Multidisciplinary Transitional Pain Service for the Veteran Population

Area of Science:

• Pain Management
• Orthopedic Surgery
• Addiction Medicine

Background:

• Patients with chronic opioid use or substance use disorder often lack coordinated presurgical and postsurgical care.
• Limited presurgical planning and postsurgical care coordination exist for at-risk surgical patients.

Purpose of the Study:

• To implement and evaluate a Transitional Pain Service (TPS) for at-risk surgical patients.
• To facilitate presurgical evaluation, education, and individualized pain management plans, including opioid tapering.
• To improve care coordination among surgical, primary care, and addiction specialists.

Main Methods:

• Developed an electronic dashboard registry to identify at-risk patients for the TPS.
• Collected baseline data including opioid dosage and patient-reported outcomes using the Patient-Reported Outcome Measurement System (PROMIS).
• Monitored pain intensity, pain interference, physical function, and pain catastrophizing.

Main Results:

• 213 patients were enrolled in the TPS during 2018.
• High rates of successful follow-up were achieved: 99% within 14 days, 96% between 14-30 days, and 72% at 90 days post-discharge.
• Overall opioid use decreased by over 40% compared to the previous year.

Conclusions:

• The Transitional Pain Service (TPS) effectively reduced opioid consumption post-orthopedic surgery.
• Despite reduced opioid use, patients reported no increase in pain interference or decrease in physical function.
• The TPS model demonstrates a successful approach to managing pain and opioid use in at-risk surgical populations.