Abstract
ABSTRACTBackground: Chronic postsurgical pain is a highly prevalent public health problem associated with substantial emotional, social, and economic costs.Aims: (1) To review the major risk factors for chronic postsurgical pain (CPSP); (2) to describe the implementation of the Transitional Pain Service (TPS) at the Toronto General Hospital, a multiprofessional, multimodal preventive approach to CPSP involving intensive, perioperative psychological, physical, and pharmacological management aimed at preventing and treating the factors that increase the risk of CPSP and related disability; and (3) to present recent empirical evidence for the efficacy of the TPS.Methods: The Toronto General Hospital TPS was specifically developed to target patients at high risk of developing CPSP. The major known risk factors for CPSP are perioperative pain, opioid use, and negative affect, including depression, anxiety, pain catastrophizing, and posttraumatic stress disorder–like symptoms. At-risk patients are identified early and provided comprehensive care by a multidisciplinary team consisting of pain physicians, advanced practice nurses, psychologists, and physical therapists.Results: Preliminary results from two nonrandomized, clinical practice–based trials indicate that TPS treatment is associated with improvements in pain, pain interference, pain catastrophizing, symptoms of anxiety and depression, and opioid use. Almost half of opioid-naïve patients and one in four opioid-experienced patients were opioid free by the 6-month point.Conclusions: These promising results suggest that the TPS benefits patients at risk of CPSP. A multicenter randomized controlled trial of the TPS in several Ontario hospitals is currently underway.
Highlights
Chronic postsurgical pain is a highly prevalent public health problem associated with substantial emotional, social, and economic costs
Chronic pain is the silent epidemic of our times.[1]
Health-related quality of life of Ontarians with chronic pain is lower than that reported by people with most other chronic diseases, including heart disease, diabetes, and chronic obstructive pulmonary disease.[2]
Summary
Chronic postsurgical pain is a highly prevalent public health problem associated with substantial emotional, social, and economic costs. Management of these known risks before and after surgery is hypothesized to reduce pain, suffering, and opioid misuse and to benefit the health care system by facilitating earlier discharge and reducing costs.[59–61] The following sections describe the Toronto General Hospital TPS and preliminary clinical outcomes.
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