical pain

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