Chronic postsurgical pain: From risk factor identification to multidisciplinary management at the Toronto General Hospital Transitional Pain Service
Background: 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 (T...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2019-07-01
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| Series: | Canadian Journal of Pain |
| Subjects: | |
| Online Access: | http://dx.doi.org/10.1080/24740527.2019.1574537 |
| _version_ | 1811233118562025472 |
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| author | Joel Katz Aliza Z. Weinrib Hance Clarke |
| author_facet | Joel Katz Aliza Z. Weinrib Hance Clarke |
| author_sort | Joel Katz |
| collection | DOAJ |
| description | Background: 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. |
| first_indexed | 2024-04-12T11:16:06Z |
| format | Article |
| id | doaj.art-bf98a3f1ebe04ec7b69093906f6b35f8 |
| institution | Directory Open Access Journal |
| issn | 2474-0527 |
| language | English |
| last_indexed | 2024-04-12T11:16:06Z |
| publishDate | 2019-07-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Canadian Journal of Pain |
| spelling | doaj.art-bf98a3f1ebe04ec7b69093906f6b35f82022-12-22T03:35:30ZengTaylor & Francis GroupCanadian Journal of Pain2474-05272019-07-0132495810.1080/24740527.2019.15745371574537Chronic postsurgical pain: From risk factor identification to multidisciplinary management at the Toronto General Hospital Transitional Pain ServiceJoel Katz0Aliza Z. Weinrib1Hance Clarke2Toronto General HospitalToronto General HospitalToronto General HospitalBackground: 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.http://dx.doi.org/10.1080/24740527.2019.1574537Transitional Pain Serviceacceptance and commitment therapychronic postsurgical painrisk factorsopioid useopioid weaningpainpain interference |
| spellingShingle | Joel Katz Aliza Z. Weinrib Hance Clarke Chronic postsurgical pain: From risk factor identification to multidisciplinary management at the Toronto General Hospital Transitional Pain Service Canadian Journal of Pain Transitional Pain Service acceptance and commitment therapy chronic postsurgical pain risk factors opioid use opioid weaning pain pain interference |
| title | Chronic postsurgical pain: From risk factor identification to multidisciplinary management at the Toronto General Hospital Transitional Pain Service |
| title_full | Chronic postsurgical pain: From risk factor identification to multidisciplinary management at the Toronto General Hospital Transitional Pain Service |
| title_fullStr | Chronic postsurgical pain: From risk factor identification to multidisciplinary management at the Toronto General Hospital Transitional Pain Service |
| title_full_unstemmed | Chronic postsurgical pain: From risk factor identification to multidisciplinary management at the Toronto General Hospital Transitional Pain Service |
| title_short | Chronic postsurgical pain: From risk factor identification to multidisciplinary management at the Toronto General Hospital Transitional Pain Service |
| title_sort | chronic postsurgical pain from risk factor identification to multidisciplinary management at the toronto general hospital transitional pain service |
| topic | Transitional Pain Service acceptance and commitment therapy chronic postsurgical pain risk factors opioid use opioid weaning pain pain interference |
| url | http://dx.doi.org/10.1080/24740527.2019.1574537 |
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