Posted on 16-05-2017

A multidisciplinary approach to the care of chronic postsurgical pain: a case report by the Transitional Pain Service

The serious risks of opioid use (including side effects, dependence, tolerance, and overdose mortality) have raised concerns about safe opioid prescribing and management. Opioid-dependent chronic pain patients who undergo major surgery are especially vulnerable. The current postsurgical care provides little guidance and education for patients to manage their pain. The Toronto General Hospital Transitional Pain Service (TPS) is a novel team that provides specialized, multidisciplinary care for chronic postsurgical pain patients. In a recent case report, UTCSP members Dr. Hance Clarke, Dr. Joel Katz, and colleagues describe the postsurgical care by the TPS team of a patient with complex chronic pain and high opioid dependence.

After surgery from a bleeding duodenal ulcer, the TPS provided a combination of pharmacological and behavioral intervention. The pharmacological approach included support with opioid weaning and subsequent treatment of buprenorphine combined with naloxone. The behavioral approach, led by a psychologist, included using the ACT matrix, a tool for teaching acceptance and commitment to manage one’s pain, and mindfulness practice. The care resulted in a dramatic improvement in the patient’s quality of life, functioning, and pain relief.  This report demonstrates the importance of incorporating behavioral interventions (i.e., support with opioid weaning and self-management strategies) as well as considering pharmacological alternatives best suited for the patient. Personalized treatment by a multidisciplinary team is a critical avenue to the current need for safe opioid management.    

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Reference: Weinrib et al. (2017). A case report on the treatment of complex chronic pain and opioid dependence by a multidisciplinary transitional pain service using the ACT matrix and buprenorphine/naloxone. Journal of Pain Research.