A transitional pain management program is associated with reduced opioid dependence after major shoulder surgery
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View abstract on PubMed
Summary
This summary is machine-generated.A Transitional Pain Service (TPS) significantly reduced long-term opioid use in shoulder surgery patients. This multidisciplinary approach decreased persistent opioid use at 90 days, offering a promising strategy to combat opioid dependence.
Area Of Science
- Orthopedic Surgery
- Pain Management
- Public Health
Background
- Opioid overprescription in the U.S. leads to dependence, overdose, and death.
- Increased opioid use during orthopedic shoulder surgery is a risk factor for long-term opioid dependence.
- A multidisciplinary perioperative pain management program (Transitional Pain Service [TPS]) was hypothesized to reduce postoperative opioid requirements.
Purpose Of The Study
- To evaluate the effectiveness of a Transitional Pain Service (TPS) in reducing postoperative opioid consumption after major shoulder surgery.
- To compare opioid use in patients managed by TPS versus a historical cohort.
- To identify factors associated with persistent opioid use after shoulder surgery.
Main Methods
- Implementation of a TPS focused on nonopioid pain management and cessation support at a Veterans Affairs Medical Center.
- Comparison of opioid consumption in patients undergoing total shoulder arthroplasty (TSA) or rotator cuff repair (RCR) with a historical cohort.
- Primary outcome: proportion of patients using opioids at 90 days postoperatively. Secondary outcomes: pain scores, time to cessation, and tablets consumed.
Main Results
- The TPS group showed significantly decreased persistent opioid use at 90 days (12.6% vs. 28.6%, P = .018).
- Predictors of increased opioid use included longer length of stay, anxiety diagnosis, and rotator cuff repair (RCR) compared to total shoulder arthroplasty (TSA).
- Median time to opioid cessation was shorter for TSA (6 days) than RCR (8 days), with reduced pain scores observed post-discharge.
Conclusions
- A TPS effectively reduces opioid use in patients undergoing shoulder surgery at 90 days postoperatively compared to historical controls.
- Fewer opioid tablets prescribed at discharge, managing anxiety, and optimizing length of stay are modifiable factors to reduce opioid consumption.
- Implementing multidisciplinary perioperative pain management programs like TPS can significantly mitigate opioid overprescribing nationally.
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