Transitional Pain Service for patients at Risk of chronic postsurgical pain Undergoing Surgery

Patients with either surgery or patient-related risk factors (e.g. pre-existing chronic pain or preoperative opioid consumption) are at an increased risk of acute and chronic postsurgical pain (CPSP) and long-term opioid use. To improve recovery, prevent CPSP and decrease opioid use, we need to identify these patients before surgery and provide a multidisciplinary pain management strategy throughout hospital admission and follow up in the post discharge period. Randomized trials assessing the impact of a multidisciplinary transitional pain service (TPS) on quality of recovery, incidence of CPSP and opioid consumption have not been conducted yet and is the purpose of this study.

The aim of our study is to investigate the effect of the implementation of a multidisciplinary TPS team for patients at risk of developing CPSP, on the quality of recovery, the incidence of CPSP and the opioid consumption. We hypothesize that the effect of implementation of a TPS team is superior to standard of care for outcomes as previously mentioned.

Baseline, 3 days postoperatively, 3 and 6 months postoperatively.

Patients will be randomized to the TPS group or standard of care group. Patients allocated to the standard of care group will receive a pre-assessment at the outpatient preoperative evaluation (OPE) clinic. Postoperative pain will be managed by the Acute Pain Service (APS) for patients with an epidural, or peripheral nerve catheter or those with patient controlled analgesia (PCA). When the APS is not involved, postoperative pain will be managed by the surgeon and/or nurses on the ward.
In the TPS intervention group, the multidisciplinary TPS team, consisting of anesthesiologists and nurses who are specialized in pain, will make an individualized perioperative pain management plan. If necessary, referrals to a psychologist, physiotherapist or social worker will be made. Education of the patient will take place.
After surgery, the APS, supervised by a member of the TPS team, will perform daily visits to monitor the effectiveness of pain treatment and to cease any medication that is deemed unnecessary. Following discharge from the hospital, the General Practitioner will be provided with information on the further pain treatment strategy for a better transition of care. Patients will be scheduled for follow-up appointments at the TPS outpatient clinic, or receive follow-up telephone calls to re-evaluate the pain treatment plan, taper opioids and if CPSP is diagnosed, referred to a pain specialist after six months.