Article Text
PDF
Abstract
Introduction The Transitional Pain Service (TPS) is an innovative, personalized approach to postsurgical opioid consumption and pain management. The objectives of this study were to identify trajectories of opioid consumption and pain intensity within 12 months after initiating treatment through the TPS, identify biopsychosocial factors associated with trajectory membership, and examine the relationship between trajectory membership and other outcomes of interest over the same 12-month period.
Methods Consecutive patients referred to the TPS were included in the present study (n=466). After providing informed consent, they completed self-report questionnaires at the initial visit at the TPS (either pre surgery or post surgery) and at every TPS visit until 12 months. Growth mixture modeling was used to derive trajectories and identify associated factors.
Results Results showed three distinct opioid consumption trajectories for both presurgical opioid consumers and opioid-naïve patients. These trajectories all decreased over time and among those who were consuming opioids before surgery that returned to presurgical levels. Being man, having a substance use disorder, or reporting higher levels of pain interference were associated with higher daily opioid consumption for presurgical opioid consumers. For presurgical opioid-naïve individuals, higher opioid consumption trajectories were associated with higher levels of psychological distress. Five pain intensity trajectories were identified, and there were no significant association between opioid consumption and pain intensity trajectories.
Conclusions Results suggest that opioid consumption and pain intensity trajectories mostly decrease after surgery in a high-risk population enrolled in a TPS. Results also show heterogeneity in postsurgical recovery and highlight the importance of using personalized interventions to optimize individual trajectories.
- Analgesics, Opioid
- Pain, Postoperative
- Pain Management
Data availability statement
No data are available. Data are available on reasonable request. No data are available for sharing as consent was not obtained from participants for this purpose.
Statistics from Altmetric.com
Data availability statement
No data are available. Data are available on reasonable request. No data are available for sharing as consent was not obtained from participants for this purpose.
Footnotes
X @drhaclarke
Contributors MGP, JK, and HC contributed to the design of the study, analysis, and writing of the manuscript. RD, GG, KSL, AH, PG, RK, DT, JF, MS, and JW all were involved with the Transitional Pain Service and contributed to the various revisions of the current manuscript. HC is the guarantor.
Funding HC and KSL are supported in part by Merit Awards from the Department of Anesthesiology and Pain Medicine at the University of Toronto (Toronto, Canada). JK is supported by a Canadian Institutes of Health Research Canada Research Chair in Health Psychology at York University. MGP is supported by a Junior 2 research scholoar from the Fonds de recherche du Québec en santé. The opinions, results, and conclusions reported in this article are those of the authors and independent of the funding sources.
Competing interests MGP is a Junior 2 research scholar from the Fonds de recherche du Québec en santé. All other authors declared no competing interests.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.